Symbolization in Psychotherapy with Patients Who Are Disabled

Article excerpt

The symbols created during psychotherapy with the disabled are a particularly enriched form of communication. The multiple levels of experiential communication contained in the kernel of the symbol permit the symbol to be used at different points in time to reveal different aspects of the depth of experience of disability, as they emerge. The symbol can serve as a frozen moment of alluded-to experience of disability for a person who is still utilizing some form of defensive denial. The often powerfully rich imagery of the symbol facilitates its storage and eventual recall during psychotherapy when psychologically tolerable.

The word symbol is derived from the Greek root meaning to connect. Symbolization is an imaginative act wherein two different items of experience are linked in a way that one comes to represent the other; an item extant in reality becomes a symbol only when it is mentally cast to stand for something else which it is not.(1) A symbol's relation to its referent is not invariant, but rather determined by context. For example, a lily could symbolize purity, death, or the renewal of spring. The ability to create and manipulate symbols is believed to be a uniquely human capacity.(2) It is not present at birth, but evolves from the dynamic interchange between experience and brain development in which one shapes the form and function of the other and results in the requisite capacity to evoke a mental representation in the physical absence of the object.(3) Piaget(4) referred to this developmental achievement as the attainment of object permanence.

Current biological theory posits that one of the primary aspects of advancement along the phylogenetic scale is the development of brain functions that make symbolization possible. The world is an unlabelled place and, through genetic regulation and interaction with the world, the brain develops the capacity to categorize perceptual input and create symbols that allow us to share our unique experiences.(5) From a different perspective, psychoanalytic theory explicates the role of sublimation in symbol formation. As succinctly stated by Loewald,(1) "sublimation is passion transformed." In sublimation, instinctual energies, both libidinal and aggressive, are neither entirely blocked nor allowed direct discharge in action. Rather, in sublimation the ego forms "a channel and not a dam for the instinctual stream"(6) (pp. 470-471). Through sublimation and symbol formation, balance is thereby obtained between the stultifying state of being cut off from one's instinctual energies and the impulse-ridden state of lacking any intermediary between impulse and action.(7) It is the attainment of this balanced state that a focus on symbol formation can restore in the psychotherapeutic process with individuals having disabilities.

In the psychotherapy process, patients can generate symbolic linkages deliberately and largely consciously through the creation of metaphors, paintings, and poems. Or the symbols may be unconsciously created as is true of dream formation and slips of the tongue. In each instance, the symbol serves as a condensed image of, and window to, the patients' inner experience. The potential function of symbols in psychotherapy is manifold. They are external representations of private meaning and, when attended to, can shed light on a range of phenomena including transformations in self-concept and identity, experience of the therapist, and feelings about important transitions in daily life. Symbols transmute what is inchoate, preemptory, and private into something that is substantive, communicable, and consensually shared.(2) Symbols restore a sense of unity by integrating and connecting emotions, perceptions, and thoughts not previously brought into juxtaposition and, in so doing, create a complex subjective experience that is deeply moving and cathartic.(1,8)

In some forms of psychotherapeutic treatment, psychoanalysis and expressive art therapy most notably, the focus on symbolic linkages and the meanings contained therein is extensive, while in other forms of therapy attention to symbols is more episodic. …