C H A P T E R 1 0
Drawing and Storytelling
offers a wide variety of applications in psychotherapy. By allowing the child to be a storyteller, the child is actively engaged in reparative work of his or her self-esteem. It facilitates the expression of difficult emotions such as worry, anger, and confusion ef-fectively and in a nonconfrontational manner (Gardner, 1974; Kestenbaum, 1985;
Lawson, 1987; Silver, 1996; Stirtzinger, 1983; Tanaka, 1992, 2001a, 2001b).
An important consideration in using storytelling is how to bridge the presented story and the child’s actual experience of internal conflict. The therapist becomes the mediator of the two. In this chapter, the use of drawing and storytelling in psycho-therapy is discussed with examples from the Squiggle Game, Egg Drawing technique, and the Cave Drawing technique.
SQUIGGLE GAME AND STORYTELLING
The Squiggle Game was based on a traditional game for children in England.
Winnicott introduced it to the therapeutic domain in his consultation with children.
The Squiggle Game later gained worldwide acceptance as an effective art directive (Walrond-Skinner, 1986). Winnicott (1971) pointed out that this technique promotes rapport building between the therapist and child through the exchange of their indi-vidual squiggle drawings and the discovery of hidden images in them (Claman, 1980;
Nakai, 1982; Tanaka, 1993; Winnicott, 1971; Ziegler, 1976). This guessing game generates playful interaction between the therapist and child. The Squiggle Game promotes the symbolic act of acceptance and acknowledgement of the client’s imper-fect or unintegrated object by the therapist, thereby facilitating a therapeutic relationship through mirroring the child’s drawing.
Based on his concept of the maturation process, Winnicott (1965) explained that infants go through a developmental stage in which they perceive that they create the objects around them and that they are undifferentiated with these objects. Winnicott emphasized the necessity for the “adult” therapist to embrace and provide a holding environment for the “infant” or developmentally arrested child’s ideas about the cre-ation. This process, in due course, helps the client to undergo proper separation from the objects and gain objectivity about the outside world (Winnicott, 1968/1989a, 1963/1989).
In the context of play therapy, the Squiggle Game allows for a smooth transition from subjective (projection) to objective experience (the use of an object), and it is precisely this bridging of the two realities that brings therapeutic benefits to the cli-ents. Finally, Winnicott did not intend the Squiggle Game to be used as a guideline for how the interplay of therapist and child client can be facilitated (Winnicott, 1968/
1989b). Tanaka saw the potential for narrative interaction in the Squiggle Game. Us-ing the art products from the game, Tanaka facilitated storytellUs-ing through makUs-ing kamishibai, a traditional Japanese art of picture card show, or four-frame cartoons (Tanaka, 1992, 1993, 2001a, 2001b). After having two to three sessions with the Squiggle Game, the therapist may elicit narrative expressions by suggesting the child create a story out of those four to six pictures. There are two approaches to this pro-cess. The therapist and child may individually create a separate story by selecting their favorite pictures as in parallel play, or collaborate in storytelling by taking turns 126 CLINICAL APPLICATIONS WITH CHILDREN AND ADOLESCENTS
selecting pictures and adding to the other’s story in a random manner. Both ap-proaches are effective in gaining insight to the child’s presenting problems within the short time required for a creative exchange.
THE EGG DRAWING AND CAVE DRAWING TECHNIQUES AND STORYTELLING
Tanaka’s art therapy techniques, the Egg Drawing and Cave Drawing, are rich in symbolic expression and facilitate storytelling (Tanaka, 1995, 2001a, 2001b). They are two separate art therapy techniques that can be employed individually or to-gether during one session or over the course of treatment repeatedly. Both techniques rely on the active participation of the therapist as the therapist initiates the storytell-ing through visual and verbal means. To begin, an oval line drawstorytell-ing is presented to the child and the therapist tells the child that this is an egg or a cave opening. These visual and verbal prompts stimulate the active imagination of the child and motivate the child to engage in art expression and storytelling. By encouraging a story, the pic-torial space is transformed into symbolic space impregnated with the child’s personal meanings. In short, the Egg and Cave Drawings enhance the potential for narratives through specific directives and guided imagery.
The content of the projective art created in the two techniques are the results of two different approaches to the psychological space and thus reflect different aspects of the child. Therefore, having the child create a story from both art products is use-ful for the therapist to understand the child’s psychological state.
ART SUPPLIES
Suggested media for the Egg and Cave Drawings are as follows:
1. Letter-size paper or 8″ × 10″ sketchbook
2. Different grades of pencils ranging from 2B to 6B 3. Eraser
4. Pencil sharpener 5. Fine-tip black markers
6. A set of crayons or color pencils in 24 or 36 colors
APPLICATION OF EGG DRAWING AND CAVE DRAWING TECHNIQUES For the Egg Drawing, the therapist should follow this directive:
• The therapist first draws an oval shape on a piece of paper.
• The therapist then asks the child client, “What does it look like?” The child may guess that it is an egg; then the therapist would acknowledge it to be cor-Drawing and Storytelling with Children 127
rect. If the child cannot tell, the therapist should suggest that it is an egg. At this point, it is important that both therapist and client recognize the image of the egg together.
• After explaining that something is about to be born, the therapist asks the child to add cracks to the egg.
• When the child draws cracks, the therapist asks, “What is about to be born?”
Most of the time, the child will say “a chick.” The therapist should respond by saying that “this is a magic egg” and “anything you can think of can come out of it.”
• The therapist provides a new piece of paper and directs the child to draw his or her fantasy creation along with the pieces of broken eggshells.
• Finally, the therapist asks the child to color the drawing.
For the Cave Drawing, the therapist should follow this directive:
• Upon completion of an egg drawing, the therapist again draws an oval, slightly larger than the previous one. He or she states that it is not an egg this time.
• The therapist should explain that it is the entrance to a cave. He or she encour-ages a drawing of the outside world viewed from inside the cave, by saying,
“Suppose you live here, what would you see outside?”
• After confirming the client’s understanding of the directive, the therapist should ask the client to proceed with the drawing.
• If the child so desires, the therapist should encourage the internal wall of the cave to be colored as well.
When the two drawings are completed, the therapist should ask the child to tell a story using both pictures created from the Egg and Cave Drawings. In general, these two drawing techniques are used together; however, it is possible to employ them individually.
CASE STUDY: L.B.
L.B. is a fair-skinned, small-framed 13-year-old Japanese female who suffered from a long history of sexual and emotional abuse. She was abandoned at birth by her bio-logical parents and was raised by her maternal grandparents. L.B. was allegedly molested by her maternal grandfather from the age of 8 until she sought help this year at a Child Guidance Center at the age of 13. Around the time L.B. reached puberty, she developed a social phobia and school refusal based on her fear that her peers saw her differently. She also presented various symptoms that resulted from the trauma of her sexual abuse such as hypervigilance to the others, sensitivity to touch and loud noises, panic attacks inside the commuter train at rush hours, and chronic somatic complaints.
L.B. described in her early session that her egg drawing (Figure 10.1) depicted a newborn angel who was hiding her face in broken eggshells. In her cave drawing 128 CLINICAL APPLICATIONS WITH CHILDREN AND ADOLESCENTS
(Figure 10.2) she drew a thick field of tall grass receding into a mysterious deep for-est whose entrance was framed by two rocks in the foreground. She then told the fol-lowing story titled “The Birth of an Angel.”
“Far from where humans live, there was a secret forest. The forest had long lost her guardian angels. The angels guarded the forest and kept humans away. The angels also healed injured people and animals. At the foot of a tree was a golden egg of an unborn angel. ‘Crack, crack, crack’ crackled the egg. A part of the egg-shell peeled off and burst with a blinding silver light. ‘Crack, crack,’ one piece after another fell off to the ground. Silver light penetrated the golden light of the egg. ‘Flap, flap, flap.’ When half of the shell fell off, something made a faint sound of flapping feathers. It was of a newborn angel. For a while, the angel was busy moving its wings and airing them dry. ‘Phew!’ Unable to speak, the angel took a big breath. The egg lost its balance and the angel was thrown out of the egg. Fortunately, she managed to not get hurt as she landed on the soft bed of tall grass. When the angel looked around, there was a cave nearby. The angel de-cided to hide in the cave for the time being. The pieces of broken egg were taken back to heaven shortly after and was turned into a star.”
As indicated in this case illustration, the narrative content that came out of com-bining storytelling with the Egg and Cave Drawings provided the clinician a deeper Drawing and Storytelling with Children 129
FIGURE 10.1.Egg drawing depicting a newborn angel who was hiding her face in broken egg-shells.
understanding of the client’s personal meaning. From the story, it may be construed that L.B. is seeking a place of safety. Upon exploration of the angel’s function as a healer the author deduced that the angel in the story was L.B.’s wish to heal and felt encouraged about her prognosis.
The symbolism of an angel evolved as L.B.’s therapy progressed. The angel that L.B. drew 6 months later (Figure 10.3) was blindfolded, and her cave drawing (Figure 10.4) depicted a rose and the cemetery. L.B. explained that “the angel was blindfolded so that she would not see the filth of the world.” Contrary to what L.B. described, her imagery repeatedly depicted a “single eye,” which can have many meanings.
It is apparent that the guardian angel symbolizes L.B. herself who was sexually abused, despite the suggested role of angel as healer. Furthermore, the picture of the rose and cemetery addresses the theme of loss surrounding her mother, whom she had never met, and her own violated sexuality. This process lead to L.B.’s voluntarily writing a short story titled “Funeral” in which she expressed her wish to gain help from her absent mother.
During the ensuing sessions L.B. drew herself as an angel who lay bleeding from its heart and eyes while her one hand gestured toward her skirt drenched in blood and the rest of her body contorted as if she was bound. She titled it “A Wounded An-gel.” The manifest content of this image is self-blame and helplessness, which are common among victims of incest. It is a self-portrait of someone who is painfully aware of the violated self.
This self-portrait became a pivotal expression as it indicated her courage to face the trauma. It is important to note that around this time, while she developed in-130 CLINICAL APPLICATIONS WITH CHILDREN AND ADOLESCENTS
FIGURE 10.2.Cave drawing with tall grass receding into a forest whose entrance was framed by two rocks in the foreground.
Drawing and Storytelling with Children 131
FIGURE 10.3.The blindfolded angel drawn by L.B. 6 months later.
FIGURE 10.4.Cave drawing depicting a rose and cemetery.
creased therapeutic alliance with the clinician, L.B. started to express anger openly toward her grandmother who had failed to protect her from the perpetrator, who was by this time incarcerated.
CASE STUDY: J.Y.
J.Y. is a 12-year-old Japanese male, who was self-referred to the counseling due to presented symptoms of selective mutism and social phobia. J.Y. lived with his biolog-ical parents and his younger brother of 8 years in age. J.Y. suffered from dwarfism and therefore had unusually petite stature compared to his peers. Since infancy, J.Y.
had received regular hormone injections to promote his physical growth. At the in-take J.Y. was shy but cordial toward the therapist. However, his speech was often la-bored and hardly audible as he became nervous with the interview.
The primary concern that J.Y. presented was a symptom of ophthalmophobia (sim-ilar to social phobia in DSM-IV). He reported that he was fearful of his female peers and felt them to be hostile in the way they stared at him. According to school’s report, there was no evidence supporting his claim, but J.Y. insisted that at least half the girls in his class gave him “dirty looks.” There were some ongoing incidents, however, with a few male peers who persistently teased J.Y. for his physical appearance.
It was evident that J.Y. suffered from poor self-image. In a low-stimuli environ-ment he was capable of expressing himself, but his behavior became inhibited as active interactions with others were required; he lacked assertiveness and was extremely controlling of his emotions in presence of others. J.Y. was motivated to treatment, and art therapy was a preferred modality because he could not participate fully in verbal therapy.
In the second session, art directives of the Egg and Cave Drawings were em-ployed. His first egg drawing was titled “A UFO, Stars, a Watch, a Bus, Shells, and Cherries.” The drawing was filled with many of these small objects. In contrast, his first cave drawing depicted molten lava exploding from a volcano. The therapist (Tanaka) was surprised by this expression of anger in contrast to J.Y.’s controlled and relaxed demeanor as he drew the volcano.
J.Y. responded well to art directives and enjoyed coming to therapy. In the course of treatment, he became increasingly self-directed with therapeutic activities and started to express his wish to draw his choice of subject matter. In the middle phase of therapy, the therapist returned to the Egg and Cave Drawing directives for the third time and asked J.Y. to create a story with two art products. J.Y. told a story that took place in outer space.
The egg drawing, titled “Space and Space Ship,” depicted a small and faraway galaxy with earth scattered in oblivion of outer space, indicating J.Y.’s tendency to detach and withdraw as his defense (Figure 10.5.) In the cave drawing, titled “An Attack of the Monster Named Ganta,” J.Y. depicted a Godzilla-like monster that destroyed the city. His repressed anger and aggression were observed through this picture (Figure 10.6). However, the story from this directive elicited a minimal verbal response from J.Y.: “The monster Ganta laid a huge egg. The egg was colorful. When it hatched, there were many stars inside.”
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Drawing and Storytelling with Children 133
FIGURE 10.5.Egg drawing titled “Space and Space Ship.”
FIGURE 10.6.Cave drawing titled “An Attack of the Monster Named Ganta.”
While the constellation of bright stars and vast galaxy in the cave drawing seemed to represent J.Y.’s developing potentials and the story indicated his ability to acknowledge positive aspects of the self (monster), the story itself ignored the mon-ster’s aggression and did not touch on the actual fighting scene. This inconsistency of verbal and nonverbal expression was interpreted as an indication of J.Y.’s continued difficulty in verbalization of his feelings despite his increased comfort level in expressing his anger in pictures.
Ensuing sessions consisted of the Egg and the Cave Drawings, Squiggle Game, and Division-Coloring Method (an activity for individuals with handicaps involving coloring in predetermined sections of a paper) with which storytelling was incorpo-rated in nonverbal drawing directives. The increase in written expression was re-markable with the stories he composed for his pictures. His word count went from initial 51 words, 69 for the story mentioned previously, and later increased rapidly to a significant amount of 171, 981, and 1,176 words. Along with this improvement was a parallel progress in his verbal participation in therapy and his involvement with others. J.Y. engaged more actively with verbal interactions and his social phobia subsided gradually.
J.Y. had been diagnosed with dwarfism as an infant and had struggled to thrive.
He was rejected and teased by his peers and suffered from terrible inferiority com-plex. J.Y.’s primary concern of fearing female peers’ gazes was interpreted as a projection of his mother’s watchful eyes and constant monitoring with his medical condition. It is conceivable that his mother’s sadness, frustration, and self-pity with the adolescent’s lack of growth were internalized and resulted in J.Y.’s own critical view of himself.
The contents of J.Y.’s drawings were anger and inability to have a proper outlet for self-expression as well as a need for control of feelings and behaviors. Having symp-toms of social phobia, J.Y. was intimidated by the format of verbal therapy that re-quired him to deal directly with a therapist. By focusing on the process of art and story-telling J.Y. was able to engage himself to a therapeutic relationship with his therapist.
As J.Y. continued to elaborate on the stories of space, aliens, monsters, and fu-turistic cities, he developed a relationship with his art and began to own his stories, propelling him to make his internal dialogue explicit. This process assisted J.Y. to come to term with his feelings related to his medical conditions and relationships with peers and family.
J.Y. learned to face his medical predicament as he gained coping skills through mastery of art and storytelling. J.Y. learned to examine and acknowledge his feelings which he could not initially express. His accomplishment came from applying him-self in a nonverbal expressive modality that eventually led him to open verbalization and alleviation of his fears and worries.
DISCUSSION
As demonstrated through the case material, children with emotional disorders fre-quently reveal themes of death, destruction, and rebirth. These themes can indicate a 134 CLINICAL APPLICATIONS WITH CHILDREN AND ADOLESCENTS
strong desire to change. The clinician’s initial task is to recognize this desire and pro-vide a safe, therapeutic space in order to allow for such expression.
The Egg and Cave Drawings techniques provide access to this inner desire, elicit their responses sensitively, and do so in a nonconfrontational manner. The egg drawing is particularly helpful through a paradoxical approach: The child who experienced a trauma or emotional problem takes on an active role in metaphorically breaking the self-image of a fragile egg. This change helps the child experience a sense of control, and at this moment something new is born. The re-sult is a self-determined transformation that is constructive rather than destructive in nature.
The theoretical basis of the egg drawing with its use of a “little” destruction con-curs with Winnicott’s (1968/1989a) notion that “the destruction plays its part in making the reality, placing the object outside the self” (p. 223). Risk taking is re-garded as an essential part of therapy in order for it to be successful. The process of the egg drawing involves the risk-taking process (cracking an egg by the client), which can lead a child to a sense of accomplishment despite the moments of raised anxiety. With repeated employment of the intervention a child may become desensi-tized to the fear of changing one’s personal image (an egg and what comes out of it), thereby engaging in the constant renewal of self-image.
Nonetheless, a word of caution must be made regarding the egg drawing for its paradox. When employing this technique, the clinician must remember that the child who has been traumatized might feel resistant, if not awkward, having been given the directive to purposely destroy a selfobject. Such an experience may exacerbate the child’s emotional decompensation. For this reason, sound clinical judgment must be maintained. Although current research indicates that reexperiencing the trauma helps to heal the client, considerations regarding the severity of abuse and appropri-ate timing in terms of introducing any interventions are critical. The process of this drawing directive can promote trauma reenactment. It may not be appropriate for clients exhibiting behavioral and mental disorganization such as psychosis or the presence of self-injurious behavior. There is a danger of leading the child with meta-phorical rehearsal of such actions that need to be contained rather than expressed openly. In general, the egg drawing technique is useful with most populations when the therapeutic relationship is a stable one.
The authors assert that the cave drawing has a wider applicability because of its metaphor of a safe place. The cave, symbolized by an oval frame, functions to set boundaries of real space and therapeutic (pictorial) space. Thus, a comfortable dis-tance is established between a drawer and his or her personal image. This disdis-tance al-lows the clinician to explore the client’s wishes and desires safely.
Furthermore, the cave drawing and narrative assist the clinician in evaluating the child during the process of treatment, including his or her limitations repre-sented in symbolical ways. Examples can be seen in the blocks of rock that protect the enchanted forest of the L.B. (Figure 10.2), her bird’s-eye view of the cemetery (Figure 10.4), and J.Y.’s comical, movie-like quality of the monster’s violence (Figure 10.6).
Whereas the egg drawing examines the child’s internal world, the cave drawing Drawing and Storytelling with Children 135