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Journal of Sex & Marital Therapy Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/usmt20
What personal photos reveal about marital sex conflicts Florence Kaslow phd
a
a
Professor in the Department of Mental Health Sciences , Hahnemann Medical College , Philadelphia, Pennsylvania, 19102 Published online: 14 Jan 2008.
To cite this article: Florence Kaslow phd (1979) What personal photos reveal about marital sex conflicts, Journal of Sex & Marital Therapy, 5:2, 134-141, DOI: 10.1080/00926237908403724 To link to this article: http://dx.doi.org/10.1080/00926237908403724
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Sex & Marital Therapy Vol. 5, No. 2, Summer 1979
What Personal Photos Reveal About Marital Sex Conflicts
Downloaded by [University of New Hampshire] at 10:21 17 February 2015
Florence Kaslow, P h D
ABSTRACT: A brief summation of the underlying rationale of the technique and a description of how photo reconnaisance is utilized are presented first. Then some specific adaptations of the technique to the therapist’s understanding and treatment of sexual conflicts in marital pairs are delineated. Although some correlations between certain configurations appearing in pictures and specific sexual conflicts or dysfunctions are hypothesized, it is not possible to posit clear-cut one-to-one linkages. The photographs provide clues and highlight forerunners of current difficulties; they do not establish definitive causation.
RA TI 0N ALE Projective techniques, such as the Rorschach and Thematic Apperception Tests, have long been utilized by psychologists to tap into one’s unconscious thought processes and to yield clues to one’s underlying personality structure.’ T h e cards utilized in these tests have been standardized. In psychodiagnosis they are introduced as new, external stimuli to which the patient is asked to respond. T h e patient’s specific answers and the patterns in the content are then analyzed, interpreted, and synthesized into a diagnostic formulation. By contrast, photo reconnaisance, which I have been using and perfecting for the past 9 years,2 may be classified as a personal projective technique since it revolves around real materials which the patient is requested to share from hidher own life. (Although I will be alluding primarily to photographs, since this is what patients can most easily bring with them to
Dr. Florence Kaslow is a Professor in the Department of Mental Health Sciences, Hahnemann Medical College, Philadelphia, Pennsylvania 19102. She is also Editor of the Journnl of Muritul and Family TheruB and maintains a private practice. Requests for reprints should be sent to Dr. Florence Kaslow, Department of Mental Health Sciences, Hahnemann Medical College, 230 North Broad Street, Philadelphia, Pennsylvania 19102.
134 0092-623X/79/1400-0134$00.95
@ 1979 Human Sciences Press
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the doctor’s office, slides and family movies can and have served the same purposes.) Often patients will spontaneously pull out their wallet to show their therapist pictures of their children, grandchildren, parents, or a new boyfriend or girlfriend. If the therapist looks at and absorbs what is being shown in the photos, he will quickly get a sense of what is going on in the patient’s world and this also provides the perfect opening to ask that the patient bring along to the next office visit hidher baby book or family photo album or picture collection. In looking at photographs with patients we have observed that these provide excellent and significant stimuli for reawakening memories of past events and reactivating the emotions and physical sensations connected to occurrences, people, and relationships. Their perusal unearths splendid material on one’s individual and family developmental history, relationships to one another, perceptions of one’s own body image, and appearance and changes over time. Although the intent is serious, the means is fun in the way that we utilize the technique. It lends itself to the brief office visit as well as to longer doctor-patient encounters. Since all families, no matter how poor or chaotic, have at some time taken photographs and will usually find among their collection some they treasure and can display with pride, the technique is usable with people from all socioeconomic groups and educational strata. By providing a visual image of the person at each stage of his personal life cycle, he can reidentify with himself and pick up many repressed threads, see his physical self and become aware of his body boundaries and separateness as the pictures provide a mirror image. The work of others who have been exploring the use of photographs in therapy corroborates our experience and conclusions. Akaret, in his book Photoanalyszs, documents the utilization of this technique as a psychologically valid way of augmenting a person’s self-awareness in individual appeal of nostalgia and reminiscence makes photographs a natural instrument for studying the impact of the past upon the present.”
METHOD AND TECHNIQUE How and when should photo reconnaisance be utilized? When patients are having trouble remembering what may be crucial data from the past, when they have difficulty articulating their concerns, when the two spouses describe the same people and events, quite differently, when interviews are deadly serious and pathetically sad, I often suggest that they bring photographs in when they come for their next visit. The assignment is a general one in which they are asked to scout around for pictures from their childhood and teen years with their family of origin and friends, as well as for photos taken of their current family-the couple only, if they are childless, or the nuclear family. Because of its novelty, the idea is generally appealing, and I have yet to meet resistance. In searching to collect these, some bring photograph albums; others a box or folder. AH
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people tend to handle this characteristically so that reflections of their neatness or chaos, continuity and integration, or discontinuity and fragmentation abound in how they pull together and present their pictorial history. If they realize that there are significant missing photos which they would like to obtain from their parents or other relatives, this may prompt a long overdue visit home which can augment the process of reviving memories and attending to some unfinished business from the past with members of their family of origin. Often it is productive to devote more than one session, not necessarily on successive visits, to considering photos. ’The photos are gone through one by one. When people first appear in a scene, patients are asked to identify them. If the therapist already knows something about the pictures’ subjects, he/she can check what he/she knows or has been told against what is actually seen. Often gross distortions are apparent; the patients’ subjective portrayal is quite different from the appearance of the persons in the photograph. It is obvious to all that the pictures neither lie nor camoufloge. This discrepancy is picked u p and worked with as the meaning of the distorted memory or image is explored. Who is in the family, how they have changed over time is easily noted, and appropriate comments made or questions raised about such alterations as major changes in weight and overall appearance, personal carriage, and family structure and alliances as revealed in preferences for who stands near, holds, and touches whom. The patients are asked to free associate to any pictures that evoke a reaction or special memory. Their spouse is then asked to respond also, and dialogue between them is encouraged where divergence is expressed. Those pictures which do not seem particularly significant are gone through rapidly. It is crucial that the therapist pause and comment upon or query about any photos that strike h i d h e r as containing keys to the past and that he/she pay attention to such details as who dropped out of the family constellation and ask where they went, about the kinds of friends each had during adolescence and any typecasting in the people they dated. Often inquiries about a missing and heretofore untalked about member of the family reveal a death of a parent, sibling, or child who has not been fully mourned and in whom libidinal energy is still so invested that it is not free to flow in a sensual way to their spouse, or one may unearth other secrets about a former spouse or a relative now institutionalized whom one member of the dyad is worried about or feels guilty about neglecting. The family doctor who has treated various members of the family already has a sense of the family tree and can draw on his recollections about the family to prod their completion of grief work or individuation. One spouse may be consciously or unconsciously blaming the other for driving a wedge between them and an ex-spouse, parent, or institutionalized relative. The spontaneous outbursts as one sees a picture bring these submerged conflicts out into the open where they can be grappled with; because of the stark reality of photos, the mechanism of denial can not be used as a protective veil.
SOME DIAGNOSTIC PATTERNS Where impotency in marriage is a presenting problem, the following case is illustrative of the kinds of significant trends in the husbands’s earlier dating pattern that may emerge when using photo reconnaisance. Mr. and Mrs. K, a couple in their early 30s, requested sex therapy because of his impotence. He indicated that he had been a successful lover before marriage and had not had difficulty sustaining an erection. Mrs. K had been a virgin until their marriage as this was consonant with her religious heritage and this intrigued him as he wanted to be his wife’s first and only lover. Although he had enjoyed “fast” women, he did not care to have someone who had “slept around’ be the mother of his children. From the time of her pregnancy with their first child, he was often impotent. His classifying of women into the
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madonnalwhore dichotomy was apparent to the therapist, but he discounted any interpretation of this and of his male chauvinist, double-standard morality. T h e couple were instructed in pleasuring and other sensate focus techniques, but they only made sporadic headway. Finally, to break the impasse, they were asked to bring in snapshots and this proved a fortuitous request. The gallery of Mr. K’s women from age 15, when he had begun dating, until age 25, when he decided to “stop fooling around,” was made up of buxom, sexy looking “dolls.” By contrast, Mrs. K was quietly pretty, had a clean, scrubbed look, and was flat chested. This data, spread out before them on the table, led him to conclude that he guessed he was okay with a “broad” but that he classified his wife as a good girl and now as a “pure mother” like his Mom and, therefore, he really could not think of her as sexy. Thus, he could not allow his desire for her to be strong enough to be conducive to potency.
N o doubt we would have arrived at this point without pictures, but the breakthrough was dramatic and rapid. As a by-product of this deeper knowledge, his wife was able to discuss her sensuous longings and to descend from her madonna throne; he, in turn, was able to integrate in his thinking the various aspects of her being and to work through the polarity that existed in his mind between good (virginal) and bad (sexual) women. As a result of experiences similar to the one chronicled above, I now may ask patients who are having difficulty remembering or talking about their sexual history to bring in photographs to help them recall what they did and felt, who with, and when. The pictorial history is utilized as an adjunct to a more standard sexual history.‘j Often with couples experiencing sexual difficulties, looking through the wedding album proves enlightening. Ones’ early attitudes to their respective in-laws are poured forth when they see them anew as they appeared then. The accord or disharmony between their two families gets described. Whether it is a second marriage for one or both generally gets revealed because members of the previous family are in attendance. A therapeutic zoom lens can be focused on the impact of former spouses on the current marriage and their continuing relationship to each other’s children. Comparisons between the real and fantasized sexual relationship with the first and second partner can be discussed and their appearances compared. If part of the sexual and/or emotional energy is still invested in the former spouse, it is likely to become apparent, and then the therapist can invervene to sever the old ties and help the new ones become more solidly connected. How fascinating to observe the nature of the pictures taken on the honeymoon or any first trip they shared! How sexy or erotic were they, how playful, how geared to what everyone at home might expect? Were they radiant and glowing or sad and looking trapped? It’s all there, bluntly revealing the beginnings of their union. If it were a happy period, the pictures may help them recapture some of their delight with one another and aid them in responding to what they still find lovable and
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appealing. If it were rocky from the start, one might probe what has held them together or look at sex as the battleground on which numerous other conflicts are being projected and fought out. Specific correlates have been found to appear in photographs of many women who present with one particular sexual dysfunction. When the presenting problems is frigidity and the wife attributes this to her husband’s lack of tact, affection, and consideration, it is not unusual to find that in her childhood pictures she is always sparkling clean, perfectly groomed, and standing prim and proper. Her fastidiousness can be pointed out and the early sources of the “please don’t touch me because I’m not allowed to get messy” syndrome explored.’ If, in addition, she is usually slightly apart from others and holds herself constrained and aloof, one can work with the graphic evidence that the coolness and attitude of frigidity may have predated the marriage and may need to be dealt with at a deeper level rather than only by instituting sensate focus exercise^.^ The fear of being touched or intruded upon theme, clearly evidenced in the pictures, can be extracted and dealt with psychodynamically . With a couple who are too deeply enmeshed with one another, the photographs can be an instrument for reviewing their separate histories and for providing a starting point to focus on the importance of establishing individual identities and spaces in their togetherness. How they have traditionally felt about and utilized their bodies often can be deduced from the photos. Therapist and patients together can determine whether their clothing is usually concealing or baggy, either of which can indicate a parental stress on puritanical modesty or the patient’s shame over his/ her own body and sexuality expressed in adulthood in frigidity, impotence, or infrequent sexual desire. Conversely, many revealing photographs from infancy on when the baby is snapped while nude, with genitals prominently displayed, to later sexy poses in skimpy bathing suits and, if a female, tight-fitting sweaters or low-cut dresses can certainly cause the doctor to speculate in terms of exhibitionism and/or seductiveness used as ways of superficially attracting attention yet covering fear of true intimacy and belying an absence of real warmth. Some hysterical traits are also exhibited by the superficially charming, sexy woman. As indicated earlier, the woman who appears in pictures as a “fashion plate,” perfectly groomed and coiffed, often presents in the office as nonorgasmic or not interested in sex; she looks lovely but is untouchable as part of her life script is to be immaculate and look beautiful, like a cold cameo jewel. Any sensitive therapist can observe if either spouse stands straight or is slumped over and if the body is tense or relaxed. One’s typical bearing reflects his view of self (proud or depressed) and the way in which he perceives the world. If it has changed markedly at a given point in time,
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the doctor can ask what was happening then that caused the change with some certainty of eliciting important data. The personal historical roots of transsexualism run deep. The mommy often dressed her young son in girl’s clothing or encouraged him to play dress up by wearing female apparel. In the photos such a young’lad is easily identifiable by the toddler stage-he is parading around dressed as a girl. In probing the transsexual’s or his mother’s associations to the photographs, they generally reveal that she thought it was cute, funny, creative, and acceptable. The father rarely did anything to interfere with or contradict the acceptability of the behavior (these findings are compatible with those of Green and Money7 on transsexualism). Thus, if a pediatrician, family physician, or child psychiatrist sees a young male patient who is cross-dressed, he can intervene preventively by helping the mother deal with her conscious or unconscious wish that the child were a girl and raise the potential consequences of the way the boy is being encouraged to play and dress. One final syndrome and case are worthy of inclusion. In recapitulating their history through pictures when a couple are having difficulty conceiving, tales of previous miscarriages or abortions are sometimes evoked. Mr. and Mrs. M, married 5 years, came in for marital sex therapy because they had been trying to conceive for 2 years but to no avail. She had been checked by a gynecologist; he by a urologist-nothing was amiss organically with either. The routine sex history and a few clinical interviews revealed little that pointed to unhappiness, uncertainty, or marital conflict. They appeared reasonably content, although overanxious and trying too hard. They were asked to bring in pictures. As they were laughingly going through photos of their first year of marriage, they both became visibly disturbed by pictures in which Mrs. M looked chubbier than usual. When I commented on her weight, her eyes misted as she recalled that they had both been in college then and she had unintentionally become pregnant. They had decided she should have an abortion, and she did during the second trimester-and had run into complications. When she came home from the hospital, each separately had decided not to talk about the happening again-intent on burying the painful memories. But each carried around a good deal of remorse and unresolved guilt and was concerned that they were now being punished for the abortion. Having reactivated the buried memories, we were able to then .work through the residual pain, guilt, and fear. This enabled M r . and Mrs. M to accept their early choice and thus helped them become relaxed enough so that about 2 months later Mrs. M did conceive.
WHO’S IN THE BEDROOM WITH YOU? This startling question, when raised in therapy, can elicit some unexpected responses. When answered literally, I’ve had patients spontaneously say, “The baby’s crib is in our room.” In this case the baby was 18 months old. It took a few more queries, such as “When did your sexual activity begin to taper off, and how does the baby’s presence inhibit you?” for this couple to realize that all of their emotional investment was being
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channeled into the baby, who had become the focal point of their lives, and that if they were to become lovers again, the baby would have to sleep elsewhere. Within the week the dinette was converted into a nursery. T h e next few treatment sessions revolved around the “whys” of their neglecting one another for so long and rather rapidly the satisfying preparenthood sexual relationship flourished again. Both had to be helped to confront their stereotypical attitude that once a woman becomes a mother, her sexual desire and desirability diminish markedly. T h e therapist can assume that similar dynamics are operative when the answer, sometimes given proudly by a protective parent, is that a toddler or latency-age child is the one in their bedroom. T h e ostensible reason for Janie’s presence there is that she has nightmares, and they can only calm these and all get some sleep if she feels safe snuggled between them. How strange that they d o not see the absurdity of this position-there can not be adult sexuality with a child in between them. T h e child is simultaneously the product of previous sexual behavior, the defense against further sexuality, and often the identified patient upon whom they can project “the problem” and therefore attempt to avoid coming to grips with the underlying marital conflict. Here, too, the triangle and the reasons for it have to be unraveled, the child physically and emotionally extricated, and the spouses helped to seek their emotional and sensual gratification from each other. On a much more subtle level, when I sense the presence of someone else in the bedroom, yet the query evokes a response of “no one,” I may persist and ask, “whose pictures are on the bureau or whose portrait is hanging over the bed?” When occasionally making home visits, I have noticed that most families have family members’ photographs in the living room, family room, den, or foyers. Those couples (14 over a 2year-period) in which sexual dysfunction o r incompatible attitudes about acceptable sexual behavior were present frequently had pictures of their parents or children in the bedroom. It was hypothesized that good sex is less likely to occur when one is chaperoned (observed symbolically) by the people in the pictures. Privacy is conducive to adult sexual behavior, and couples need a place of their own for intimacy-uninhabited by representations and memories of others. We, therefore, discuss the symbolic removal of everyone else from the sanctity of the marital boudoir and, interestingly, for those with family pictures in the bedroom, the relocation of the pictures in other rooms seems to bring about a declaration of sexual freedom. Their own adult attitudes toward sexuality can come to the fore as the parental messages from the past are exorcised from the environs; greater experimentation and enjoyment become permissible. I encourage my students and trainees to utilize these photo reconnaissance techniques, and they have been intrigued with them. At least a half a dozen a year have reported back similar results with the “who is in the’
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bedroom” question. When the patients can recognize that the third party’s presence is a disturbing force and can move the person (either the real child or the pictorial representation of parents or child) out of the room, patients become more relaxed, less involved in triangulation, and more receptive to the interventions of the therapist.
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SUMMARY Photo reconnaissance is a rather new technique in the armamentarium of projective choices currently available to therapists. It is adaptible to use with all kinds of patients-young and old, rich and poor, cosmopolitan and unsophisticated. It appeals to be the patient since it enables him to revive and share fragments from his past, to look at what he has been and become, and to use this to chart his future course in a more satisfying direction. Utilizing pictures provides a dynamic sense of the couple’s history, physical contact and distance, sexual attractiveness o r lack of same, and it is conducive to a growth and change orientation as it reflects pictorially the developments in and alterations achieved in the past. It is a novel, interesting, and appealing technique which actively engages patients experiencing marital and sexual dysfunctions in their own therapy.
REFERENCES 1. Kaslow F: Photographs as clues to sexual problems. Med Aspects Hum Sex 7:8 1-84, 1978. 2. Kaslow R, Friedman J: Utilization of family photos and movies in family therapy. J Mum Fum C O U ~3:19-25. S~ 1977. 3. Akdret RU: Phuloanalysis. New York, Wyden, 1973. 4. Anderson M, Malloy ES: Family photographs: In treatment and training. Fam Process 15:25Y, 1976. 5. Kaplan HS: New Sex Therapy. New York, BrunnedMazel, 1974. 6. Masters WH, Johnson VE: Human Sexual Inadequacy, Boston, Little, Brown, 1970. 7. Green R, Money, J (Eds): Trunssexualism and Sex Reassignment. Baltimore, Johns Hopkins Press,
Journal of Sex & Marital Therapy Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/usmt20
What personal photos reveal about marital sex conflicts Florence Kaslow phd
a
a
Professor in the Department of Mental Health Sciences , Hahnemann Medical College , Philadelphia, Pennsylvania, 19102 Published online: 14 Jan 2008.
To cite this article: Florence Kaslow phd (1979) What personal photos reveal about marital sex conflicts, Journal of Sex & Marital Therapy, 5:2, 134-141, DOI: 10.1080/00926237908403724 To link to this article: http://dx.doi.org/10.1080/00926237908403724
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Sex & Marital Therapy Vol. 5, No. 2, Summer 1979
What Personal Photos Reveal About Marital Sex Conflicts
Downloaded by [University of New Hampshire] at 10:21 17 February 2015
Florence Kaslow, P h D
ABSTRACT: A brief summation of the underlying rationale of the technique and a description of how photo reconnaisance is utilized are presented first. Then some specific adaptations of the technique to the therapist’s understanding and treatment of sexual conflicts in marital pairs are delineated. Although some correlations between certain configurations appearing in pictures and specific sexual conflicts or dysfunctions are hypothesized, it is not possible to posit clear-cut one-to-one linkages. The photographs provide clues and highlight forerunners of current difficulties; they do not establish definitive causation.
RA TI 0N ALE Projective techniques, such as the Rorschach and Thematic Apperception Tests, have long been utilized by psychologists to tap into one’s unconscious thought processes and to yield clues to one’s underlying personality structure.’ T h e cards utilized in these tests have been standardized. In psychodiagnosis they are introduced as new, external stimuli to which the patient is asked to respond. T h e patient’s specific answers and the patterns in the content are then analyzed, interpreted, and synthesized into a diagnostic formulation. By contrast, photo reconnaisance, which I have been using and perfecting for the past 9 years,2 may be classified as a personal projective technique since it revolves around real materials which the patient is requested to share from hidher own life. (Although I will be alluding primarily to photographs, since this is what patients can most easily bring with them to
Dr. Florence Kaslow is a Professor in the Department of Mental Health Sciences, Hahnemann Medical College, Philadelphia, Pennsylvania 19102. She is also Editor of the Journnl of Muritul and Family TheruB and maintains a private practice. Requests for reprints should be sent to Dr. Florence Kaslow, Department of Mental Health Sciences, Hahnemann Medical College, 230 North Broad Street, Philadelphia, Pennsylvania 19102.
134 0092-623X/79/1400-0134$00.95
@ 1979 Human Sciences Press
Downloaded by [University of New Hampshire] at 10:21 17 February 2015
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135
the doctor’s office, slides and family movies can and have served the same purposes.) Often patients will spontaneously pull out their wallet to show their therapist pictures of their children, grandchildren, parents, or a new boyfriend or girlfriend. If the therapist looks at and absorbs what is being shown in the photos, he will quickly get a sense of what is going on in the patient’s world and this also provides the perfect opening to ask that the patient bring along to the next office visit hidher baby book or family photo album or picture collection. In looking at photographs with patients we have observed that these provide excellent and significant stimuli for reawakening memories of past events and reactivating the emotions and physical sensations connected to occurrences, people, and relationships. Their perusal unearths splendid material on one’s individual and family developmental history, relationships to one another, perceptions of one’s own body image, and appearance and changes over time. Although the intent is serious, the means is fun in the way that we utilize the technique. It lends itself to the brief office visit as well as to longer doctor-patient encounters. Since all families, no matter how poor or chaotic, have at some time taken photographs and will usually find among their collection some they treasure and can display with pride, the technique is usable with people from all socioeconomic groups and educational strata. By providing a visual image of the person at each stage of his personal life cycle, he can reidentify with himself and pick up many repressed threads, see his physical self and become aware of his body boundaries and separateness as the pictures provide a mirror image. The work of others who have been exploring the use of photographs in therapy corroborates our experience and conclusions. Akaret, in his book Photoanalyszs, documents the utilization of this technique as a psychologically valid way of augmenting a person’s self-awareness in individual appeal of nostalgia and reminiscence makes photographs a natural instrument for studying the impact of the past upon the present.”
METHOD AND TECHNIQUE How and when should photo reconnaisance be utilized? When patients are having trouble remembering what may be crucial data from the past, when they have difficulty articulating their concerns, when the two spouses describe the same people and events, quite differently, when interviews are deadly serious and pathetically sad, I often suggest that they bring photographs in when they come for their next visit. The assignment is a general one in which they are asked to scout around for pictures from their childhood and teen years with their family of origin and friends, as well as for photos taken of their current family-the couple only, if they are childless, or the nuclear family. Because of its novelty, the idea is generally appealing, and I have yet to meet resistance. In searching to collect these, some bring photograph albums; others a box or folder. AH
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people tend to handle this characteristically so that reflections of their neatness or chaos, continuity and integration, or discontinuity and fragmentation abound in how they pull together and present their pictorial history. If they realize that there are significant missing photos which they would like to obtain from their parents or other relatives, this may prompt a long overdue visit home which can augment the process of reviving memories and attending to some unfinished business from the past with members of their family of origin. Often it is productive to devote more than one session, not necessarily on successive visits, to considering photos. ’The photos are gone through one by one. When people first appear in a scene, patients are asked to identify them. If the therapist already knows something about the pictures’ subjects, he/she can check what he/she knows or has been told against what is actually seen. Often gross distortions are apparent; the patients’ subjective portrayal is quite different from the appearance of the persons in the photograph. It is obvious to all that the pictures neither lie nor camoufloge. This discrepancy is picked u p and worked with as the meaning of the distorted memory or image is explored. Who is in the family, how they have changed over time is easily noted, and appropriate comments made or questions raised about such alterations as major changes in weight and overall appearance, personal carriage, and family structure and alliances as revealed in preferences for who stands near, holds, and touches whom. The patients are asked to free associate to any pictures that evoke a reaction or special memory. Their spouse is then asked to respond also, and dialogue between them is encouraged where divergence is expressed. Those pictures which do not seem particularly significant are gone through rapidly. It is crucial that the therapist pause and comment upon or query about any photos that strike h i d h e r as containing keys to the past and that he/she pay attention to such details as who dropped out of the family constellation and ask where they went, about the kinds of friends each had during adolescence and any typecasting in the people they dated. Often inquiries about a missing and heretofore untalked about member of the family reveal a death of a parent, sibling, or child who has not been fully mourned and in whom libidinal energy is still so invested that it is not free to flow in a sensual way to their spouse, or one may unearth other secrets about a former spouse or a relative now institutionalized whom one member of the dyad is worried about or feels guilty about neglecting. The family doctor who has treated various members of the family already has a sense of the family tree and can draw on his recollections about the family to prod their completion of grief work or individuation. One spouse may be consciously or unconsciously blaming the other for driving a wedge between them and an ex-spouse, parent, or institutionalized relative. The spontaneous outbursts as one sees a picture bring these submerged conflicts out into the open where they can be grappled with; because of the stark reality of photos, the mechanism of denial can not be used as a protective veil.
SOME DIAGNOSTIC PATTERNS Where impotency in marriage is a presenting problem, the following case is illustrative of the kinds of significant trends in the husbands’s earlier dating pattern that may emerge when using photo reconnaisance. Mr. and Mrs. K, a couple in their early 30s, requested sex therapy because of his impotence. He indicated that he had been a successful lover before marriage and had not had difficulty sustaining an erection. Mrs. K had been a virgin until their marriage as this was consonant with her religious heritage and this intrigued him as he wanted to be his wife’s first and only lover. Although he had enjoyed “fast” women, he did not care to have someone who had “slept around’ be the mother of his children. From the time of her pregnancy with their first child, he was often impotent. His classifying of women into the
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madonnalwhore dichotomy was apparent to the therapist, but he discounted any interpretation of this and of his male chauvinist, double-standard morality. T h e couple were instructed in pleasuring and other sensate focus techniques, but they only made sporadic headway. Finally, to break the impasse, they were asked to bring in snapshots and this proved a fortuitous request. The gallery of Mr. K’s women from age 15, when he had begun dating, until age 25, when he decided to “stop fooling around,” was made up of buxom, sexy looking “dolls.” By contrast, Mrs. K was quietly pretty, had a clean, scrubbed look, and was flat chested. This data, spread out before them on the table, led him to conclude that he guessed he was okay with a “broad” but that he classified his wife as a good girl and now as a “pure mother” like his Mom and, therefore, he really could not think of her as sexy. Thus, he could not allow his desire for her to be strong enough to be conducive to potency.
N o doubt we would have arrived at this point without pictures, but the breakthrough was dramatic and rapid. As a by-product of this deeper knowledge, his wife was able to discuss her sensuous longings and to descend from her madonna throne; he, in turn, was able to integrate in his thinking the various aspects of her being and to work through the polarity that existed in his mind between good (virginal) and bad (sexual) women. As a result of experiences similar to the one chronicled above, I now may ask patients who are having difficulty remembering or talking about their sexual history to bring in photographs to help them recall what they did and felt, who with, and when. The pictorial history is utilized as an adjunct to a more standard sexual history.‘j Often with couples experiencing sexual difficulties, looking through the wedding album proves enlightening. Ones’ early attitudes to their respective in-laws are poured forth when they see them anew as they appeared then. The accord or disharmony between their two families gets described. Whether it is a second marriage for one or both generally gets revealed because members of the previous family are in attendance. A therapeutic zoom lens can be focused on the impact of former spouses on the current marriage and their continuing relationship to each other’s children. Comparisons between the real and fantasized sexual relationship with the first and second partner can be discussed and their appearances compared. If part of the sexual and/or emotional energy is still invested in the former spouse, it is likely to become apparent, and then the therapist can invervene to sever the old ties and help the new ones become more solidly connected. How fascinating to observe the nature of the pictures taken on the honeymoon or any first trip they shared! How sexy or erotic were they, how playful, how geared to what everyone at home might expect? Were they radiant and glowing or sad and looking trapped? It’s all there, bluntly revealing the beginnings of their union. If it were a happy period, the pictures may help them recapture some of their delight with one another and aid them in responding to what they still find lovable and
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appealing. If it were rocky from the start, one might probe what has held them together or look at sex as the battleground on which numerous other conflicts are being projected and fought out. Specific correlates have been found to appear in photographs of many women who present with one particular sexual dysfunction. When the presenting problems is frigidity and the wife attributes this to her husband’s lack of tact, affection, and consideration, it is not unusual to find that in her childhood pictures she is always sparkling clean, perfectly groomed, and standing prim and proper. Her fastidiousness can be pointed out and the early sources of the “please don’t touch me because I’m not allowed to get messy” syndrome explored.’ If, in addition, she is usually slightly apart from others and holds herself constrained and aloof, one can work with the graphic evidence that the coolness and attitude of frigidity may have predated the marriage and may need to be dealt with at a deeper level rather than only by instituting sensate focus exercise^.^ The fear of being touched or intruded upon theme, clearly evidenced in the pictures, can be extracted and dealt with psychodynamically . With a couple who are too deeply enmeshed with one another, the photographs can be an instrument for reviewing their separate histories and for providing a starting point to focus on the importance of establishing individual identities and spaces in their togetherness. How they have traditionally felt about and utilized their bodies often can be deduced from the photos. Therapist and patients together can determine whether their clothing is usually concealing or baggy, either of which can indicate a parental stress on puritanical modesty or the patient’s shame over his/ her own body and sexuality expressed in adulthood in frigidity, impotence, or infrequent sexual desire. Conversely, many revealing photographs from infancy on when the baby is snapped while nude, with genitals prominently displayed, to later sexy poses in skimpy bathing suits and, if a female, tight-fitting sweaters or low-cut dresses can certainly cause the doctor to speculate in terms of exhibitionism and/or seductiveness used as ways of superficially attracting attention yet covering fear of true intimacy and belying an absence of real warmth. Some hysterical traits are also exhibited by the superficially charming, sexy woman. As indicated earlier, the woman who appears in pictures as a “fashion plate,” perfectly groomed and coiffed, often presents in the office as nonorgasmic or not interested in sex; she looks lovely but is untouchable as part of her life script is to be immaculate and look beautiful, like a cold cameo jewel. Any sensitive therapist can observe if either spouse stands straight or is slumped over and if the body is tense or relaxed. One’s typical bearing reflects his view of self (proud or depressed) and the way in which he perceives the world. If it has changed markedly at a given point in time,
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the doctor can ask what was happening then that caused the change with some certainty of eliciting important data. The personal historical roots of transsexualism run deep. The mommy often dressed her young son in girl’s clothing or encouraged him to play dress up by wearing female apparel. In the photos such a young’lad is easily identifiable by the toddler stage-he is parading around dressed as a girl. In probing the transsexual’s or his mother’s associations to the photographs, they generally reveal that she thought it was cute, funny, creative, and acceptable. The father rarely did anything to interfere with or contradict the acceptability of the behavior (these findings are compatible with those of Green and Money7 on transsexualism). Thus, if a pediatrician, family physician, or child psychiatrist sees a young male patient who is cross-dressed, he can intervene preventively by helping the mother deal with her conscious or unconscious wish that the child were a girl and raise the potential consequences of the way the boy is being encouraged to play and dress. One final syndrome and case are worthy of inclusion. In recapitulating their history through pictures when a couple are having difficulty conceiving, tales of previous miscarriages or abortions are sometimes evoked. Mr. and Mrs. M, married 5 years, came in for marital sex therapy because they had been trying to conceive for 2 years but to no avail. She had been checked by a gynecologist; he by a urologist-nothing was amiss organically with either. The routine sex history and a few clinical interviews revealed little that pointed to unhappiness, uncertainty, or marital conflict. They appeared reasonably content, although overanxious and trying too hard. They were asked to bring in pictures. As they were laughingly going through photos of their first year of marriage, they both became visibly disturbed by pictures in which Mrs. M looked chubbier than usual. When I commented on her weight, her eyes misted as she recalled that they had both been in college then and she had unintentionally become pregnant. They had decided she should have an abortion, and she did during the second trimester-and had run into complications. When she came home from the hospital, each separately had decided not to talk about the happening again-intent on burying the painful memories. But each carried around a good deal of remorse and unresolved guilt and was concerned that they were now being punished for the abortion. Having reactivated the buried memories, we were able to then .work through the residual pain, guilt, and fear. This enabled M r . and Mrs. M to accept their early choice and thus helped them become relaxed enough so that about 2 months later Mrs. M did conceive.
WHO’S IN THE BEDROOM WITH YOU? This startling question, when raised in therapy, can elicit some unexpected responses. When answered literally, I’ve had patients spontaneously say, “The baby’s crib is in our room.” In this case the baby was 18 months old. It took a few more queries, such as “When did your sexual activity begin to taper off, and how does the baby’s presence inhibit you?” for this couple to realize that all of their emotional investment was being
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channeled into the baby, who had become the focal point of their lives, and that if they were to become lovers again, the baby would have to sleep elsewhere. Within the week the dinette was converted into a nursery. T h e next few treatment sessions revolved around the “whys” of their neglecting one another for so long and rather rapidly the satisfying preparenthood sexual relationship flourished again. Both had to be helped to confront their stereotypical attitude that once a woman becomes a mother, her sexual desire and desirability diminish markedly. T h e therapist can assume that similar dynamics are operative when the answer, sometimes given proudly by a protective parent, is that a toddler or latency-age child is the one in their bedroom. T h e ostensible reason for Janie’s presence there is that she has nightmares, and they can only calm these and all get some sleep if she feels safe snuggled between them. How strange that they d o not see the absurdity of this position-there can not be adult sexuality with a child in between them. T h e child is simultaneously the product of previous sexual behavior, the defense against further sexuality, and often the identified patient upon whom they can project “the problem” and therefore attempt to avoid coming to grips with the underlying marital conflict. Here, too, the triangle and the reasons for it have to be unraveled, the child physically and emotionally extricated, and the spouses helped to seek their emotional and sensual gratification from each other. On a much more subtle level, when I sense the presence of someone else in the bedroom, yet the query evokes a response of “no one,” I may persist and ask, “whose pictures are on the bureau or whose portrait is hanging over the bed?” When occasionally making home visits, I have noticed that most families have family members’ photographs in the living room, family room, den, or foyers. Those couples (14 over a 2year-period) in which sexual dysfunction o r incompatible attitudes about acceptable sexual behavior were present frequently had pictures of their parents or children in the bedroom. It was hypothesized that good sex is less likely to occur when one is chaperoned (observed symbolically) by the people in the pictures. Privacy is conducive to adult sexual behavior, and couples need a place of their own for intimacy-uninhabited by representations and memories of others. We, therefore, discuss the symbolic removal of everyone else from the sanctity of the marital boudoir and, interestingly, for those with family pictures in the bedroom, the relocation of the pictures in other rooms seems to bring about a declaration of sexual freedom. Their own adult attitudes toward sexuality can come to the fore as the parental messages from the past are exorcised from the environs; greater experimentation and enjoyment become permissible. I encourage my students and trainees to utilize these photo reconnaissance techniques, and they have been intrigued with them. At least a half a dozen a year have reported back similar results with the “who is in the’
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bedroom” question. When the patients can recognize that the third party’s presence is a disturbing force and can move the person (either the real child or the pictorial representation of parents or child) out of the room, patients become more relaxed, less involved in triangulation, and more receptive to the interventions of the therapist.
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SUMMARY Photo reconnaissance is a rather new technique in the armamentarium of projective choices currently available to therapists. It is adaptible to use with all kinds of patients-young and old, rich and poor, cosmopolitan and unsophisticated. It appeals to be the patient since it enables him to revive and share fragments from his past, to look at what he has been and become, and to use this to chart his future course in a more satisfying direction. Utilizing pictures provides a dynamic sense of the couple’s history, physical contact and distance, sexual attractiveness o r lack of same, and it is conducive to a growth and change orientation as it reflects pictorially the developments in and alterations achieved in the past. It is a novel, interesting, and appealing technique which actively engages patients experiencing marital and sexual dysfunctions in their own therapy.
REFERENCES 1. Kaslow F: Photographs as clues to sexual problems. Med Aspects Hum Sex 7:8 1-84, 1978. 2. Kaslow R, Friedman J: Utilization of family photos and movies in family therapy. J Mum Fum C O U ~3:19-25. S~ 1977. 3. Akdret RU: Phuloanalysis. New York, Wyden, 1973. 4. Anderson M, Malloy ES: Family photographs: In treatment and training. Fam Process 15:25Y, 1976. 5. Kaplan HS: New Sex Therapy. New York, BrunnedMazel, 1974. 6. Masters WH, Johnson VE: Human Sexual Inadequacy, Boston, Little, Brown, 1970. 7. Green R, Money, J (Eds): Trunssexualism and Sex Reassignment. Baltimore, Johns Hopkins Press,
