Colin Alive

A Critical Case Study on the therapeutic value of Image Work - An example of Psychodynamic Surgery

Introduction

A principal purpose always guiding the production of a full length case study is the professional advancement of the author. The acknowledged purpose may be to prove a psychological theory or to advocate a psychotherapeutic method, at least to the extent that one case can do either, in the belief that the theory or method may be of benefit to others. Both theory and practice have, in the past, been formulated on the basis of work conducted on the only client whose process was fully available to the investigators, that is, themselves. So also in this case study the method of working with a client's imaginal world that I am advocating is founded on my own internal experience as a fragmented schizoid individual.

Until the age of forty I lived as the uncomprehending observer of many semi-autonomous internal fantasy worlds. When I entered the real world of psychotherapy training and became conscious that all the 'people' inside me were parts of myself, I was able to apply the theory I was learning to their dramas and understand the healing that I experienced as their many intractable conflicts were resolved. Training in psychosynthesis gave me a good grounding in using images in working with clients, my internal experience showed me the more effective way and the theory that best explained me to myself gave me the necessary understanding to interpret the images.

The Object Relations Theory of Guntrip (1968), expanding on the work of Fairbairn, postulates an original unitary ego in the infant at birth, which splits under adverse environmental conditions such as neglectful or smothering maternal behaviour. The internalised world of bad object relations which results is the cause of the external problems that schizoid clients bring to therapy. My own experience demonstrated to me that this pattern of splitting can repeat under childhood pressures so that there can be, repressed in the psyche, a number of part selves, complexes to use the Jungian term (Stevens, 1990), sub-personalities for Assagioli (1975), or ego-fragments which is the label I adopted for my inner people.

Not all clients have a facility for using images but to those who, in my training, were called mind-identified, the work comes naturally. These are the people who tend to intellectualise and to be out of touch with their emotions, that is they demonstrate to some extent the schizoid personality according to the original definition 'a divorce between the emotional and intellectual functions' (Ryecroft, 1972). It was not immediately obvious that Colin, a single man in his late twenties who is the subject of this study, fell into this category. However, his images proved more eloquent than his verbalisations. Colin came to me shortly after I qualified and while I was beginning to develop my own way of working with images. Fortunately the requirements of purpose number one above, that this should be a critical account, serve my purpose number two, since the mistakes that I made in working with Colin effectively demonstrate the trustworthiness of the psyche when communicating in its primary language of images. Jung's (1966) dictum that dreams do not seek to deceive but rather show the reality of the unconscious situation applies also to the more conscious products of the imaginal world. So too his finding that dream figures can be considered as personifications of complexes. Fairbairn and Guntrip (1968), in their turn, recognised in patients' dreams portrayals of libidinal, anti-libidinal and regressed egos engaged in symbolic enactments of their internal conflicts. The I adopt in working with consciously summoned imaginal figures is to resolve such inner conflicts by facilitating effective verbal communication within the imaginal world between the ego-fragments so represented.

Encouraged during my training to tape record sessions for supervision purposes I discovered the wealth of information to be found by a careful post session study of client's image work and have continued the practice, always with permission. Stoller (1974), in the introduction to his book-length case study consisting principally of tape transcripts, comments 'there is not a single psychoanalytic report in which the conclusions are preceded by the data that led to them' (p.xiii) and disputes the right of analysts to claim scientific status on that account. He acknowledges however the enormous difficulties of preserving and presenting such data. As I do wish to maintain my right to the identity of a scientist I have chosen a case that achieved resolution within twenty sessions. The submission of complete transcripts of image work, which is in any case relatively contained in duration within each session, though still bulking large, remains manageable.

The Client

Colin presented with the issue of depression. It was his brother who first made contact with me, feeling it necessary to explain Colin's condition and his difficulty in talking, so that I first received the impression that he had a speech impediment. However, at our first meeting, though very inarticulate, he was able to supply enough information about himself to make it clear that he fell within the range of what my tutors had called the healthy neurotic and that there were solid reasons to explain the depression that had taken hold some months before. My conclusion was that a holiday in the home of a married friend, an episode of relapse in the Multiple Sclerosis he had known he suffered from for some years and a fraught situation at work (he had a well paid job in information technology) had brought him up against the reality of his long term prospects for the first time.

The third of five siblings, Colin's parents, with each of whom he currently had a good relationship, had divorced when he was fifteen (or possibly thirteen). Although claiming his childhood was happy, he retained an aversion to raised voices and arguments stemming from the many parental quarrels he had witnessed. His father had been a heavy drinker and as soon as he left school at the age of seventeen he had followed this example, drinking and smoking to an excess that, he commented, would have killed him if he had not fundamentally altered his life-style following the diagnosis of MS. Colin did not make the connection, claiming that at the time he had thought it not serious, something that would go away. Bored by school work, his interests had up to that time been sporting and, though he could no longer participate, he had maintained the social connections, but had developed other interests and friendships. Relationships were an issue. None of his siblings had married and he felt that his parents failed marriage had left scars on all of them. He himself had had no relationship since the diagnosis and even before those he had were mostly of short duration, he seemed to lose interest. He had no close friends.

First Contract

The session following our initial meeting made it clear that the essential problem to be overcome, as his brother had indicated, was that of talking. There was no spontaneous flow of verbal material, Colin spoke only in answer to direct questions with factual and very brief replies. Significantly he had almost no memory of his week's activities, from which normally I would expect to find some episodes revealing the dynamics of a client's issues, to be used as a kernel from which the session's work can grow. Colin's lack of sleep was the only available starting point. A symptom of the depression, he woke hours too early even after late nights, yet still could not rise in time for work. He had no thoughts or feelings about the subject, but commented that he had put his feelings 'on the back burner' since the MS was diagnosed. Probing revealed that it had always been so and, focusing on the anger that could have been expected to surface at certain past events and also I felt in the present work situation, I was able to elicit the facts that Colin had once or twice witnessed parental violence as a child and feared causing permanent harm if he got angry. At that point I moved with relief to image work.

Asked to see his anger, Colin immediately reported a mass of black rocks with flames leaping fiercely from among them. In relation to this image Colin's fear became a present rather than a past or future affect and in the imaginal world his brevity of expression became an asset. It will be seen from the attached transcript (T.Co.1) that the redundant verbalising in this case came from the therapist. At this time I still thought that repetitive playback of the client's descriptions were advisable to deepen the experience of the image. Colin would not at first speak to the flames, not, it should be noted, because to do so would be meaningless, but because they would not listen. Desoille (1966) felt it necessary to remind patients that anything can happen in the imaginal world. I have never found this necessary. If people can see images they know it. Logic still works however, the mixture of directed and fantasy thinking as Jung would have it (Stevens, 1990) or of primary and secondary process thinking by Freud's (1916-17) definition. Once Colin had been persuaded to speak his fear, he was able to approach the tamed fire and experience warmth, contentment and comfort.

The overall impression left on me by this first piece of work, when I transcribed the tape, was of a child lying in the dark,  BOOKMARK  angry at parental inattention and needing comfort, but at the time I interpreted the work to Colin in a simple here and now fashion - when he came into relationship with his anger there was no cause for fear. He admitted to having had the notion that getting angry would exacerbate the MS. 'It's mine, it isn't really going to hurt me unless I let it.' He finished the session feeling relaxed and volunteering the comment that 'this back burner has quite a lot on it.'

The next meeting revealed Colin's panic at having to think about himself, and he became quite articulate on the subject of his flaws and failings. My notes on the session comment that 'he judges himself and cannot meet his needs', both factors confirming the underlying schizoid issue that Guntrip (1968) suggests exists in all. Since Colin had tried during the week, and failed, to visualise the fire of his anger, I followed that lead and encouraged him to try again and the result, transcript T.Co.2, demonstrates that the unconscious will maintain its truth regardless of the errors of the therapist. The difficulties in establishing a viable image led me to lose track of the fact that it was his own anger he was attempting to visualise and in assisting him to express anger to the 'flashes' he saw, I was colluding with his pattern of suppression and his belief that anger was harmful. Eventually, to break the impasse which naturally developed, and probably not as aware as I could have been of my own rising frustration and panic, I used the psychosynthesis dis-identification model (Assagioli, 1975) to alter the imaginal situation. Colin was left observing his twenty-year-old self surrounded by flames, in a state of natural agitation, and although he had no problem with expressing love to his younger self, I gave him a contradictory, even though properly assertive, message to speak which proved useless. This, as always, was demonstrated in the imaginal world by an absence of visual response. I compounded my errors by enabling Colin to express hatred and anger towards the image of his anger, the flames. I was actually encouraging him to identify with the anti-libidinal aspect of himself, his self-hatred (Guntrip, 1968). The result was that he saw his twenty-year-old self almost consumed by the fire. The image was an accurate picture of the self-harm he had been perpetrating by his alcohol abuse, etc. at that age, and of the current harm also with a recent binge and the turning of his anger against himself, denying himself sleep and relaxation. Colin's despair led me to push for what my own inner experience had shown me was effectively healing, the representation of physical contact in the imagery. The suggestion that Colin might help his other self by touching him led to the unambiguously positive communication that was needed, 'I love you. I don't want to hurt you.' The charred flesh became whole and the two part selves, central ego and libidinal ego-fragment, ended the work sitting together in peace and harmony but without having touched and in nondescript if flame free surroundings. In the brief space of session time remaining Colin was able to speak of the ending of a relationship when he was twenty and contact the hurt and anger he had not experienced at the time. He left feeling less tired than he had on arrival which demonstrated, as I emphasised, that it wastes energy to keep emotions on the back burner.

My client admitted the following week to having felt perturbed by the last session; he had never thought of loving himself like that (he was an active Christian!), it was unknown. His experience of his week had been different, at times tense but at others more relaxed, he had slept better but was tired right now. Again this seemed the only point of entry in his account and I went for it with a standard psychosynthesis sub-personality approach (Whitmore, 1991) evoking the two voices inside him, one wanting to give up and go to sleep, the other insisting that he keep at it. He opted to visualise the one craving sleep (T.Co.3). These days I would expect an image something like the grey old man with walking stick who came into view and mentally connect it to the client's probable infantile experiences of ineffective mothering which 'aged' his baby self, but at the time I was seeing Colin I had not worked with my own inner baby. Being still split from my most painful early experiences, I was, in effect, working blind in this and the following sessions, playing by the rules that I had so far understood and 'trusting the process' to quote my psychosynthesis guides. So I missed the hint at 'baby' given by the old man's cowled robe (T.Co.3, A).

I have referenced the key points in the session transcript A-U and will run through the interpretation as I now see it.

Condensed within this waking 'dreamwork' (Freud, 1916-17) I perceive many night time (G) experiences of a tired but wakeful baby (B) needing help. A positive verbalisation (C) from Colin's central ego got a minimal response. It should be noted that an incorrect intervention (D) by the therapist did not disrupt the process. The transfer of consciousness from central ego to ego-fragment (E) was accomplished readily and evoked no question. Once again this is a step I have never had to explain to clients; 'putting one's self in the other person's shoes' is an empathic gesture that most people at least pay lip service to.

As the old man Colin saw an indistinct figure in the dark who would not respond to a friendly overture (H), just as perhaps the parent looking in on baby sometimes would not. The baby was angry but had already partly learned to suppress his anger (I). At this point I facilitated the effective expression of the buried affect by the old man/baby and changed the course of the replayed experience to a new track. But Colin could not retain identification with the openly angry figure and became again himself. However, he did perceive the positive results (N) of even that minimal catharsis as symbolised by a healthier face (K), a white robe (L) and a stronger stance (M).

Colin's desire to walk up the hill as a response to this interaction can be seen in two ways. During my training it was a common psychosynthesis practice to take issues, such as a conflict between sub personalities, up a mountain in the imaginal world as a way of accessing the energies of the higher unconscious (Assagioli, 1975) from which a resolution could arise. This could be seen as a spontaneous move in that direction and that is how I understood it at the time. However, it is also the standard schizoid defence when faced with problematic emotions to go 'up' into the head, that is to seek refuge in the intellectual function and I have found this also symbolised by upward movement in image work.

As the two walked together up the grassy bank, Colin suddenly felt tired (P). Although clear that the old man was feeling good, Colin perceived him to be looking concerned (Q). I made the immediate assumption that the concern of the one was caused by the tiredness of the other and Colin's instantaneous recovery suggests that my interpretation was correct. I certainly did not understand this piece of work at the time. Now I catch a glimpse of another sample memory of times when mother did respond to her baby's 'ruthless' aggressive demand and pick him up, and the baby, once satisfied, experienced 'concern', Winnicott's very word, at the results of his behaviour (Greenberg and Mitchell, 1983). Colin's reference to wanting lunch (R) once they reached the top, again hints at a feed for baby. In disidentifying from the old man, Colin moved into a part-self identified with the exciting frustrating object, to use Fairbairn's term (Guntrip, 1961). With more experience I could have gained useful diagnostic indications from the dusty plain (S) below them where Colin was glad not to be (T). Those who have suffered more severe childhood deprivation see deserts, wastelands, or rubbish tips. My inability to understand most of what was happening did not prevent a positive result (U) from the work.

Colin arrived for our next meeting feeling better, sleeping better, with more energy, yet again my efforts to find an episode from his week to start our work failed. The one he tried to engage with was on the tip of his tongue, but he could not remember it. His frustration at this experience of repression in action led him to talk of the frustrations that resulted from his physical condition and I used this as a lead in to imaginal work with the part-self in conflict with the old man, the part of him that wanted to keep going.

Transcript T.Co.4 documents how, for the first time, Colin failed to obtain an image on request and how I used the technique of evoking the will (Assagioli, 1975) to initiate the process. The laborious series of verbal interactions by which the imaginal figure, first seen only as a hand (A), then an arm (C), followed by a head (D) and at last as a whole (H, I) was dragged from the obscurity of the unconscious, gives a vivid impression of the power of the repression operating here. The description of the man, which I have censored, showed that Colin was seeing himself, but why at age forty (F)? Only now, in revisiting this case have I recognised the answer which will be clarified by a later session. Now also I know that Colin's feeling of confusion (G) was a signal that an intrapsychic stalemate was beginning to give way.

Meanwhile, though Colin knew he wanted to talk to this person, he had the same problem as externally in sessions with finding something to say. On becoming the forty-year-old at my suggestion he named himself Clive.  BOOKMARK  Following this image work I wasted a considerable amount of session time trying to track down the source and meaning of this name in Colin's life. Later by applying Freud's (1914) work on slips of the tongue, etc. I was able to translate Clive as C.live - Colin alive, confirming that this figure was a libidinal ego-fragment in relation to Colin's tired depleted central ego.

'Clive's' wish for peace and for the indistinct figure that he saw to have peace (K) points to the witnessed parental quarrels and at the time I understood the figure's 'faceless face' (G) to signify the depth of the split these had induced in my client. The image work progressed readily enough however to the point when 'Clive' spontaneously hugged (M) this figure, who was now clearly shown by the description to be the Colin I could see in front of me, though 'Clive' did not recognise him. As himself again Colin returned 'Clive's' embrace, but his instruction to Clive to live in peace (K), which he gave without speaking aloud, produced puzzlement in Clive (N), tiredness in Colin (O) and separated the two of them. I had allowed Colin to fall back into peace by suppression.

It will be recollected that the conflict I originally set out to reconcile was between the sleep-craving part self and the active part represented by 'Clive'. I therefore intervened directively at this point to bring the robed old man back into the picture (P). As Colin perceived him (Q), it appeared he had lost some of the gains he made through the previous work. At first the complete imaginal situation (R) as Colin described it exactly demonstrated the central ego's position caught between two opposing needs, and the expression of love to the old man had no effect on this. When I probed at the feelings that this visually symbolised separation provoked (S) the suppressed affect began to surface and by again evoking will (T) I could supply Colin with an effective because truthful assertive phrase 'I'm a bit annoyed when you are separate. I'd like you to be together', with which he could close the gap between the two as well as going some way to restore the old man. The positive phrase, probably something like 'I feel better when I can see you both together' lost in the tape change, led to the two embracing (V) and when Colin expressed his desire for physical contact with the two part selves they moved towards him and helped him stand up (W). This showed visually the reality that integration of the parts with the whole strengthens the individual and the happy laughter (X) they shared illustrated the energy released. But this unity did not hold (Y). Colin had to leave the two and sit down again. Though Clive and the old man continued looking happy together Colin, it was clear, still had blocks to overcome. His comment on surfacing from the imaginal world, that he felt as though he had been on a long journey (Z) confirmed the depth of the work.

For the following session my notes tell me that Colin seemed more 'with it', more present, but was I seeing what I wished and expected? What is certain is that he had much more to say. He was able to unburden himself about his difficulties with the hidden conflict between his two managers who he could not trust and from whom he experienced no support. Unsurprisingly this led into memories of his earlier family situation and in particular to his anger at his father's prolonged absence after the divorce at the time Colin was struggling with 'O' levels and associated choices, and badly needed support and guidance. He was able to get in touch with his fear of his own power because of the responsibility that went with it and acknowledge his inability to forgive himself for wasting opportunities. Finally he volunteered that he knew himself to be suppressing a part of himself that wanted to live a different way because it was unknown, 'a gamble'. My request for an image, a gamble on my part with four minutes left, paid off with an undisguised baby, looking in trepidation at the curtain of hair covering his mother's face (T.Co.5). I knew this was a representation of the failure of maternal mirroring (Greenberg and Mitchell, 1983) but again my own unresolved issues led me to ignore the fear and focus on the love from Colin that allowed him to leave the session with the image of a smiling baby.

It is a feature of the psychosynthesis style I had learned to give client's 'homework' and as I was at that time convinced that for the reconciliation of ego-fragments to be effected it was advisable to maintain their images in consciousness between sessions, this had been my regular assignment for Colin. Checking at the start of session six Colin reported that he could see the baby easily at any time, had glimpsed the old man twice, still upright, could not see the twenty-year-old, and was confused about Clive. He was clear however about feeling better, seeing goals now at work, having more energy, and better concentration. Things had improved at home as he was talking more to his brother.

In spite of all this, he experienced a physical heaviness in his body and eventually I used that as the focus for the image work that I felt at the time to be pivotal. Looking back, I recognise that was as much because of all I learned from it as about Colin's process. He, afterwards, remembered none of it.

Representing his heaviness Colin saw a big, muscular, dark-skinned and masked man weighed down with chains (T.Co.6). My efforts to get a clear picture of what my client was seeing (A, B, C) demonstrate that leading questions have no influence. The image accurately portrayed Colin as the cause of his own repression, holding on to his burdensome chains. Later I linked the mask (D) to the mother's hair in the previous image (T.Co.5) and the loincloth the figure wore to the nappy that pointed to the baby ego-fragment here engaged. Because my own internal images had carried out their healing function before I had gained understanding through my training, I imagined that explanations would abort the process in clients and so gave no interpretations to Colin. Of course I was protecting my own unreadiness to face my baby issues. Yet again I ignored the fear (F) that touched on my own and suggested a fudged verbalisation to Colin. Now I tend to link intimidating laughter (H) with anti-libidinal or sadistic super-ego (Guntrip, 1968) influence. Parents can control children by laughing at them. The dark skin I could have linked, correctly, with Jung's idea of the shadow (Stevens, 1990) but I have found blackness in images the mark of the anti-libidinal, the life-preventing. The unconscious does not take on political correctness and for all peoples the absence of light is experienced as blackness, and inimical.

That the anti-libidinal in Colin existed was shown by his self-castigation (Guntrip, 1968) but that it was not strong was demonstrated by the ease with which his anger was accessed, expressed (J), and proved effective causing the figure to drop the chains in response. Quickly the two become friendly (K) and shook hands. My next standard move (L) to have Colin switch his consciousness into the dark man led to my great discovery, for which I can allow myself little credit since it was purely accidental, that my standard question to Colin-as-the-dark-man came out in open form 'What are you seeing' instead of the presumptive form used in T.Co.3, F and T.Co.4, J. Perceived by Colin as standing in close proximity, the dark figure experienced himself to be alone in darkness. Naming himself Rufus, he did not want his 'good' tiredness and contentment disrupted by irritating talk. The baby had learned it was better off blocking its need for the disturbing unsatisfying parental object.

It will be obvious to any reader of transcript T.Co.6 that from this point on I was floundering in an increasingly desperate attempt to engage my client's will to move towards a relational context. I was experiencing some anxiety also because Colin was falling ever deeper into a hypnotic sleep. By the end of the session he was half snoring, his head sunk low on his chest and his body slumping to one side so that I feared he would fall off his chair. I knew that Colin's issues with restless hands and legs and aching limbs, symptoms I had experienced for years, were all about the anger locked up in his body and my internal association to the name the dark man had chosen was William Rufus, the red-haired king supposedly murdered, if my schoolgirl history served me, in a hunting 'accident'. My image work experience had already shown me that red signalled anger and Colin's anger could be surmised to have been betrayed and 'murdered' by early experience. But I did not fully recognise Rufus' links to the regressed ego of Guntrip's (1968) theory. Nevertheless my questioning about the mask brought up the suggestion of a fancy dress party as a metaphor, I now think, for the life the regressed ego hopes to be reborn into. The expression of some anger by Rufus gave him access to the house and party and evoked, at last, a will-full statement (U,V), but this defiance of anti-libidinal pressure caused a disidentification from Rufus who was immediately perceived to have reverted to a solitary, regressed state, and the internal work ended in disarray.

When I next saw Colin, memories of this work had disappeared almost beyond recall, only the name Rufus, when I tried again for associations, produced a flash of 'a big coloured chap - unshaven' so I went with that image because it was present. Rufus was now clothed in red tee shirt, jeans, and white trainers. At the time all I noted was that the red of anger had become more  BOOKMARK  explicit. Now I make the link to the rebellious and distressed teenager inside Colin. I had not understood the clue given by the number sixteen (T.Co.6, T) which today would tell me that my client's sixteenth year needed exploring in depth. This piece of image work (T.Co.7a) contains a complicated series of switches requiring careful study and though I realised at the time that more than one ego fragment was involved, it is only now as I attempt to analyse it for this paper that I decipher the number and the culturally encoded colour clues that clarify the process.

Initially Colin had no problems relating to Rufus, who, now without his mask, appeared to be in his late thirties, though still with an indistinct face and within an indistinct setting. The first switch into becoming Rufus revealed his situation to be three feet away from a 'white guy' in a white shirt. This configuration I suggest shows the repeat splitting at around age three between Colin and his anger. White I now take to symbolise the infantile innocence that is the reward gained by such a split. The white-shirted part-self is not guilty of the angry hostility held behind the dark skin and red tee shirt. A direct question caused this figure to sit down on a bench and write on a piece of paper. This could not be a three year old so it seemed the question about identity pulled in a different example of the basic split. I then focused on what was being written, which was never elucidated because the information Colin's unconscious was attempting to convey was about writing itself as an issue. A switch of consciousness into the casually dressed white guy found him alone in a pleasant landscape, knowing his name, Colin, but not what he had written and the question again seemed threatening. The momentary sleep and need to sit down on the grass suggest another switch, a regression, or a powerful repression of something as yet unknown. When Rufus returned from behind a building he was seen at a precise distance, ten feet (my original expectations were for answers with feeling tones - close, quite distant, etc). The development of the environment associated with different part-selves, green grassy hills for the more regressed, and therefore closer to Winnicott's true self (Guntrip, 1968), ego fragment, urban pavement for what may have been the teenager, I find of particular interest because of my fantasy world experience. Casually dressed Colin and Rufus expressed real warmth towards each other in their physical interaction and a transfer into identification with Rufus brought the process full circle since the blue-suited thirty-year-old he saw was the Colin I could see. However, this Colin was precisely four feet away. The two were wanting, and able, to go for a drink together in a fully realised, old fashioned pub around the corner. The work ended on a companionable note but Colin came out of it still tired.

The normal psychosynthesis procedure after a piece of image work is to look at it with the client to let them find their own meaning in it and then suggest what the therapist has seen, but Colin had little memory of the process and my questioning and reminding stimulated physical reactions - his feet were jumpy, he yawned continuously, his eyes were heavy and jaw felt tight, he was clenching his teeth. I tried the ploy of exaggerating the physical and when he let his feet make running motions he saw an image of the girl at work he had mentioned in passing before to whom he felt attracted. Now he said he felt very frustrated because she was involved with someone else. A piece of work with this frustration, T.Co.7b, was ineffective except insofar as it allowed some expression of anger. I ended the session with another standard psychosynthesis exercise looking at why he chose to focus on girls who were not available, the advantages and disadvantages of entering a relationship.

When we met again, it was following a two week break caused by my absence and Colin had taken his sleep problems back to his doctor and been prescribed anti-depressants instead of the sleeping pills requested. An analytic supervisor would have pointed out that I had failed to pay attention to Colin's feelings around my holiday. My internal judge, or sadistic super-ego (Guntrip, 1961) still quite as much a problem for me as my client's was for him, blamed me for failing to cure this sleep problem. However a positive indication was the fact that Colin had had such a row with his brother as to cause his sibling to move out of the shared flat for a week. Also Colin had much clearer memories of his daily activities. He admitted to feeling apprehensive about the work related course he was due to attend, with fear and anger about having to write a report on it. My request for related memories led via exams, school subjects, his problems with authority and his parents' authoritarian behaviour enforcing household and gardening tasks, to the sudden statement that his handwriting was 'awful'. At age ten he had been made to attend special writing classes but 'they stopped - they gave up on me'.

It is embarrassing now to see how I missed the real significance of what I was hearing. My questions turned to the issues of initial learning. Colin had learnt to read easily but had no memory of first learning to write. I was allowing my own early difficulties, so important in my process, to influence my response. Work with previous clients had suggested to me that for those with schizoid tendencies learning to read and write could be split forming issues. It was around that time at age eight that Colin had first started to smoke, stealing cigarettes from his mother, who responded not by disciplining her son, but by ceasing to smoke herself. My client's reason for smoking, to become instantly adult and therefore free, could have given me an understanding as to why all his ego-fragments appeared in adult form. Perhaps if I had begun to use the child-centred explanatory language that is my normal mode these days, speaking in terms of the inner child or inner baby, it might have been different.

Colin brought the session back to the track of his unconscious was following by describing how he smoked and got drunk when age fourteen at his older brother's party, another time when his parents took no disciplinary action. While still asserting his claim to a happy childhood the other reality emerged of a distant idealised father, immersed in academic study or at times debilitated by ill-health, whose angry need for quiet imposed limits on a small boy's spontaneity and whose high achievements set a burdensome standard. Colin's adult self excused parental failings, understanding financial difficulties and the lack of time to devote to individuals in a large family, yet still for a moment tears showed as he acknowledged for the first time the sadness inside. 'Other kids were closer to their fathers.'

Again there came a gap in sessions, a long one, occasioned this time by Colin's holiday preceded by the training course on which he felt he acquitted himself well. The holiday had been a great success, made so especially by the companionship, with all his natural untrammelled exuberance, of his friends' little son. So once more Colin had no issue to engage with but tiredness and although he was clear that this was a different tiredness because he had chosen the activities that caused it, I tried for another image of the heaviness he experienced. I imagine I was hoping for Rufus again, what I succeeded in doing was getting Colin to disidentify from his persona. He did not recognise himself even when the figure, in response to a request to know his name, held up lights that spelled out 'Colin'. Switching position into this other Colin he saw a figure who when verbally engaged, moved into the light, revealing himself a 'mirror image' and who when questioned as to the cause of the tiredness that still exercised Colin, held up a sign reading 'lack of sleep'. I felt thoroughly embarrassed by this outcome but Colin did not. In the image work each alter-ego had experienced and expressed gratitude and love to the other and also the absence of judgement and blame. 'I can't see him clearly so I can't judge' and 'it's not his fault he looks like me.' It will be observed that I was still not getting the message about writing, because I went straight into a second piece of imagery, this time focussing on the energy visible in Colin's twitching legs. This gave my client the opportunity to express his fear of his energy and, coming into relationship with it, he experienced happiness in the recognition he was glad it was there. This piece of work, showing Colin how his pattern was to suppress his energy, led him to consider its true value and how he wasted what could enable him to do all the things he wanted, not just physical activities (the sports now denied him though he did not say this). The word waste led the discourse back to school days and at last Colin put the name to the resentment he felt towards teachers and parents for the lack of guidance he had experienced. No one had explained the purpose of the work he was forced to do. He had been told it was a waste of time trying to teach him, inducing guilt, and parents were always critical when he used his energy in ways that gave him satisfaction. At the end of this release of childhood feeling-toned memories Colin was interested to experience a sense of 'something being unravelled'.

The next session should have been our review. I worked then with ten session contracts followed by a review of the progress of the work and of outstanding issues, but Colin forgot to come. This was fortunate as it happened since  BOOKMARK  I was in hospital with a broken ankle and had been unable to make contact to cancel. When we did meet a week later I learned of dramatic developments. Colin was under disciplinary suspension from work, and had fallen 'head over heels' in love.

Refusing to let my client follow his old pattern of putting his feelings on the back burner, I insisted we spend some time on the work problem and facilitated a short piece of assertiveness (Dickson, 1982) in imagery with Colin expressing his anger towards his supervisor, and feeling better for it. Of course he would have preferred to spend the time with the happiness engendered by the mutual love-at-first-sight experience with Liza. However, we did review and Colin was quite clear about which sessions he felt he got most out of, the ones exploring memories. He did not voluntarily mention the images and I found that he could now only see the baby and the old man. (A quick take on the latter showed him wearing a brown speckled overcoat and ten feet away). This ought not to have come as a surprise. The 'mirror images' episode really indicated that the healing of Colin's splits was well advanced, but Colin said that he still had work to do, he felt fragmented and wanted to be whole. But he did have more of a sense of purpose and a desire to use his energy 'productively'.

Our second series of ten sessions I will cover in less detail. For the first, with love Colin's major preoccupation, all I could focus on was the stream of yawns that was engulfing my client. This proved unexpectedly illuminating. Colin recognised that he was hiding behind them from the sound of his own voice which, talking about himself, he found disturbing. Afraid of freedom, independence and choice, he had lived for years in a secure but lonely isolation, distrusting people and never risking self-revelation.

My standard appeal for relevant memories brought a reprise of generalities concerning parental non-availability for a communicative relationship and the great need Colin had felt as a child for explanations that were never forthcoming. All this brought him up against his 'frightening' dearth of specific recollections. So I asked directly for his earliest distinct anecdotal memories and after producing a couple of happy impressions he disclosed that, at age four, he had hit his grandmother with a racket hard enough to really hurt her and she had called him a wicked child. The guilt and regret he still felt about this episode was palpable. The next recollection was of being hurt in his turn, but aged eight, by a brother and, though comforted by his father, still crying alone 'feeling bad for showing weakness'. Another memory brought to light some resentment against his mother and led on to the recognition that he was afraid to speak about himself, because to do so was liking giving away a bit of himself and 'it might be taken away and never given back'. This can be related to the ideas of object relations theorists (Greenberg and Mitchell, 1983) on, for example, anal-retention. Although he feared exposing his weaknesses by this voicing of memories, Colin volunteered that he felt the better for it.

The flow of affect-laden and reality-based reminiscences was now well in train and the next session both amplified previously brief accounts, on parental rows for example, and brought up fresh material. Most important was Colin's expression of anger at his father for which there were many occasions. Also significant was his shame at his own behaviour, which he recognised was attention seeking. My notes comment that 'he hates the angry part of himself'.

For the first time Colin came to the following session with an issue from his week ready to hand, a quarrel with Liza. Investigation showed that this had been provoked by my client's avoidance of the more intimate level of dialogue Liza had attempted. Colin was afraid that real knowledge of him would drive her away. This was not on account of the MS, of which she had been aware from the start, but this denial opened a space for his own fears to find expression at last, fears of being unable to work or 'to run around with my own kids'. No, the fear of intimacy went much deeper and led to the boy's questions - 'Was it my fault father left, was it my fault they quarrelled? If father does not love me, can anyone?' Colin's inability to allow weakness in himself, or to ask for help, was made explicit, laying bare the loneliness beneath. From out of his 'churned up' feelings Colin formed the decision that he would talk to Liza about personal matters, and thanked me as he left.

Colin attended our next meeting in casual clothes, a noteworthy departure, and with better re-call on his week but yet again with tiredness as the only issue. This time, however, it was connected to his regular lateness at work which, with talk of redundancies in the air, was creating feelings of insecurity. Expecting memories about school to arise in response to my inquiries I was disconcerted to be confronted with the episode of grandmother and the tennis racket. Colin had no problem making the connection of feeling hurt for others; I made a tentative suggestion that he was laying himself open to being hurt, perhaps needing punishment to lessen his guilt. My decision to use this memory as a basis for image work arose primarily from my frustration with Colin's failure to produce any spontaneous image of his ego-fragments in child form but regardless of my conscious motives I had at last responded to one of the indicators my client's unconscious had been projecting. This memory was the key to the forty year old Clive, the lively little four year old, angry at the constraints on his activity who had to be split off and repressed because of the guilt and shame engendered by the adult reactions to his behaviour.

The engagement with this memory (T.Co.10) though unsatisfactory by my current standards - I could have enabled the child to apologise directly to his grandmother with his adult self in support - nevertheless gave that adult self a deeper insight into the original experience. Colin grasped the simple truth 'he didn't realise why she wanted him to stop' his play with the ball, or that being hit, whether accidentally by a ball or deliberately with the racket, could cause the old lady such pain. I fostered this dawning empathy with his younger self by making the connections with our previous work on the absence of parental guidance.

The process was now building a momentum and the frightening task of having to write a memo at work took the next session straight back to the special writing classes and the criticisms heaped on the child Colin by teachers and parents for his lack of achievement. There came the sudden intrusion of a memory his mother had recently reminded him to tell me. It concerned the occasion when Colin had been taken for an evaluation - with no explanation at the time or later, he now thought perhaps for learning difficulties - and the assessor had interpreted to his mother that his drawing of the family with himself shown very small illustrated his sense of self-worth. Interestingly Colin had thought this occurred before the special classes when he would have been seven or eight but the memory, which again I used as a base for image work, showed a recognisable secondary school room proving he had been eleven. The image work (T.Co.11) reveals the importance of the writing issue and shows that his fears at the time had been quite extreme. Afterwards Colin was left experiencing some of the confusion he had at the time and seemed hardly able to talk. He denied fear of school but admitted apprehension of punishment and we ended on his avowal of his fear of being judged by his boss on the contents and style of the memo he had yet to write, and of falling in his esteem.

Colin's body language when we next met made it clear there was unfinished business from this session and so I returned to the image (T.Co.12a) to reach a more effective conclusion. This still left anger twitching in his feet and his expressed grievances about favouritism at work evoked, with my clarifications of the parallels, his expression of the envy and jealousy aroused in his eleven old self at the approval granted to his academically successful siblings. And so, via his anger with his father and the frustrations his indisposition had imposed on Colin's childhood, we returned to the writing classes (T.Co.12b) and a chance for him to re-experience and express his child's angry boredom and hear from his adult self the loving commendation he had never received. By the end of the session Colin was again in touch with sadness at all he had missed. 'You can't go back and become four again'. He understood his parents' problems but he would do it differently. He was now talking to Liza.

Another spat with his beloved took our next engagement to the heart of the matter. It was occasioned by animpulsive contrary action on Colin's part which he himself could not understand. I hazarded the opinion that, for some unconscious reason, he deliberately angered those around him, an idea Colin found alarming. His appalling handwriting had been a sure fire way to provoke teachers and parents, and I took him into an imaginal re-enactment with the most daunting master in the hope it might uncover more. In the event it gave Colin another opportunity to express the original repressed emotion, this time fear, aroused by his predominant issue and experience the consequent enhanced self-esteem. His boyhood belief 'nice kids have beautiful handwriting' was being undermined (he had found an article that argued against it) and he was able to recollect some recent favourable  BOOKMARK  comments on his neat style.

Colin forgot his next session and so put his pattern of inciting anger at the top of our agenda two weeks later together with his fear of what our work was uncovering. He was in the sleepy mode that I would now automatically read as fear and repression. I linked the idea, of which he needed reminding, with all the rebellious behaviour which had usually failed to gain the attention he sought. Recollections of his cynical teenage companions led him to recognise his defensive response of controlling his emotions by judging himself, concealing his vulnerability because it would be despised. I confronted this belief system and he switched to the need to cocoon himself against emotions for fear of exacerbating the MS though eventually he had to concede that love and friendship were also inhibited inside this safe but isolating structure. Talk of yet another row with Liza elicited the cry 'Strong women are the bane of my existence' and some real exploration of his earlier relationship with mother. At last I could sum up the little boy's dilemma. 'To get Father's attention I must make him angry - but if Mother gets angry she leaves me', and from out of his ensuing sadness Colin gained the strength to articulate his life's goals, to be the managing director of his own firm, to be married with children, and to be as healthy as possible.

In this, our eighteenth meeting, Colin's fundamental, though mild, schizoid problem (Guntrip, 1968) was laid bare. His infant love, made needy by earlier deprivation, was too risky a base for relating and since isolation was also a threat, angry relations were his only resort.

When we met again my client felt there still remained a problem with his self-esteem. The direct attempt to engage imaginally with the part of himself he could not value (T.Co.14a) proved inconclusive (though the age twenty-seven/twenty-eight may indicate that a seven/eight year split was receiving treatment) but a confrontation with an image of what blocked his self-knowledge, a massive ice-berg, threw Colin into identification with the devalued ego-fragment. I had previously worked with a client whose image of a conical icy mountain was recognisably Klein's bad breast (Greenberg and Mitchell, 1983) and though Colin's vision was in the nature of an unending cliff face, I had no doubt that it represented bad mother, as the light revealed behind it at the end stood for good mother, and Colin was at last expressing the fear and anger of his inner baby. The ice gave the feeling-tone belonging to the concealing hair or mask or facelessness of previous images, contrasting with the sunny warmth of mother's attentive face, so vital to an infant (Stern, 1985).

Though Colin maintained at our review that he still had issues to resolve, his forgetting of our two subsequent appointments led me to challenge this, and having worked through his apprehensions about ending, Colin was able to acknowledge that he enjoyed a new inner calm 'a kind of spiritual peace'. His final statements included: 'You've got to be able to relate to yourself and understand yourself', 'I've got to take more notice of my emotions' and 'I'm more aware of people and interested, people are the most interesting thing in the world, with people there is always something new - I wouldn't have said that when we started'. His confidence can be illustrated by his reply to my request for permission to use the material from our work for study and possible publication. 'Of course you can, you can use my real name if you like, after all who is going to know who Colin ---- is?'

Conclusion

I present this case study as evidence for the value of image work with an object relations theoretical base and a directively assertive communication technique, but of course it contains no incontrovertible proof. Firstly, it could be asserted that my client's assessment of the sessions spent on cathartic exploration of memories as most valuable was correct and the image work, which he sooften forgot, was irrelevant. It could be claimed that the more existential investigations (von Deurzen-Smith, 1988) with Colin of his attitudes and belief systems in relation to his current behaviours were the effective elements in the work. A critique from a person-centred perspective (Rogers, 1980) would suggest that twenty hours of unconditional positive regard from a, relatively, congruent therapist was the crucial factor. A hypnotherapist could argue that I had used a form of hypnotic suggestion to cure the underlying problem of low self-esteem and psychosynthesis practitioners certainly recognise the link in that imaginal working involves altered states of consciousness. A medical judgement would surely point to the anti-depressants as the most significant treatment and note unfavourably that this, unnamed, medication disappeared from my account on the instant. I do not in fact know whether or not Colin continued to take the pills after he fell in love, which is a mark of my inexperience as well as of my failure to work through the experienced threat to my professional self-image that his recourse to his doctor represented. Only the psychoanalytic objections that could be raised, to the effect that allowing my client to 'free-associate' (Freud, 1916-17) would have raised relevant issues more effectively, can I firmly rebut. Left to talk under his own volition, I feel sure Colin would have abandoned therapy. But since my psychosynthesis training has left me firmly in favour of a multi-method approach I would not wish to undervalue other methods in advocating image work. And finally, of course, it could be said that Colin's depression was, in reality, very minor as it did not prevent his functioning and that life, not therapy, supplied the only cure he needed, Liza.

My response is to underline the evidence that ten sessions, occupied principally with image working, brought Colin from a long standing emotional isolation intensified by a crisis of depression to a sufficiency of emotional freedom to allow him to fall in love. When we parted he was fully committed and deeply confident of Liza's commitment in return.

However, even within my favoured technique I must admit the evidence to be far from consistent. For example, I suggest the 'forty year old' and 'four feet away' point to the four year old's guilt ridden outburst but the second time Colin referred to that episode he said he was five years old. I link 'ten feet' similarly to the ten year old but 'three feet' and 'late thirties' have no associated memory while significant episodes such as the one at age eleven had no clued reference in the image work. To which objections I can only reply that the unconscious is not a realm that conforms to rational expectations and standards.

The metaphor I use with clients to explain this way of working is surgical intervention on a broken limb. My ankle was not 'cured' in hospital, the bones were aligned and screwed in place to enable my body to heal itself as perfectly as possible. In the same way, by facilitating the images representing Colin's ego fragments to come into relationship with each other and make loving physical contact I believe I was assisting the psyche in its on-going process of opening up neural pathways between functionally separated endo-psychic structures and so in healing itself. I will end by citing Hobson's conclusions from his work The Dreaming Brain:-

Dreams are the product of a 'genetically determined, functionally dynamic blue-print' in the brain, whose function is 'to construct and to test the brain circuits that underlie our behaviour - including cognition and meaning attribution'.

(In Stevens, 1996: 114)

This is a justification for calling the image work I practice psychodynamic surgery.

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