Zoltán Arany – Emőke Sarungi – István Fedor
SAILING (family visual psychotherapy)
Zoltán Arany
(family therapist, social worker) e-mail: arany16@freemail.hu
Emőke Sarungi
(adult and child psychiatrist, visual therapist) e-mail: sarungie@freemail.hu
István Fedor
(child psychiatrist, family therapist, supervisor) e-mail: fedorist@yahoo.com
Abstract
We present one of our cases, where we were working with a family in a therapeutic method
we call “family visual psychotherapy”.
Marika (a 10 years old girl) was referred for child psychiatry inpatient treatment with the
symptoms of obsessive – compulsive disorder, and sever insomnia.
Her mother suffered of major depression, and her father was treated for Alzheimer disease
and depression too. Marika nursed her parents as a “little mother”.
We thought that the main problem is the dysfunction of the family and the parentificated role
of the child.
The topics of the sessions followed our hypothesis. Throughout each session we worked in
both therapeutic modalities, included structural family techniques and worked with pictures
made by family members as well.
After concluding the therapy, their communication improved substantially, and Marika’s
symptoms had almost completely disappeared.
Method
We have been experimenting for years with a new method, aiming to combine two therapeutic
modalities with different focuses: structural family therapy and visual psychotherapy.
Throughout the therapeutic process, both methods’ theoretical frameworks and tools were
used. We have experienced, that family members’ joint or parallel creative work resulted in a
distinctive new form of visual psycho~ and family therapy. (1.)
From a family therapy point of view, joint artwork and symbolic meanings emerging from the
drawings shake up the rigid pathological family system. Images made by family members
result a faster family diagnosis and more dynamic change process. Hidden beliefs and
assumptions can be realised and become overt for family members through visualisation. (2.)
Family members can experience the joy of creating together again, through drawing together.
Joy acts as a resource facilitating change for the family. Presenting the whole system, not only
one member of it, brought a distinctive change in the method of visual psychotherapy.
Experiencing a new kind of cooperation can strengthen the individual change process.
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Therapeutic setting
Marika, aged 10 was repeatedly hospitalised for obsessive-compulsive symptoms and
suspected psychosis. Sexual abuse and depression of both parents were in history. Her father
suffered from Alzheimer’s disease as well.
Because of mental disorders of all family members and interactional dysfunctions of the
family context, we decided to use a complex approach combining visual psychotherapy and
family therapy. (Fig. 1.)
Inequal sharing of tasks between parents
 Depression
Mother
 Attachment
Rejection
Individual level: 
Interactional level: 
Family level: 
Father
 Enmeshed boundaries
 Compulsions limited
to family context
 Parentification of the
child
Marika
 Alzheimer’s
disease
 Depression
 Ambivalent
expectations of
father
 Phobia (touch)
of Marika
 Sexual harrasment
(by stranger)
 Phobic-obsessive
symptomatology
Figure 1. 3 level diagnosis
Therapeutic process
The parents’ limited emotional and physical capacity put a weight that overwhelmed Marika’s
emotional and physical abilities. During initial sessions Marika presented her parentificated
role in her drawings (Session 3, Picture 3.) Regressive elements appearing in her drawings
refer to her desire to become a child again. The secure field of therapy helped her to express
her desires. (3.)
After this session (No.3.) 2 couple therapy sessions were included in order to strengthen the
parental subsystem. In the joint drawings of the last 2 sessions water as an element and a ship
appeared again, both were present on their introductory picture as well. Family travelled on
the Sea of Emotions from a dark coast to a peaceful island in one ship together this time.(4.)
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In the last picture, “Present” they drew about a family game, where joint, joyful experience
became part of their everyday life, can be a cohesive force for them.
It was striking to see, that the pictures of Marika, especially one entitled “Presenting the Evil”
(Fig. 3.) provoked string emotions in parents even without interpretation. They understood
without verbal expression, confrontation, interpretation, and working through resistance, how
Marika feels herself in the family.(3.) This coming to terms helped them to search for new
resources in their relationship, despite of their instable mental balance and variable endurance.
This made possible for the parents to provide emotional safety for their child. Shared
problem, common future, joint effort as appeared in the picture entitled “Family vision” (Fig.
6.) contributed to this process.
The ship – powered by 2 paddles (parents) – also has a motor, which they called the “power
of family”. According to the father they have a sail just in case if the power of the motor
would decrease and they should trust the forces of nature.
Process in pictures
Family therapy
Psychodinamics -pictures
Therapeutic process
Session I

Dysfunctional family
boundaries
- rigid inside
- loose outside
(many people on the
picture, who are not family
members)
 Homework: paradox
instruction
3x30 min/week
M. measuring time
The aim was to bring
parental conflict to surface,
where M’s task to
substitute the symptom.
Measuring
time
has
regulatory function.
Introduction of family (drawn together)
Figure 1.
 Water bounding an
ideal from a fantastic
family
 Father draws, M.
controls
 „Everybody is in
his/her own ship, with
his/her own diseases”
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Family therapy
Psychodinamics -pictures
Therapeutic process
Session II

Shared past as resource
(shift in perspective)
Introduction of Good (drawn together)
 Absence of family
Figure 2.
feasts in the present
 Hw: „Setting
boundaries” –
Present for the parents: a
dinner together, M sleeps
at a girlfriend
 Regressive elements in
M’s drawing and
behaviour
Session III




Reordering of
subsystems continues
Emerging parental
conflicts
Naming that no
standard practice in
parenting exists
Introduction of Evil (without instructions)

Contracting:
Improving communication



Marika’s
parentification appears
on her own picture
Parents gained insight
the position of M. in
the family, and her
emotions related to this
M’s drawing style and
behaviour on the
session showed
regressive elements
Parents draw a picture
together with 2
problem focus
Marika’s drawing (Figure 3.)


Parents drew about decline and death
Couple therapy sessions were included in order to strengthen parental subsystem
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Family therapy
Psychodinamics -pictures
Therapeutic process
Session IV – VI (Couple therapy)

Shared past as
resource
 Hw: Paradox
instruction
Intimacy without sex
IV: Dating (Figure 4.)

Regression of couple
until getting married
 ”Forming a couple”
they tear them apart from
the mass of people
Solemnity highlighting
the strength of their
relationship


Parental subsystem,
rebuilding couple
relations
 Birth of family as a
unit , setting boundaries
of subsystems
 Separation as a need
presented by the parents
V: Change (Figure 5.)
VI: Family vision (Figure 6.)
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 Couple as emotional,
sexual unit introduce
itself
 Gentle and moderated
presentation of intimacy
From a dark coast to a
peaceful island, they sail
across the “Sea of
Emotions”, created
symbolically by the water,
in one ship

Family therapy
Psychodinamics -pictures
Therapeutic process
Session VII

Restructuring of the
family system
Present (Figure 7.)

Realistic image of
family, acceptable, but
not perfect
 Joint joyful experience
present in everyday reality
Summary
During therapeutic process (3 months) Marika gradually became symptom less, and the
family system transformed substantially. Family subsystems were reorganised. (4.) Marika
got back to child subsystem again. One year after the end of therapy we had a follow up. The
subsystems kept their boundaries. Marika stayed symptom less. They still had difficulties,
because father’s condition gradually deteriorates. It seemed that the family could overcome
their difficulties.
During therapeutic sessions therapists made decisions which approach were used in the actual
situation. In this course family therapist was less directive and visual therapist did not
interpret at all.
Combining visual psychotherapy and family therapy gives new qualities to both. For
structural family therapy images help to understand the system easier, to reorganise the
pathological dysfunctions more dynamically. For visual psychotherapy, it gives opportunity to
work through individual problems and in the meantime family reorganise itself.
Primary profit for the family, that the combination is especially change-oriented, working
through a lot of resistance with the help of pictures.
In summary we can state, that combining family therapy and visual psychotherapy makes
more effective, changes occur more rapidly, therefore we recommend it for your
consideration.
References:
1. Vizuális Psichoterápia . szerk: Vera Vasarhelyi/ Animula, Bp.1996 (6-11old.)
2. Böszörményi-Nagy Iván, Barbara R. Krasner: Kapcsolatok kiegyensúlyozásának
dialógusa / Coincidencia, Bp. 2001 (205, 303 old.)
3. Thessa Daelly: Images of Art Therapy / Rautledge, London-New York 1992. (68-70,
159-161 old.)
4. Családterápiás Olvasókönyv I. / Animula, Bp. 1990. (20-27 old.)
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