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      FOCUS: A Guide to AIDS Research and Counseling
      Volume 9, Number 2 - January 1994
      ----------------------------------------------

      Editorial: Truth and Metaphor
      Robert Marks, Editor

      Perhaps all psychotherapy involves interpreting metaphor.
The unmentionable, the awesome, the overwhelming in our lives is
most often conceived in metaphorical terms, allowing the
conscious to distance itself from what it is too disturbing to
approach. AIDS, stigma, disability, dying, and death, itself,
certainly meet this definition, and the epidemic's challenges
lend themselves to metaphor to help integrate and master them.

      Jung, the Swiss psychologist, was the master of the use of
archetypal symbols: metaphors for the fundamental, universal,
but ultimately unknowable "ordering principles of the collective
psyche" (see the first "Recent Report" in this issue). Jung saw
these devices as the bridge between the unconscious and the
conscious, between unknowing and awareness.

      Therapy and Archetypes

      In this issue of FOCUS, we present two applications of the
archetype to HIV-related therapy. Using folkloric stories to
identify basic archetypal symbols, Allan C. Chinen debunks the
myth of the Hero as it relates to the healer. He presents,
instead, an equally venerable archetype, the Trickster, and
offers therapists an analysis that suggests alternatives to
burnout. Robert Bosnak approaches the archetype from the
perspective of client-centered counseling, explaining how
therapists can use dreams to help clients define and work
through emotional responses and their physical manifestations.

      Chinen and Bosnak both offer ways to hook into the
universal truth represented by archetypes, but they approach it
from opposite directions. Chinen uses the story, the folk-tale,
told to us by our parents and teachers: a received truth that
crosses culture and time. Bosnak searches for the reflection of
these truths inside our dreams, where we are the storytellers,
where the truth is ultimately personalized. Each opens the door
to a cognitive exploration that urges truth toward
transformation.

      Defining Universal Metaphors

      Practitioners might find such alternative therapeutic
approaches useful as tools to help them handle the response to
an epidemic that is becoming more, not less, complicated. It is
especially crucial--at a time when cultural differences threaten
to impair understanding among practitioners and between
therapists and clients--to defining universal truths and common
cultural metaphors.

      **********************
      Beyond the Hero-Healer
      Allan B. Chinen, MD

      The ancient image of the Hero appears in countless myths
and folk-tales, and his example motivates many therapists today.
For healers working with AIDS, the heroic ideal often takes the
form of an unconscious fantasy about rescuing other people,
conquering illness, or defeating death. Against an adversary
like HIV, however, which cannot yet be conquered, heroic efforts
often lead to therapist burnout. Is there an alternative to the
ideal of the hero?[1, 2] Myths and folk-tales can provide a
surprising answer--the Trickster.

      The Trickster is usually considered a juvenile delinquent
or a sociopath, but this is wrong. Contemporary research in
folklore reveals that the Trickster is a powerful, positive,
generative figure, who typically brings to humanity language,
fire, and healing. In fact, the Trickster embodies an
alternative to the Hero for people with HIV disease, and
perhaps, most poignantly, for their healers. In particular, the
Trickster shows how therapists can avoid heroic burnout. A fairy
tale from the Grimms--"Brother Lustig"--highlights the
Trickster's wisdom and offers five insights for therapists.[2]

      "Brother Lustig"

      Once upon a time, a man named Lustig served in the King's
army. After 25 years of loyal service, the King dismissed Lustig
with only a loaf of bread and four coins. Lustig decided to
wander the road, and as he traveled, he met three beggars one
after the other. Lustig gave each poor man a slice of bread and
a coin, not knowing that the beggars were really St. Peter in
different disguises.

      St. Peter reappeared as a soldier and started traveling
with Lustig. They came to a kingdom where the daughter of the
King had just died. St. Peter went to the King and offered to
resurrect the Princess. Assisted by Lustig, the apostle cut up
the Princess' body, boiled the pieces in a pot until only bones
were left, laid the skeleton on the bed, and commanded the
Princess to arise. She reappeared, healed and whole. The
overjoyed King and Queen offered a great reward, but St. Peter
refused anything. So Lustig hinted for something, and the King
filled his knapsack with gold. The two men parted ways, and
Lustig continued his travels on his own.

      Lustig soon spent all his money. He came to another
kingdom where the daughter of the King had just died, so,
thinking he could win a great reward, he tried to raise her from
the dead. Unfortunately, Lustig could not revive the Princess.
St. Peter, still disguised as a soldier, passed by and saw
Lustig in his plight. The apostle, after making Lustig promise
not to take any reward, resurrected the Princess. To prevent
Lustig from being tempted to raise the dead again, St. Peter
gave him a magic knapsack. Whatever Lustig wished to go into the
pack, the apostle explained, would do so.

      Lustig resumed his journey and came to a haunted castle.
Unafraid of ghosts, he decided to stay the night. At midnight,
he was attacked by many demons. He fought back, but was soon in
desperate straits. Then he remembered the magic knapsack. "Into
my pack with you demons!" he cried out. Instantly, the demons
were trapped in the pack, and Lustig slept peacefully through
the night. In the morning, he asked a smith to pound his pack,
killing all the demons except one tiny imp, who escaped back to
Hell barely alive.

      After many years, Lustig met a holy hermit who told him he
could take one of two paths: a long, difficult trail that went
to Heaven, or an easy, pleasant road ending in Hell. Lustig took
the easy route and soon arrived at Hell. When the gatekeeper saw
Lustig, the devil locked the door. He was the imp who had
escaped the beating in Lustig's knapsack! He told all the demons
in Hell not to let Lustig in, lest the old soldier wish everyone
into his pack. So Lustig labored up the narrow path and reached
Heaven. Lustig recognized his old comrade, but St. Peter refused
to admit him to Heaven.

      Lustig shoved his magic pack through the gate. "If you
won't have me, I don't want anything from you, so take your
knapsack back." When St. Peter put the bag next to him, Lustig
cried out, "Into the pack with me!" Lustig climbed out of the
knapsack, and St. Peter did not have the heart to throw him out
of Heaven.

      Healers as Comrades

      The tale begins with the collapse of the heroic ideal: a
soldier, an archetypal heroic figure, is dismissed with almost
nothing to show for his 25 years of loyal service.  Lustig
dramatizes the plight of therapists working with AIDS: after
long, heroic struggles with the epidemic, we often feel we are
left with nothing but despair, cynicism, and exhaustion. The
King's betrayal of Lustig highlights another response of
healers-feeling abandoned by society, given few emotional and
financial resources for work with HIV-infected clients .

      Unlike the Hero, who would rebel against and defy an
unjust king, Lustig is not angry at his plight. He remains
active, involved, and open to new events. This is a major task
for therapists: leaving the hero's anger and despair behind, and
embracing a flexible exploratory attitude, more typical of the
Trickster. Indeed, when therapists, like Lustig, remain open,
astonishing developments occur.

      As Lustig travels, St. Peter appears in various disguises
and plays tricks on him. The apostle functions as the Trickster.
Yet St. Peter also helps the soldier, later giving him the magic
knapsack. St. Peter is, in fact, a helpful companion, acting as
mentor and teacher to Lustig. Yet the two men also treat each
other as comrades, and the very title of the story, "Brother
Lustig," emphasizes their fraternity. The story contains a vital
insight here: healers, no less than Lustig, need comrades,
mentors, and teachers.

      For therapists, this may mean joining a support group,
finding a spiritual advisor, seeing a therapist, or seeking
supervision. But the helpful "brother" can be an inner figure,
too, who may appear in dreams and visions. For example, C. G.
Jung, during his midlife crisis, turned to "Philemon," a
Trickster figure who first appeared in Jung's dreams. The chief
obstacle in finding a helpful comrade, inner or outer, is
reluctance to ask for help. Heroes, after all are supposed to be
solitary, like John Wayne. In seeking help, however, therapists
break free of the hero's spell, and move on to the next stage of
the journey, which involves the power to heal.

      St. Peter resurrects the two Princesses, he demonstrates
the most dramatic form of healing. The story reveals that the
Trickster is a healer, and in the mythology of most cultures,
the Trickster brings vital medicines and healing rites to
humanity. The Trickster is closely related to the oldest known
healing figure--the Shaman--and St. Peter's ritual directly
reflects ancient shamanic tradition across the world. Shamans
are typically initiated by a vision of being dismembered,
reduced to a skeleton and then resurrected, and shamans use this
imagery in their healing rituals. Lustig's tale thus emphasizes
an unexpected aspect of the Trickster: he is a shaman. Indeed,
as Jung and Joseph Campbell suggest, the Shaman and Trickster
constitute a single archetype. As "Brother Lustig" demonstrates,
the image of the Shaman-Trickster offers therapists vital
advice.

      The Therapist as Shaman-Trickster

      First, the Shaman-Trickster emphasizes that therapists
must accept the dark underworld, which is so evident in AIDS
work. Where the hero tries to conquer evil and suffering,
slaying the dragon or the witch, shamans descend into the
underworld, where they suffer greatly at the hands of evil
spirits. Only then do shamans gain the power to heal.
Psychologically speaking, as therapists, we must descend with
our clients into the underworld of pain, helplessness, fear,
despair, and rage. From this experience of death and rebirth
comes unexpected new life. Most therapists have witnessed such
transformations in some HIV-infected clients: individuals who
have struggled through despair and rage arrive at an inner
serenity, often resolving lifelong conflicts and doubts. Because
the descent is difficult, it is another reason therapists need
an inner or outer companion. We, ourselves, need help as we
enter the underworld with our clients.


      Second, the Shaman-Trickster stresses that the power of
healing does not come from the ego. When Lustig tries to
resurrect a dead princess on his own, he fails. The power of
life comes from St. Peter, the divine Trickster, not Lustig, the
mortal. The capacity to heal ultimately comes from a
transcendent source. Indeed, in mythology, the Trickster is sent
specifically by the Supreme Deity to clear the world of demons
and disease, making it safe for humanity. Whether conceived of
as God, the life force, a great mystery, or a Higher Power, the
power of healing comes from beyond the healer's ego. Relying
only on the ego, in fact, quickly leads to burnout.

      For therapists, transcending the ego means suspending tidy
preconceptions about healing, because healing may take
unexpected forms with our clients. Therapists also need a
spiritual practice, whether meditation, prayer, or communal
worship, because responding to the challenges of AIDS is
ultimately a spiritual problem, involving painful questions
about the meaning of life, suffering, and death.

      Third, the story tells us that therapists must acknowledge
their own needs. St. Peter declines any reward for curing the
farmer or resurrecting the princesses, while Lustig asks for
something. The story nicely summarizes a conflict most
therapists feel: the idealistic urge to help, on the one hand,
as symbolized by the sainted apostle, versus the need for
personal reward, on the other, as personified by the practical
soldier. As a spirit, St. Peter does not need to eat, while
Lustig--and therapists--do.

      Transcendent spirituality is important for healers, but so
is taking care of our own human needs. Excessive altruism leads
to burnout and often reflects a hidden arrogance- the hero's
secret belief that he has infinite resources, that he can do
anything he wills or wants.

      Fourth, the Shaman-Trickster brings an irreverent humor
that is useful in therapy. Lustig's story continually makes fun
of Christian doctrines, like presenting St. Peter as a Trickster
rather than a holy patriarch. Satire is a vital function of the
Trickster. In Native American tradition, Tricksters take the
form of holy clowns who carry out outrageous antics during
solemn tribal rituals.

      The Trickster's irreverent humor has two vital lessons for
therapists. Dark wit helps us cope with tragedy. As Freud
pointed out, gallows humor is actually one of the most mature
forms of defense. Such black humor is essential for preventing
emotional exhaustion from AIDS work, and can be healing for
clients too. The Trickster's satire, in fact, breaks down social
conventions, and helps HIV-infected clients break free from
traditional roles and beliefs so they can discover their own,
unique, authentic selves.

      Finally, the Shaman-Trickster teaches that the role of
therapy is to integrate darkness and light. In the final
episode, Lustig travels to Hell and Heaven, to the underworld
and the upper world. His journey represents what is perhaps the
central task for therapists working with AIDS: to come to terms
with the suffering, despair, and rage-Hell-and yet not to lose
sight of spiritual development and transcendent insights-Heaven.
Most therapists have witnessed such profound personal
transformations in HIV-infected clients-the breakthrough, in the
midst of suffering, of radical peace and moments of wholeness.
These epiphanies remind us of the Trickster's ultimate
purpose-not to defeat death, but to bring light and meaning into
suffering.

      Traveling to Hell and Heaven is also a central function of
shamans. The story shows how Lustig has become a master
Shaman-Trickster, having learned from St. Peter, his spiritual
mentor. Lustig has matured from a youthful Soldier-Hero to a
wizened Shaman-Trickster, and his development demonstrates the
healer's inner journey.

      Conclusion

      This is a brief discussion of an abbreviated tale. The
story has many more symbolic meanings, but its principal message
is clear for therapists: when the ideal of the heroic healer
collapses, destroyed by the tragedy of AIDS, the
Shaman-Trickster offers an alternative to the heroic cycle of
valiant struggle, exhaustion, and burnout.

      The image of the Trickster can be supportive for people
with HIV disease as well. The tools of the Trickster-healing
instead of heroism, humor rather than hierarchy, communication
over conquest, and exploration in lieu of exploitation- are a
prescription for living with HIV disease as well as maintaining
ourselves while ministering to clients.

      One final gift from the Shaman-Trickster is crucial: he is
a storyteller, and through tales like "Brother Lustig," he gives
us insight and encouragement. We can, in turn, use these stories
with clients. As a Hasidic proverb says, "Tell someone a fact
and you reach their mind. Tell them a story and you touch their
soul." Through such soul-stories, outrageous and touching,
spiritual and practical, the Shaman-Trickster brings the promise
of healing to the mortal world.

      Authors

      Allan B. Chinen, MD is Associate Clinical Professor of
      Psychiatry at the University of California San Francisco
      and a therapist in private practice. He lectures widely on
      the use of fairy tales and myth in psychotherapy and the
      psychological tasks of midlife and aging.


      *********

      Dreamwork and AIDS
      Robert Bosnak, JD, IAAP

      A man with AIDS presents a dream in a dream group:

           I'm in a familiar room with other people I don't feel
           connected to.  I see my father who rejected me when he
           heard I had AIDS.  Now he tries to make it up to me.
           I don't want to have anything to do with him and push
           him away. Then I see a corridor behind the house where
           many people go in and out of rooms.  There I see my
           deceased grandmother.  She does not know I have AIDS
           or that I'm gay. She embraces me.

      Group dreamwork is based on C. C. Jung's notion of the
reality of the psyche.  Whereas Freud posits that psyche is
ultimately derived from external events and dream images should,
therefore, be reduced to their external causes, Jung believes
that psyche is a realm unto itself, related to external reality
but not reducible to it. So real is the dream-world that most
individuals, anywhere on the planet, are most of the time
convinced that they are awake while they are dreaming. It is
only waking consciousness in its daytime arrogance that declares
the dream-world less real.

      Our dreamwork makes use of the reality of the psyche by
leading the dreamer back to the direct experience of dreaming.
We do so by lowering the threshold of consciousness until it
hovers above dreaming, staying just abreast of falling asleep.
If we fall asleep, the work stops.  If we move too far into
wakefulness, the sense of the reality of the dream-world
diminishes. The dream group assists the dreamer in the effort to
stay in this in-between consciousness. In this way, there emerge
emotional realities previously hidden from awareness.

      Dreamwork is particularly helpful for people infected with
HIV because it releases the energy it takes to repress the host
of unconscious emotions HIV infection provokes, energy that
HIV-infected people cannot spare. Working with HIV-infected
people in groups also breaks through the isolation of serious
illness. To experience others in the dramatic struggle with an
often harsh inner world gives members of the group a profound
sense of belonging.

      Dreamwork can be practiced by any skilled psychotherapist.
The most important attitude is the realization that a dream is
an unconscious product and, therefore, in principle, unknowable.
Stay with the uncomfortable confusion of the unknown, a state
full of profound emotions. In addition, Jung believed that
paradox is one of the most fundamental and healing experiences
a human being can go through. Look for the most contrasting
emotions in dreams, and try to feel them as close together as
possible.

      The Dreamwork Process

      The group leads the dreamer of the "grandmother" dream
back to the experience of being in the room with his father by
helping him conduct a thorough investigation of the room. "What
kind of light is in the room?  Objects?  Where is the coffee
table?  What is on the coffee table?  Is it a large book?  Are
the pictures in the book color or black and white?  Where is
father in relation to the coffee table?  What is father's
posture?"  As the dreamer remembers more and more detail, he
finds himself back inside the space where, only a few hours ago,
he actually met this likeness of his father, this father of his
dream.

      This detailed recollection evokes the atmosphere of the
dream, and the dreamer sobs profoundly upon recalling his
father's rejection. He feels the rage against his father and the
father-world that rejects his sexuality. When the atmosphere
recreated by the dreamwork truly feels as if it accurately
resembles the atmosphere of the dream, we begin to observe the
father closely. We observe how he stands and moves, and what
emotions he conveys. Suddenly we find ourselves identified with
the father, and we can feel the remorse in the father's heart.
Although he can't forgive his father, the dreamer feels less
alienated from him.

      The corridor behind the house is stark and hollow, like a
hospital, where people wander in and out of rooms. When the
dreamer returns to the detailed recollection, finding himself
once again in the corridor, he remembers that it feels as if it
is the afterlife, the corridor separating death and life. He can
feel how AIDS has permanently located him here. The starkness of
this realization makes the 14 group members shudder. Many of us
weep. The alienation the dreamer is feeling breaks, and he finds
himself in his grandmother's arms, feeling her total acceptance.

      The dream group then returns to the previous feeling of
rejection and helps the dreamer move back and forth between the
polar opposites of rejection and acceptance. After a while the
dreamer is able to experience these feelings simultaneously,
thus moving to the heart of the paradox. The contrast between
this acceptance and the earlier feeling of utter rejection
stretches the dreamer's soul to the utmost, making it tense like
a violin string. Suddenly he can feel the release of catharsis,
and experiences it as quiet and sad. The group feels the
catharsis with him, like an audience of a classical tragedy
witnessing the torment of the protagonist. For a moment we are
all heartbreakingly close.

      By leading the dreamer to the core of the paradoxical
emotions inherent in the AIDS experience, the dreamwork releases
a profound new vitality. Michael Dupre, in an advanced stage of
AIDS, refers to this physical release in an article in which he
describes dreamwork: "I will share with the reader that as part
of the aftermath of this dream, I enjoyed three weeks of normal
bowel movements. It's funny to hear that, but the experience was
wonderful."

      The Value of Dreamwork

      Dreamwork can provide a counterforce to the sense of
rejection--a volatile mixture of shame and self-loathing--that
many people with HIV disease suffer. This self-loathing cannot
be approached in a rational way: the societal encouragement to
accept oneself evaporates in the face of the poisonous feelings
of alienation. Often, these feelings, as well as the animal fear
of death, are repressed with a kind of pseudo-spirituality that
enables a person to leave behind the suffering body and
experience a kind of disembodied transcendence. The result of
repressing unwanted emotion into the body is a feeling of
well-being leading to an increase of physical symptoms.

      Dreamwork helps to avoid this false sense of well-being,
because it offers a path between repression and
pseudo-transcendence. Through dreamwork a person with HIV
disease can experience the fear of death and alienation, and the
bliss of love and acceptance simultaneously. This insight into
life's paradox has a healing result.

      Group dreamwork is body-centered, and the dreamer explores
each emerging physical sensation. When these sensations are
focused on, they can "melt" into deeply felt emotion. This
relieves the body and, at the same time, provides a visceral
experience of emotion. In this way, emotions become undeniable,
leaving the dreamer no option but to acknowledge them.

      Conclusion

      Dreamwork can deal with death and dying like few other
forms of therapy. The "grandmother" dreamer was able to
experience what it is like to be in the corridor between two
worlds. He did not experience this as concept, this in-between,
but as an actual location. Dreamwork may orient people in their
illness and give back to them a sense of direction and feeling
of identity. Therapists working with people with HIV disease
should consider harnessing this powerful technique.

      References

      1. Dupre M. Russia, dreaming, liberation. Dreaming. 1992;
2(2): 123-134.

      Authors

      Robert Bosnak, JD, IAAP is a Jungian analyst in Cambridge,
      Massachusetts. He is the author of Dreaming with an AIDS
      Patient (Shambhala Publishers, 1989) and A Little Course
      in Dreams (Shambhala Publishers, 1988).

      ************
      Comments and Submissions

      We invite readers to send letters responding to articles
published in FOCUS or dealing with current AIDS research and
counseling issues. We also encourage readers to submit article
proposals, including a summary of the idea and a detailed
outline of the article. Send correspondence to:

      Editor
      FOCUS
      UCSF AIDS Health Project
      Box 0884
      San Francisco, CA 94143-0884

      Recent Reports

      Archetypal Symbols, Death, and Dying
      Welman M, Faber PA.  The dream in terminal illness: A
      Jungian formulation. Journal of Analytical Psychology.
      1992;37(1):61-81

      Using dream imagery can help clinicians treating
terminally-ill patients by offering insights into the
unconscious processes intrinsic to life-threatening illness,
according to an overview of Jungian dream archetypes and a dream
history of one patient. Such therapy also assists patients by
providing some relief from the uncertainty and isolation
engendered during the dying process.

      As part of a larger study, researchers concentrated on the
dreams of one cancer patient--a 70-year-old man who was
terminally ill with prostate cancer whose dream material
reflected the material recorded by other study participants.
Over six months, the patient recorded seven dreams, each of
which consistently revealed allusions to death and post-mortal
existence. Researchers interpreted the dreams as a series, that
is, conclusions regarding any one dream were supported or
refuted by related dream material, and refuted material was
excluded in the final analysis. In order to prevent influencing
subsequent dreams, researchers did not relate the dream
interpretation to the dreamer.

      According to Jung, archetypal dreams anticipate and
orchestrate psychical transformation that occurs during critical
developmental stages including dying. Archetypes are the
universal and fundamental ordering principles of the collective
psyche. Archetypal symbols derive from archetypes, pertain to
the problems and mysteries of everyday life, and mediate between
the conscious and the unconscious. Archetypal dreams--as opposed
to personal dreams--allude to archetypal symbols, and typically
display irrational plot development, intense emotion, and
remoteness from everyday events.

      Archetypal images manifest in dreams when people face
particularly powerful events such as terminal illness or death.
Archetypes facilitate psychological transformation, because they
to the conscious attention of the dreamer otherwise unconscious
emotions. Archetypal symbols--because of their mediation of the
unconscious--can transform the dying process into a more
positive event, a time of enhanced creativity in living, if the
dreamer is able to relate to and consciously interstate these
symbols.

      The cancer patient's seven dreams presented a range of
symbols. Analysis most readily identified the image of
post-mortal existence, that is, the idea of the beginning of new
life or the continuation of psychical life after death. In one
dream, the patient reported having seen a bright flower and
thinking that he had always wanted such a flower in his garden.
According to Jung, flowers are archetypes from Persian mysticism
and Egyptian folklore--that symbolize post-mortal existence and
the resurrection of the body.

      In another dream, the patient saw himself as having two
bodies fitting together like two parts, one body slowly floating
away from the other.  This symbol--from alchemist Paracelsus,
and Bolivian, Eastern, and Egyptian folklore--expresses the
conviction of life after death. Other images included items with
a violin- or cello-like shape, a reference to the mother and
daughter Roman goddesses Demeter and Persephone and the allegory
of death, immortality, and rebirth.

      For the patient, dream analysis was useful. When he was
diagnosed and told he had six months to live, the patient
continually denied the diagnosis. His dreams, however laced with
death imagery, helped the patient to confront physical reality.
Symbolically, the patient's dreams represented periods of
confrontation, realization, acceptance, and enlightenment.
Indeed, when the patient did face death, he showed no signs of
anger, regret, fear, or denial.

      ---------------------
      Art Therapy and HIV Disease

      Edwards, CM.  Art therapy with HIV-positive patients:
      Hardiness, creativity and meaning.  The Arts in
      Psychotherapy. 1993;20:325-333 (Walter Reed Army Medical
      Center, Washington, D.C.)

      Art therapy helps facilitate mourning and enables
therapists to define client issues, according to a commentary on
this technique. An analysis of the artwork of more than 600 HIV-
infected patients suggests distinct themes and visual
characteristics that can be helpful in identifying emotional
states.

      Drawings done by patients shortly after they learned they
were HIV-infected were characterized by disorganization,
fragmentation, and dark, empty areas, revealing shock and
helplessness. Opposing shapes, sharp edges, and diagonals
expressed anxiety and rage, and abstract geometric designs
seemed to bind anxiety or contain intense emotion. Dead trees,
empty landscapes, and coffin-like shapes expressed depression
and mourning. Divisions of space and content reflected
isolation, stigmatization, and guilt. Faces, eyes, and
boundaries represented paranoid fears, while tears, drooping
flowers, and shrunken images represented sadness.

      Artwork seemed to facilitate not only mourning, but also,
once past this stage, restitution to a more positive outlook. At
that time, images such as the sun, rainbows, home, church, and
material comforts began to appear. A flower, for example,
expressed caring, nurturing, and the continuity of life. Artwork
also served to restore patients by facilitating a "high" when
they had produced outstanding, creative, or respected pieces of
art.

      Artwork also enabled patients to strengthen problem
solving skills and creativity, and to create challenges,
commitments, and goals. Thus, in addition to helping discover,
analyze, and work through emotions, producing art helped
patients to identify sources of meaning, and strengthen
characteristics that correlate positively with long-term
survival.

      --------------------------------
      Story Telling and HIV Prevention

      Bracho de Carpio A, Carpio-Cedraro FF, Anderson L.
      Hispanic families learning and teaching about AIDS: A
      participatory approach at the community level. Hispanic
      Journal of Behavioral Sciences. 1990; 12(2):165-176. (LA
      CASA Family Services, Detroit, Michigan.)

      An overview of a Detroit HIV prevention program suggests
that stories can help Hispanic families explore HIV-related
knowledge, attitudes, and beliefs, and enable parents to talk to
their children about AIDS.

      The program has three objectives. First, it seeks to allow
participants to share with the group their HIV-related
behaviors, and knowledge, attitudes, and beliefs. Second, it
seeks to enable participants to identify effective prevention
strategies at the individual, family, and community levels, and
the main issues involving implementation. Third, it seeks to
encourage participants to model for each other HIV-related
family communication techniques.

      The program is based on the concept that discussion will
help participants clarify their understanding of the story and
integrate communication skills and HIV prevention into their
lives. To recruit Hispanic families into the prevention program,
community workers approach a family member, arrange to meet the
family, and describe the program to the family. Often the family
agrees to host a session and invite several other families to
their house. At the session, a counselor presents a story and
facilitates discussion by asking participants to respond to the
children's--the main characters of the story--concerns.

      While the stories are fairly basic, they prove useful as
an opening to discussions to explore what families know and feel
about HIV disease. For example, to raise this issue of talking
to children about the fears of AIDS and death, the program uses
the story of a little girl who hears from a friend that the
friend's mother has HIV disease. The little girl immediately has
all sorts of fears about her own mother becoming infected, and
relates these fears to her father.

      The story has been piloted with more than 30 parents and
12 preteens in the community. Early evaluations of the program
show that the story method is well-accepted by both counselors
and participants, and is effective in increasing knowledge,
developing skills, and overcoming attitudinal barriers,
prejudices, and misinformation about HIV disease.

      ***********
      Next Month

      Social class represents perhaps the greatest divide in
western society, eclipsing even race as a barrier among people.
In the February issue of FOCUS, Gary W. Dowsete, PhD, Deputy
Head of the National Centre for HIV Social Research, at
Macquarie University in Sydney, Australia, reports on an
Australian study of homosexually active, working-class men. He
discusses two issues in particular: the responses of these men
to prevention education materials designed and disseminated by
gay community-based organizations; and the relations of these
men to established and recognizable gay communities.

      Also in the February issue, Barry Chersky, MA, a counselor
and trainer on discrimination in the workplace, and Michael
Siever, PhD, director of a substance abuse program, discuss
approaches therapists can take when counseling working-class gay
men.

      Copyright (c) 1994 - Reproduced with Permission.
      Reproduction of FOCUS must be cleared through the Editor,
      FOCUS --UCSF AIDS Health Project, Box 0884, San Francisco,
      CA 94143-0884, [phone].  Subscription information:
      12 monthly issues- $36 individuals; $90 institutions.