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Use of drawings in evaluating children who may be incest victims
Use of Drawings in Evaluating Children Who May Be Incest Victims _
University
Jean Goodwin of New Mexico School
of Medicine
Five semi-structured drawing tasks are described which have been helpful in evaluating children who may be incest victims. Such children can be asked to do a kinetic family drawing, a drawing of the alleged perpetrator, a dralving of their house, a drawing of their own body, or a drawing of a dream. In a sample of 19 alleged victims, all children under 12 drew freel! and expressed relief at being asked to draw. Children 12 and over tended to accept a drakving task only if it ivas structured as diagramming. These tasks lvere also found to be helpful in evaluating brothers of alleged victims to determine how aivare the boys were of the incest situation and how critical it was for them to be included in therapy. Such drawings can be collected in pediatric and gynecologic settings as well as in the playroom. Use of drawings allolvs the physician to respect the child’s developmental needs while obtatmng the information about the incest complaint necessary for medical, protective, and forensic purposes.
Psychiatrists, pediatricians, and gynecologists tend to find the task of evaluating an alleged incest victim troubling and perplexing. The physician who evaluates such a child will often be asked to testify in court about whether the child’s complaint about incest is true. Physicians are uncomfortable in this role of truthfinder, espeClinical work described in this study was funded in part by a Demonstration Grant from the National Center for Child Abuse and Neglect. Requests for reprints may be addressed to Jean Goodwin, Department of Ps)-chiatr)-, C’niversity of New Mexico. School of LIedicine, Albuquerque. New Xiexico 87 I3 I. 269
270
Goodwin
cially kt.hen the child involved seems to need rest from the trauma of family upset, rather than more length!. interrogation about the sexual allegations. In addition, pre-school children mav not have the abstracting skills, the ability to assess duration. or th’e abilitb. to sequence events, that are necessarv to describe in i\.ords i\.hat ‘has happened to them. However, a ‘detailed understancling of the child’s sexual complaint may be necessary in order to protect the child and to plan necessary meclical treatment. This report describes how dral\;ings can be used Lvith the child tictim both to obtain more information about ivhat happened to the child sexually, and to respond to the child’s need to escape from the traumatic situation into fantasy and play. This report is based on 19 consecutive intervie\vs with girls age 5 to 16 who were suspected incest victims. Dral\.ings \\-ere collected in each interview and analyzed with other diagnostic information about the child and her family. The child’s dralving of the alleged perpetrator was particularlv helpful in understanding the allegation of incest. The use of dralving w-as introduced in the evaluation of each victim, but a particular clrawing task often became an important metaphor that regularly recurred throughout the child’s treatment. Study Population
and Methods
The author is psychiatric consultant to a protective service agency which treats 50 incest cases a year. Cases in Ivhich substantiation is difficult are referred for psychiatric consultation. This series of 19 consecutive cases represents the author’s experience over an 1%month period. All 19 children were girls: fatherdaughter incest was suspected in 10 cases and step-father-daughter incest in 9 cases. Fourteen of the girls Lvere eventuall? judged to have been victimized by the suspected father figure. This judgment was reached as a consensus by the treatment team after studying other medical and family evaluations as well as results of the psychiatric interview Faith the victim. Five children it.ere judged. by the to be non-victims. Three of these girls M.ere same procedure, younger siblings of actual victims and had not themselves alleged incest. Two girls, one 5 and one 13, were judged to have made false accusations. Both were seriously emotionally disturbed and the S-year-old had been a victim of actual incest before making the false accusation against an innocent family member. This preschooler was also mildly retarded and had difficulty differentiating the many different father-figures in her life and also in differentiating present from past experiences. The 13-year-old l\‘as being
271
Use of Drawings
physically and emotionally abused by her father and was later diagnosed as schizophrenic. This adolescent iv’as extremely hostile totvard the father and intermittently delusional. Schizophrenics often have delusions about incest tv.hich seem related to the core schizophrenic experience that one’s thoughts, jvords and actions are being forcibly controlled by someone else. The incidence of false accusation is higher in this referred population than the incidence (less than 5 per cent) in the program’s total incest caseload (Goodwin, Sahd, & Rada, 1978). All children were asked during a playroom session to draw whatever they wanted. The children were then asked to draw a picture of the whole family doing something together and then to draw a pict.ure of the perpetrator. Depending on problems expressed in the interview, some children lvere asked to draw a picture of their house, of the inside of their bodies, or of a dream. For example, a child with a possible psychosomatic symptom might be asked to draw her body, or a child whose mother reported frequent nightmares would be asked to draw the frightening dream. In three cases, male siblings of actual victims were seen and asked to do a similar set of drawings. The draw-a-person task is given during routine psychological testing also done with these children and so was omitted from this battery. Results
All nine children under 12 drew freely and completed at least three drawings. However, of the ten children age 12 and older only two would draw at all. Except as indicated, the follov.ing results apply only to children under 12. Draw-the-Perpetrator
This drawing task was developed by the author after it became apparent that children refused to draw the incest event as frequently as they refused to talk about the event. Figure 1 shows with its many false attempts that even the more neutral task of drawing the perpetrator was often painfully difficult for these girls. Of the seven actual victims under 12, three could not draw the father at all, “x”ing out repeated attempts and finally giving up. Three others were able to draw the father but drew the figure with an obvious phallus as shown in Figure 1. Children who drew such figures identified the apparent phallus as a “decoration” or said it was “nothing.” Only one of the seven actual victims was able to
272
Goodwin
FIGURE
1.
Draw the Perpetrator.
easily produce a non-phallic drawing of the perpetrator. Both of the non-victims under 12 did this easily. Alcoholic perpetrators were often drawn without hands or without feet. One girl was referred for evaluation of possible incest Lvhen she drew a picture of her father for her therapist. The father \vas drawn after many unsuccessful attempts without legs or feet, in a dress, and with an obvious phallus. Investigation revealed that the father had become an alcoholic after his wife abandoned him and this small daughter. He and the girl had been involved in an incest relationship for five years. Further evaluation of the father indicated that he had initiated the incest relationship in part to defend against the masculine shame and the homosexual anxiety he felt in assuming the maternal role. The daughter’s perception of her father’s dilemma about sexual identity could not be verbalized, but emerged in her drawing. Another incest victim drew her father holding a baseball bat; the bat was touching the obvious phallus in the drawing. This father had engaged in mutual masturbation with his daughter before and during severe physical beatings.
273
Use of Drawings
In two cases, the child’s dratving was the first clue to psychosis in the father. The father was drasvn surrounded by small, disembodied heads which represented his “voices.” Kinetic
Family
Drawing
In this drawing task the child is asked to draw a picture of the whole family doing something together. This allows the child to represent overall family relationships and her view of her own role in the family (Burns & Kaufman, 1972). Johnson (Note 1) has found evidence of isolation, manifested by drawing the family members in separate compartments, and evidence of role reversal, evidenced by drawing child larger than the mother, in the drawings of incest victims and in the drawings of children raped by strangers. Two of the kinetic family drawings in this series were particularly eloquent depictions of the child’s situation. One IO-year-old girl had been expelled from her family because of an incest accusation (judged to be true) which both parents angrily rejected as a lie. Her kinetic family drawing depicted a vast barren mountain ivith only a few thornbushes and no people. In another case, an eightyear-old girl drew her family with an extra person standing between herself and her father. “That’s the Watcher,” she said. Her alcoholic father was still drinking heavily and she was afraid that, without the monitoring of the protective services case-worker, incest would recur. In an earlier report describing drawings in incest hoaxes, we explained how the kinetic family drawing of a IO-year-old helped to reveal her motivation for falsely accusing her new stepfather of incest (Sahd, 1980). She depicted her parents standing together holding dagger-like pens and staring accusingly at her. The stepfather shared the mother’s work as well as social and sexual parts of the marital relationship. The child’s false accusation expressed both her anger at feeling excluded from their relationship and her wish to be included. Draw-Your-House Incest victims are often frightened of bedrooms and of houses in general. They may express this by drawing themselves carefully outside of a house they have drawn, or, in play, by removing all the child-dolls from the doll house. One phobic S-year-old drew her house with front and back doors wide open. Other children compulsively draw walls in their house picture, as if in an effort to keep
274
Goodwin
family members in their assigned places. Reluctant-to-draw older girls v\Gll often become interested in helping the therapist to draw a floor plan of their house. Rene Spitz recommended this technique for adult analytic patients who denied exposure to the primal scene. Confronted with their own sketched floor plan of the house in which they were reared, patients realized that they must have been exposed to the sights and sounds of parental intercourse (D. Metcalf, Note 2). Such a floor plan is very helpful in understanding the lack of privacy and the bizarre sleeping arrangements that make the incest situation possible. In one family the father had built the home himself and had placed the bedrooms of the four daughters in a long wing extending between the parents’ bedroom and the only bathroom. Each daughter had to pass through the parent’s bedroom to get in or out of her room and the father had to go through each daughter’s room in turn to get to or from the bathroom. Draw-the-Inside-of-Your-Body
About 20 per cent of incest victims complain of somatic symptoms such as stomachache or headache (Maisch, 1973). Some child victims asked if they had “been ruined” by the experience or assumed that they could never have children because of what had happened. Children with these problems were asked to draw their body as though the skin were transparent and one could see through to the inside. A girl who had presented with pharyngeal gonorrhea drew a recognizable vagina where the pharynx should have been. She was experiencing recurrent nausea and vomiting, and expressed great relief when the therapist explained that one could not be impregnated through oral intercourse. The physician or therapist can often proceed from this drawing to using drawing to help clarify the child’s questions about her own and the perpetrator’s genitals. Draw-a-Dream
About 15 per cent of incest victims suffer nightmares or other sleep disorders (Maisch, 1973). Some of these children will draw a dream as their free drawing. A nine-year-old drew a dream picture which showed herself in a wedding dress standing outside a house in a field of flowers. As she discussed the dream and her drawing, the child revealed her own longing for a new father and a new wedding for her mother, and her fears that her mother might be unable to divorce the incestuous father. Flotvers like those depicted
275
Use of Drawings
in this dream are often seen in the clrali-ings of these children rb.ho feel “de-flotvered.” One depressed seven-year-old victim drew page after page of droopin g flot\.ers without petals. In another case, an eight-year-old girl’s draining of a dream about camping shelved a zipped-up tent. She \\.asinside the tent, but in the drawing, a phallic-appearing tree intrusively overlapped the tent despite the careful zipping. As she described her draining of the dream, this girl told about an earlier attempt to escape the incestuous relationship. Several years before, she had told a boy in her class about her incest relationship Lvith her father. The tlvo had decided that she must leave home and had gathered together a tent and camping equipment in a vacant lot near their school. Their runaway was discovered after a few hours, but the motive for running away to the tent did not emerge until the incest was revealed (Sahd, 1980; Goodwin, Note 3). Drawings
by Brothers
Families are often determined to keep an incest problem secret from uninvolved siblings. Yet a recent study sh0ib.s that a year after the incest accusation, it is the uninvolved siblings rvho are the most distressed family members (Kroth, Note -I). Recently I have begun asking brothers to do the same set of dralvings that victims are asked to do, and, in addition, to draw the victim. Brothers are often less stressed by the task of drawing the father or the family than is the actual victim. Playroom evaluations of these boys show they have much sensitivity to the family’s problems despite parental attempts to shield them from information about the incest accusation. Figure 2 is a free dra\\.ing by a nine-year-old boy lt.ho had moved out of the family home with his mother and sister after an incest accusation was made. His drawing shows a large phallic tree splitting his house in two. At the time of this interview he was desperately homesick for the old house; he drew this fractured house repetitively until his mother found an apartment of her own. This fractured house is reminiscent of a preiiously published drawing by a 13-year-old victim who depicted her house as being lifted up into a phallic tornado (Stember, 1980). A brother in another family drew as his free drari.ing a picture of the older sister who had been the father’s incest partner. The drawing shows the sister battered and bruised like a prize fighter, but dressed and with the proportions of a ).oung toddler. This was a very accurate portrait of the sister’s feelings after the father was acquitted in a criminal incest trial that had been, for her, a humiliating battle. Bringing the brother into joint sessions between
Goodwin
276
FIGURE 2. Drawings by Brothers.
mother verdict
and daughter helped the family to integrate the court’s with their experience that actual incest had occurred. Discussion
The use of drawings is usually helpful in evaluating incest victims under the age of twelve. The majority of teenage victims will not draw at all, and those who did so in a compliant way revealed little in the drawings. However, teenage victims can become interested in sketching houseplans or anatomic diagrams. With the younger child, drawings can be used in pediatric settings and in the gynecologic examination as well as in the psychiatric interview. During the forensic pelvic examination, the pediatrician and the child victim can use the paper sheet that covers the examining table to draw pictures of what part of the body was touched, of the person who did the touching, of the place where all this happened, and of the parts of the body that hurt now or that might be damaged.
277
Use of Drawings
Diagnostically, the dravbings are helpful in understanding the child’s fears and ansieties, her view of the family, and her self image. Fear and anxiety emerge in the repeated, unsuccessful attempts by incest victims to draw the fathers and also in their drav\.ings of phallic objects intruding into homes. Children vvho drew their alcoholic incestuous fathers without hands or feet and with an obvious phallus convey elements of both their conscious and unconscious images of the father. Drawings of the victim as a defeated prizefighter or a flower without petals convey in a singularly rich way the child’s self-image. Such drawings, by themselves, are not sufficient to make a diagnostic decision. It is the child’s increasing sense of being able to communicate and her experience of being understood that are helpful to the clinician in re-constructing what is happening in the family. The discovery of a workable avenue of communication is also helpful in reducing the anxiety of a child vvhose enmeshment in family secrets has often blocked other means of asking for help. Children usually show relief when asked to dra\\.. Asking a that the child needs to be child to draw conveys many messages: treated as a child, that the child in play can create something the physician values, and that the child can defend herself from traumatic experience through play and dravving, without having to resort prematurely to the defensive strategies of the adult world. Often, the next step in therapy is to help the child to draw with other people (Stember, 1980) as, with the therapist, v\ith other children in a victims’ group, with her siblings, or vvith her mother. Reference Notes hi. S. K. Dynamic themes in the psyhosocial diagnosis of .sexuall~ r&rented Presented at the Second International Congress of Child Abuse and Neglect, London, England, September 1978. 2. Metcalf, D. Personal communication, 1978. 3. Goodwin, J. Interagency collaboration in reporting and treating child abuse. Presented at the American Association of Psvchiatric Services for Children, Xtlanta, Georgia, November 1978. 4. Kroth, J. A. Family therapy impact on intrafamilial child sexual abuse. Presented at the Second International Congress of Child Abuse and Neglect, London, England, September 1978. 1. Johnson, children.
References Burns, R. C., 8: Kaufman, New
York:
BrunnerAlazel,
S. H. Action, 1972.
st$es
and qmbols
in kinetic/anmilJ
drawing.
Goodwin
278
Goodwin, Bulletin
J., Sahd,
D., & Rada,
of the American
R. Incest
Academy of Psyhiat?
hoax:
False accusation, false denials. 1978, 6, 269-376.
and the Law,
blaisch, H. Incest. New York: Stein & Day, 1973. Sahd, D. Psychological assessment of sexually abusing families and treatment implications. In W. Holder (Ed.), Sexual abuse of children. Englewood, Colorado: The American Humane Association, 1980. Stember, C. J. Art therapy: A new use in the diagnosis and treatment of sesuall) abused children. In B. Jones & K. MacFarlane (Eds.), Sexual abuse and neglect: Selected readings. Washington, D.C.: U.S. Department of Health and Human Services, 1980.
University
Jean Goodwin of New Mexico School
of Medicine
Five semi-structured drawing tasks are described which have been helpful in evaluating children who may be incest victims. Such children can be asked to do a kinetic family drawing, a drawing of the alleged perpetrator, a dralving of their house, a drawing of their own body, or a drawing of a dream. In a sample of 19 alleged victims, all children under 12 drew freel! and expressed relief at being asked to draw. Children 12 and over tended to accept a drakving task only if it ivas structured as diagramming. These tasks lvere also found to be helpful in evaluating brothers of alleged victims to determine how aivare the boys were of the incest situation and how critical it was for them to be included in therapy. Such drawings can be collected in pediatric and gynecologic settings as well as in the playroom. Use of drawings allolvs the physician to respect the child’s developmental needs while obtatmng the information about the incest complaint necessary for medical, protective, and forensic purposes.
Psychiatrists, pediatricians, and gynecologists tend to find the task of evaluating an alleged incest victim troubling and perplexing. The physician who evaluates such a child will often be asked to testify in court about whether the child’s complaint about incest is true. Physicians are uncomfortable in this role of truthfinder, espeClinical work described in this study was funded in part by a Demonstration Grant from the National Center for Child Abuse and Neglect. Requests for reprints may be addressed to Jean Goodwin, Department of Ps)-chiatr)-, C’niversity of New Mexico. School of LIedicine, Albuquerque. New Xiexico 87 I3 I. 269
270
Goodwin
cially kt.hen the child involved seems to need rest from the trauma of family upset, rather than more length!. interrogation about the sexual allegations. In addition, pre-school children mav not have the abstracting skills, the ability to assess duration. or th’e abilitb. to sequence events, that are necessarv to describe in i\.ords i\.hat ‘has happened to them. However, a ‘detailed understancling of the child’s sexual complaint may be necessary in order to protect the child and to plan necessary meclical treatment. This report describes how dral\;ings can be used Lvith the child tictim both to obtain more information about ivhat happened to the child sexually, and to respond to the child’s need to escape from the traumatic situation into fantasy and play. This report is based on 19 consecutive intervie\vs with girls age 5 to 16 who were suspected incest victims. Dral\.ings \\-ere collected in each interview and analyzed with other diagnostic information about the child and her family. The child’s dralving of the alleged perpetrator was particularlv helpful in understanding the allegation of incest. The use of dralving w-as introduced in the evaluation of each victim, but a particular clrawing task often became an important metaphor that regularly recurred throughout the child’s treatment. Study Population
and Methods
The author is psychiatric consultant to a protective service agency which treats 50 incest cases a year. Cases in Ivhich substantiation is difficult are referred for psychiatric consultation. This series of 19 consecutive cases represents the author’s experience over an 1%month period. All 19 children were girls: fatherdaughter incest was suspected in 10 cases and step-father-daughter incest in 9 cases. Fourteen of the girls Lvere eventuall? judged to have been victimized by the suspected father figure. This judgment was reached as a consensus by the treatment team after studying other medical and family evaluations as well as results of the psychiatric interview Faith the victim. Five children it.ere judged. by the to be non-victims. Three of these girls M.ere same procedure, younger siblings of actual victims and had not themselves alleged incest. Two girls, one 5 and one 13, were judged to have made false accusations. Both were seriously emotionally disturbed and the S-year-old had been a victim of actual incest before making the false accusation against an innocent family member. This preschooler was also mildly retarded and had difficulty differentiating the many different father-figures in her life and also in differentiating present from past experiences. The 13-year-old l\‘as being
271
Use of Drawings
physically and emotionally abused by her father and was later diagnosed as schizophrenic. This adolescent iv’as extremely hostile totvard the father and intermittently delusional. Schizophrenics often have delusions about incest tv.hich seem related to the core schizophrenic experience that one’s thoughts, jvords and actions are being forcibly controlled by someone else. The incidence of false accusation is higher in this referred population than the incidence (less than 5 per cent) in the program’s total incest caseload (Goodwin, Sahd, & Rada, 1978). All children were asked during a playroom session to draw whatever they wanted. The children were then asked to draw a picture of the whole family doing something together and then to draw a pict.ure of the perpetrator. Depending on problems expressed in the interview, some children lvere asked to draw a picture of their house, of the inside of their bodies, or of a dream. For example, a child with a possible psychosomatic symptom might be asked to draw her body, or a child whose mother reported frequent nightmares would be asked to draw the frightening dream. In three cases, male siblings of actual victims were seen and asked to do a similar set of drawings. The draw-a-person task is given during routine psychological testing also done with these children and so was omitted from this battery. Results
All nine children under 12 drew freely and completed at least three drawings. However, of the ten children age 12 and older only two would draw at all. Except as indicated, the follov.ing results apply only to children under 12. Draw-the-Perpetrator
This drawing task was developed by the author after it became apparent that children refused to draw the incest event as frequently as they refused to talk about the event. Figure 1 shows with its many false attempts that even the more neutral task of drawing the perpetrator was often painfully difficult for these girls. Of the seven actual victims under 12, three could not draw the father at all, “x”ing out repeated attempts and finally giving up. Three others were able to draw the father but drew the figure with an obvious phallus as shown in Figure 1. Children who drew such figures identified the apparent phallus as a “decoration” or said it was “nothing.” Only one of the seven actual victims was able to
272
Goodwin
FIGURE
1.
Draw the Perpetrator.
easily produce a non-phallic drawing of the perpetrator. Both of the non-victims under 12 did this easily. Alcoholic perpetrators were often drawn without hands or without feet. One girl was referred for evaluation of possible incest Lvhen she drew a picture of her father for her therapist. The father \vas drawn after many unsuccessful attempts without legs or feet, in a dress, and with an obvious phallus. Investigation revealed that the father had become an alcoholic after his wife abandoned him and this small daughter. He and the girl had been involved in an incest relationship for five years. Further evaluation of the father indicated that he had initiated the incest relationship in part to defend against the masculine shame and the homosexual anxiety he felt in assuming the maternal role. The daughter’s perception of her father’s dilemma about sexual identity could not be verbalized, but emerged in her drawing. Another incest victim drew her father holding a baseball bat; the bat was touching the obvious phallus in the drawing. This father had engaged in mutual masturbation with his daughter before and during severe physical beatings.
273
Use of Drawings
In two cases, the child’s dratving was the first clue to psychosis in the father. The father was drasvn surrounded by small, disembodied heads which represented his “voices.” Kinetic
Family
Drawing
In this drawing task the child is asked to draw a picture of the whole family doing something together. This allows the child to represent overall family relationships and her view of her own role in the family (Burns & Kaufman, 1972). Johnson (Note 1) has found evidence of isolation, manifested by drawing the family members in separate compartments, and evidence of role reversal, evidenced by drawing child larger than the mother, in the drawings of incest victims and in the drawings of children raped by strangers. Two of the kinetic family drawings in this series were particularly eloquent depictions of the child’s situation. One IO-year-old girl had been expelled from her family because of an incest accusation (judged to be true) which both parents angrily rejected as a lie. Her kinetic family drawing depicted a vast barren mountain ivith only a few thornbushes and no people. In another case, an eightyear-old girl drew her family with an extra person standing between herself and her father. “That’s the Watcher,” she said. Her alcoholic father was still drinking heavily and she was afraid that, without the monitoring of the protective services case-worker, incest would recur. In an earlier report describing drawings in incest hoaxes, we explained how the kinetic family drawing of a IO-year-old helped to reveal her motivation for falsely accusing her new stepfather of incest (Sahd, 1980). She depicted her parents standing together holding dagger-like pens and staring accusingly at her. The stepfather shared the mother’s work as well as social and sexual parts of the marital relationship. The child’s false accusation expressed both her anger at feeling excluded from their relationship and her wish to be included. Draw-Your-House Incest victims are often frightened of bedrooms and of houses in general. They may express this by drawing themselves carefully outside of a house they have drawn, or, in play, by removing all the child-dolls from the doll house. One phobic S-year-old drew her house with front and back doors wide open. Other children compulsively draw walls in their house picture, as if in an effort to keep
274
Goodwin
family members in their assigned places. Reluctant-to-draw older girls v\Gll often become interested in helping the therapist to draw a floor plan of their house. Rene Spitz recommended this technique for adult analytic patients who denied exposure to the primal scene. Confronted with their own sketched floor plan of the house in which they were reared, patients realized that they must have been exposed to the sights and sounds of parental intercourse (D. Metcalf, Note 2). Such a floor plan is very helpful in understanding the lack of privacy and the bizarre sleeping arrangements that make the incest situation possible. In one family the father had built the home himself and had placed the bedrooms of the four daughters in a long wing extending between the parents’ bedroom and the only bathroom. Each daughter had to pass through the parent’s bedroom to get in or out of her room and the father had to go through each daughter’s room in turn to get to or from the bathroom. Draw-the-Inside-of-Your-Body
About 20 per cent of incest victims complain of somatic symptoms such as stomachache or headache (Maisch, 1973). Some child victims asked if they had “been ruined” by the experience or assumed that they could never have children because of what had happened. Children with these problems were asked to draw their body as though the skin were transparent and one could see through to the inside. A girl who had presented with pharyngeal gonorrhea drew a recognizable vagina where the pharynx should have been. She was experiencing recurrent nausea and vomiting, and expressed great relief when the therapist explained that one could not be impregnated through oral intercourse. The physician or therapist can often proceed from this drawing to using drawing to help clarify the child’s questions about her own and the perpetrator’s genitals. Draw-a-Dream
About 15 per cent of incest victims suffer nightmares or other sleep disorders (Maisch, 1973). Some of these children will draw a dream as their free drawing. A nine-year-old drew a dream picture which showed herself in a wedding dress standing outside a house in a field of flowers. As she discussed the dream and her drawing, the child revealed her own longing for a new father and a new wedding for her mother, and her fears that her mother might be unable to divorce the incestuous father. Flotvers like those depicted
275
Use of Drawings
in this dream are often seen in the clrali-ings of these children rb.ho feel “de-flotvered.” One depressed seven-year-old victim drew page after page of droopin g flot\.ers without petals. In another case, an eight-year-old girl’s draining of a dream about camping shelved a zipped-up tent. She \\.asinside the tent, but in the drawing, a phallic-appearing tree intrusively overlapped the tent despite the careful zipping. As she described her draining of the dream, this girl told about an earlier attempt to escape the incestuous relationship. Several years before, she had told a boy in her class about her incest relationship Lvith her father. The tlvo had decided that she must leave home and had gathered together a tent and camping equipment in a vacant lot near their school. Their runaway was discovered after a few hours, but the motive for running away to the tent did not emerge until the incest was revealed (Sahd, 1980; Goodwin, Note 3). Drawings
by Brothers
Families are often determined to keep an incest problem secret from uninvolved siblings. Yet a recent study sh0ib.s that a year after the incest accusation, it is the uninvolved siblings rvho are the most distressed family members (Kroth, Note -I). Recently I have begun asking brothers to do the same set of dralvings that victims are asked to do, and, in addition, to draw the victim. Brothers are often less stressed by the task of drawing the father or the family than is the actual victim. Playroom evaluations of these boys show they have much sensitivity to the family’s problems despite parental attempts to shield them from information about the incest accusation. Figure 2 is a free dra\\.ing by a nine-year-old boy lt.ho had moved out of the family home with his mother and sister after an incest accusation was made. His drawing shows a large phallic tree splitting his house in two. At the time of this interview he was desperately homesick for the old house; he drew this fractured house repetitively until his mother found an apartment of her own. This fractured house is reminiscent of a preiiously published drawing by a 13-year-old victim who depicted her house as being lifted up into a phallic tornado (Stember, 1980). A brother in another family drew as his free drari.ing a picture of the older sister who had been the father’s incest partner. The drawing shows the sister battered and bruised like a prize fighter, but dressed and with the proportions of a ).oung toddler. This was a very accurate portrait of the sister’s feelings after the father was acquitted in a criminal incest trial that had been, for her, a humiliating battle. Bringing the brother into joint sessions between
Goodwin
276
FIGURE 2. Drawings by Brothers.
mother verdict
and daughter helped the family to integrate the court’s with their experience that actual incest had occurred. Discussion
The use of drawings is usually helpful in evaluating incest victims under the age of twelve. The majority of teenage victims will not draw at all, and those who did so in a compliant way revealed little in the drawings. However, teenage victims can become interested in sketching houseplans or anatomic diagrams. With the younger child, drawings can be used in pediatric settings and in the gynecologic examination as well as in the psychiatric interview. During the forensic pelvic examination, the pediatrician and the child victim can use the paper sheet that covers the examining table to draw pictures of what part of the body was touched, of the person who did the touching, of the place where all this happened, and of the parts of the body that hurt now or that might be damaged.
277
Use of Drawings
Diagnostically, the dravbings are helpful in understanding the child’s fears and ansieties, her view of the family, and her self image. Fear and anxiety emerge in the repeated, unsuccessful attempts by incest victims to draw the fathers and also in their drav\.ings of phallic objects intruding into homes. Children vvho drew their alcoholic incestuous fathers without hands or feet and with an obvious phallus convey elements of both their conscious and unconscious images of the father. Drawings of the victim as a defeated prizefighter or a flower without petals convey in a singularly rich way the child’s self-image. Such drawings, by themselves, are not sufficient to make a diagnostic decision. It is the child’s increasing sense of being able to communicate and her experience of being understood that are helpful to the clinician in re-constructing what is happening in the family. The discovery of a workable avenue of communication is also helpful in reducing the anxiety of a child vvhose enmeshment in family secrets has often blocked other means of asking for help. Children usually show relief when asked to dra\\.. Asking a that the child needs to be child to draw conveys many messages: treated as a child, that the child in play can create something the physician values, and that the child can defend herself from traumatic experience through play and dravving, without having to resort prematurely to the defensive strategies of the adult world. Often, the next step in therapy is to help the child to draw with other people (Stember, 1980) as, with the therapist, v\ith other children in a victims’ group, with her siblings, or vvith her mother. Reference Notes hi. S. K. Dynamic themes in the psyhosocial diagnosis of .sexuall~ r&rented Presented at the Second International Congress of Child Abuse and Neglect, London, England, September 1978. 2. Metcalf, D. Personal communication, 1978. 3. Goodwin, J. Interagency collaboration in reporting and treating child abuse. Presented at the American Association of Psvchiatric Services for Children, Xtlanta, Georgia, November 1978. 4. Kroth, J. A. Family therapy impact on intrafamilial child sexual abuse. Presented at the Second International Congress of Child Abuse and Neglect, London, England, September 1978. 1. Johnson, children.
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blaisch, H. Incest. New York: Stein & Day, 1973. Sahd, D. Psychological assessment of sexually abusing families and treatment implications. In W. Holder (Ed.), Sexual abuse of children. Englewood, Colorado: The American Humane Association, 1980. Stember, C. J. Art therapy: A new use in the diagnosis and treatment of sesuall) abused children. In B. Jones & K. MacFarlane (Eds.), Sexual abuse and neglect: Selected readings. Washington, D.C.: U.S. Department of Health and Human Services, 1980.