Identification Projection-Series as a tool in psychotherapy and counseling (I-P-S)

Incorporating works of art into psychotherapy and counseling can be very effective because they can function like a storage space for the artist’s psychological energies that the viewer can then retroactively experience. At the same time, the work of art can develop into an instrument that brings the viewer’s own psychological energies to the surface, leading to identification and projection in relation to the person(s) displayed in the work of art. This process may lead to visible reactions of joy, but also mourning or anger. The working title I-P-S derives from this interpretation.

The suggested limitation of 40 picture cards is based on empirical values derived from psychotherapy sessions with duration of 50 minutes on average. They size of the cards is A6, equal to postcards. I do not pre-determine a certain viewing duration per image. The selection of currently 88 images derives from my patients’prevalent therapy themes, the hypotheses following from these themes, and the level of trust or remaining hesitation on the patient’s side. In the current set of cards, one subset shows the female socialization process. It contains images of female children, teenagers, and women of different ages and constellations in their lives. A second subset is tailored to men’s life. Both subsets also contain images showing couples, landscapes, and cities.
The cards were selected so they contain pictures showing a dramatic conflict between parents and their children, between a man and a woman, or between friends in the course of childhood, youth, maturity, and old age. Approximately half of the currently used cards display images that express satisfaction, success, harmony, tenderness, and love.

The images can be shown in the early stage of therapy, when the patient has difficulties verbalizing his current situation and his wishes for therapy results. They are also suited for patients who are skeptical towards the opportunities a therapy offers, are convinced that their symptoms are primarily organic, and who only started psychotherapy for their general practitioner’s sake. The images are a good possibility to let the patient experience the correlation between feelings and physical reactions through external stimuli. At the same time, the images pique the patient’s curiosity for the therapist’s overall mode of practice, and often trigger a previously invisible need to communicate his or her feelings.

When I feel that the time for it has come, I ask the patient to slowly look at the images one after another and guide the patient into simultaneously becoming aware of his mood and his emotions. Images that trigger an emotion or a memory are put on a stack. Images which are experienced as neutral or meaningless are put on another stack. After all cards have been allotted, I ask the patient to comment on the meaningful images, by including his or her associations with the image and any physical reactions s/he might have experienced while viewing the image. The suggestion to separate the stack of meaningful images into three subsets has proven to be very effective and has proven to be the easiest method to activate the client’s cooperation. These subsets, or fields, symbolize “Past”, “Present”, and “Future”. According to the patient’s set of goals and the current therapy phase, and my hypotheses regarding the patient, I suggest only two fields: “Present” and “Future”. Alternative possible sets are: “Interior and Exterior”, “Therapy Session”, etc. “
Toward the end of an image viewing session, I put the events into perspective. I concede that the presented set of images constitutes only a selection. Then I suggest that the patient looks for images at home, e.g. photos, postcards, or pictures taken from magazines, which might be more poignant to his or her dominant therapy themes. The patient almost always accepts this suggestion, often with fervor and a desire to explore. The search for images strengthens the awareness of his/her capability to gain new insights on their own. It also strengthens a feeling of equal status, of cooperation and of involvement in a project, which not only the patient but also the therapist and future patients can benefit from. This often leads to a sense of pride and satisfaction. This is how my set of images has expanded.
At times, patients spontaneously ask me in the following session whether they could now look at the images that they previously dismissed as not suitable or meaningless. The patients now experience – after having becoming aware of their bodily reactions – their ambivalent feelings towards some subjects and are now more open to dealing with this.

Record of nonverbal and verbal expression upon confrontation with the image series:

Duration: - until allocating the image (A) - of reflecting on the image verbally and nonverbally (B)
Breath: faster, more audible;
Eyes: pupils, higher rate of spontaneous eye blinking, fear-potentiated startle, moistness, tears;
Skin: redness, paleness, spots;
Voice: louder, lower, constrained, trembling;
Hands: grasping, defensive, fidgety;
Body posture: turning away, turning towards

Content analysis: various possibilities, depending on theoretical approach:
for example: acquired-needs theory: achievement, power, and affiliation“ (D. McClelland)/
approach-avoidance conflict(Kurt Lewin) / suspected defense mechanisms / a wish - an imagined response by the object - the subject’s to that response ( L.Luborsky)


Utilization of the cards to strengthen therapy goals

Immediately after arranging the cards according to the criteria “emotional response, proximity to own experiences, wishes, fears, hopes, interests”, I ask the patient to select three images each: three cards representing the most prevalent themes in the present and three cards representing expectations for the future. Observing the patient during the process of deliberating, searching, and finally deciding for a small number of images provides further indicators concerning ambivalence, rank order, and anxiety about decision making. I then give color prints of the selected images to the patient, and suggest that the patient places them in a visible location at home. During the next session I ask where s/he placed the cards, and whether s/he consciously selected a good location for the images. Alternatively, the cards may be printed in business card size and carried in the patient’s wallet or pocket planner. If the procedure succeeds in evoking emotional resonance in the patient, these particular types of self-reinforcement can be highly effective. Analysts may call these images transitional objects and note their common attribution to a phase in ego development during childhood. Behavioral therapists, on the other hand, would associate the procedure with conditioning and cognitive restructuring. Hypnotherapists would possibly associate it with post-hypnotic suggestion and autosuggestion.