Journal of Family Therapy (1985) 7: 99- 11 1

Drawing up boundaries: a technique

Simon Wilkinson*

A technique is described for eliciting information about family structure in terms of boundaries and alliances through an individual session with a child using the medium of drawing. An advantage of this approach is that the child’s perspective is elicited through a medium with which the child feels familiar and at ease, which can subsequently be taken further with the child in or out of the family.

Introduction

Within family therapy the concept of family boundaries has been developed through the work of Minuchin (1974). Although boundaries are subsequently described in both strategic and structural terms, Minuchin lays most weight on the way in which they are maintained through family rules and decision-making behaviour. A developmental perspective on family function must include some way in which these family codes become internalized in the children. Originally boundaries have been deduced as one way of interpreting information gained from a family interview. In this paper I will describe one way of building hypotheses about family boundaries based on information obtained from individual children.

Family boundaries have been conceptualized as moderately rigid structures within which the family operates. Nevertheless family structure, of necessity, alters as the family goes through its life cycle (Wood and Talmon, 1983). Family rules evolve when the family must address new situations which are salient for them. For example, this can be illness or antisocial behaviour in the family. In this way illness can come to alter not just the ‘rules’ which generate particular patterns of family behaviour, but also the family’s decision-making behaviour. Particular forms of illness behaviour (Mayou, 1984) can have more pronounced effects on the family. At times these effects can apparently

Received February 1983; revised version received January 1985. * Department of Child and Family Psychiatry, Royal Hospital for Sick Children,

3 Rillbank Terrace, Edinburgh. Address for correspondence: Per Lassons Vei 17, 1410 Kolbotn, Norway.

99 0163-4445/85/020099 + 13 $03.00/0 @ 1985 The Association for Family Therapy

100 S. Wizkinson

facilitate the functioning of the family system (Selvini Palazzoli et al., 1978). I believe that it is useful to explore these benefits through looking at how illness behaviour can alter family boundaries. The goal of therapy could mistakenly be directed to removing the symptomatic behaviour; without noting whether there is a concomitant need to address family structural shifts. A clarification of which structural shifts are maintained because of the illness behaviour, will enable treatment to be directed to both elements in an integrated fashion. The family structure and the processes occurring within that structure are dependent on each other in a way which Sluzki (1983) has neatly summarized as ‘Process is to structure as verb is to noun’. It is only together that meaning can be expressed.

In this paper a technique which was developed from work with asymptomatic children is described. I then describe a way in which it can be modified for use with children with a variety of symptoms so that the family structure and decision-making rules can be compared in situa- tions with and without symptoms. I developed the technique in relation to illness behaviour and so I will draw my examples specifically from that area. At the same time I will relate this information which can be obtained from children to the adult lay views on the pragmatic effects of illness, described comprehensively by Herzlich (1973), so that the children’s perspectives are placed in a developmental context. I believe this latter step to be particularly important as her system of categorizing adults’ views about illness as ‘liberating’, ‘destructive’ or an ‘occupation’ (see discussion) describes the adult context within which the children’s views are being formed. In order to interpret the views obtained from the children it is necessary to both know more about the general range of adult responses as well as the particular situations of the individual children. I will take this point further in discussion of the validity of the observations one can make using the technique I describe here.

Just as the dynamic interplay of circumstances and inter-subjective experiences makes the objective description of family boundaries hazardous, so also must the technique of ‘Drawing up Boundaries’ con- centrate on the subjective reality of the child’s perception of boundaries. The child’s perception, which might be one of many possible alterna- tives, is a starting point for hypothesizing which begins from the child’s position.

Kinetic family drawings

A child may be seen on his own for a variety of reasons. Some children talk less freely without the support of their family, whereas others give

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more of themselves in trusting relationships with relative strangers, a situation in which the constraints of family expectations are altered. Some of the possible implications of seeing children on their own are discussed by Montalvo and Haley ( 1 973). Some children who find it hard to communicate with words, find drawing an enjoyable way of giving more of themselves. This can bypass the problem described by Dare and Lindsey (1979) in which ‘a demonstrated preference for verbal material will almost inevitably result in a failure to gain engagement of the children in treatment’. Through utilizing their drawings it is possible to develop a picture of the family structure, and the strategies which they use to maintain their boundaries.

The technique I use is based on the procedure for doing a Kinetic Family Drawing (K.F.D.) (Burns and Kaufman, 1971). In this task an individual child is asked to ‘Draw a picture of everyone in your family, including you, doing something. Try to draw whole people, not cartoons or stick people. Remember, make everyone doing something-some kind of action.’ They developed the original technique on the basis of their experience with 10 000 such drawings in the clinical situation where some evidence for their interpretations of the drawings was available from case histories. Their interpretations of the drawings were developed from the categories used by Machover (1949) when she studied individual human figure drawings (there was no instruction for the person in her drawings to be doing anything). The following charac- teristics with the clinical hypotheses they generate are some of those which were developed from that earlier work.

(1) Shading covers areas of preoccupation or anxiety. (2) Enlargement of body parts suggests preoccupation with those

(3) Omission of body parts often indicates denial of the function of

(4) Facial expressions are often used to indicate emotions. ( 5 ) The size of the person. People who feel very inadequate usually

draw tiny people. (6) Cross hatching is seen as a way of controlling; a particular form of

shading. (7) Precise drawings often reflect a child’s concern or need for a

structured environment. (8) The style of drawing, in terms of pencil pressure, reflects the

child’s impulses being ‘heavy’, with acting out aggressive individuals, or ‘light’ with the helpless feeble response of depressed people.

parts.

that organ.

102 S. Wizkinson

In addition they introduced various other categories to reflect the much greater richness of information conveyed in drawing the whole family in action. Here 1 wish to concentrate on the information conveyed about boundaries between people and ways of assessing alliances. I present first the categories interpreted by Burns and Kaufman as illustrating these themes. These interpretations arise out of discussion of the K.F.D.s and awareness of the family contexts. I present them as reified constructs, but it is important to remember their origins as repeatedly individually-validated interpretations.

Boundaries may be drawn as clear compartments around individuals or groups of individuals. The lines may be total barriers firmly drawn, or light and broken (by coincidence very similar to the conventions used by Minuchin, 1974, p. 54). Some children use this device to isolate themselves to varying degrees from people or to deny feelings. The strategies people use to maintain boundaries can also be illustrated where structural compartmentalization in the K.F.D. is less evident. For example food is often a prominent element in these drawings and it is useful to note who gives food to whom, and who is placed nearest to the food. Do some people turn their backs on the food giver? Are all the people receiving the food of equal size or are some made more signifi- cant? By looking at things in this way Burns and Kaufman describe family alliances and how the family maintains such alliances.

Actions ascribed to individual members give clues to the strategies employed by family members to cope with uncertain structure, and to maintain boundaries and alliances. Some members are given tools which Burns and Kaufman interpret as being to ‘cut others down to size’, whereas others carry warmth and light to allies in the form of lamps and candles. The latter symbols are seen by Burns and Kaufman as reflecting sexual alliances in some families. Identical postures of family members also give clues to identification and alliances.

Sometimes the action may appear chaotic and wild. In some of these drawings the wish for control and order to be restored is signified through ‘X’s across those parts of the action particularly significant to the child. An alternative strategy used to represent the wish for control and order is the use of shading across the base of the drawing. This may include shading over those ‘forces’ which threaten boundaries and alliances valued by the child.

Alliances can be conveyed in the drawing through teams playing games together, such as with balls being thrown from one to another. Others might be excluded from the game through compartmentaliz- ation of the drawing, driving off in a car, or being left out of the picture altogether.

Drawing up boundaries 103

Drawing up illness boundaries

Although all these themes and more are interpreted by Burns and Kaufman as reflecting the structure in the families, it is also useful to explore the function of particular behaviour in altering familystructure. All families need ways of re-negotiating family organization in the face of changes in the life-cycle. Their responses to problems or illness may be one way of bringing about a helpful change. The value of looking for the advantage for each family member of the problem continuing has been suggested by Selvini Palazzoli et al. (1978). Sometimes the advantage comes through an alteration in family structure which results from the orientation to the illness, or ‘problem’. The therapeutic goal may then be to find ways of maintaining the structural changes without the problem.

It is possible to explore this through a modification of the K.F.D. task. The child is asked to do a drawing of each person in their family doing something when one person in their family is ill. I have found it most useful to let the child decide which family member shall be ill. This drawing can then be compared with a previous one done using the standard instructions. Clearly there are several alternative modifications to the standard instruction which could be used. One could compare the standard K.F.D. to one depicting how the child wished the family to be, or how the family handled an episode of stealing etc.

Families have always reallocated functions to different family members when one member becomes ill. This may mean, for example, that there is a different provider of food, or people’s need for food alters, so that alliances and boundaries around food themes change. As giving of food is often used to show care during illness, this becomes a particular theme to note. Needs for control may also shift and the control may be provided by different people. Consequently the drawings may illustrate changes in the amount of shading, cross hatching, the presence of ground to the picture, or presence of ‘X’s.

A problem with all the interpretations is to know the form of their validity. Burns and Kaufman felt able to make general statements about the symbols and signs which they saw in K.F.D.s. based on their clinical experience with a large number of cases. I have tried additionally to dis- tinguish the two aspects of what children say-are they saying it primarily to bring about an effect in the listener, or to convey informa- tion?

If they are conveying information it is helpful to elaborate on the assumptions underlying their answers, so that a more comprehensive and genetic picture of their world is built up. In communication a

104 S. Wilkinson hypothesis is deduced by the listener about the nature of these assump- tions. The hypothesis then evolves through testing its explanatory potential in the subsequent discussion until a coherent explanation of the further information coming from the child is available. These assumptions held by the individual child are thus validated within the child’s own framework of beliefs, to the extent that the further discussion was comprehensive and the listener was flexible in developing his provisional hypotheses (Williams, 1981a, 6 ; Will, 1980).

An underlying difficulty is to know how one can separate out the element of the child’s communication which is directed primarily to having an effect on the listener. It is necessary to find out whether the information elicited is a result of seeing the child in that particular setting or if it was that child’s independently-held view (Bronfen- brenner, 1979). In the latter case the child’s underlying views would be the same regardless of the groups in which the child was seen. Through seeing the child both with his family, school peers, and myself, it was possible to distinguish those views largely attributable to the child him- self, especially if one uses the relatively neutral form of interviewing described by Selvini Palazzoli et al. (1980).

Following this form of assessment I believe that the hypotheses which can be developed from the drawings form a very useful base from which contact can be made with the child’s views on boundaries and alliances. I base this on the high degree of validation of these hypotheses which occurred in the subsequent discussion with the children, held using the principles outlined above. The interpretations of the drawings were validated through the way in which they fitted into a coherent picture of the child’s subjective world as revealed in discussion about a wide range of illness themes. These discussions were held in the different settings of family, school and dialogue with myself. In this way I could be clear that I obtained views which were moderately independent of the settings in which they were elicited.

Two examples

I will use the two following pairs of drawings to illustrate some of the observations which can be made (Figures 1-4). Both sets of drawings were done by boys aged eight years who were neither patients nor seen in clinical settings. I will concentrate on looking at boundary issues. After they had finished their drawings they discussed them with me. The following account is therefore a description of the drawings, the children’s accounts and my interpretations. I have not included tran-

Draw& up boundaries 105

scripts of my discussions with the children, but instead have summarized the main themes raised through inspection of the drawings which appeared to be validated in discussion with them.

Figure 1. John’s Kinetic Family Drawing.

Figure 2. John’s drawing of the family in illness.

In the first drawing using the standard K.F.D. instructions there is no compartmentalization but there is little coherence of the three activities. The top figure was described as mother ‘doing the dusting’. Father is the next figure and is much smaller, portrayed ‘OR his way out to play the cello’. In the drawing the boy, ‘John’, is at the bottom of the picture doing something apart from his parents. A11 figures were drawn very lighdy. This also accounts for their poor reproduction.

The picture is markedly different in Figure 2. The three people in this family reverted to closely involved dyadic relationships when one person

Drawing up boundaries 107

was ill as shown in the drawings. The compartments were sharply defined by ruling the lines. In contrast to the first drawing the top people are John and his father, with father described as actively involved in caring. In the bottom picture John’s relationship to his mother is in mirror form to that usually encountered in health as John is described as here caring for his mother rather than vice versa. The instruction had been to do a drawing involving one person being ill, yet everyone had to have their ‘turn’. Father’s turn, though, is less clear than for the others. The drawing shows him without legs, which I interpret as making it impossible for him to be ‘leaving’ the family as he was described as doing in the first drawing. Father appears framed in the drawing and not in a position to lie down to receive care from his wife, who although ‘preparing food for him’ seems to me ambivalent about it, the cooker appearing as a form of barrier.

This pair of drawings is interpreted according to the categories described here. They show the way in which alliances can be created in illness. Father’s position on the outskirts of the healthy family is initially portrayed. Illness can be seen to have a r61e to keep him more involved for the child only. The parents appear to have a boundary more clearly developed between them than around them. This theme is hinted at in the first drawing but becomes clearer in Figure 2.

Figure 3. Davids Kinetic Family Drawing.

108 S. Wilkinson

Figure 4. Davids drawing of the family in illness.

The other pair of drawings (Figures 3 and 4) show a different impact of illness. The first drawing of the family is highly compartmentalized with the parents in the centre and the children at the sides. The parents are described ‘doing their own things’. The ‘X’ across mother as part of her ironing board could b.e interpreted as representing some wish to control her provision of warmth. Father is ‘digging with his spade’. These figures in the original pencil drawings were all equally firmly drawn, and relative sizes of the people suggested equal significance of mother and father. The one person whom I interpret as keeping his emotions hidden, revealing only his back, is the boy who did the drawing, ‘David’.

The impact of illness alters the whole structure. David is now the sole focus of the parents’ activities. He appears to have established a boundary round his own compartment. I interpret this as potentially controlling too much intrusion by his parents or protecting them from him as his own particular form of quarantine boundary. His younger sister is excluded altogether from this picture, which I interpret as a way of recreating in illness the initial family threesome, in which the exist- ence of his younger sister is denied. The parents appear to become united in their task to make him better, with no boundary drawn between them, as mother telephones the doctor and father comes with medicine. Both rbles were described with equal importance and linked together through the medical advice given over the telephone. The parental emotions have changed. In the drawing their smiling faces have disappeared, and mother’s face is not even shown. David meanwhile appears faceless

Drawing up boundaries 109

which I interpret as an avoidance of his own emotions. Additionally his arms are not included, possibly being Davids way of saying that he had no hand to play in creating his illness.

Discussion

My aim here has been to illustrate a technique for finding out the child’s perspective on family boundaries and how these can be altered in illness. I illustrated this with two examples. I now wish to place these changes brought about by illness in their social context, that of the adult views on illness. In this way it is possible to appreciate some of the social and developmental influences which could have aided the formation of these children’s perspectives.

When Herzlich (1973) surveyed the views on illness in her adult samples she felt that their responses to illness fell into three categories. She labelled these as illness being ‘destructive’, ‘liberating’ or an ‘occupa- tion’. She was using the individual’s own perspective on their illness and did not have the benefit of an objective developmental history in order to interpret the origins of these views. I believe it particularly useful to look again at the examples which I used to illustrate the technique, as they can also be categorized according to the same schema. In this way potential origins of the adult views can be postulated, and a develop- mental perspective can be integrated into the currently rapidly expanding field of medical anthropology as well as the more widely known, in this context, family therapy literature.

In discussion with John it became clear that the altered boundaries in illness emphasized the pain of the lack of care between the parents. This was less prominent when they were healthy. The closeness which illness generated for him and mother on the one hand, and father and John on the other, could have been perceived warmly and as potentially liberating from his apparent isolation. However, at this stage it was not interpreted as such by him. John perceived the ‘destruction’ of the relations between the three moderately independent people, as portrayed in the first drawing, as relatively more important. This was in spite of the way in which the coherence of the three figures can appear minimal to an outside observer. John’s understanding of the sick rble could therefore be described as an early stage of a ‘destructive’ view of ill- ness.

It was also important to record how David perceived the effects of his illness, rather than imposing my views on it. In discussion he described advantages in having his parents to himself. He described his parents as

more united in this situation. In other words the advantages came from the alterations in alliances and boundaries. Emotional pain was blanked out as indicated by the ‘blank faces in the drawing. The importance of emotions could have influenced him to categorize the situation as ‘destructive’. Instead it was the altered alliances which proved to be the more salient for him. In contrast to John, Davids ‘use’ of illness could be interpreted as a precursor to the adult ‘liberating’ view of illness. This could only persist if family structure continued to alter in a way which David continued to perceive as ‘liberating’.

Whether these boys will feel the same way about their experiences of illness in the future is a different question demanding a different form of enquiry. My emphasis has been to compare the lay concepts of illness of adults with those from the two boys I describe here, in order to add weight to the understanding of illness behaviour in terms of the advantages and disadvantages which accrue to the family organization.

Conclusion

1 believe that this technique is useful for gaining an understanding about family structure and how this can alter in the face of illness. It especially emphasizes the usefulness of obtaining the child’s own perspective in a non-verbal fashion. It is only the child who can definitively categorize the family reorganization in terms of whether their response is ‘destruc- tive’ or ‘liberating’ for him.

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