AN ILLUSTRATION OF THE THERAPEUTIC CHANGE PROCESS
Jean A. Thurow, Psy.D.
Thurow, J. (1989) Interactional Squiggle Drawings with Children: An illustration of the Therapeutic Change Process. The Focusing Folio. Vol. 8, n. 4, pp. 149-186.
This paper is centered around a presentation of D.W.Winnicott’s squiggle game as I have come to use it in my work with children. In his book, Therapeutic Consultations in Child Psychiatry, Winnicott presented 20 clinical examples of what looks to be initially a simple drawing game. He used the game in the first interview with a child and explained it as “one way of getting in contact” with children (Winnicott, 1971b, p. 3). Winnicott did not offer further prescriptive guidelines for its use, beyond his own comments, scattered throughout the text. Initially, I saw his game as a useful diagnostic tool and began to use it in that capacity.
As I began to actually play the squiggle game I became more and more aware of the drawing sequences. I realized that often the child’s drawings were a form of communication to me and often my drawings seemed to be a response to that communication. I then re-read Winnicott and realized that he had always conceived of his game as interactive, as a form of therapeutic “communication with children” (Winnicott, 1971b, p. 8). Looking at squiggles as somehow part of the therapeutic process in the first session with a child increased my interest in and my use of the game.
Winnicott also suggested that the drawings could be used to communicate something of the child to others, as in consultations with parents and teachers. He found that the drawings expressed the troubles of the child in a way that often could be usefully understood by the child’s parents. I began to show some of the drawings to parents, and was surprised that the parents often responded with little defensiveness and great understanding. They often added important historical detail to the situations and feelings expressed in the drawings. I began to wonder how these drawings were able to help so much in the communication process.
I also discovered that squiggles had their difficulties. I often did not understand their meanings and found the communicative process hard to follow. I occasionally found myself disturbed by my own images drawn during the game. I could not tell if my drawings were a further expression of the child’s difficulties or if they came from my own inner world. I could not always tell if my images were useful or harmful. I wondered if Winnicott had some sixth sense available to him, one that allowed him to be so confident in his playing of the squiggle game and so perceptive in his later understanding of its meaning to himself and to the child.
These questions prompted me to consider a more complete understanding of squiggles as the main task of this paper. As a preliminary step, I began to show sets of squiggles to more and more people, inviting responses to the drawings. Often the people perceived important meanings in the drawings, much as the parents had been able to do. As my sense of the meanings within the squiggles increased in this way, my own drawings became richer and fuller. The children also seemed to become more expressive and responsive.
At this time I had not yet attempted to think of the actual process of the squiggle game in any systematic way. Winnicott had presented it as clinical “play” and that definition was an important part of the game’s essence. I was concerned that looking at the game within any kind of therapeutic context other than that provided by Winnicott might spoil the sense of play and delight. I was afraid that they would become concretized within some therapeutic “system,” thereby losing their essential significance.
Without resolving this difficulty in my own mind, and as the next step in formulating this paper, I began to study, the sequential process of the drawings. Because I was interested in the interactional component of that process, I chose to begin my study within the interactional framework provided by Eugene Gendlin’s theories of personality change. I began to think that there was a great deal of overlap between the way Gendlin viewed the process of change and the way Winnicott viewed the process of squiggles. This was true in spite of vastly different therapeutic models and diverse therapeutic backgrounds. Winnicott developed his squiggles out of the frame provided by psychoanalytic theory and practice, while Gendlin developed his theories out of a Rogerian model of therapeutic interaction.
I discovered that looking at squiggles within the context of Gendlin’s experiential focusing model tended to broaden and deepen the significance of the drawings. This context allowed the underlying process of the squiggles to emerge from the sometimes confusing series of drawings. As this process became clearer to me, the drawings themselves gained additional meanings and new significance. The overall therapeutic importance of the squiggling process was more clearly revealed as the pattern of the therapeutic process was discovered and understood within the experiential context.
Examining the connections between Gendlin’s and Winnicott ‘s models also serves to establish more securely the essentially interactive core of Winnicott’s therapeutic model. The interactive process is often hidden by Winnicott’s use of static concepts to describe dynamic processes. When such concepts as “subjective” and “objective” objects are looked at from a process frame, their interactive meanings can be seen more clearly and explicitly.
In this paper I will present a specific formulation of the change process as it appears within the essentially visual motor mode of communication through squiggle drawings. I will discuss the phases of therapeutic change as they occur within the sequence of drawings and I will formulate an interactional model for those sequences. Placing the drawings within a step- by step verbal context will provide a set of words that can make the drawings more easily thought about and talked about. They can then be presented as a process that can he both taught and learned.
I will thus establish a theoretical context for the understanding of the squiggle game as part of the therapeutic change process. I will then take that understanding and demonstrate its usefulness within the context of a case study. This study will include a set of squiggles done during an initial interview with a child. I will use them to illustrate the phases of change as I presented them in earlier chapters. I will also consider, briefly, their diagnostic significance and their use in the understanding of the on-going therapeutic relationship.
I hope, in this paper, to demonstrate some of the important richness and depth available to the therapist through Winnicott’s squiggle game. I will have explicated some of the communicative power available within the squiggle process. My earlier questions about the meaning of the process and of the drawings themselves, which seemed to be somewhat magical and mystical, will be revealed as understandable steps in an ongoing, communicative process.
As a final addition to this introduction, and before I begin the formal sections of the paper, I would like to describe, in just a few words, the squiggle game as I play it with children, the supplies are simple: I use lots of half sheets of typing paper and other sized sheets as well. I provide pencils, markers, and crayons. After the child and I have settled in for a minute, I tell him (or her) that I would like to teach him a drawing game called squiggles. I tell him that I will make a scribble on the paper, and that I will give it to him so that he can make something out of it. Then I say that he can also make a mark on another sheet of paper for me to use in making something. This process goes back and forth, as long as both the child and I wish to continue.
WINNICOTT’S THEORIES OF DEVELOPMENT AND PSYCHOTHERAPEUTIC CHANGE
From the beginning, Winnicott considers individual development to be part of a larger environmental context. He calls this context “the average expectable environment.” It includes as its most important element the concept of the “good enough” mother. Winnicott conceptualizes this environment to be a “continuously helping, fostering, nursing environment, accepting the infant’s immature dependence while supporting his tentative adventures into independence, individuality, and find a life of his own in and through personal relationships” (Guntrip, 1973, p. 113).
Winnicott uses three broad categories to delineate this progress through the first three years of life. They are organized around the concept of dependence. First there is the stage of “absolute dependence,” then a period of “relative dependence,” and finally a stage called “towards independence” (Winnicott, 1965. p. 4. It is important to remember that these stages include both the infant and the mothering person.
Winnicott’s premise is that personality growth and change have their roots in the early matrix of the child and the maternal care. Therapy, for Winnicott, is a process that re-establishes the interactive process, begun in earliest infancy, at that point where it had become disrupted. Just as the self was formed as a result of interaction between the infant and the mother (who represents the environment), so the ongoing development of the self can be re-established as a result of interactions between the self and the therapist (who also represents the environment.) This is the crux of therapeutic change. The squiggle game, with its interactional structure, its physical “holding” environment, and its offering of a useable object for use in communication, becomes a graphic illustration of Winnicott’s therapeutic model.
GENDLIN’S THEORIES OF PERSONALITY CHANGE AS A FRAMEWORK FOR THE SQUIGGLE GAME
The actual process of the squiggle game remains implicit within Winnicott’s writings, and as Clegg has noted may have remained implicit within Winnicott as well.
The inability of Winnicott to adequately describe the process of squiggles in words seriously limits their usefulness to anyone other than their inventor. Reliance upon clinical presentation alone requires a natural affinity for Winnicott’s style. Since much is left unsaid in his clinical descriptions, the therapist must fill in the gaps. The lack of specific words to describe a specific process causes uncertainty as the game is learned and limits its ongoing growth and expansion.
Without a framework, the drawings within the game can lack inner coherence. The important interactions can appear to the therapist as if they “popped up” out of nowhere. The therapist is left with the knowledge that something important has been going on, but lacking any clear context for its understanding.
The purpose of this section is to deal with that limitation. I am going to use Gendlin’s theories of personality change to provide a process framework for the squiggle game. In doing so I propose to place a firmer theoretical ground under the squiggle game process, thereby significantly increasing the usefulness of this potentially rich and powerful mode of therapeutic communication.
Gendlin describes focusing as a concrete description of a “mode of experiencing”. It is a process that involves the use of what he calls a “direct referent” to a “felt datum,” that which he described earlier as an inner “felt sense.” The ability to refer to the “felt sense” establishes a mode of experiencing that is the process of change.
Winnicott also describes the squiggle game as a concrete illustration of the “playing process.” It requires a connection to the inner spot of “potential meaning” where “play” can begin. “Play” then becomes the process of emotional change.
I will now go on to describe the process of the focusing experience. It is important to -remember that the phases of focusing are only the verbal artifacts of an actual dynamic process. They draw a map of the territory of change, but they are not the change process itself.
Focusing is broken down into four phases. These phases are (a) the initial sense of the direct referent, (b) unfolding, (c) a global application of the unfolding process, and (d) the referent movement (Gendlin, 1964,
p. 115-120). I will now describe the phases of focusing and connect them to the process of Winnicott’s squiggle game as he described it.
The initial sense of the direct referent. This is the beginning process of focusing in which a “definitely felt, but conceptually vague referent is directly referred to by the individual” (Gendlin, 1964, p. 115). In this phase, the person attends inwardly to his “vaguely felt inner sense”, his “felt meaning.” Gendlin states that it is not always easy to refer to that “inner sense.” Other modes of functioning, such as intellectual thought and emotional discharge, may interfere with and prevent the “mode of experience.”
He therefore provides specific focusing instructions to help in connecting to that inner felt sense. They include asking an individual to “stack up” the present difficulties in front of you and to step back and survey them “from a distance.” This distance can then allow a person to “touch” the “felt sense” of these difficulties without getting lost in them (Gendlin, 1970, p. 23, 52).
Winnicott, in his squiggle game, is following some of the same focusing instructions. He states that the squiggle game is a way of “putting down” on paper “the current problem or the emotional conflict or the pattern of strain which obtains at this moment of the client’s life” (Winnicott, 1971b, p. 7).
Others have also pointed out that the putting down on paper of one’s troubles can create an optimal sense of distance from the disturbing problems. (Claman, 1980, Gardner, 1980, Milner, 1957, Ziegler, 1975). Therefore, while the squiggle game was not conceived as a focusing instruction, its very form provides one of the conditions necessary for that process.
Unfolding. The “unfolding” or opening up of the “direct referent” refers to the moment when, after “touching” the “vaguely felt sense” the person suddenly “knows what it is” (Gendlin, 1964, p. 119-120).
It may not yet be possible to place this knowing into words or images, but there is a sense that words and concepts will follow. If that moment is allowed to expand, new words and images will be created as the person moves into a new experience of the difficulty.
Gendlin states that this new experience is the process of change. It “provides an emotional recognition of the good sense of our own (previously so seemingly irksome) feelings .... because what was previously felt now actually makes sense.” This unfolding of a felt referent does not just inform one about what was involved, but rather, it changes the whole manner in which one experiences. (Gendlin, 1964, p. 119-120).
I would now like to refer to Winnicott’s case of Ruth, because it contains a description of a process that is very closely connected to Gendlin’s concept of unfolding. While I will present just part of Winnicott’s interaction here, I will draw out the sequences more fully later, using my own case material.
In Winnicott’s case of Ruth, there is a moment when she begins to draw a dream. It is a hopeful dream, which ends well, but it is filled with vague anxiety in the middle. This vague anxiety may be similar to what Gendlin called “vague, felt sense.” Winnicott hears the vague sense of anxiety, or as he labels it, “the pessimistic version of the dream.” He invites Ruth to “draw the worst of it.”
His words to her are actually common focusing instructions in Gendlin’s focusing process. She then begins again to draw and, with surprise, exclaims, “O look, I’m further and further away from my mother” (Winnicott, 1971b, p. 326-327). This is a clear illustration of a felt sense suddenly unfolding into a specific image of a little girl getting farther and farther away from her mother. It was the crux of Ruth’s sense of deprivation. The worst of it had “unfolded.” Winnicott’s case description of Ruth’s squiggle can now be seen as an illustration of Gendlin’s focusing process.
Ruth’s experience also introduces the element of surprise. It is close to what Gendlin calls the “great physical relief and sudden dawning ... when a person suddenly ‘knows’ the felt sense of it all ... when feelings open up into something which sounds worse and more hopeless than one had expected,” but which is also accompanied by a sense of “relief and inner discovery” (Gendlin, 1964, p. 119).
Gendlin states that the unfolding of a direct referent always involves a “surprising and deeply felt recognition of the good sense of our own feelings This surprise occurs because the unfolding does more than inform; the creation
of new explicit meaning changes the whole manner of experiencing” (Gendlin, 1964, p. 119-120).
Winnicott also includes the element of surprise as part of the overall creative process. Ruth reacted with surprise as she moved into the symbolic depiction of deprivation. Winnicott describes this movement as “the significant moment ... (when) the child surprises himself or herself” with spontaneous, rather than compliant or acquiescent play (Winnicott, 1971a, p. 5l).
For both Gendlin and Winnicott, surprise accompanies the creative process. Surprise is felt as explicit meaning is created, and as the moment of play unfolds.
There is one more connection to be made here. For Gendlin, this unfolding process is more than insight and understanding, it is actual change. Winnicott also emphasizes that Ruth changed after her “experience” of becoming deprived. He also views the squiggle process as more than an inner discovery, it is also the therapeutic process itself.
A global application of the unfolding process. This phase continues the unfolding and the explication of the implicit felt sense. It allows the many other implicit meanings that share in the same “vague sense” to become explicated within this new context of knowing. Gendlin describes this process as the time when the “person is flooded by many different associations, memories, situations, and circumstances, all in relation to the direct referent” (Gendlin, 1964, p. 120). The person continues the process of inner change. He or she does not “think about the differences which the unfolding has made”(Gendlin, 1964, p.120), he experiences these differences within the process itself.
Winnicott describes a similar process occurring in the case of Ruth. As she continued to talk about her drawing, she spoke with earnestness about how she had to “eat hard” after her sister was born to counteract the “poison” that was “shrinking” everyone. She also spoke of stealing baby food at the time of “shrinking.”
Winnicott emphasized that it was “important to get this from Ruth herself” (Winnicott, 1971b, p.328). This description of Ruth talking within the new context of becoming deprived connects very closely to Gendlin’s conception of experiencing the unfolding process.
The referent movement. After there has been a direct reference, which has unfolded and expanded within its global applications, the person “finds that he refers to a direct referent that feels different. The implicit meanings which he can symbolize from this direct reference are now quite different ones. It is a new direct reference and so the four-phase process begins again” (Gendlin, 1964, p. 121).
It is important to note that this change is a change in an inner referent, not a change in “sheer emotion.” For Gendlin, emotions can block or defend against the realization of the direct referent. “They skip the point at which we might complete, symbolize, respond, or attend to that which centrally we feel” (Gendlin, 1964, p. 121). They prevent the completion of a process.
When we turn again to Winnicott’s case of Ruth, we find drawings that indicate just such a completion of a process. Winnicott offered Ruth a possible completion of the hunger process in his last drawing. He “put it (her squiggle) on a plate and it was a dish of food with bread, etc,” for them to eat. Following his exchange Winnicott reports that Ruth lost the compulsion to steal .... There were favorable changes in her total personality, and the school quickly forgot that they had bothered about her in the first place (Winnicott, 1971b, p. 330).
This vignette illustrates a felt sense, that of deprivation, as it was carried all the way through to one of its possible completions, leaving Ruth free to grow again.
The actual inner process of focusing has now been partially illustrated with Winnicott’s squiggles in a spot-by-spot sort of way. Some of the drawings indicate that a process similar to what Gendlin would call “focusing” can be inferred. Later, I will follow the squiggle process from beginning to end within a case study, utilizing Gendlin’s concepts of focusing as a taking-off point to a fuller explication of the squiggle process.
A MODEL FOR THE EXPERIENCING PROCESS OF PLAY
AS EXPRESSED WITHIN THE DRAWINGS OF WINNICOTT’S SQUIGGLE GAME.
The First squiggle exchange. This squiggle, offered to the child by the therapist, begins the first step in the experience of play. This unformed, yet potentially meaningful line can be seen as both a “psychological event,” and as a “transitional object.” In either case, it is also an invitation to “play.”
In order for the child to respond to the invitation, to turn the squiggle “into something”, it must be received inside the child. He must be able to say to himself; what does this squiggle look like to me. If a spot of meaning can be found inside the child, if the squiggle can begin to look like something, the child can then take the squiggle and, by interacting with it, using his own sense of inner meaning, “turn it into something.” This first drawing then becomes a newly drawn explication of some inner sense of implicit meaning.
If this interaction is not yet possible for the child, if he is not yet able to receive something from another person, the process may end here. The squiggle might be refused or ignored in some way. The therapist may then need to find some other way to begin a therapeutic connection with that particular child until he becomes able to “play.” If the squiggle is accepted, then the therapist and the child have together created a re-connective object of meaning, made by them alone, (the first squiggle drawing) within (literally) the playing space between them.
The second squiggle exchange. After the child has used the first squiggle in a drawing, he is invited to return a squiggle of his own to the therapist. Here the therapist has a choice. If this were not a therapy situation, he could use the squiggle just as the child had done, as a way of reaching his own inner process.
However, in therapy, the responses are made within the context of encouraging the experiencing process of the child, not of the therapist. Therefore, the therapist receives the child’s squiggle as an explication of some vaguely felt inner sense of the child. He includes the already explicated meaning of the child’s first drawing as he allows the child’s line to resonate within him. As he thinks about what that line might “look like”, he allows the empathic image of the child’s first drawing to be included in his own sense, of what the child’s squiggle line might “look like.” The resulting drawing can be seen as a form of non-verbal empathic communication.
Winnicott stresses that in order to do this process, one must “evidence a capacity to identify with the patient .... There must be a capacity in the therapist to contain the conflicts of the patient, that is to say, to contain them and to wait for their resolution within the patient. There must be an absence of the tendency to retaliate, and any system of thoughts which provides an easy solution” can tend to close of f the process (Winnicott, 1971b, p.2). It is important for the therapist to have confidence in his own empathic ability to contain the difficulties of the child, because those difficulties must be contained if the therapist is to feel comfortable about the images that form inside himself in response to the child.
The first completed drawing by the therapist can therefore be considered an empathic containing of the child’s first expression of the self. In this way the child can feel that his first attempt to use the therapist’s squiggle was both valued and understood.
The two completed squiggles of this sequence can be considered to form a mutual introduction of the child and the therapist. They can be compared to the “sign-on” formulation used in the sequential analysis of projective tests such as the TAT or the Rorschach (Rupar, 1985). This sequence also can be viewed as the beginning of the therapeutic contract.
The transitional squiggle exchange. This group of drawings must be looked at as a unit, since there is no set number of drawings required for the next step of the squiggle process. They continue the introductory phase begun in the first exchange of drawings. They also can begin to set the stage for the next step in the squiggle process. In these drawings, the child is “unconsciously weighing up the reliability of the professional relationship and taking a little time to decide whether to accept the risks that belong to deeper involvement” (Winnicott, 1971b, p. 202).
If the child decides to take that risk, the squiggle game will change as it reaches toward what Winnicott and Khan called the “sacred moment of self-discovery,” a time when the felt sense of the child’s inner difficulties can be experienced and explicated within the next series of drawings.
The empathic point of contact. These drawings begin to express some form of new experience, a creative explication of the implicitly felt difficulties of the child. It is at this point that a decision to “play” is reached, and both the child and the therapist decide to accept the risks of further discovery.
The drawings that appear- in this stage are experienced as new and different. They can be drawn in the usual back and forth squiggle style, or they may be drawn by both the child and the therapist, as they help each other begin to express the inner difficulties of the child. This point of contact between the implicit felt sense of the child and the empathic understanding of the therapist can provide an opportunity for the child to wove into the experience of his difficulties within the new context of a therapeutic holding environment.
Winnicott and Khan call this point the moment of creative play. They consider it to be at the center of all therapeutic change. Gendlin calls it the moment of a new experience of the self, and also states that it is at the core of the change process.. Michael Tansey and Walter Burke describe this moment as the achievement of “an empathic outcome” (Tansey & Burke, l985, p. 1).
This moment can occur in many different ways within the drawings. In Winnicott’s example of Ruth, it was as she drew herself so small and so far away from her mother that the full realization of her abandonment became clear to her. She was then able to experience her stealing and her worries about being poisoned. Finally, she was able to “leave” the completed experience and move on to health once again.
The next step in the exchange. Usually, at this point the squiggle game begins to bring itself to an end. Often there will be an explication of the next step in the experiencing process before the game is finished. A drawing or a series of drawings may appear that say something new about the difficulties of the child. This becomes a statement about the next step within the forthcoming therapeutic relationship.
The end of the drawings. The ending is difficult to describe, since it can take many forms. Sometimes there is a drawing that seems to “sum up” the play. Sometimes the child or the therapist draws something that they can label as their last drawing. Sometimes, due to the approaching end of the session, the therapist will need to state that the next set of squiggles will be the last for that day, and the next drawing will have to be designated the last. In any case, the last drawing closes the sequence and brings the squiggle game to an end.
Often it becomes a statement of the new experience of the self, summing up the process of the game.. Sometimes the last drawing will carry some sense of the next step, sometimes it just becomes the last picture, with no immediately discernable meaning.
It is important to note that these stages are not specifically delineated within the game itself, and also to realize that the entire sequence may not be completed. Often it is difficult to recognize, while drawing, the exact unfolding of these sequences. It is important, therefore to become familiar with the squiggling experience of play, so that the therapist can begin to gain a sense of trust in the squiggle process and a sense that the game will provide whatever might be needed for that child at that time.
I also wish to emphasize that the game of squiggles was not felt by Winnicott to be a useful mode of on-going therapeutic treatment. It seemed to him to belong specifically to those first few hours of treatment, when the child and the therapist are both intermixed in each other’s minds. I have found that the game can be useful within the course of treatment, not as a mode of on-going play therapy, but at certain moments when turning points in treatment have been reached. I have also found it useful during the termination process of treatment.
These issues are not within the scope of the current discussion, but belong to further exploration of the therapeutic usefulness of the squiggle game.
THE SQUIGGLE GAME WITHIN THE CONTEXT OF A CASE STUDY
Now that I have provided a verbal framework for the presentation of ‘the squiggle game, I would like to turn to ‘the game itself. In this section I will present a complete set of squiggle drawings within the context of my therapeutic work with a child. I will provide some idea of how the game is actually played; I will offer a discussion of the experiential process of play, as it unfolds within the set of drawings; and I will highlight the specific themes and images as they appear.
A description of the client. These squiggles were drawn in an initial interview with “Heidi” when she was 11 years old. Heidi is Korean by birth. She was found, around the age of two, near a police station that was known to help needy children reach adoptive homes in the United States. She was small for her age, undernourished, but well and warmly dressed against the winter weather The workers at the orphanage where she was sent, concluded that she had been lovingly care for, apparently by a family that found itself without sufficient resources for her care. During her stay at the orphanage, due to a shortage of caretakers, she was confined to a bed and bottle fed.
Heidi was adopted before the age of three by an American couple as their first child. They described her as initially very scared, quiet and in need of almost constant comfort and soothing. She was unable to stop eating while food remained within her reach. These difficulties gradually improved, following great soothing efforts by both parents.
A year later she had more than tripled her weight, had grown several inches and her first Christmas pictures portray a laughing, robust and healthy child. She continued to demand and enjoy cuddling and soothing, more often from her father than from her mother. Her parents reported that her father had more patience with her demanding behavior.
When Heidi was five, her parents adopted a brother, also Korean, who was a year younger than Heidi. The brother is described as a more outgoing and friendly child. Heidi soon became preoccupied with feelings of envy and resentment towards her brother. She found it hard to tolerate any attention given to her brother. She also became very possessive of her father, getting angry when he spent time with the rest of the family.
These feelings continued throughout her childhood and often culminated in bitter battles with her mother and her brother. Her mother became frustrated as her attempts to soothe Heidi often ended in failure. At the age of 11, Heidi’s unhappiness intensified at home and was compounded by increasing problems at school. She reported that teachers did not like her and that children called her names such as “chink” and “gook.” She became very angry at any mention of her Korean looks, and stated to her parents that she wanted to be an American girl Her parents could no longer soothe tier. They felt that she was deeply unhappy, perhaps irrevocably so.
On the day of our first interview, Heidi came quickly and easily into the room. She was casually dressed in a “preppy” style and had a neat and pulled together appearance. She responded politely, but warily, to my introductory remarks. She said that she was unhappy, but that she didn’t want to talk about it. She did mention that she had become homesick during summer camp after some girls had called her “chink” names. She stated that it no longer bothered tier. When I suggested the squiggle game as a way that she and I could get to know each other, she readily agreed, stating that she loved to draw, and that she often drew pictures at home and at school.
Heidi’s set of squiggles. I will begin this section by presenting Heidi’s first drawing, a picture of Dorothy from The Wizard of Oz (Figure 1), and following the process that finally led to her last drawing of that session, an image of Nadia Comaneci, the Rumanian gymnast who had recently starred in the Olympic Games (Figure 2).
I will, through the drawings, trace the evolution of Heidi from the blonde, stiff and lifeless image of Dorothy to the dark-haired, graceful and enthusiastic image of Nadia.
The first squiggle exchange. In this sequence I offered Heidi a simple circular type of squiggle. She took it and immediately made it into a face (Figure 1), and then carefully colored the whole drawing. She said that it was a drawing of Dorothy, the girl from Oz.
This “sign-on” drawing introduces Heidi as a neat, stiff and proper girl, one who does not show much outward feeling. The blonde hair in the drawing carries Heidi’s fervent wish to be an American girl. The image of Dorothy also brings up the issue of adoption, and of the loss of her homeland. Dorothy was not only an adopted girl, living in Kansas with her Aunt Em, hut she was also blown away from Kansas as well. She landed in the land of Oz, filled with strange people, sights and sounds. Heidi too first lost her family and then was “blown away” in an airplane to the United States.
At the time of the squiggles, I only remembered Dorothy’s scary journey into Oz. I mentioned to Heidi that Dorothy’s journey may have been very similar to her own. She did not respond. It seemed to me that even a mention of Korea was troublesome to this girl who had drawn herself as a blonde Dorothy.
An interaction had begun in this first sequence. Heidi, by turning my squiggle into Dorothy, had accepted my initial invitation to play. She was able to take my squiggle and use it to create an explicit sense of herself at that moment. She was also willing to provide a squiggle for me. We had begun the experiencing process of play.
Developmentally, this sequence has diagnostic significance as well. It establishes Heidi’s ability to take something from the outside (my squiggle) and to use it for herself. She also was willing to provide a squiggle for me, therefore expressing some trust that her first self-expression would be met with a response. It can be assumed, therefore, that Heidi had developed some sense of basic trust, and an autonomous self that is able to accept some help from others to use in an expression of the self.
The second squiggle exchange. Heidi offered me a figure-eight-type squiggle. Aware that I was drawing somewhat loosely in some reaction to her stiffness, I made it into a cat (Figure 3). 1 remember feeling rather like a kitten or a puppy who bounces up to someone, wanting to play. This squiggle was, in some way, an exaggerated and gay response to her exaggerated stiffness. It contains an empathic reflection of that exaggerated quality, with the addition of the possibility for lively play. I remember feeling that she needed this invitation from me, and that any initial sense of exuberance would have to come from me.
The transitional exchanges. Heidi’s response to my invitation of further communication and my attempt to provide something for her represented a temporary withdrawal from the interaction. She stopped the game, perhaps feeling that my response was somewhat too enthusiastic and that I had not yet provided what she herself needed.
Heidi then asked if she could draw a picture. She also asked me to draw a picture separately, and so we began a form of parallel play. Her drawing (Figure 4) was a very stylized drawing of a banana split. It looked inviting, but not really edible. It also looked cold, and it reminded me of her first stiff drawing.
At the same time, I was busy drawing a clown (figure 5), still reflecting on my invitation to a playful experience, but in a more subdued and controlled manner. I also felt that clowns could be sad, and mentioned that to Heidi.
In this sequence, my invitation to play had not yet been offered in a useable way. Heidi responded to my stated wish to help her by withdrawal and by continuing to explicate her initial image. The banana split contained the elements of hunger, of cold and of inedible food. It may also have contained the sense that my invitation was too rushed, too overstated ad not yet digestible.
The next two drawings illustrate the continuing evaluation of the process, made by Heidi, of my attempts to establish a useable holding environment for her. She looked at my clown and then asked me to draw another picture, but this time did not draw one herself. She continued to want something more from me, something that I had not as yet given her. She watched as I drew a tree, lowing in the wind, with a swing suspended from a low branch (Figure 6). I told her that I use to play on a swing that hung in that kind of a tree. Again, I was continuing my invitation to play, a little more restrained now, and including an actual image of “holding,” the image of the tree holding the swing. The swing is empty. It represents a “potential” play space, available to Heidi, if she cares to use it.
Heidi then drew another drawing by herself, as I looked on. This drawing is of a kitten running up into a tree (Figure 7). In this drawing Heidi dynamically “incorporated” both of my images, the cat and the tree, and combined them to make a new picture. Tue cat had become a kitten (Heidi) wishing to use the tree (the therapist) for climbing and perhaps wishing to hide in its leaves, as trees are also places of safety for kittens.
Her drawing also included the image of a scared kitten, clinging to the tree with her claws. Her “frozen” self-representations had begun to open up into an image of a scared kitten, hoping for shelter and hanging on for dear life. She had explicated a new possibility, and had begun a creative interaction with the therapist. This drawing picked up the empathic connection that had begun in the first sequence of squiggles. Heidi had used my symbolic forms to experience another sense of herself, in her image of a kitten, she had also been able to reconnect with earlier feelings of being alive, of being supported and sheltered, as well as the feelings of fear and panic that she felt when the early support of her family was lost to her forever.
As Heidi drew, I began to think of the song, “playmate, come out and play with me, climb up my apple tree ....“
I asked if she knew the song, and we sang a little of it. She then asked to resume the squiggle game.
Heidi next drew a wavey squiggle for me and I turned it into a swan, thinking of the “ugly duckling,” and wanting to say something about turning into a “swan” (Figure 8). I remember thinking that the swan image might have something to do with the “ugly duckling” feelings of being Korean and that I might be able to express some hope of beauty coming from those feelings. I gave a wavey squiggle back to her, and she turned it into a bird. It was not a graceful swan, but a fierce-looking creature that she called a “Broppler Bird” (Figure 9). Her response contained the beginnings of fierce emotion. The Broppler Bird was a different representation than the peaceful swan. The flashing eyes and the fierce look of the bird, however, were still contained within a cartoon-like image and a silly name.
She then provided me with a straight line. I had no idea what that line looked like. I made it into a stage, holding curtains, and with happy and sad theater masks, connecting somehow back to my earlier clown image (Figure 10). I seemed unable to provide any other response to her Broppler Bird.
Later I realized that the drawing of the happy and sad theater masks could be seen as a re-statement of the previous interaction where the pretty swan is followed by the fierce Broppler Bird. It was my attempt to contain both of these images within one drawing.
The image of the theater itself also can be seen as another offer of a potential place for play. As with the swing in the tree, the stage was provided but there are as yet no actors on the stage and the curtains had not yet been opened.
Heidi then gave me another line, all curly and twisted, and I turned it into a telephone (Figure 11), taking quite a long time in doing this. Winnicott states that telephones can express something about connections to another person (Winnicott, 1960). In this drawing I was using the line as another wish for a useable connection and the care that I took represented the value that I placed upon this connection. This image also contained the sense of a readiness to receive Heidi’s communication. I was now “on the line.”
Heidi then resumed the game but asked me to give her a spirally line like the one that she had given me. In this way, she may have been stating that her wish for communication, represented somehow by the lines, could now be realized in some interactive way. She turned her line into a picture of “Frizzy Fran” (Figure 12). This is another cartoon figure, very similar to the Broppler Bird, with the alliterative name, but less fierce and flashing and less cartoon-like in style. The picture represents some combination of the fierce Broppler Bird along with her previous self-representations, with the result being the new image of a “Frizzy Fran.”
I looked at the cowboy boots and said that I thought that “Frizzy Fran” looked like a “western cowgirl.” I also noted the proper hair bow on the top of the far less proper girl. This bow linked her drawing back to the original image of Dorothy.
At the time of this drawing, I was quite taken up by my image of Heidi’s drawing as a western cowgirl. I realized later that a “western” girl is the opposite of an “eastern” girl. Frizzy Fran could have been another expression of her wish to be a western girl; this time, being western also is connected in some way to communication, through the requested wavey line. It may express some felt sense of a need to be western in order to communicate with me and to be understood by me, a western woman.
The empathic point of contact. Heidi’s next squiggle represents the empathic point of contact in this set of squiggles. It contains my explication of some sense of sadness in a way that she was able to use and to amplify. It is a drawing that we did together.
Heidi began with a yellow squiggle. It is significant that she has changed colors and given me a yellow squiggle instead of her usual darker line. I looked at the line and saw within it the image of a China doll that had been given to me as a child by a much-loved aunt. This doll was different than any other, with yellow skin and Chinese dress.
I began to draw this doll, and instead, a figure of a sad, Chinese child appeared in front of me (Figure 13). We both looked at this drawing with surprise. Heidi took a marker and silently added the tears, the words “boo, hoo” and the words “China man.” I then told her that the squiggle had reminded me of the doll that I had known as a child. I wondered out loud if the tears might have begun for Heidi when she had lost her family and her homeland. Heidi responded by telling me about the little yellow Korean dress that she had worn on her journey to the United States. It was in a trunk and she would sometimes take it out and look at it. The yellow of Dorothy’s hair, her wish to be an American, now included the yellow of her eastern dress. The dress is a transitional object, reading back to her early eastern self.
This sequence illustrates the point of therapeutic change described by Gendlin as the unfolding and explication of the implicit felt sense, and by Winnicott as the point of self-discovery. My drawing was able to express some of Heidi’s implicit, unfelt sense of sadness that had not been explicated in her images. It was locked up somewhere within the cartoon-like drawings. Her drawing of tears and her mention of her yellow dress from Korea confirmed the accuracy of my response and allowed her to put into words what had been previously unreachable and unexpressible. Together we had created a crying Chinese child.
Winnicott would say that a re-connection to the time of lost meaning, so early in her life, had been reached within a useable holding environment and in an interaction with the therapist’s images, and that this re-connection allowed a part of the “knot” in development to become loosened into tears.
This drawing and my explanation of the drawing using the models of both Winnicott and Gendlin illustrate my earlier proposal that the models create a more complete understanding of the process of change when they are combined. The experiential process combined with the metaphor of Winnicott’s interactional “play” allows for a fuller understanding of the therapeutic process. Together these models can gather up the earliest experiences of lost meanings and reconnect them, using present detail, to create a new expression of that self. The China doll was more than an artifact from my past experience. It appeared as a present image, capable of carrying Heidi’s feelings and their meanings.
The image of the China doll also illustrates Frieda Fromm-Reichman’s concept of therapy as a bridge to reality (Reichrnan, 1950). For Heidi, experience had previously entailed communicating to others as a “western girl” This was the main theme in her first self-representation. It wasn’t until the reality of herself as an “eastern girl” had emerged with the help of the drawing of my cherished China doll that she could feel understood and “cherished” as herself. The China doll became a bridge to the reality of her Korean self.
The next step in the process. I began the next sequence with a squiggle in an orange color. This squiggle can be seen as a new psychological event, a new context that can now interact with Heidi’s recovery of her lost felt sense as Korean, just explicated into the feelings of sadness and loss. She now can continue to explicate another, different felt sense, one that had been touched upon with her “Broppler Bird.” Heidi turned my squiggle into a “mad banana” (Figure 14). She added just a few lines to my squiggle and said, “This is the peel, and this part is the inside, the mad banana.” I remembered the stiff, cold banana split in her earlier drawing. In this drawing, the stiffness and coldness had “unfolded” into the image of a “mad banana.” It carried the explicated sense of being “mad” as well as an implicit suggestion of some vulnerability and exposure in the “unpeeling” of the banana.
These drawing illustrate the evolution of content and process from her first drawings, done as rigid cartoon figures, to these new and spontaneous images. The yellow hair of Dorothy has been combined with the yellow china doll and the yellow Korean dress. The yellow also formed the original banana split and then included the yellow of the “mad banana” There is an expanded range of explicit feeling that was only a frozen potential in the first sequences.
Heidi now asked me for another squiggle. She was unable to find a squiggle of her own to give to me. My squiggle was an angry jagged line. I was thinking of the mad banana, and searching for some way of re-expressing that anger for Heidi. She turned my jagged line into an ugly and toothy witch (Figure 15).
I asked her about witches, but she could say very little, except that the witch in the Wizard of Oz scared her. Heidi gave me an angry, jagged squiggle which I turned into the house that had killed the first witch in Oz (Figure 16).
We talked about the story, but it didn’t feel finished. I then drew her another jagged line, and she turned it into another witch (Figure 17). At the time I thought that she might have felt that it was too early yet to kill off witches, but I later realized that there was another witch left in Oz, to be faced by Dorothy later in her travels. Perhaps this witch belonged to that next step in our journey.
At this point I again became aware of a wish to help her, first expressed by killing the witch and now by some clearly felt inner wish to console her. I tried to draw her a teddy bear for comfort, but succeeded in drawing another angry image (Figure I8).
I cannot remember if she had provided a squiggle or if she had asked for another drawing by itself. I said that I couldn’t make it any nicer. Heidi offered to draw a better one, and indeed, drew a friendly, plump and agreeable bear (Figure 19). We agreed together that it was far more satisfactory.
The image of the bear reflected my sense that we had reached a spot where some comfort from a transitional object might have been found. However, as Winnicott has stated, transitional objects are “created” out of some “needed” object that is also “found.” Since I cannot remember if Heidi was able to give me a squiggle for a soothing use, she may have felt unable to find any sense of comfort by herself.
At any rate, I tried to provide it. She was able to take the image of my bear and re-form it into an acceptable image of comfort. In this context, the bear was not an object of meaning for her as the doll and the yellow dress had been earlier. Rather, it was an image that I had thrust upon her. This interaction is an example of a failed opportunity for continued self-expression. In a way, it mirrored my earlier cat drawing, where I had wanted to express an invitation to play in a somewhat overdone way. I felt the same sense of urgency in my teddy bear.
The End of the Drawings. The interaction had now almost come to a close. Heidi stated that she did not want any further squiggles. She asked if she could do one more drawing by herself. She was thinking of a drawing that she had tried to do at home but had never really drawn. This last drawing (Figure 20) was a return to an image that Heidi liked about herself, the image of herself as a gymnastic star. This time she was able to draw it to her satisfaction.
The image of Nadia was one of a black-haired, energetic, and graceful foreign girl. It carried Heidi’s realization of herself as black-haired and foreign, but also as successful and receiving applause. Her ability to draw the image at the end of our session may have been a response to my sense of valuing her and her communication, expressed in the earlier drawing of the telephone and in the image of the cherished China doll.
Nadia is exuberant in Heidi’s drawing, and is happily acknowledging admiration from the crowd and perhaps from me. She is foreign but she is also successful on western television screens. Heidi may be expressing some internalized hope that she will be able to succeed as a “foreigner” in a “western game.” Nadia even had Heidi’s own black hair, flying in the wind.
The image of Nadia expresses a new sense of play, but within a clear context of control. A gymnast has stereotyped routines that must be performed. However, it should be remembered that it was in the less-structured floor exercises that Nadia had actually triumphed. This image therefore may express Heidi’s deeply held wish to be expressive and creative.
I will now take the images Heidi and I created within the drawings of the squiggle game, and follow those images as they re-appeared again in our treatment relationship. I propose that those first “meaningful symbols” of a “reconstituted interactive process” continued to carry meaning throughout our relationship. We used them to
reconnect to those first times where the implicit sense had begun to unfold and to become explicated. They became our own transitional images, images that held the original beginnings of our experiential play. Through them we could return to those beginnings and allow the sense of meaning, established during the squiggle game, to continue unfolding and completing itself during the course of therapy. It is this continuation of symbolic meaning that I now wish to discuss in the next section of this paper.
The Subsequent Therapeutic Re1ationship
The image of coldness, the coldness of that first banana split, was the main feature of the first six months of treatment. In play, my room became a cold castle that always felt drafty and bare. Within this castle we used yarn to finger knit an afghan to warm the babies inside the castle.
The yarn was also directly used as a symbol of communication (Winnicott, 1971a, p. 17). Heidi taught me to play cat’s cradle with it; that was the only game that we actually played within the castle. Cat’s cradle can be seen to have a similar form to the squiggle game. It is a back-and-forth game, but instead of original images, the players create a set pattern of designs. I found them very difficult to learn. Cat’s cradle also carried our image of a cat climbing a tree, and re-expresses a wish for communication, for shelter, i.e. the cradle, just as the squiggle game had done. The predictability of the game prevented any sense of premature disruption or loss of control. It provided a built-in sense of safety and a protection from the too-early emergence of painful thoughts and feelings.
Later we began to go outside to play. We took walks and explored around the creek and found a family of large furry groundhogs. They became the first things that Heidi wanted to see after returning from a vacation. She would also ask me to take care of them while she was gone. They became our own transitional object, reflecting the original teddy bear that Heidi had re-drawn into a comfortable image.
The actual image of a teddy bear also returned during treatment, but only from me. I gave her teddy bear stickers which were never very satisfactory. I think that I gave them to her at times of worry, times when I felt some urgent need that seemed too difficult to ignore, much as I had felt during the original squiggle game.
During a consultation, Heidi’s adoptive parents had brought the picture albums of her first years with them, so I could have some idea of those early times. I mentioned them to Heidi. She said that she also liked to look at the albums when she was feeling sad. It was soothing to her. She asked me if I had noticed the little yellow dress from Korea, the dress that she had mentioned during the squiggle game. This dress also seemed to carry the soothing sense of a transitional object.
Shortly after this session she told me about her doll collection. I mentioned my squiggle image of the crying China doll. The next week she brought her own doll collection, which included many Korean dolls. We talked about Korea and she told me her original Korean name. This was the first time that anything remotely Korean had ever been brought up between us since that first meeting.
She had used my squiggle image of the China doll to bring to me her Korean dolls and her Korean self.
Heidi’s life now began to change considerably. She began to get straight A’s in school. Her mother began to feel less discouraged, and both parents found themselves able to comfort her through several upsetting periods. However, the image of Dorothy as an orphaned girl returned and was dramatically acted out. Heidi ran away from home following a fight with her parents that had culminate in a spanking from her father. Her frightened parents “found” her just as she had been “found” in Korea. She returned home, and although she still fears that no one really loves her, she has not become “orphaned” again.
As Heidi became ready to terminate, the squiggle images of coldness, of the China doll, the playful cat, the banana split and a new form of Nadia came into play. She mentioned that the “coldness” in her bedroom had been cured by her new electric bed warmer. She mentioned an incident at a Korean restaurant where the owner had stopped their family to thank her parents for “taking care of our (Korean) children. Instead of being offended, Heidi expressed pleasure at being recognized as Korean.
At our next-to-last meeting Heidi drew a cat. This cat, unlike our squiggle cat, was not a frightened animal clinging to a tree. It was feisty, with lots of fun and it had just caught a mouse. It was clearly a cat that could take care of itself. She drew a banana split at our next meeting. This banana split (Figure 21) was no longer icy and inedible. It was more tentative, softened with pastels, and looked very appetizing. The outline of the drawing had begun to fill in, although there were still empty places, and it was hard to see the whipped cream on the top. (I have outlined it for this paper.) It looks like a restored symbol of nurturing within the hard, empty outline of the original banana split.
After this drawing, she asked if I would play cat’s cradle again with her. To my surprise, I could remember the patterns, and after a couple of tries, we were able for the first time to work our way through the entire sequence without spoiling the design. She then went through a series of designs by herself. Again, the play indicated that she could begin to take care of herself.
We visited the groundhogs, and Heidi told me about her horseback riding lessons. She rides English style, which reminded me, with its costumes and graceful control of a beautiful horse, of Heidi’s earlier image of Nadia, the controlled and graceful gymnast. In general, we both began to agree that it was time for Heidi to say good-by.
Summary of the Case
After reading this case, it should now be possible to have some feel for the squiggle game as it is actually played. There should also be some understanding of the game as an interactional, responsive, experience of therapeutic play, play that can result in the re-establishment of a sense of self. Gendlin states, and Winnicott implies in his case of Ruth, that it is this experience of the difficulty, and its explication into words or images or both, that is the process of change. It is also the squiggle game, with its exchange of “found,” and “needed” symbolic forms and psychological events that are then used and interacted with the inner felt sense of the person, that produces the potential for such experiencing. If the therapist, through the squiggle game, can offer something needed and used by the child, the potential of the squiggle game can be enacted.
As we saw in the case of Heidi, the drawings that the child and the therapist “create” together during that first interview can remain “meaningful symbols” between them. Because they are mutual creations, transitional objects within the potential space, they retain that re-connected quality when they are re-invoked within the therapeutic relationship that follows.
This retention of the drawings as meaningful symbols was especially clear in the case of Heidi. The squiggle images became the foretelling of what would later become an on-going therapeutic relationship. They became “meaningful symbols,” useable by us because they had been “created” by us. On another day, or with another person, different images would have been created to carry the same implicit felt sense.
During Heidi’s therapy these images expanded to become interactional images within the interactive process that developed between therapist and patient. The banana split carried the possibility of being eaten, Heidi’s cat had even been able to “interact” with a mouse, Heidi herself had begun a relationship with a horse, and I think that our final cat’s cradle game, played with all its designs intact, carried our last creation of mutual symbolic meaning. It held all of our meaningful symbols within its yarn loop, the loop that Heidi took with her as she said good-by.
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