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The present authors have elsewhere reviewed (Haworth and Keller 1962) the literature on the symbolic meanings attached to food and eating, as well as the significance of various types of reactions to food in the diagnostic setting and in psychotherapy.
The early association of pleasant experiences surrounding food and feeding with feelings of love, comfort, and security has been frequently pointed out in the psychoanalytic literature. Therapists such as Sechehaye (1951, 1956), Federn (1952), Rosen (1953), and Schwing (1954) have reported the introduction of feeding situations as a vital part of therapy with seriously disturbed adult patients in an attempt to re-create the initial mother-child relationship and to work through early affectional deprivations.
Probably the earliest report of the use of food in therapy with children is to be found in Slavson's (1943) descriptions of therapy sessions with groups of boys. He points out rather definite stages in the boys' attitudes to the snack times which were provided toward the close of each session. First there was a stage of shyness and tentative holding back, then overreactions of horseplay and messiness, until finally the refreshment period became a time for relaxation and mutual social interchange.
Reports of therapy with young autistic children, such as Waal (1955) and Alpert (1959), describe the child's reactions when food has been offered. These may include gorging on the food or hoarding of crumbs and pieces, as well as leading to further exploration of his own, and the therapist's, mouth and teeth. Kaufman and colleagues (1957) briefly discuss the values inherent in the use of food with the psychotic child as a means of building up the ability to accept gratification and of reassuring the child that his oral needs are not dangerous.
Only quite recently has the meaning of the patient's offer of food to the therapist been treated at any length. In a paper by Anthony (1961) and its discussion by Kramer (1961), two opposing theories are proposed to explain the meaning of this act. In discussing his analysis of an 18-year-old girl, Anthony describes her bringing him a cookie which she had baked, and at the end of each hour she would take it home, only to bring it back the next day. "Both in real life and in her dreams, she was haunted by the anxiety that what she offered would prove unacceptable. If I ate what she produced, it would be proof that I was accepting her since I would be assimilating her products. Something from her would have gotten right inside me" (Anthony 1961, p. 213). Kramer (1961) presents an alternate hypothesis: "I wonder, though, whether the act of feeding the analyst is not also an attempt to. . . assert a degree of independence from him" (p. 249). Kramer proceeds to describe the usual infant's attempts to stuff food into his mother's mouth and interprets such behavior "as one of the earliest efforts at establishing the child's identity separate from his mother. There is a display of purposeful activity where only passivity was present before." He suggests that Anthony's patient was demonstrating both the wish to merge with him and the wish to become free and grow up.
The material to be presented here represents the authors' experiences in work with neurotic children. The general types of reactions these children exhibit toward food will be discussed, as well as a more detailed description of food behavior from one child's therapy.
In providing food for the child the therapist is, in effect, presenting herself as the all-giving, good, and nurturant parent. But the child may experience such a situation as very threatening, since it may dramatize his conflict between wanting to receive such nurturance and his feeling that this food is somehow forbidden or potentially dangerous. It may be too difficult an act to spontaneously reach out to take a bite of food in the presence of an adult. If the therapist points out the availability of the food or specifically offers it to the child, he may withdraw even more. The therapist's exact role, beyond making certain that the cookies are at hand for each session, cannot be specified in advance, but must be adapted to the child's idiosyncratic reactions to the situation.
While he may not refuse a bite outright, the child may take only one, and this when the therapist's back is turned. Even then, he may not eat it, but slip it into his pocket. Guilt and shame reactions, as well as fearfulness, may have become associated with the child's earlier experiences with food, and these will be reflected in his present pattern of denial and inhibition. Negative feelings related to infantile oral deprivations may now be transferred from the mother to the therapist and become manifest in this tangible eating situation.
As children come to feel more at ease in the playroom, they may help themselves more openly to the contents of the cookie jar, but they are apt to want to wrap the cookies in a paper towel to take with them when they leave. As therapy progresses in all areas, changes will also be noticed in such secretive food reactions. The child will gradually take more than one piece, eat these in front of the therapist, and count out fewer to take home. When the constricted child spontaneously offers cookies to his therapist at the same time that he is eating freely and with enjoyment, definite gains in other aspects of therapy as well can probably be observed.
Suspicious, paranoid children may have fantasies that the food is bad, or dirty, or poisonous. They may refuse food for long periods of time. When they do finally give in, they have been observed to hold a cookie between their teeth for several seconds before chewing it. One boy, who was sensitive to being watched, would close his eyes as he reached for the cookie jar.
In contrast to the inhibited child, others, who still bear sensitive scars of earlier deprivations, are apt to gorge themselves with cookies or candies, at first seeming to never get enough. They will notice at once if the jar is not in its accustomed place and be in near panic until it is produced. As they gradually come to feel secure and satisfied, if not actually satiated, the number of cookies will be reduced and the sense of urgency toned down to reasonable proportions. Again, after many weeks, such a child may suddenly wish to share his treasure with his therapist.
Once the initial reactions to the food have been worked through, regressive feeding behaviors are often observed. The child may pretend to be a baby and ask the therapist to feed him, piece by piece. Others will take a handful of cookies to a play shelf, crawl up in a fetal position, possibly covering the opening with a blanket or towel, and indulge in cozy solitude. Food has also been noted to serve a comforting role as the child progresses to more normal functioning. One 10-year-old boy engaged in many target shooting contests with his therapist and always took a cookie whenever he lost a bout. Children who may not ordinarily take cookies have been observed to do so the last session before a vacation period.
Aggressive reactions toward food also occur, sometimes as an initial behavior, but always as an expression of hostility. Rather than eating the cookies, the child may crush them to bits or throw them across the room. This may represent an aggressive act directed toward the therapist and her "gift," or reluctance to admit to strong oral hungers, or a form of self-punishment and denial. One boy offered a cookie to his therapist after first concealing a thumbtack in the bottom of it. Other children have shot at the cookie jar with water pistols, with or without first making sure the lid was tightly in place. A quite hostile and jealous youngster emptied the cookie jar each week so. there would be none left for "the other children who come here." Diminution of such aggressive acts with time, along with an increase in pleasurable eating, represent indications of therapeutic gains.
One further behavior frequently noted pertains to parental reactions. Once they are aware that their children are being given food, some mothers have developed a routine of stopping on the way to the therapy session, to buy the child a Coke or ice cream cone, thus beating the therapist at his own game! A healthier reaction was noted in one case when, after six months of therapy and when real gains were becoming evident in all areas, the child announced that his mother had started buying him a treat on their way home from their concurrent sessions.
Some procedural aspects should be pointed out with respect to the use of food in the therapy hour. It is important to determine whether the child has any allergies that would prevent his being able to eat certain foods. It does not seem sufficient to merely have the food available. To be therapeutic one should verbalize the permissiveness of the situation and stress over and over again, "How nice it is to be able to have all the cookies you want" or "It feels good to be able to have them all," and so forth. In this connection, the number of cookies in the jar becomes quite important. Some therapists feel they can demonstrate their all-givingness best by filling the jar but, ironically, this makes it practically impossible for the child to eat them all and so to experience the joy that comes with feeling they can all be his. On the other hand, too few cookies may be regarded as niggardliness on the part of the therapist in spite of his protestations of magnanimity.
It should go without saying that as the various meanings of food to the child and his reactions to the situation become evident, the therapist should reflect and/or interpret as he would in any other play situation.
The therapist wisely lets the child set the pace as to when he offers cookies to the therapist and how many he wishes to share. As discussed earlier, Kramer (1961) points out the possible dual aspects of such offerings-either the desire to be incorporated by the therapist or a demonstration of separateness and independence. The latter explanalion has seemed more relevant in the authors' experience. When children reach this giving stage it seems to represent a real milestone; it is as if they have achieved a new maturity in now being able to give, where formerly they have been preoccupied with receiving. The therapist is then viewed in a new perspective, as an individual in her own right, rather than just a familiar fixture in the playroom.
Excerpts from the therapy of a 7-year-old boy have been selected to demonstrate many of the symbolic and supportive uses to which cookies were put during a year and one-half of therapy.
During the first session, Billy did not appear to notice the cookies until time to leave. He then asked if he could "have a few" and took two, saying, "Two is a few." Halfway through the second session he ate one cookie. Later in this hour, he sucked water out of two bottles at once and said, "These are the mother's." In the next four sessions he continued taking only one or two cookies, while his play themes during this time were concerned with symbolic birth fantasies and much interest in sucking activities.
In the seventh session he displayed more anxiety than usual and played out various representations of his guilt and fears concerned with looking and seeing. He accompanied these activities with constant eating of cookies and also offered one to the therapist for the first time.
In the ninth session he drew several pictures of "statues of eagles." At one point he got up to get a cookie, but, due to an oversight, none were available that day. He said he really didn't mind since he hadn't gotten used to them, and so he didn't miss them. Later in this same hour he reported the following dream: He had shot a mother eagle and brought back the babies-they were almost starved to death; he had fed the babies and sold the mother for a lot of money. When the therapist suggested that the babies were starving because the mother had not fed them or taken good care of them, he denied this vigorously and blamed it on himself (in the dream) for shooting the mother bird. (While he can immobilize the depriving mother eagle in his drawings and shoot her in his dream-fantasy, on the conscious level he must stoically deny his oral needs and take the blame for the infants being deprived.)
Sessions ten to fourteen were occupied with activities symbolically representing comparison of size, strength, and virility in phallic rivalry with his father. It is interesting to note that he did not eat any cookies in these sessions.
The next twelve sessions were marked by much oral emphasis as he struggled with his fears of eating and his desires to be fed. First he set up situations in which he would beg for toys and objects which he knew the therapist could not let him have, thus putting her in the role of the depriving mother. In the following session, he mixed plaster-of-Paris with water to form a thin milky substance which he poured into the baby bottles to "fool the baby." Then he fashioned three oral receptacles out of clay-a canteen bottle, a cup, and a bowl. He saw the cookie jar and announced he was "going to eat cookies today." He held his first one in his teeth a long time before chewing it, while he drew a target and shot at darts. Once he started eating, he made repeated trips, finally asking the therapist to bring the jar over to him and hold it for him. His desire to be given all he wanted, especially of food, was repeatedly pointed out. He made quite a point of leaving two cookies in the jar and said he'd get sick if he ate them. The therapist remarked that he seemed to be afraid that something bad might happen if he took all he wanted of anything. He immediately became unusually spontaneous and quite daring in his play, as if a great load had been removed.
The following session Billy took the cookie jar to his play area and ate many of them. He offered one to the therapist, but refused to accept any that she offered to him, preferring to pick out his own. He commented he was saving the last cookie for her and again she reflected that he didn't ever seem to want the last ones, that maybe he felt it's bad to take all he wants, or that he might get sick, or something bad might happen to him. Toward the end of this session he had been mixing red paint with sand; then he suddenly darted to the shelf for two small bottles. He filled them with red and green paint and specified that these were "poison" for the therapist. (The paranoid attitude to food is clearly evident with the fear of getting sick and so not taking all of the food; then he expresses the wish to poison the agent of his food deprivations-the mother-therapist-by first giving her the last, bad cookies and then by mixing up a concoction for her which he labels directly as "poison.")
The next session he inspected the cookie jar at once and said, "Oh, you got a lot because you knew I was coming." He ate many as he played and once the therapist put one up to his mouth which he opened so wide that he engulfed the whole cookie and managed to suck momentarily on her fingers. (Only after having "poisoned" the therapist can he let himself actually be fed by her.) He avoided further opportunities to be fed, kept the jar close and helped himself often, and again made a point of giving the last cookie to the therapist. He denied her reflection of his fears about eating or taking all of anything.
The following five or six sessions were marked by much regressive play with sand and finger paints, accompanied by baby talk and gross eating of cookies. He would stuff several in his mouth at a time, completely emptying the jar and often getting still more from the supply box. At the close of one of these sessions he took two cookies with him "for me and mama." Another time he set up a "tea party" of cookies and water, giving the therapist more cookies than himself because he wanted to see her get fat. He crushed some of his cookies, later asking if he could also crush pieces of chalk and expressing concern about wasting the chalk or the water when he let it run for a long time. It also became obvious, during this period, that whenever he was told his hour would soon be over, he would go at once for more cookies.
An eventful session (the twenty-sixth) occurred the day before he was to go on a long summer vacation. He was engaged in cleaning out the sink with soap flakes and brought the cookie jar to the sink so the therapist could put cookies in his mouth as he worked. She deliberately fed him in steady succession, and he seemed to settle into a comfortable, relaxed regression-wallowing in cookies, soap, and water. When the therapist once did not observe that his mouth was empty, he said, "Cookie, please. No, not please." The therapist commented that he seemed to feel she should know when he was hungry without his having to beg, to which he agreed. She then discussed his great need to be given things, that children have a right to feel their mothers will feed them good things without their having to ask, it's fun to be given all you want, and so forth.
He ate cookies throughout the first session following the vacation, but from then on he largely ignored the cookie jar or ate only a single cookie at the end of the hour. The last session before the Christmas holiday he again showed interest in the cookies, eating throughout the hour, asking the therapist to feed him, and offering one to her.
During the next four months his general play themes were becoming less symbolic and more creative and constructive in nature. Cookies held little interest for him. Only when termination plans were being discussed did he return to the cookie jar at one point when he was verbalizing some of his concerns and questions about the future.
Three weeks before his final session he brought a bag of hard candies to the playroom and offered some to the therapist. She pointed out that before this time he was getting things in the hour while now he was able to give and that this was a real change, to which he agreed. In his next to last session he once more stuffed his mouth with cookies, but did not seem to notice them in his final hour.
In summary, Billy's use of food
can be divided into several stages. At first he was very constricted, denied
his desires for food, or allowed himself only one or two cookies in an hour. Only
after he acted out his fears of the bad food and retaliated against the bad mother
could he then permit the therapist to feed him. This rapidly led to much regression
in play and gorging of cookies as he played out pleasurable infantile feeding
situations. As gains were noted in all areas of his play, his need for cookies
also diminished, and he used them only when he needed extra support, for example,
at the close of an hour or before a long vacation. Finally, he brought in food
to give the therapist which signified a newly achieved stage of maturity for him.
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