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Client R was a young man diagnosed schizophrenic. He was extremely fearful of interaction with
others. He had got into trouble with the Police and had been Sectioned. His art work was based
around fortress-like buildings, with ghosts seeping out of them. He didn't want to talk about
these ghosts, which had fierce faces, with open mouths. R was afraid to talk about the ghosts
because he didn't want to know what they meant. He was suicidal and agoraphobic.

Another piece of art work shows a landscape, hill after hill like a patchwork quilt. Each hill has a
crucifixion scene with three figures, Christ and the two thieves. R talked about this image quite
openly. He said he was angry because every time he climbed a hill, another loomed up in front
of him. However, in a small corner there is a small hill without a crucifixion on it, and I
wondered what that hill was and where it was, and had he lost that place in his own mind – his
own 'piece' of mind.

The quilted landscape was rainbow pastel colours. I asked the client which colour stood out for
him. He replied, 'To God, all colours are equal'. The issues that were central in my relationship
with this client were the issue of colour and racism, and the client's fear of being seen.

Client D. was told by his psychiatrist that 'he thought D. might be' schizophrenic. He shows
symptoms of delusions, hallucinations and thought broadcasting. He freely talked about this in
the sessions. This client used landscape to express himself as well. He depicts himself in a bubble
floating around. In the last few sessions, the bubble turns into the womb of a pregnant sea-horse.

The major issues around working with this client were identity and the sense of fragmentation,
the loss of self. The bubble showed his sense of disconnectedness from family and community.
The womb of the pregnant sea-horse, he felt was his old self coming back to life. Through
therapy, he believed he was giving birth to his old self again.

The issues we faced together centred around the fact that felt he had no positive sense of his skin
colour. (He was mixed race.) He had no positive sense of his own sexuality – he said he had been
abused as a child. Religion was also very important in his life.

5. The issue of skin

As a therapist, I am keenly aware of the issue of skin, and the power struggle that can go on
between a therapist and a client over the issue of skin. A few of my clients were mixed-race.
Some of my clients at Pittsmoor Day Centre were white. For the therapeutic relationship to be a
success, one has got to address the issue of skin.

Many clients, white or black, view black professionals with suspicion. I was asked many times,
'Was I qualified?' Yet the black clients were deeply suspicious of white professionals because of
the historical fact of white dominance. The white therapist is seen as wielding the power that
white has over black.

I have followed Klein's theory on the splitting of the ego. Bick's theory on skin [1988] I have
found more relevant to the black experience, in that we have to hold our skin together in the
face of the onslaught of white society. The ego develops through the skin, and what the skin
absorbs. The skin contains the self. Fernando [1991] talks of skin as being the determinant of self-

In Yoruba society, the skin is the particular 'suit of clothes' that your spirit wears. This is how the
artist Tam Joseph describes himself: