Posts Tagged ‘Case Report’
I’m remembering recess in the schoolyard. We are in the process of deciding who gets to go first and we play the game of Rock-paper-scissors. Each child assumes a hand posture resembling either a rock, piece of paper, or scissors. According to the rules of the game, each of these items “can “defeat” one of the other items and the remaining one is the winner. For example, scissors “beat” paper; rock “beats” scissors. These relationships make perfect sense, given that scissors cut paper and rocks can smash scissors. Yet, one of the relationships spelled out in this childhood game is counter intuitive: paper rules over rock. But doesn’t a heavy rock rule paper? An anonymous comment on the Internet sheds light on this issue: Paper rules rock because paper represents the realm of higher knowledge. We master the world of physicality symbolized by the rock, by using principles of higher knowledge. Ah yes, paper does, in fact, rule rock!
Given the importance of paper, we shouldn’t be surprised that pen and paper are useful in the therapeutic endeavor, despite the fact that most therapists limit its use to process notes. In fact, Erickson frequently brought pen and paper into the therapy process. At times, he would have his patients journal their life story, or he would give homework assignments, having a bed wetter woken up early in order to practice handwriting. Other times, Erickson would utilize automatic writing, wherein hypnotic subjects would respond to hypnotic suggestions to produce meaningful writing or drawings, all outside of conscious awareness. One fascinating case bears reviewing. Erickson and Kubie (1938)1 reported the case of a 24-year-old woman who volunteered to be a hypnosis subject. She explained that in recent months she had been overcome with feelings of agitation, and simultaneously found herself mindlessly drawing pictures and doodling whenever she was studying or sitting in class. She was puzzled by this new habit, and by her agitated state, and she wished to find meaning in her illustrations.
In a subsequent interview, she recounted her history. She was raised as an only child in a happy home with two loving parents. She reflected that the only problems on her mind of late were feelings of resentment about the growing emotional distance between her and her best friend from childhood. Throughout the interview, the woman nervously doodled.
Erickson scheduled a follow-up appointment and gave her specific hypnotic suggestions: that her unconscious mind would organize the material she hoped to access, while her conscious mind would be busy with school and social activities. She would report on her conscious activities when she attended her next appointment. Feeling incredibly well at the next appointment, the woman described the story line of a novel she had been reading. While giving a verbal report of the book, she picked up a pen and doodled, first penning the usual scattering of lines and shapes, but ultimately making a singular, unified drawing that integrated all the elements that she had been randomly drawing. Yet, she was not able to interpret the picture for Erickson. In response to questioning, she gave Erickson a pack of matches from her pocket, then left abruptly. Of note, these matches advertised a local hotel.
Over the next several weeks, the young woman dropped by for a series of visits. Erickson recounts the gradual process by which the woman retrieved awareness of the meaning of the drawing, ultimately leading to a revelation: Her father was having an affair with her girlfriend. Father had been bringing matches home from the hotel where he had frequent encounters with his mistress and all this was ultimately confirmed by the girlfriend, who was eventually brought to a meeting with Erickson!
The case report documents the nuanced way people first hide, then later reclaim knowledge that is difficult to bear. In this particular case, the revelation brought an end to the young woman’s agitation. The case also demonstrates the use of pen and paper in therapy. Clients can spontaneously draw or write material, which can then be analyzed to better access material that has been, for one reason or other, hidden from consciousness.
In the end, we may learn a thing or two from the game of Rock-paper-scissors. It can be a reminder that the seemingly innocuous sheet of paper is more powerful than it looks. It can serve as a proverbial blank slate, and much can be achieved if we will bring it into the clinical context.
Annette Poizner, MSW, Ed.D, RSW serves on the Board of Directors of the Milton H Erickson Institute of Toronto and is the author of “Clinical Graphology: An Interpretive Manual for Mental Health Practitioners” published by Charles C Thomas Publishers.
1 Erickson, Milton & Kubie, Lawrence (1938). Psychoanalytic Quarterly, 7, pp. 443-466.