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Ethical Boundaries: Treating Childhood Sexual Trauma
Childhood Sexual Trauma continuing education psychologist CEUs

Section 17
Sexual Abuse Analysis of Drawings:
The Projections of Ego Functions

CEU Question 17 | CEU Test | Table of Contents | Child Abuse
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

The remainder of this chapter is devoted to looking at how these breakdowns in youngsters' ego strengths are manifested through abused children's projective drawings. In analyzing the House, 'free, Person, and Kinetic Family Drawings created by misused children within six months of their abuse, images of the ego damage they have sustained will be graphically portrayed. While there may be other interesting and noteworthy aspects in each of the renderings, for the purpose of this chapter, we will focus exclusively on those items that reflect disturbances and strengths in ego structure.

This first drawing, Plate B, depicts ego dysfunction and was penciled by 8-year-old Carole. She was violated by her father by being forced to view pornographic videos while lying In bed at his side. It is not clear how many times this occurred nor for how long. Soon after the last of these events, her parents separated, and in the process, her mother became extremely depressed and incapable of functioning. Carole tried to care for her mother and assumed full responsibility for her 4-year-old brother, Evan. These circumstances blended together and led to the Impairment of her ego.

Carole First Drawing Childhood Sexual Trauma CEUs

The most striking feature of Carole's drawing is her treatment of the head, the body part most commonly associated with the ego (Machover, 1980; Ogdon, 1977). Generally speaking, we expect to see exaggerated head sizes in the drawings of 4-year-olds. By the time a youngster reaches Carole's age, she or he is more reality-based. As such, a head as large as the torso is considered unusual (Hammer, 1980). When we couple the enlarged head with the reinforced hairline, we see a picture of a child who is struggling to contain her impulses through ego defenses. The break between the head and body (the head is not attached to the body) may graphically represent Carole's deployment of the defense mechanism of isolation. Isolation is a means through which an individual copes by separating ideas from the feelings with which they were initially connected. Carole's use of this particular defense alerts us to the possible process of emotional numbing, which is one of the ways that many sex abuse victims cope with feelings and anxiety too overwhelming to otherwise handle. A major consequence of the habitual use of this defense may be the development of alexithymia.

Plate 11 represents the second phallic body produced by a child asked to draw a picture of a person. This one, drawn by 5-year-old Ralph, is brimming with indications of sexuality gone amuck. Ralph is an identical twin who was physically and sexually abused by his father and his father's girlfriend. The molestation consisted of exposure to pornographic movies, objects forced into his anus, and needles inserted into his toes and penis. The physical violations were confirmed through medical examination. In addition, his father and aunt took pictures of him naked in his bedroom. Ralph revealed that his father threateningly showed him a brown egg and warned that if he or his brother told anyone what they were doing, he would crack the egg and kill the chick growing within it.

Ralph plate 11 Childhood Sexual Trauma CEUs

The Person Drawing appears frightening. The arms and hands hover menacingly as if to ward off Intruders. Ralph seems to be identifying with the aggressive posture of his father. This is his way of coping and trying to develop the self-caring function of protecting his body from harm. However, it is easy to see that this is a thin veneer presented in order to defend against his intense feelings of helplessness, which are also represented In the drawing. The figure stands quite precariously balanced on feeble sticklike legs. The legs are drawn with a single thin line, with a break in each near the top, which further confirms the powerlessness he experienced (Hammer, 1954) when unable to protect himself against the extreme violation.

A second striking feature is the thin and elongated neck which is associated with feelings of body weakness and organ inferiority "with a compensatory drive or reaction formation towards physical power or aggression tendencies" (Ogdon, 1977, p. 79). This type of neck also connotes Ralph's attempt to separate his thoughts from his emotions, since these feelings contribute to his problems controlling his impulses. The tiny head in relation to the huge phallic body, however, tells us that his impulses are winning the battle for control and overrunning his ability to use his intellect.

Roger, Ralph's identical twin, was the unfortunate recipient of the same abuse foisted upon his brother. What is particularly noteworthy, however, is the different reactions each child had to the trauma. Both boys were treated at a local child guidance clinic once the abuse was revealed. While Ralph easily recounted the events that took place with his aunt and father, Roger sat silently by his side and shrugged his shoulders sadly when asked if he recalled the same events. Roger neither disputed nor acknowledged his brother's statements. He appeared overcome with shame, inhibiting his capacity to elaborate on his feelings or thoughts. Although these twins look exactly alike, their internal world is markedly divergent. This is revealed by both their behavior and their drawings.

Ralph presents a menacing figure whose impulses have gone wild and whose controls are strained to their limits. Roger, on the other hand, drew two figures (Plate 12 and Plate 13) whose robotlike quality shows successful restraint. Roger struggles to control, or box in, his feelings and Impulses. Although he is effective in keeping his Impulses at bay, the cost is his disconnection from his feelings- emotional numbness. He Is not only alienated from himself but, as important for a latency-age child, keeps himself distant from others. The single, second-floor window in Plate 14 projects his withdrawal from the world (Jolles, 1964). No one is tall enough to look within; he is therefore able to remain aloof.

Roger Drawing Plate 12-15 Childhood Sexual Trauma CEUs

We note that this same dynamic is present In the 'free Drawing (Plate 15). The crown and branch structure is associated with one's ability to interact and derive satisfaction from the environment (Buck, 1981). "Outer parts of the crown, the extremities, form the zone of contact with the environment, the zone of relationship and exchange between what Is within and what is without" (Koch, 1952, p. 5). Like the window In Plate 14, everything remains out of reach. The enclosed structure of the crown is encapsulating and does not allow the entrance of outside forces. It also prohibits the branch structure from reaching out into the vicinity and reaping any possible benefits.

Remarkable to Roger's drawings is the tenuous connection between the crown and the tree trunk. While it is normal for a 5-year-old to draw a line separating the crown from the trunk (Koch, 1952), the space created by Roger emphasizes a division. It graphically portrays the foliage's disconnection from the nourishing juices of the trunk. The trunk is an accepted representation of the ego (Buck, 1981). The gap between the two tree parts may, therefore, mirror Roger's inability to self-care, an important ego function. This may also explain the description Roger gives In the PD! that the circles or fruits on the crown are oranges. Like the oranges, he has developed a thick skin to protect his fragile interior. Similarly, the boxy torsos (Plates 12 and 13) shield the vulnerable self from the world. These squared-off bodies represent Roger's attempt to hold things In, in order to keep himself together, not fall apart, and not act on his impulses.

Roger Drawing Plate 16 Childhood Sexual Trauma CEUs

Another defense Roger utilizes is denial. Like many other abuse victims, he literally draws a happy picture. Both the Human Figure Drawings (Plates 12 and 13) and the Kinetic Family Drawing (Plate 16) present people wearing a smile.

Yet, the other parts of the figures belie these joyful expressions. Particularly, in the KFD, the family members look much like unrooted flowers waiting to be plucked. Roger's distress is further echoed In the HFDs, where we note the short, flimsily connected arms. Machover (1980) states that arms and hands refer to "ego development and social adaptation. It is with arms and hands that we feed, dress, perform skills, explore our body and contact persons about us. It is with arms that we love and caress, hurt and kill, disrupt and adapt" (p. 80). Roger's treatment of arms in his drawings depicts his difficulty in ego development and socialization. However, we also notice that, despite their weakness, the arms extend outward Into the environment representing his desire for contact. Sadly, however, his ability to achieve this is impaired. This helplessness is further confirmation of the message conveyed by the encapsulated branch structure In Plate 15.

A final noteworthy point is the reflection of Roger's anxiety. A huge cloud runs the width of the drawing in Plate 14, looming above the house. Beneath it floats a smaller but menacing one. Clouds represent the artist's anxiety (Hammer, 1954). As such we see that despite Roger's efforts to deny and defend against his feelings, anxiety breaks out and shadows his home environment.
- Kaufman, Bobbie, & Agnes Wohl, Casualties of Childhood: A Developmental Perspective on Sexual Abuse Using Projective Drawings, Brunner-Routledge: New York, 1992.

Personal Reflection Exercise #3
The preceding section contained information about the projections of ego functions in the drawings of sexually abused children. Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Ensink, K., Borelli, J. L., Normandin, L., Target, M., & Fonagy, P. (2020). Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties. American Journal of Orthopsychiatry, 90(1), 115–124.

Jones, T. M., Bottoms, B. L., & Stevenson, M. C. (2020). Child victim empathy mediates the influence of jurors’ sexual abuse experiences on child sexual abuse case judgments: Meta-analyses. Psychology, Public Policy, and Law. Advance online publication.

Schuler, M., Mohnke, S., Amelung, T., Dziobek, I., Lemme, B., Borchardt, V., Gerwinn, H., Kärgel, C., Kneer, J., Massau, C., Pohl, A., Tenbergen, G., Weiß, S., Wittfoth, M., Waller, L., Beier, K. M., Walter, M., Ponseti, J., Schiffer, B., . . . Walter, H. (2019). Empathy in pedophilia and sexual offending against children: A multifaceted approach. Journal of Abnormal Psychology, 128(5), 453–464.

Online Continuing Education QUESTION 17
The break between the head and the body (the head is not attached to the body) according to Kaufman may graphically represent development of what defense mechanism? Record the letter of the correct answer the CEU Test.

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