PROJECTIVE TECHINQUES IN DEALING WITH PRE-SCHOOLAND YOUNG SCHOOL CHILDREN WITH ABUSIVE BACKGROUNDS

ABSTRACT: 

This work is a qualitative approach to the use of different projective techniques for the psychological assessment of a child in clinical practice. The battery of projective tests used is made up of the following: tree drawing, human fi gure drawing, (CAT) Child Apperception Test, Duss fables Test, Rorschach Inkblots Test.The subjects were chosen from among children between 5 and 10 years of age, referred to our clinic with a wide spectrum of symptoms which, at the end of the assessment investigation,proved to be linked to diff erent forms of abuse. The purpose of this paper is first of all to point out the necessity to correlate the data obtained by means of the projective tests administered during the psychological assessment of the child with those obtained through other methods of investigation (observation, clinic interview) in order to clarify the determiners of the symptomatology which brings the patient to the clinic. At the same time, this correlation helps the clinician to obtain a more vivid image of the emotional impact of certain abusive situations in which the patient is involved. Secondly, the work tries to point out how rich and refined is a child’s expression when living a psycho-trauma.

INTRODUCTION

Abuse and neglect affect the essential dimensions of child development.Th e effects are profound and accompany the individual all his or her life. That is why it is very important to identify and treat the problems linked with abuse and to deal with all the childhood psycho-traumas attentively.

This work is an overview of the clinic psychologist’s practice, face to face with preschool or young schoolchildren who were brought to the clinic by their parentsfor different symptoms: sleep disorders, restlessness,depressive disposition, uncontrolled aggressiveness, somatic complaints … when no clearly identifiable motivation could be determined after the clinical interview.

The aim of this work is, mainly, to point out the necessity to correlate the data revealed by the projective tests with those obtained by other means of investigation (interview, observation) during the procedure to assess the child and have a more complete and vivid image of the emotional impact of diff erent abusive situations in which the child is implied.
Secondly, the work aims to present aspects of therich and refined palette of child’s expression referringto the problems they have to face and their experienceslinked to their involvement in an abusive relationship.

MATERIALS

The children presented within the frame of this study have been assessed by means of the following tests:
— Koch’s tree drawing test
— Colette Jourdan – Ionescu: Family Drawing Test
— Rorschach Inkblot Test
— Child Apperception Test (CAT) – Bellak – Abrams
— Düss Fables – Louisa Düss
— Wechsler Intelligence Scale for Children (WISC)
— Binet-Simon Scale

Besides these tests, the free drawings made by the children during the interviews have been analysed.

THE PARTICIPANTS

The subjects have been chosen from among children aged 5 – 10 years, with normal intellect, who have been brought to our clinic with a most varied symptomatology (sleep disorders, uncontrolled aggressiveness, somatic pains…) which fi nally, after the psycho-diagnostic undertaking, proved to be generated by different kinds of abuse.

We selected 5 cases and, after administering them a set of projective tests, we discovered that the respective children were involved in abusive relationships.In order to point out the correlations we have made,we present drawings, significant fragments from the projective test, protocols that we have used, accompanied by comments concerning the children’s various reactions during the interviews.

METHOD

Each child has been assessed during at least 3 sessions.

The following sequence has been applied:
— anamnesis,
— interview – observation,
— assessment of mental development level,
— projective tests,
— structured interview.
— projective tests.

Passing from one step to the following one and thedecision for the next tests to be used have been established according to the result from the previous step,and, as a consequence, one cannot speak of a rigid orderin this undertaking. We considered that the fl exibilityof the method is an essential condition in dealing withchildren. Still, we must mention that, during the fi rst interview, the child’s intelligence quotient was assessed.

This step was necessary in order to interpret the result of the projective tests correctly. All the selected children had a normal intellect.

CASE ANALYSIS

B.I., aged 8.6 years, is brought for assessment to the Clinic by the paediatric clinic with the following clinical picture:

— abdominal pains, sensation of suff ocation,frequent urination, an attitude of exacerbating physical pain.

Following the anamnesis we retain the following:

— only child, organised family;
— both parents have graduate studies;
— mother is a housewife;
— for over one year, the child went through repeated tests and consultations in the paediatric clinic without relevant data for a somatic diagnostic.
— the child had suffered an appendectomy two weeks before, but the accused symptomatology was maintained.

Intellectual assessment (WISC), IQ = 138

Tree drawing test:

— the tree head was with blanks – visible impregnations of exterior pressures, generating intrapsychic tension and suffocation of the marked urge for vitality (the presence of some big fl owers);
— the hollow – indices of developing trauma;
— the contour was vague, fragile, with interrupted lines – a weakness of the Self, uncertainty,adaptive difficulties

It is an afflicted (resigned) tree.

Fig. 1. The tree

Fig. 2. The ideal tree

The Ideal Tree:

The child describes her own drawing very eloquently: “It glows entirely, both the tree and the hollow. If you touch a leaf, any wish you may have comes true. If you put your hand into the hollow, you may get whatever you wish… I like cherries”

It is evident the effort to embellish the experiences:dysphoria, the feeling of discomfort generated by exhaustion. A wish to give is remarked, represented by the swelling of the head and of the hollow, while thetree itself is slouched, impoverished of its resources.(one must note the spontaneous remark about her authentic wish: “I like cherries”) It is a signal that leads toa more profound understanding offered by other tests.

The Rorschach Protocol is a performant one fromthe quantitative point of view but it is poor concerning its interpretative capacity. The protocol abounds ininsignificant details, the formal element prevailing.Th e avoidance of affective expression is evident. Tacklingwith the task of the test is relaxed, and the need to produce is foremost. Most of the answers are descriptions.We witness an avalanche of dry descriptions, an assiduous search for infinitesimal locations.Tackling with thedrawings is relaxed – an attitude which is evident inspeaking about her somatic sufferings.

At Drawing II: A significant remark is made: ‘this empty space confounds me… why could it be placed here? To see how developed your imagination is’. At Drawing III, whose symbols remind of the need for self representation, we have a flight into patched aspects, small details without managing to perceive the entirety.

Not even in Drawing V, although the stimulus is compact, the child does not manage a unitary approach. We note even a conflict, an interior confrontation which prevents the access to the feeling of self integrity ‘crocodiles that shoot with arrows’

The only elaboration comes at Drawing VII: ‘a place with ice, all the drawing seems to be covered with ice. Mouth of a crocodile, spider’s eye, mouths of quarrelling animals.’ Drawing VII is the one which inspires associations with the maternal figure and allows the exteriorization of emotions in relation to the maternal fi gure.

Thus, we have:
— a feeling of void, of fundamental insecurity,
— the maternal figure is perceived as aggressive,
— neurotic signs,
— active adapting eff ort,
— refuge into a regressive position which allows her not to deal with the aggressive problems that she is facing,

Ulterior interview:

— Mother
o has insomnias;
o is afraid that someone might kidnap the child, her “investment”;
o gave up everything in order to be byher daughter’s side in fact did not have a chance to professional fulfi lment at her level of education in that little town where they live;
o is permanently dissatisfied with her daughter’s achievements (in spite of the girl’s remarkable school and extracurricular results) and is convinced that “B.I. surely can do better”;
o the girl has a programme of supplementary activities (mathematics, Romanian, English), which is organised a attentively supervised by mother (I want her to be the best! Nothing could satisfy me completely”).

— Father

o was diagnosed with panic attacks
o daily alcohol consumption, lately.

The hints in this case are for emotional abuse of power. The adult, living the lack of personal value,searches in the child the fulfilment of what she did not manage to achieve. The parent feels glorious, a conqueror due to her “investment”, the child, while the latter grows up with a weak self trust (the void that creates problems).

The child is not appreciated for herself, but for herperformance. Metaphorically speaking, the child is herparent’s food: she empties herself in order to fill her parent. If, in the first part of the relationship, the child is‘eaten’ without being able to oppose, later, the child assumes the action out of the habit to act like that, but alsourged by the wish to control, at least partially, the situation – here comes B.I.’s assumed urge to be performant.

Now we can understand the message in the ideal tree drawing.

What B.I. wishes is:

— a normal life, without excessive supplementary math problems,

— to be allowed to read fairytales and not to be obliged to read ‘Oliver Twist’ or ‘A Christmas Tale’,

— to play with pets,

— to eat sweets and mother to make cakes,

— mother should not get angry any longer over all kind of trifl es.

After a short psychotherapeutic intervention, whenher way of functioning was mirrored, B.I. has the courage of taking the responsibility of her fi rst attitude.Coming out of the office, she met her mother on thestairs and burst suddenly: “It is she who scolds me!”…and finds the power to sustain her mother’s gaze.

Mother was counselled.

P.C., 4.5 years old, is brought to the clinic with the following clinic picture:

— psychomotor inquietude,
— pavor nocturnus,
— fright of fierce ghosts without eyes and without mouth.

He is an only child, coming from a family in divorce for 6 months. The parents still live together.

The Binet-Simon test reveals a good intellect: IQ = 128.
 

Figure 3 

 Tree drawing test: 

The child starts to draw a sun. He stops and says: ‘actually it is clouded and it rains very hard’. Th en he draws a tree in a hurry, with its head up to the sky; thehead is hardly visible through the dark rain. At the basis of the tree the child draws a ghost with a big eye andmany small people who are taken up by the water.

The drawing expresses a state of agitation, disorder, anxiety and discomfort.

Afterwards, the child draws the image in Figure 4 spontaneously, but he cannot explain it, and we shall attribute it the title of “The Fierce Ghost”.

CAT

At the CAT test we have some remarkable answers:

Drawing 3: “A lion which is from the cartoons and I always see it. It is not evil, it is good. Th ere is something small in the mouth – it is a lion. The big one does not see it. The small one wants to climb up the big one and eat out from it”.

Drawing 8:“Just monkeys that lie on a bed. A man,a child and a woman. The child is punished – because he has hit mother or, I think, there was a danger for that lion” (introduces a character from another story).

Our conclusion:

— Oedipus complex (development stage);

— identification with paternal authority, compensation and inadequate identification.

Figure 4. The Fierce Ghost

Rorschach Test brings symbolic answers, some ofthem very transparent for the problems the child faces:

Drawing II: « Something black, with blood, that is to say, a ghost who has killed a man and now there is blood flowing out of him. » (expression of a destructive aggressive pulsion determined by an Oedipus complex of higher intensity)

Drawing III: «Two monkeys, legs like those of a woman and the belly like that of a fat man. But I still see blood, too. (an answer with a complex determination which sends to the perception of the primitive scene which troubles him and raises the destructive aggressiveness)».

Drawing VI: «chicken meat … this the bone …roasted chicken… this scares me! (this exploration of the sexual dimension is rarely met in a small child and it remains in our attention) ».

At the coloured drawings we have strange and perseverant global approaches: “cabbage monster, red oranges” that have a value of excessive pulsional expression.

Our conclusion:

— the human kinaesthesia in Drawing II, which deals with the main, even obsessive preoccupation of destructive aggressiveness;

— massive emotional reactivity related to an abusive situation and /or the fright of castration.

Mother’s ulterior interview reveals the following aspects:

• the child witnesses scenes of domestic violence;
• he is physically aggressed by his father;
• father uses to stay undressed in the house
• he has witnessed sexual scenes between his parents and he had even interrupted them by“patting his mother on her back”.

The last two free drawings, which the boy had made spontaneously, are presented below:

Figure 5 and Figure 6.The fierce ghost with a big belly and a cuckoo which frighten him

Witnessing the primitive scene (an abusive situation) in a difficult stage (Oedipus Complex) within the context of participation to frequent scenes of domestic violence led to an exacerbation of living the complex in a pre-psychotic manner.

S.S. a boy aged 7.10 years is brought to the clinic with the following symptoms:

• sad disposition
• threatens with suicide, that he will “jump in the void” in minor confl icting situations at school ,
• physically and verbally aggressive,
• recent encopresis,psycho-motor restlessness,

The anamnesis reveals the following aspects:

• the child comes from his mother’s previous marriage,
• the child was born prematurely (at 6.5 months),
• one sister (3.5 years old) – with autism,from the actual marriage of his mother

The intellectual test shows a good intelligence quotient IQ = 107 (WISC)

The tree drawing (Figure 7)

S.S. is drawing many rugged trees, the lines arebold, and the rest of the sheet of paper is ‘fi lled’ withhardened lines.

The neurotic charge is evident and we note the soilwaving, too – an indicator of a heightened pressure ofaggressive impulses.

Figure 8. Free drawing

A child with a dog and a tree in a smeared background.Th e dog is introduced as a need for support,as a securing image, in an environment perceived ashostile. Spontaneously, the child takes a red colouredpen and smears the drawing, while saying: “this iswhat my sister does with my drawings”. Th e messageof the feeling of threat with destruction is evident.

Rorschach Profile

Drawing II: “a huge shot tarantula has a hole in it and seems to resemble a little with a black widow with crab-like nippers.”

Drawing III: “a little frog with a tie, wrapped up ina spider web so as not to disguise itself into somethingelse, but it is perforated. Even if the frog would manageit, this disguise, the spider would still find it … due tothe web. It has got poison, too, in its arms”. Th e surveyof the limits – the child does not perceive the banalengram. (the human representation which imposes itself in a stressed manner is eloquent for the need torepresent oneself in relation to a human being and thenature of this relationship gives us an image of a captiveself in an environment felt as dangerous and hostile)

Drawing VII: “two little rabbits, which fall down.They have rips on their backs. They cannot jump in different directions because they are tied. Th e puma had taken a little from its head and broke its back.

We conclude:

— the theme of destructive aggressiveness,

— the need of a representation of the self is suffocated and we have the projection of the annihilation, of destruction, anxiety.

— regress in trying to find securing elements,

— perception of the relationship balance – united destinies – as dangerous, destructive,
— The confabulatory element (see the scene in Drawing VII) sends us to the problem which the child has to face: his autistic sister.

Ulterior interview of the child:

— S.S. was obliged to sleep with his sister, to take care of her all the time: “I do not know what she would do without me”. “When I am missing, it is a disaster!”

— His sister lacks control of sphincter muscles:“at night she wets the bed and it stinks like a pigsty.

— On holidays, in weekends he has to stay with his sister. This means “boredom and heat”.

The drawing of the family (Figure 9) evidences structural impulsivity and a low threshold of tolerance to frustration – the drawing fills the page. Th e representations of the adults seem to suff ocate the figures of the children, while the mother and the children make up a distinct group, distanced from the rest of the family.

Figure 9. The Family

During the last session, the child draws spontaneouslythe sketch from following fi gure, which he gavea suggestive title “Th e Vesuvius erupts” – an expressionof the aggressive impulsions that explode, a statof unbearable inner tension.

Figure 10. The Vesuvius erupts

In this case we have an abusive situation of emotionaltype induced by neglecting the needs of the ageand by attributing responsibilities which surpass thechild’s maturing stage. Th is situation overlaps an unsolvedsibling rivalry complex, thus leading to a depressive disorder. S.A., aged 6, was brought to the clinic for the followingsymptomatology which had fi rst manifesteditself two weeks before:

• Pavor nocturnes

• Uncontrolled aggressiveness,

• Defence refl ex reactions,

• Psychomotor restlessness.

The anamnesis revealed the following aspects:

• 9 siblings ( 2 – 28 years old),

• organised family,

• father -alcoholic +Tuberculosis IQ = 84 (Binet-Simon)

During the sessions we remark the child’s psychomotor restlessness, moves in his chair, falls down frequently,has got a hoarse voice, does not find his words. He hasmoments when he stares and moments when he hides his head behind his arms. He makes refl ex gestures ofdefence, when he sees the ugly that scares him.

Free drawing

The child draws “The Ugly that scares him”.

Figure 11. The Ugly

Figure 12. The Tree Drawing

The child comments this drawing spontaneously:“A tree, a branch grows out of the bush”. Th e phallic symbolism is evident. Question marks arose so wedecided to continue with other tests.

Rorschach Protocol

Drawing III:“This… this… an animal, a ghost, two ghosts that grab their babies. The ghosts are evil.”

Drawing IV: “the monster which I saw while I was asleep”.

Drawing IX: “a whale cut to pieces, a wolf has probably eaten it… and this is the stick which the wolf used to cut it with.”

If Drawings III and IV suggest a possible abusive situation, at Drawing IX we have an expression of the felt annihilation anxiety.

Duss Fables: We retain two answers:

— Fable 2 The marriage anniversary – “the child left for the garden because a wind came and overturned him then a big rain came. Th e child looked out of the window and the wind took him away. He saw something … the evil tree that is rocking.”

— Fable 10. The bad dream – ‘a black man who keeps coming when there is dark and he gets undressed.’

Then the child retells us one of his own bad dreams:

‘The window is open and there was a basket and inside the basket there was somebody who was looking at him. There was a big, bad elephant – not a human – that was scaring the sleeping child.”

Here are two answers for the CAT Test:

Drawing 6 “a bear hole. The little one is on guard but the big bear that looks like a wolf jumps on it and eats it.”

Drawing 8 “ the monkeys drink coffee and one of them tells the little one to go up the tree because there is no tiger around. But, when they came back, they found the little monkey on the ground, killed by the tiger.”

The themes are Oedipal, charged with culpability but, in correlation with the other tests, they suggest the possibility of a potential abuse and give a clue to the source of the danger – inside the shelter – where the child feels exposed, without protection.

Mother’s ulterior interview:
— during pregnancy she had been physically aggressed by the child’s father and she had to stay in canals for a while.
— the child had been left in charge of the weekly nursery until the age of 3.5 years old, where he was isolated from the other children.
— Father: exhibits disinhibition pulsions
— accommodation conditions: 2 rooms.

Mother avoids giving further details.

Spontaneous drawing

Figure 13

“The tree with branches” we present below thecommentary made by the boy.

“A child climbed up a tree… he climbed in order to cut this big branch… this tree, it is like a monster…the branches keep growing. – Why should they cutthem down? – The police said they must be cut downbecause they did not like it to make a fool of itself. But the problem was, the branch was bigger than themachine of the police.” (the orange one)

A new interview of Mother:

• Father had problems with the police due toaggression. Father’s attitude towards authoritiesis one of derision.
• She did not want to give any informationabout what happened in the home.

In this situation, we considered that the unsolved Oedipal problems were overlapped by a physical,emotional and possibly sexual abusive situation resultingin a reaction of post traumatic stress.

We recommended that the case should be monitoredand investigated by the Direction of the ChildProtection.

B.R.I., aged 9.5 years, was brought to the clinic ather mother’s initiative but the child was accompanied by both her parents for

• psychomotor restlessness.
• physical and verbal aggressiveness towardsher mother (the girl was said to have recentlypoured dish detergent into her mother’s salad).
• The girl no longer wanted to stay with her mother and had threatened to throw herselfout of the window , after staying with her fatherfor a while, during the summer holiday.

From the anamnesis we found out that:

• the girl was an only child,
• the family had been disorganised itself by divorce for a year,
• the girl was in her mother’s custody, and thefather did not ask for a right to visit her.

Rorschach Protocol:

Drawing II: “blood… a bleeding bat. A bird that spitted blood.”

Drawing III: “two twin girls, identical, who hold a scales and are bleeding.”

Drawing VII:“two girls with their head down, madeup of smoke, ashes, they are twin sisters – one is morerebel, the other is smarter… A vampire with fangs.

We conclude:

— The answers are given in a completely detached manner.

— The dominant themes are morbid and aggressive.

— A stable self image was diffi cult to establish because of undistinguishing the position ofaggressor from that of aggressed and the balance between the two positions.

— Character polarity.

The occurrence of the phantasmatic element in the interpretation of the coloured drawings stresses the phantasm and the anxiety of destruction and degradation. (The answers are anatomic, evoking the degradation: rot that flows over the livers, …lungs… spiders that spit mucus, in fact spiders made of mucus etc.)

From the CAT protocol we render the answer to Drawing 10:

‘One day the she-puppy’s mother obliged her totake a bath and the she-puppy did not want to do as mother said. But the big she-dog held her and forced her head into the toilet and killed her. After that she washed the little puppy making her ready for the funeral and mother was crying … she was crying three times…”.

More structured interview with the parents:

— the grandmother on the paternal side is diagnosed with bipolar disorder.

— the father is addicted to gambling and that iswhy he is full of debts which he cannot honour. He had been frequently aggressed by his creditors and last time he had been in hospital for a week. (When he got out of hospital he took the girl to stay with him.)

— initially, the father did not claim his right to visit, he continued to stay in the same apartment, and now, when they were in the middle of a full legal action for partition, he took the girl who, after some time, refused to go backto her mother.

— the father used to aggress the mother physically in front of the child who, would smile watching these scenes.

— the mother had then imposed a strict timetable and common sense rules, which the girl deemed as stupid rules.

— the maternal grandparents threatened the girl repeatedly that she might become one day as mad as her father and her paternal grandparents.

— the father and the girl accused the mother ofill treatment and of severe physical aggre-ssionwhenever the programme imposed by her wasnot obeyed, which the mother denied. Th e drawing of the ideal family is the expression ofexacerbated, fanatic and unmotivated fury.

Figure 14. The Ideal Family

The data of the interview and of the projective tests contour an alienating type of abuse, which, on a genetically vulnerable foundation, led to a personality disorder of the pre-psychotic type, with a defence mechanism of the hypomania conduit type.

RESULTS AND CONCLUSIONS

The use of projective tests in the psychological assessment of children reveals the richness and subtlety of child expression and off ers informationon the psychic functioning of the child. Besides, thismethod facilitates the meeting with the child, givinghim/her an opportunity to express him/herself. moreadequately.

During the first encounter, the child reveals him/herself by his/her symptoms and by the discourse which the entourage (parents) have about him, veryfrequently the discourse is controlled or involuntarily or purposely deformed.

The child’s clinical interview does not seem to be the most inspired method of dealing with the child’s problems, we had to offer the child the chance of other more adequate ways of expression.

The projective tests have a twofold function: a perceptive one and a projective one, thus both the adequacy to the real situation and the material projected are aimed at.

The analysis of the results of these tests might bean indicator for the appropriateness of certain psychotherapy, later constituting the basis of its structuring.

In many situations we could remark the catharsis effect the tests had on the child. The moment of data synthesis is crucial and it should be taken into consideration the fact that the initial diagnosis could bemodified or nuanced according to the arrival of new information. It is not correct to interpret a test, in the sense of extracting a diagnosis following a unique pathognomonical manifestation. An interpretation is not valid until it proved to be supported by other congruent tests.

Finally, we must insist on recommending the administration of at least two projective tests to a child,namely the Rorschach test and a thematic test.

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