ARTICLES
CLINICAL PSYCHOLOGY

 

Family secret and artistic-expressive resources in family psychotherapy: a theoretical-clinical study

 

Secreto familiar y los recursos artísticos-expresivos en la psicoterapia familiar: un estudio teórico-clínico

 

 

Ricardo da S. Franco^I; Maíra B. Sei^II

^IDepartment of Psychology and Psychoanalysis, Londrina State University (UEL)
^IIDepartment of Psychology and Psychoanalysis, Londrina State University (UEL)

Mailling address

 

 

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ABSTRACT

This study aimed to discuss the use of artistic-expressive resources in the psychoanalytic psychotherapy of couples and families through a theoretical-clinical study based on the clinical-qualitative method. The family secret consists of a message that cannot circulate freely in the family because it is associated with a traumatic or shameful situation experienced by one of the members of the family, with its disclosure possibly putting the maintenance of the family bonds at risk. Therefore, this defense mechanism of the family dynamic is implicated as one of the leading causes of couples and families withdrawing from psychotherapy. For the discussion, clinical vignettes of a case attended at a psychology school-service of a public university were used. It was observed that the use of artistic-expressive resources favored the emergence of unconscious contents and the development of the therapeutic process.

Keywords: Family therapy. Resistance. Psychoanalysis. School-clinics. Art therapy.

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RESUMEN

Se objetivó discutir el uso de recursos artísticos-expresivos en la psicoterapia psicoanalítica de pareja y familia por medio de un estudio teórico-clínico pautado en el método clínico-cualitativo. El secreto familiar consiste en un mensaje que no puede circular libremente en la familia por estar asociado a una situación traumática o vergonzosa vivida por uno de los miembros de la familia, con su revelación pudiendo poner en riesgo el mantenimiento de los vínculos familiares. Siendo así, este mecanismo de defensa de la dinámica familiar implica una de las principales causas de desistimiento de la psicoterapia por parte de parejas y familias. Para la discusión, se utilizaron viñetas clínicas de un caso atendido en un servicio-escuela de psicología de una universidad pública. Se observó que el uso de recursos artístico-expresivos favoreció la emergencia de contenidos inconscientes y el desarrollo del proceso terapéutico.

Palabras clave: terapia familiar; resistencia; psicoanálisis; escuela clínica; arte-terapia.

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1. Introduction

From the perspective of couple and family psychoanalysis, the unconscious of each subject is shaped by family and social bonds, that is, they carry within themselves marks of another unconscious present in the environment in which they live (Vasconcelos & Lima, 2015). These marks consist of psychic contents transmitted from one generation to another and refer to affections, beliefs, myths, and fantasies (Santos & Ghazzi, 2012). The family group is organized through unconscious alliances composed of various pacts and contracts among its members, in order to allow the process of generational psychic transmission, with the sharing of the psychic contents and the definition of the role of each member within the dynamic of the family (Kaës, 2014).

Concerning psychic transmission, this is divided into intergenerational and transgenerational. About intergenerationality, this refers to the transmission of conscious contents that can be elaborated, such as the importance given to studies, sense of justice and honesty, humility, religiosity, appreciation of the woman figure, among other facts (Scorsolini-Comin & Santos, 2016). Transgenerationality, on the other hand, affects the transmission of so-called harmful content that is difficult to elaborate psychically, due to it being traumatic and symptomatic contents, for example, unelaborated mourning, excessive feelings of shame, sexual abuse, domestic violence, and others (Rehbein & Chatelard, 2013).

The two types of psychic transmission, especially transgenerational, contribute to the creation and installation of defense mechanisms in the dynamics of family functioning and one of these mechanisms refers to the family secret (Melo, Magalhães, & Féres-Carneiro, 2014). For Ramos (2006), all families have a secret that consists of a message, associated with a traumatic or shameful situation, that cannot circulate freely through the group, being shared in pairs or subgroups, with the intention of keeping the secret in the field of the unspoken, being able to assume a central function in that family.

This secret is maintained as a consequence of the unconscious alliances that arise in the space called the family metapsychic continent (Benghozi, 2009). This continent consists of a psychic envelope that the family can provide for its members (Benghozi, 2009; Eiguer, 2014). In other words, the family group can accept the projections, affections, and attacks and favor the emotional development of the family members (Kaës, 2014; Benghozi, 2009; Eiguer, 2014). However, sometimes this envelope cannot offer its members a welcoming atmosphere.

One of the alliances that make it difficult for this envelope to provide a welcoming environment is the denegative pact. According to Trachtenberg and Chem (2013, p. 26), a denegative pact implies:

[...] a kind of unconscious alliance and statement of all that is imposed in the intersubjective ties related to the negative in its various forms. We could say that it is the expression of the negative within the scope of intersubjectivity and it is characterized by offering to each subject of the set what is destined for repression, denial, refusal, rejection or encystment in the inner space of a subject or several subjects. The denegative pact, that is, a pact based on the work of the negative, is present in the nucleus of the origin and functioning of the set (family, social group, laws, etc.) and the singular subject.

Considering such aspects, coupled with the fact of working with more than one individual at the same time, it is understood that there is greater complexity in the psychoanalytic psychotherapy of couples and families compared to that of the individual (Sei, 2011). In this sense, the use of artistic-expressive resources tends to favor the comprehension of the conjugal and family dynamics and the development of the therapeutic process (Franco, Almeida, & Sei, 2016; Machado, Féres-Carneiro, & Magalhães, 2011). This clinical strategy allows access to the repressed contents that weave the unconscious plots and alliances of the couple and of the family, as it functions as a mediator of the psychic work of figuration by mobilizing the group psychic apparatus and the metapsychic continents that give support to the formation and maintenance of the family bonds (Benghozi, 2009; Eiguer, 2014). It also allows a reanalysis of the material at later moments, both by the therapist and by the patients themselves, because it is concrete material produced by the group (Sei, 2011; Franco et al., 2016).

From these considerations, it was sought to discuss the use of artistic-expressive resources as a therapeutic strategy capable of accessing the unconscious contents that permeate and bond the family members, in order to assist the therapist in the development of the clinical process. These discussions were performed from a case attended at a psychology school-service of a public university.

 

2. Method

This was a theoretical-clinical study using the clinical-qualitative method. This method, when using a comprehensive-interpretative approach, is less concerned with finding quantitative regularities in the phenomenon studied, since it prioritizes the comprehension and interpretation of the meanings of the phenomena experienced by the subjects and society (Silva, Herzberg, & Matos, 2015). In this way, it allows a more in-depth analysis of the phenomenon in question and an increase in the possibilities for the investigation of the study object, revealing particularities not perceived with other research strategies (Maldavsky, Álvarez, & Gomes, 2014).

The particularity of a case of family psychoanalytic psychotherapy was analyzed, in which the family was attended at a psychology school-service of a public university. Eight consultations were performed before the family withdrew from the family psychotherapy, with one of the family members being referred for individual care.

The analysis focuses on the content of two of the sessions, the fifth and seventh, to discuss the contribution of artistic-expressive resources as a therapeutic strategy in family psychoanalytic psychotherapy. Activities were carried out using these resources, such as life-line and genogram, and in the fifth session, an activity inspired by photo-language was proposed (Vacheret, 2008). The family members were asked to look for an image that answered the question: "What do you expect from the family psychotherapy?" From this perspective, they individually selected a figure that was cut out and glued onto a sheet of paper, discussing together the choice of these images. It was understood that the fifth and seventh sessions related more directly, since the family secret revealed in the seventh session had already been presented in one of the images selected in the activity proposed in the fifth session.

 

3. Results

At the time, the family was composed of four members: Fatima, married to Pedro, both aged between 30 and 40 years, with Pedro being a few years older, parents of Eduarda, the eldest daughter, and Mateus, both adolescents. During the eight sessions performed, the family changed the configuration of the participants of the psychotherapy twice until they stopped attending.

The mother and the two children attended the first session. Fatima reported the family conflicts that were making it difficult for them to live together. After Pedro suffered a "robbery," in which he was stabbed and carried physical sequelae of the aggression, the family relationship, especially between the couple, changed significantly because aspects of this incident remained poorly clarified. Regarding the children, the mother expressed concerns about certain behaviors of the two: Mateus, after what happened to his father, began to behave aggressively at school and home, before he had been a well behaved and sweet boy; Eduarda had sent some intimate photos to an adult man. Fatima and Pedro complained to the police, and the girl began to be attended individually in the same psychology school-service before they started the family therapy. Thus, in addition to the family psychotherapy, Eduarda was also in individual psychotherapy.

The complaint brought up by the family in this first session was unclear. Fatima spoke of her concern for the children, however, seemed uneasy when she spoke, emphasizing the gaps in her husband's story regarding the details of how, when, and where the alleged "robbery" occurred. Asked about her husband's absence from the session, she replied that he had not been able to attend due to work. However, she asked about the possibility of him attending the services if he could reorganize his schedule. It was said that he could participate and that there was a space precisely so they could talk and unravel issues regarding communication and family relationships that could cause discomfort and conflict between them.

In the second session, again, only the three of them showed up. Unlike the previous session, they were more reserved, with a life-line activity having been proposed, with instructions to draw a line on a sheet of paper. On this line, in chronological order, from the birth of each one until that moment, they should highlight happy or sad events considered important. However, the moments highlighted by each one seemed to be insignificant, as can be seen in the lifeline (Figure 3.1).

 

 

At the end of the second session, Fatima returned to the idea of her husband's participation in the sessions, with the third session being marked by the presence of the four. With the attendance of Pedro, the function of the family psychotherapy space was again explored, discussing issues covered with Fatima and the children in the previous sessions in which Pedro had not been present. He then began to talk about the behavior of the children with the beginning of a long superficial discussion about what their problem was. The couple disagreed on several points regarding how to raise the children. This discussion of how each child should or should not behave on a day-to-day basis lasted until the fifth session. Sometimes, both of them questioned the therapist about who was right and what the right decision was.

In the fourth session, the same discussion about the children continued for almost the entire session, with the proposal of the genogram, aiming to identify the composition of the family better. They were asked to draw the family tree, without presenting a model, with the freedom to draw as they wished. However, little attention was paid to the activity, with a return to the discussion about the children.

Faced with the difficulty of talking about issues that were more delicate and important for the development of the therapeutic process, the activity inspired by photo-language was applied to evoke a discussion about the meaning of the family psychotherapy for them. After this activity, it was decided to continue the consultations in the framework of couple psychotherapy and not as a family anymore. Two more sessions were held with the couple and then, after a more intense session, they did not come. The psychotherapist got in contact with Fatima, who reported her husband's resistance to continue. However, she said that she would try to persuade him not to give up. In the final session, the eighth, only Fatima attended to report that they had decided to stop. As an alternative, she was offered continuity through individual psychotherapy, an offer that was readily accepted by her and then she attended individually for more than a year.

 

4. Case discussion

In many moments of the setting, communication through language alone does not seem to be enough for the patients to be able to express themselves fully (Sei, 2011). This many occurs because anxieties are closer to the pre-verbal, from a more unconscious, primitive terrain (Sei, 2011, Franco et al., 2016). Thus, the use of artistic-expressive resources enables other forms of expression beyond words, guided by freer and more spontaneous expressions, closer to the repressed contents. For example, the choice of an activity adapted from photo-language was because it is an activity that uses photographs to express something unconscious, that is, it mobilizes visual thinking beyond thinking in words. According to Freud (2006, p. 35), regarding visual thinking:

We must not be led, in the interests of simplification perhaps, to forget the importance of optical mnemic residues, when they are of things, or to deny that it is possible for thought-processes to become conscious through a reversion to visual residues, and that in many people this seems to be the favored method. The study of dreams and of preconscious phantasies as shown in Varendonck's observations can give us an idea of the special character of this visual thinking. We learn that what becomes conscious in it is as a rule only the concrete subject-matter of the thought, and that the relations between the various elements of this subject-matter, which is what specially characterizes thoughts, cannot be given visual expression. Thinking in pictures is, therefore, only a very incomplete form of becoming conscious. In some way, too, it stands nearer to unconscious processes than does thinking in words, and it is unquestionably older than the latter both ontogenetically and phylogenetically.

The first two activities proposed before the application of the activity inspired by photo-language clearly showed the resistance of the family in accessing specific themes. For example, the incident with Pedro was only brought up in the setting in the first session, when he was absent, with subsequent silencing, resembling a taboo and resurfacing only in the final session with the couple. It was also observed that these activities ended up giving rise to more thinking in words. Faced with this difficulty in thinking in words for specific themes to be accessed, it was sought to mobilize visual thinking so that the reflection about the expectations regarding the consultation could be performed more efficiently.

According to Melo, Magalhães, and Féres-Carneiro (2014), the psychotherapist must understand the importance of respecting the rhythm of the family in the unfolding of their plots and conflicts, since the family must have resources to get in touch with their secrets. Thus, the activity aimed at highlighting the setting as a safe place in which they could trust and talk about fears, anxieties, and family problems in general. It was noted that the activity favored access to the conflicting family issue, although it did not reveal the content itself, it showed the fact that there was a secret that surrounded them and remained in the field of the unspoken.

Accordingly, Eduarda, when invited to comment on her chosen image, was very emotional and irritated and indicated that none of it would do any good. When saying this, she wrote the word "nothing" and drew several arrows that went out of the word and pointed to her figure (Figure 4.1). Everyone looked at her in surprise, but the silence among the family continued, similar to the image she had chosen, which represented everyone involved in darkness, not wanting to see what was hidden among them.

 

 

The others verbalized the same idea that the psychotherapy could show the right path so that they could improve. Figure 4.2, chosen by Fatima, is highlighted as, through this, an analogy can be made with the theory of Freudian metapsychology, from the deepest layers to the surface, from the unconscious to the consciousness, that is, from that individual climbing a mountain to arriving at the top of it, the surface.

 

 

Fatima and Eduarda suggested that the psychotherapy should only be between the couple, since Eduarda was already in individual treatment and Fatima seemed to want the sessions with her husband only, so that, perhaps, they could touch on matters that the presence of the children was making it difficult. So the sixth and seventh sessions were only with the couple.

In the sixth session, however, the couple repeated the same dynamic as when the children were present. They touched on shallow subjects about how to raise children and who was right or wrong. They did not talk about how they felt about each other, and when questioned about it, they turned their attention to practical issues. It was realized that it would be of no use to try to enter into more delicate matters since the two were not ready and to force them to do so could increase "[...] the risk of psychic disintegration or abandonment of the treatment" (Melo et al., 2014, p. 165).

At the beginning of the seventh session, Pedro questioned the treatment, because he understood that changes were not happening. He was told that psychotherapy was a time-consuming process because its development depended on the steps of the patients, what was worked on in each session from what was taken to the consultation, considering what could or could not be endured.

There were a few minutes of total silence, when Fatima, impatiently, touched on the matter of the "robbery." She said that the road her husband had taken that day was not the usual and complemented this relating what she had heard from one of her brothers-in-law and one of the policemen: that the square in which Pedro was allegedly robbed was a well-known prostitution point, mostly populated with transgender men. Ramos (2006, p. 79-80) argues that:

[...] the secret determines the exclusion of one or several members, dividing the family between those who "know" and those who "do not know" something. The identified patient, that is, the one identified by the family as ill, is usually the one who is found to be excluded by the family secret. Their inappropriate behavior may be a symptomatic attempt to denounce this secret.

The children appeared from the beginning as the chief complaint of the couple, mainly Eduarda, as a result of the photos she had sent, and it was precisely her who carried out the main movement of trying to denounce the family secret. Thus, the emergence of a denying alliance between mother and daughter can be assumed. According to Kaës (2014, p. 127), this alliance "[...] characterizes a situation in which the relationship is used to keep the representations rejected through means of the denial in her daughter out of the secondary repression in the mother". In this way, the daughter ended up being an overinvestment of representations that were unrepressed and simultaneously denied by the maternal psyche (Kaës, 2014). However, it was not only a matter of passively receiving that which could not be elaborated or repressed in the mother, the daughter actually assumed an active role, so that there was this movement of Eduarda's desire to denounce something, even if, in the words of Kaës (2014, p. 128), this something was "[...] totally devoid of meaning [...]" Therefore, the image chosen by Eduarda was something obscure, meaningless, and without any form.

One can hypothesize bisexuality or homosexuality unadmitted, however, unconsciously known and denied by Fatima and Pedro for the construction and maintenance of a family. That is, the denegative pact, like any other unconscious alliance, cannot be formed from the inner space only, but in the space of the family metapsychic continent that allows the contents to permeate the family members and bonds to be established and maintained between them (Benghozi, 2009; Eiguer, 2014). In the words of Kaës (2014, p. 119), this type of pact "[...] requires an alliance which gives each one his/her place and the function of guardian or guarantor of the pact."

According to Melo et al. (2014), secrets can be constructed from real traumatic or shameful events or even fantasies. Two types of secrets can be considered: those that move to the possibility of outcome for all and those that cannot be shared, as they interfere in the maintenance of the bonds, and could cause a rupture among the members. Thus, Pedro reaffirmed his story that he was the victim of a robbery, having said crying that he was not gay so that the bonds were not destroyed. However, this denial has a cost because it was not enough. In Pedro's case, he performed acting out, that is, he sought sex from prostitutes that did not presuppose a connection and a risk of exposure. However, he ended up suffering the robbery that denounced something that he sought to be denied by the group. In Fatima, the cost was probably located in the alienating denegative pact, that is, the denying alliance with the daughter.

About the adolescents, this secret seemed to have configured a transgenerational content of which both could inherit. It was configured as something that possibly influenced them to present the symptoms described by the couple: from an obedient and supportive son to an adolescent that was aggressive with friends and family, engaging in physical fights; from a responsible daughter to an adolescent without limits who puts herself in a relationship with an adult, exposing intimate photos of herself.

Regarding the psychic cost of maintaining the denied content, Kaës (2014, p. 118) states that:

When the denegative pact is constructed on repression and the renunciation of the immediate satisfaction of the destructive instinctual goals, it follows that the repressed content, the "sidelined" and the rest, the sprouts of which are always capable of returning to relations under the form of symptoms of neurotic structure, results in conflicts between desires and defenses.

In this sense, the symptoms of the children, as well as the alienating pact between mother and daughter, also appear as a way of preserving the family bonds. Rehbein and Chatelard (2013) argue that, as it refers to the order of the symbolic, the central question of the family secret is not necessarily related to its content, but to the need to talk about and bring to the verbal that which is unsaid. However, given the fear of breaking the bonds and due to shame or guilt, the secret is installed. The desire to discuss the issue of the family secret in couple and family psychoanalytic psychotherapy configures an important problem since it is one of the leading causes of withdrawal from the treatment (Ramos, 2006; Melo et al., 2014). In the case in question, the existence of high resistance that prevented the continuity of family psychotherapy was perceived. Despite this outcome, it was comprehended that the use of artistic-expressive resources helped in the emergence of unconscious contents and the consequent comprehension of the family dynamic (Franco et al., 2016), constituting a pertinent proposal for the scenario of couple and family psychoanalytic psychotherapy

 

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Mailling address:
Ricardo da Silva Franco
Rua República, n. 227, Vila Odilon
Ourinhos, SP, Brazil. CEP 19905-154
E-mail: rs_franco@hotmail.com

Submission: 04/10/2017
Acceptance: 13/11/2018