Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Unconscious communication of children in psychotherapy : analysis of sessions with respect to variables… Bonac, Vesna A. 1991

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1991_A8 B66.pdf [ 7.15MB ]
Metadata
JSON: 831-1.0053721.json
JSON-LD: 831-1.0053721-ld.json
RDF/XML (Pretty): 831-1.0053721-rdf.xml
RDF/JSON: 831-1.0053721-rdf.json
Turtle: 831-1.0053721-turtle.txt
N-Triples: 831-1.0053721-rdf-ntriples.txt
Original Record: 831-1.0053721-source.json
Full Text
831-1.0053721-fulltext.txt
Citation
831-1.0053721.ris

Full Text

Unconscious Communication of Children i n Psychotherapy: Analysis of Sessions With Respect to Variables Pertaining to Langsian Ground Rules of Psychotherapeutic Relationship by Vesna A. Bonac B. A., Vassar College, 1968 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department of Counselling Psychology) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA November 1991 (c) Vesna A. Bonac, 1991 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of The University of British Columbia Vancouver, Canada Date jo Septehiber /^/ DE-6 (2/88) ABSTRACT The central thesis of t h i s study says that the ground rules and boundaries of the psychotherapeutic r e l a t i o n s h i p (the frame), as defined by Robert Langs f o r adults and adolescents, are the same for children. Transcripts from memory of v e r b a l i s a t i o n and behaviours from 12 sessions of children i n i n d i v i d u a l psychotherapy were analyzed with the purpose to t e s t Langsian communicative psychoanalytic hypotheses. Unconscious communications were analyzed i n accordance with Langs' theories to determine the impact of the state of the frame on children. The dependent variable, unconscious communication, was analyzed with respect to the following nine independent variables of the frame: (a) change i n therapy rooms, (b) audio recording of session, (c) missed sessions and holidays, (d) therapist's contact t h i r d parties, (e) disruption of session, (f) time extension and time reduction of session, (g) observation mirror, (h) forced termination of treatment, and (i) touching toys. The analysis of data was li m i t e d to: (a) tr i g g e r s , (b) p o l a r i t y of themes and images, (c) perceptions of the therapist, (d) models of r e c t i f i c a t i o n , and (e) v i c i s s i t u d e s of resistances. This i s a limited, multiple case empirical study of two boys (ages 5 and 11) and one g i r l (age 6) i n i n d i v i d u a l psychotherapy i n a public c l i n i c s e t t i n g . The process of unconscious v a l i d a t i o n and non-validation by the c l i e n t was used to determine the correctness of i n d i v i d u a l hypotheses, which were formed for each session on the basis of the state of the frame. Conclusive empirical proof of the e f f e c t s of three types of breaks i n the frame on the process of c h i l d psychotherapy i s presented: contact with t h i r d p a r t i e s , observation mirror, and changing the time for sessions adversely influence the process of c h i l d psychotherapy. These three findings were made possible because the available data included the breaking as well as securing of the frame which permitted the execution of complete Langsian analysis. Each of the three instances represents a piece of conclusive evidence of the p r e d i c t i v e value of Langs' theory regarding children and therefore conclusive evidence of the three aspects of the basic t h e s i s of t h i s study. The analysis of data revealed that the i n d i v i d u a l Langsian hypotheses were correct i n a l l instances. The analysis also revealed that none of the data would s a t i s f y a r i v a l hypothesis which would propose an outcome opposite to Langsian hypotheses. A l i m i t a t i o n of the study i s the fact that the majority of available data contained material that allowed only p a r t i a l Langsian analysis of the impact of the frame on the c h i l d . Further studies of secure frame psychotherapy are needed to complete the set of ground rules and boundaries of c h i l d psychotherapy by empirical means. TABLE OF CONTENTS ABSTRACT i i TABLE OF CONTENTS V ACKNOWLEDGEMENTS v i i CHAPTER ONE 1 INTRODUCTION 1 Review of Lite r a t u r e 1 Purpose of the Study 8 Objectives of the Study 10 Def i n i t i o n s 10 Research Methods 14 V a l i d i t y 19 R e l i a b i l i t y 21 Limitations of the Study 21 Procedures 24 Co l l e c t i o n of Data 28 CHAPTER TWO 31 ANALYSIS OF DATA 31 Case One, Session One 31 Case One, Session Two 42 Case One, Session Three 52 Case One, Session Six 64 Case Two, Session One 74 Case Two, Session Two 88 Case Two, Session Three 97 v i Case Two, Session Four 107 Case Three, Session One 114 Case Three, Session Two 131 Case Three, Session Three 138 Case Three, Session Fourteen 146 CHAPTER THREE 159 DISCUSSION OF RESULTS 159 REFERENCES 166 APPENDIX I 177 Letter of Contact 177 APPENDIX II 179 Parental Consent Form 179 v i i ACKNOWLEDGEMENTS I would l i k e to express my gratitude to my thes i s committee, Dr. Larry Cochran and Dr. John A l l a n of University of B r i t i s h Columbia, and Dr. Marc McKee of I l l i n o i s School of Professional Psychology, for t h e i r support, encouragement, guidance, and patience. Without the c l i n i c a l findings and discoveries of Dr. Robert Langs t h i s study would not have existed. I thank my c l i e n t s who had trusted my e f f o r t s and without whom t h i s study would not be possible. I would l i k e to thank my family for t h e i r help and understanding. 1 CHAPTER ONE INTRODUCTION Psychotherapists of d i f f e r e n t t h e o r e t i c a l orientations conduct therapy following d i f f e r e n t e x p l i c i t and i m p l i c i t ground rules and boundaries of conduct and thus maintain d i f f e r e n t conditions for and apply d i f f e r e n t means i n the treatment of t h e i r c l i e n t s . L i t e r a t u r e , both lay and professional, on the subject of the influences of the ground rules on the therapeutic process i s r e l a t i v e l y scarce. The issue of determining which the r a p i s t ' behaviours, that define the ground rules and boundaries of the therapeutic r e l a t i o n s h i p (the frame) are constructive and which are destructive to treatment i s an important one in applied psychology and a c r i t i c a l one i n the moment-to-moment therapeutic i n t e r a c t i o n . The issue i s ce n t r a l to the theory of therapeutic technique. Review of Lit e r a t u r e The reported and implied ground rules of therapy, as they appear i n c l i n i c a l papers and i n works on technique, reveal a very wide range of behaviours by both therapists and c l i e n t s : from s t r i c t adherence to n e u t r a l i t y , c o n f i d e n t i a l i t y , absence of physical contact, and so f o r t h (e.g., i n c l a s s i c a l psychoanalysis) to psychotherapy i n 2 public and sexual contact. Since the goal of t h i s study i s to compare, i n a li m i t e d way, the unconscious communications of childr e n with the unconscious reactions of adults and adolescents, as reported i n the psychoanalytic studies of the therapeutic process, the review of l i t e r a t u r e w i l l be li m i t e d to authors who consider unconscious communications. References that involve the communication of implied and pre-conscious meaning or those that define "unconscious" d i f f e r e n t l y from the psychoanalytic d e f i n i t i o n w i l l be omitted because communication other than unconscious i s of peripheral relevance to t h i s study and because i t would not contribute to the comparative nature of the present study. References w i l l be therefore li m i t e d to psychoanalytic l i t e r a t u r e with emphasis on the works of Robert Langs. The issue of ground rules has been brought up by several psychoanalytic writers. The f i r s t psychoanalyst to describe the ground rules and boundaries of the psychotherapeutic r e l a t i o n s h i p was Freud (1912) who stressed the importance of the analyst's adherence to n e u t r a l i t y and abstinence and who recognised the harmful e f f e c t s of unpaid treatment. In 1919, Freud (1919) recommended several modifications i n h i s previously held b e l i e f s which may have held an important influence on l a t e r psychoanalysts who advocated such modifications. 3 The psychoanalytic writers who recommended various modifications i n technique include such famous and i n f l u e n t i a l psychoanalysis as Alexander (1954), B a l i n t (1968), Berman (1949), E i s s l e r (1953), Ferenczi (1921), F a i r b a i r n (1957), Frank (1956), Anna Freud (1954), Glover (1955), Greenson (1965), Jacobson (1954), Stone (1954), and Winnicott (1958). Most of t h e i r recommendations were proposed i n r e l a t i o n to treatment of more severely i l l patients who were considered poor candidates f o r psychoanalysis proper. Strachey (1934) was one of the f i r s t psychoanalysts to caution against deviations i n technique from the ground rules proposed by Freud i n 1912. He based h i s observations on the important incorporative i d e n t i f i c a t i o n s of the patient with the analyst and emphasized the i n t e r a c t i o n a l nature of the therapeutic r e l a t i o n s h i p . E i s s l e r (1953) emphasized adherence to the o r i g i n a l ground rules but proposed that some deviations (parameters) are j u s t i f i e d when the basic model of technique i s not s u f f i c i e n t when t r e a t i n g patients whose the patient's ego i s severely dysfunctional and cannot be modified by interpretations. E i s s l e r did point out, however, that such modifications may have l a s t i n g e f f e c t s on the patient's transference and that such e f f e c t s may not be undone by interpretations. 4 E i s s l e r (1974) wrote extensively about the payment of fees f o r treatment. He f e l t that t h i r d party payments need not create complications. He recommended that the treatment of severely depressed patients and children should be continued when the t h i r d party refuses to pay and that such patients should not be charged f o r missed hours. He observed that payment by for treatment government agencies has powerful e f f e c t s on patients. However, he considered i t possible to analyze most insured patients i f the c o n f i d e n t i a l i t y of patients' communications was guaranteed. Another important contribution was made by Winnicott (1954) who discussed extensively the influence of the management of the ground rules of therapy on his patients. He was one of the f i r s t analysts to demonstrate the inherent therapeutic q u a l i t i e s of the secure frame. He observed that deviations i n the ground rules create serious resistances i n the patient that cannot be analyzed before the deviation i s r e c t i f i e d . Khan (1960, 1969) elaborated on Winnicott's ideas and stated that the frame i s i n essence the a n a l y t i c s e t t i n g and that the t o t a l a n a l y t i c s i t u a t i o n functions i n terms of the a n a l y t i c setting, the transference, and interpretations. He believed that those modifications i n technique that enable the therapist to function as a supplementary ego to the patient are e s s e n t i a l to therapy 5 to enable the necessary regression. Greenacre (1954) departed from the majority of psychoanalytic writers who defended deviations i n technique and advocated general adherence to the basic ground rules of analysis except i n si t u a t i o n s of c r i s e s . The p r i n c i p a l reason for her stance was the necessity to safeguard the transference that must remain uncontaminated by therapist's actions. She believed that modifications i n t e r f e r e with the therapeutic a l l i a n c e , damage the patient's autonomy, on some l e v e l repeat e a r l i e r pathogenic interactions, and preclude analysis. In addition, she observed that deviations may be followed by severe disturbances i n the patient and also, that deviations may be damaging to the therapist. She cautioned therapists that the unconscious i s a powerful force not to be treated l i g h t l y . An important contribution to the discussion of ground rules was made by Milner (1952) who studied the importance of i l l u s i o n i n the an a l y t i c s i t u a t i o n . She observed that the temporal-spacial frame of the a n a l y t i c r e l a t i o n s h i p makes possible the development of the transference i l l u s i o n and that the frame i s e s s e n t i a l for the therapeutic q u a l i t i e s of the therapeutic i n t e r a c t i o n . Szasz (1962, 1980) wrote extensively on the ground rules r e l a t e d to privacy and c o n f i d e n t i a l i t y of treatment. His p o s i t i o n i s that t o t a l privacy i s the hallmark of the 6 psychoanalytic treatment and that any modification i n t h i s r u l e changes the very basis of the therapeutic q u a l i t i e s of psychoanalysis. Some authors (e.g., Nacht and Viderman, 1960; Reich, 1958; F a i r b a i r n , 1957) advocated digressions from n e u t r a l i t y for c e r t a i n patients, others observed that n e u t r a l i t y must be maintained for the benefit of the patient (e.g., Langs, 1982; Rangell, 1969; Tarachow, 1962). Contact between patient and therapist outside of treatment i s considered disruptive by Greenacre (1959) while Tarnower (1966) believes that such meetings may provide important material for analysis even though he recognised that they exert a powerful e f f e c t on the patient. Throughout hi s writings Langs maintains the po s i t i o n that contact between patient and therapist must be confined to the therapy session even a f t e r treatment has been completed because any such contact undermines therapeutic work. A systematic review of p r a c t i c a l l y a l l e x i s t i n g psychoanalytic writings that deal with the frame brought Robert Langs (Langs, 1976a, 1976b) to the conclusion that i n the papers " v i r t u a l l y no attempt was made s p e c i f i c a l l y to investigate the unconscious meaning of a modification i n technique for either the patient or the analyst" (Langs, 1976b, p. 413). His central c r i t i c i s m concerns 7 the f a c t that the writers r a r e l y reported complete information that contains data on the frame and that they r a r e l y considered the modification i n the frame as the tr i g g e r for the patient's subsequent material i n t h e i r evaluations of modifications. Since the authors made v i r t u a l l y no attempt to " s p e c i f i c a l l y investigate the unconscious meanings of a modification i n technique for either patient or the analyst" (Langs, 1976b), Langs believes that they have i n e f f e c t neglected to investigate the implications i n r e a l i t y of a modifications i n the frame. Langs' empirical studies have shown that systematic analysis of unconscious communications from patients i s only possible when complete data from sessions are ava i l a b l e . Years of such empirical investigations (Langs, 1975, 1976, 1978,1978a, 1979, 1979a, 1979b, 1979c, 1979d, 1980, 1981, 1982a, 1984, 1989) yielded the discovery of a universal human need for s p e c i f i c ground rules and boundaries i n any therapeutic r e l a t i o n s h i p , whether psychoanalysis or psychotherapy. His de t a i l e d and extensive empirical research i n human communication, conscious and p a r t i c u l a r l y unconscious, has brought many new and unexpected discoveries i l l u m i n a t i n g various l e v e l s of meaning and various l e v e l s of experiencing of human rela t i o n s h i p s . His research resulted i n the empirically found ground rules and boundaries of the therapeutic 8 r e l a t i o n s h i p which he termed the frame. Langs (1985b) has empirically defined the following basic elements of the ground rules for psychoanalysis and for psychotherapy of adults and adolescents: (a) therapist's n e u t r a l i t y , (b) therapist's anonymity, (c) t o t a l privacy of treatment, (d) t o t a l c o n f i d e n t i a l i t y of treatment, (e) single set fee, (f) s p e c i f i e d and consistent length of sessions, (g) s p e c i f i e d and consistent appointed time of sessions, and (h) s p e c i f i e d and consistent frequency of sessions. Purpose of the Study Of c r i t i c a l importance to the present study i s Langs• discovery of the universal overwhelming influence of the basic therapeutic contract, e x p l i c i t and i m p l i c i t , on the c l i e n t s ' unconscious communications i n psychotherapy (Langs, 1976). This discovery has important implications for the p r a c t i c a l conduct of psychotherapists, both i n terms of t h e i r adherence to a basic therapeutic contract as well as i n terms of the way they l i s t e n to t h e i r c l i e n t s . The present l i m i t e d comparative study w i l l make a small contribution to the area of c h i l d psychotherapy as much as i t can illuminate children's unconscious reactions to those therapist's behaviours and verbalizations that constitute modifications i n the frame as defined by Langs' theory. The findings of t h i s study may contribute to the 9 growing l i t e r a t u r e of c l i n i c a l evidence that c a l l s f o r a r e v i s i o n i n the technique of psychotherapy as practised by most c h i l d psychotherapists. Comparable empirical research with children has not been published even though the Langsian communicative approach to psychotherapy with childre n i s practised by many contemporary psychotherapists i n the c l i n i c a l and private settings. Publication of any c l i n i c a l material i s a break i n the frame and i s not practised by those therapists who maintain a secure frame for t h e i r c l i e n t s . According to psychoanalytic theories of psychology, psychopathology has i t s most important roots i n infancy and childhood. Langs (e.g., Langs, 1982) has found empirically that modifications i n the ground rules of therapy evoke conscious and unconscious memories of important h i s t o r i c a l precedence for the c l i e n t . The therapist, when breaking the ground rules of psychotherapeutic r e l a t i o n s h i p , repeats i n some way the o r i g i n a l trauma for the c l i e n t as he or she repeats, on some l e v e l , the same type of in t e r a c t i o n that had o r i g i n a l l y contributed to the c l i e n t ' s present problem. I t would l o g i c a l l y follow, that the same ground rules of psychotherapy that apply to adults also apply to children. This i s also the basic proposition of t h i s study. 10 Objectives of the Study The objectives of t h i s study are: (a) to investigate the e f f e c t s of the modifications i n the frame on the unconscious communication of children i n psychotherapy, (b) to compare such e f f e c t s with e x i s t i n g empirical findings of research with adults, and (c) to discuss the r e s u l t s . The following independent variables, pertaining to the ground rules of the psychotherapeutic r e l a t i o n s h i p , w i l l be investigated: (a) change of therapy rooms, (b) audio recording of session, (c) missed sessions and holidays, (d) therapist's contact with the c h i l d ' s parents, (e) interruption of session, (f) time extension and time reduction of session, (g) observation mirror, (h) forced termination of treatment, and (i) touching toys. D e f i n i t i o n s Terminology used i n t h i s study follows d e f i n i t i o n s developed by Langs (e.g., Langs, 1982, 1985) for several reasons. Since Langs* d e f i n i t i o n s have been operationalized within the context of h i s empirical research of the therapeutic process, the presentation of research of unconscious communication can be made much clearer and more useful i f the same terminology i s used by a l l authors. The present study i s a li m i t e d and confined r e p l i c a t i o n study of Langs' research applied to a d i f f e r e n t population (children). To provide an e f f e c t i v e and i n t e l l i g i b l e comparison of the findings of Langs with the r e s u l t s of t h i s study I consider i t best that the terminology be the same. The terms used by Langs are mostly de s c r i p t i v e and common to a l l texts i n psychology (e.g., t r i g g e r , model of r e c t i f i c a t i o n ) . When Langs' terminology d i f f e r s from that of other authors i t i s usually because Langs had found that the process i n question describes a d i f f e r e n t phenomenon and requires a separate term (e.g., communicative resistance). The three broadest and most important d e f i n i t i o n s used i n the communicative research involve: (a) the therapeutic r e l a t i o n s h i p , (b) the process of unconscious communication, (c) the process of unconscious v a l i d a t i o n , and (d) decoding. Langs (1982) gives the following d e f i n i t i o n of the therapeutic r e l a t i o n s h i p , formulated on the basis of h i s c l i n i c a l observations: The therapeutical r e l a t i o n s h i p embraces a l l components, conscious and unconscious, pathological and nonpathological, of the in t e r a c t i o n between patient and therapist. For the patient, the therapeutical r e l a t i o n s h i p involves both transference and nontransference components, while for the therapist i t involves countertransference and noncountertransference elements. (p. 746) According to Langs, the most awesome marvel i n the process of human communication " i s the a b i l i t y of the human mind to express i t s e l f simultaneously on two d i s t i n c t , and yet interconnected, l e v e l s of meaning" (Langs, 1983), conscious and unconscious. Unconscious  communication i s activated (triggered) i n si t u a t i o n s of c o n f l i c t and danger. The manifest message of an unconscious communication i s the c a r r i e r of the raw message which had been encoded through the use of the primary process mechanisms of displacement and symbolization, discovered by Sigmund Freud i n 1900 (cited i n Langs, 1985). The unconscious meanings and functions of a manifest expression can be conveyed only through latent (encoded) messages and can be consciously understood only by decoding the manifest expression i n l i g h t of the t r i g g e r (stimulus) that had evoked i t as the sender of the message (e.g., the c l i e n t ) i s engaged i n e f f o r t s at adaptation to such t r i g g e r s (e.g., therapist's interventions). Decoding involves the undoing of the primary process mechanisms of displacement and symbolization. The basic endeavour i n analyzing the message i s to i d e n t i f y the theme shared by the two le v e l s of communication, conscious and unconscious. The best vehicles for der i v a t i v e (encoded) communication have been found to be "narratives, images, memories, and dreams" (Langs, 1985). Decoded messages reveal the unconscious implications of the t r i g g e r that had set them o f f and centre p r i m a r i l y upon unconscious v a l i d perceptions (rather than fantasy d i s t o r t i o n s ) of the t r i g g e r by the sender of the message. Trigger decoding i s the basis f o r explanations (interpretations) offered by the therapist to the c l i e n t . I t has been one of Langs' most important discoveries to f i n d that only decoding i n the l i g h t of the t r i g g e r i s followed by unconscious v a l i d a t i o n by the c l i e n t (Langs, 1967) . Unconscious v a l i d a t i o n comprises the emergence of three messages i n the c l i e n t ' s communication: (a) cognitive v a l i d a t i o n i n the form of "revelation of fresh encoded material...which extends the i n t e r p r e t a t i o n i n a unique and unexpected fashion" (Langs, 1985); (b) interpersonal v a l i d a t i o n i n the form of the emergence of "po s i t i v e and constructively functioning f i g u r e s " (Langs, 1985), which represent the c l i e n t ' s i n t r o j e c t i o n of a well-functioning therapist; and (c) conscious understanding and working through by the c l i e n t . Resistance i s defined as "any impediment within the patient to the work of psychotherapy or analysis" and i t i s "often based on contribution from both therapist and patient" (Langs, 1982, p. 740). Communicative resistances are the obstacles that are discovered through an analysis of the c l i e n t ' s material. In the presence of such resistances the verbal material contains l i m i t e d unconscious meaning. I t i s possible to observe simultaneously gross behavioral resistance to therapy -the c l i e n t wants to leave therapy, and l i t t l e communicative resistance - the c l i e n t t e l l s r i c h s t o r i e s and represents the t r i g g e r that has acted as the stimulus for the communication. Behavioral resistances are impediments to psychotherapeutic work that "appear i n the d i r e c t behaviours and associations of the patient" (Langs, 1982, p.741) and they include silences, disruptions of the session, e f f o r t s towards premature termination, and the l i k e . Research Methods In t h i s study the only dependent variable i s the unconscious reaction by the c l i e n t (the meaning and structure of t h e i r unconscious communications) to the s p e c i f i c modifications i n the frame, which represent the independent variables. The state of the frame defines the c o n t r o l l e d environment ( i . e . , known constants) which makes possible the observation of the dependent va r i a b l e which i s evaluated on the basis of the unconscious v a l i d a t i o n process described above. A modification i n the frame i s any inappropriate modification by e i t h e r therapist or c l i e n t (Langs, 1985). Previous research (e.g., Langs, 1967) shows that any modification i n the ground rules always influences unconscious communication 15 of the c l i e n t i n an exqu i s i t e l y s e n s i t i v e and consistent, therefore predictable, way. Following the central thesis of t h i s study that the basic ground rules of psychotherapy which apply to adults also apply to children, each single hypothesis regarding a ch i l d ' s unconscious reaction to a s p e c i f i c modification i n the frame (trigger) was formulated i n terms of the universal reaction of adults and adolescents, as found empirically by Langs, under the heading "Hypotheses". The ch i l d ' s actual reaction was f i r s t recorded under the heading "Data", then analyzed under the heading "Data analysis", and l a s t i t was compared with the i n i t i a l hypothesis under the heading "Discussion". Each session i s therefore analyzed and discussed separately. The discussion of findings from a l l sessions i s included under the heading "Discussion of Results" i n Chapter Three. I have used data from my psychotherapy sessions with three children who were referred to me at a public mental health centre. I have made the following basic assumptions that are also the basic assumptions of Langs' research, namely: (a) that there e x i s t s unconscious communication between the partic i p a n t s of the therapeutic i n t e r a c t i o n , and (b) that such unconscious communication pertains to the moment-to-moment in t e r a c t i o n i n the session between the par t i c i p a n t s . S p e c i f i c a l l y , I made predictions of the e f f e c t s of the modifications i n the frame on the unconscious communication of a c h i l d for each session on the basis of the following functions of the s p e c i f i c aspects of the frame on the psychotherapeutic process as empirically established by Langs: The secure frame - o f f e r s basic t r u s t , c l e a r interpersonal boundaries, support f o r r e a l i t y t e s t i n g , sound holding and containment. Sources of anxiety: r e s p o n s i b i l i t y and confinement that produce claustrophobic anxieties, fears of loosing control ... (Langs, 1985b, p. 259) The deviant frame - o f f e r s basic mistrust, impaired interpersonal boundaries, disturbances i n r e a l i t y t e s t i n g . Sources of inappropriate g r a t i f i c a t i o n : serves as a basis for pathological defense v i a merger, o f f e r s counterphobic and manic-fusion defenses, and escape from experienced subjective madness. (Langs, 1985b, p. 259) Following Langs' theory, the most important aspects of unconscious meaning of a narrative are found i n the following components of the c l i e n t ' s : (a) t r i g g e r s , (b) themes and images, (c) models of r e c t i f i c a t i o n , and (d) signs of resistances. Triggers. Langs' found that "without exception, everything that a therapist does and does not do i n respect to the psychotherapy of a p a r t i c u l a r patient i s an adaptation-evoking context for the patient" (Langs, 1985a, p. 13). Adaptation-evoking contexts are t r i g g e r s that evoke unconscious communication from c l i e n t s . The therapist's management of the frame involves the "core r e l a t i o n s h i p between patient and therapist and the basic holding and containing q u a l i t i e s of the therapist's e f f o r t s " (Langs, 1985a, p. 14) and t h i s i s why "the interventions that pertain to the ground rules of treatment always take precedence for the patient" (Langs, 1985a, p. 14) over a l l other interventions. According to Langs' theory, a break i n the frame w i l l always be the central organiser of the c l i e n t ' s material and i t w i l l usually be mentioned manifestly (dire c t l y ) or else w i l l be represented i n encoded form ( i n d i r e c t l y , symbolically) with various degrees of disguise. Searles (1965,) and Langs (1976) independently discovered the human capacity for unconscious perceptions of exquisite v a l i d i t y and complexity. I t i s communicated symbolically (the language of unconscious communication) to the s e l f (dreams) and to others i n spontaneous narratives. I t has been Langs' important contribution to discover empirically that adult c l i e n t s i n psychotherapy unconsciously communicate almost exclusively v a l i d  perceptions of the therapist when they are faced with a break i n the frame. In t h i s study, themes and images i n the children's material were subjectively evaluated i n 18 t h i s respect and characterised as either v a l i d perceptions or else fantasy (misperceptions). P o l a r i t y of themes and images. In t h i s study, data analysis includes an abstraction of the themes or images i n the c l i e n t ' s material to determine the p o l a r i t y as either p o s i t i v e or negative themes and images. E f f o r t was made to determine the universal meaning of a p a r t i c u l a r narrative and to assign i t either a constructive and h e l p f u l (positive) meaning or else a destructive and harmful (negative) meaning. According to Langs' theory, breaks i n the frame are harmful to c l i e n t s and generate negative images and themes i n t h e i r narratives while actions by the therapist that secure the frame (especially when such securing followed a s p e c i f i c model of r e c t i f i c a t i o n by the c l i e n t ) generate p o s i t i v e images and themes. The p o s i t i v e and negative images and themes are considered evidence f o r the expression of the c l i e n t ' s i n t r o j e c t i o n of the therapist who i s functioning well and of the therapist who i s functioning poorly, respectively. Models of r e c t i f i c a t i o n . According to the theory, when faced with the t r i g g e r of a break i n the frame the c l i e n t usually includes a theme that i s communicated to the therapist as a model to r e c t i f y the break i n the frame. Such models are always communicated symbolically (with derivatives) because the c l i e n t i s not aware 19 (unconscious) of the t r i g g e r and of i t s e f f e c t s on him or her. Some models are clear while some are disguised and e f f o r t i s made i n t h i s study to subjectively evaluate the degree of disguise for each example. Langs' research shows that c l i e n t s usually communicate compelling models of r e c t i f i c a t i o n to the therapist as soon as a new break i n the frame occurs. If the therapist does not understand the c l i e n t ' s unconscious messages and does not explain (interpret) i t s meaning to the c l i e n t and i f the therapist does not follow with a r e c t i f i c a t i o n of the break i n r e a l i t y , the c l i e n t usually gives up hi s or her e f f o r t s and shows signs of non-therapeutic regression and resistance. In t h i s study, resistances and regressions w i l l be i d e n t i f i e d and connection with the therapist's interventions discussed. V a l i d i t y I consider that the v a l i d i t y of the operational d e f i n i t i o n i s s u f f i c i e n t l y high because the dependent variable being evaluated i s measured d i r e c t l y , rather than by using another dependent variable (e.g., a standardized test) with which there i s an assumed l i n e a r r e l a t i o n . The r e l i a b i l i t y of the d e f i n i t i o n s i s also considered to be high because the technique of determining the emergence of either p o s i t i v e (constructive) or negative (destructive) figures i n the c l i e n t ' s narrative i s r e l a t i v e l y simple and straightforward. Determination of themes does require some pra c t i c e and I have studied the workbooks (Langs, 1985, 1985a, 1985b). Langsian unconscious v a l i d a t i o n (as defined above) w i l l be used whenever applicable, that i s whenever a r e c t i f i c a t i o n and a correct explanation of the implications of a modification of the ground rules was ac t u a l l y offered by the therapist to the c l i e n t and unconscious v a l i d a t i o n of such explanation followed. P a r t i a l unconscious v a l i d a t i o n and p a r t i a l unconscious nonvalidation of the therapist's interventions by the c l i e n t w i l l also be taken into account. This study i s not a t e s t of Langs• methods used i n his c l i n i c a l research that yielded the rules of the frame with i n c r e d i b l y p r e d i c t i v e power. I t i s a l i m i t e d comparative analysis that uses the same basic methodology so that r e s u l t s can be compared. In the l i t e r a t u r e discussing Langs' works (e.g., Bejerholm & Windahl, 1984; G i l l , 1984; Grotstein, 1984; Hodges, 1984; Lubin 1984; S i l v e r s t e i n , 1984;) there has been no r e f u t a l of either r e l i a b i l i t y or v a l i d i t y of either the constructs or the methods employed by Langs. Writers who applied h i s methodology to the analysis of the c l i e n t ' s material i n psychotherapy (e.g., A n i s f e l d , 1984; Brown & Krausz, 1984; Cheifetz, 1984; Dorpat, 1984, 1987; Keene, 1984; Korn & Carmignani, 1987; Raney, 1984, 1987; Vlosky, 1984) came to conclusions that were i n accordance with Langs• theory. R e l i a b i l i t y R e l i a b i l i t y of the study rests on my s k i l l to decode unconscious communication and thus to r e p l i c a t e the basic method of analysis used by Langs i n h i s c l i n i c a l studies. I have been studying the method for several years and I am confident that I can r e l i a b l y , within allowable l i m i t s of error, follow the p r i n c i p l e s of Langsian methodology. Limitations of the Study The proposed study i s l i m i t e d i n the following ways: 1. Data are l i m i t e d to the material of sessions held at a public mental health centre. 2. The author of t h i s study was the therapist i n a l l sessions used as data. 3. The number of sessions i s l i m i t e d to 12, and the number of cases i s limited to three with four sessions per case. (A fourth case had been planned and was included i n the proposal for t h i s study, however, the parental consent for p u b l i c a t i o n was eventually not granted.) 4. The cases involve uneven representation of gender - two boys and one g i r l and uneven representation of age -5,6,and 11. 5. The sessions selected for analysis i n t h i s study from a pool of more than 40 sessions, are those sessions that were transcribed i n t h e i r e n t i r e t y and that contain the c l e a r e s t and r i c h e s t derivative material. 22 6. The analysis of data i s l i m i t e d to the most c r i t i c a l components of unconscious messages (determination of t r i g g e r s , perceptions, p o l a r i t y of images and themes, models of r e c t i f i c a t i o n and resistances). 7. The study applied incomplete method of analysis of the e f f e c t s of frame deviations on the c l i e n t i n a l l but three instances. According to Langs (1975, 1976, 1976a, 1978, 1979, 1980), the i d e a l and complete method for the analysis of frame deviations can only be applied i f a v a i l a b l e material includes frame-securing interventions by the therapist. Such complete analysis includes: (a) the analysis of c l i e n t ' s material i n the l i g h t of the s p e c i f i c frame break and - following the r e s t o r a t i o n of the secure frame by the therapist complying with the c l i e n t ' s model of r e c t i f i c a t i o n , and (b) analysis of the c l i e n t ' s unconscious comment about such securing of the frame which follows the therapist's securing of the frame. In t h i s way, the analysis of data y i e l d s not only the information about the e f f e c t s on the c l i e n t of a break i n the frame, and about e f f o r t s by the c l i e n t to do something about the break, but also the important information of the e f f e c t on the c l i e n t a f t e r the frame has been restored. Complete analysis provides c l e a r and convincing evidence for the following: the s p e c i f i c break i n the frame, which was defined as the independent variable i n the i n i t i a l hypothesis, i s i n fac t the same break i n frame which the c l i e n t i s reacting to. The empirical proof then l i e s i n the evidence provided by the reaction of the c l i e n t which follows the r e c t i f i c a t i o n of that same break i n the frame. If the c l i e n t were reacting to some other than hypothesized break i n the frame (and several breaks were indeed contemporary i n a l l sessions i n t h i s study), then the r e c t i f i c a t i o n of the hypothesized break would not generate unconscious v a l i d a t i o n by the c l i e n t and the c l i e n t would continue to react adversely to the c r i t i c a l and u n r e c t i f i e d break. The same empirical evidence provided by complete analysis also provides the proof for Langsian hypothesis that the c l i e n t was not reacting to some other type of stimulus which i s not a break i n the frame. Only with complete analysis can the constructive e f f e c t s of the securing of the frame be f u l l y e m pirically validated and only i n t h i s way can the rules for secure frame therapy of children be empirically derived. The present study used data that were c o l l e c t e d i n a c l i n i c s e t t i n g , replete with various breaks i n the frame. The data were recorded from therapy sessions by a therapist who r a r e l y secured the frame. The understanding of the e f f e c t s of the breaks i n the frame, as presented i n t h i s study, i s therefore a limited understanding and the f i n a l d e f i n i t i o n of the complete set of rules of the frame of c h i l d psychotherapy i s therefore not possible i n t h i s study. Procedures According to Robert Yin (Yin, 1984), an experimental psychologist, the core of the s c i e n t i f i c method i s not experimentation per se, but the useful employment of p l a u s i b l e r i v a l hypotheses. Stephen Hawking, a t h e o r e t i c a l p h y s i c i s t , defined the task of science to be "the discovery of laws that w i l l enable us to predict events " (Hawking, 1988, p.173). The present study, a li m i t e d r e p l i c a t i o n study, follows the basic precepts of the methodology established by Robert Langs i n h i s c l i n i c a l supervision studies. Langs employed the technique of r i v a l hypotheses (Langs, 1976, 1978, 1979, 1980, 1981) by discussing and t e s t i n g the s p e c i f i c propositions offered by supervised therapists: t e s t i n g hypotheses against sequential material from c l i e n t s and employing unconscious v a l i d a t i o n yielded the formulation of patterns that c r y s t a l l i z e d into the rul e s that comprise the frame. The frame, unconsciously requested by a l l c l i e n t s , involved r e c t i f i c a t i o n of harmful actions by therapists. The rules that comprise the secure frame and the findings that describe the e f f e c t s of the modified frame thus enable to predict u n i v e r s a l l y the unconscious reactions of c l i e n t s to s p e c i f i c modifications i n the frame. I have omitted the evaluation of r i v a l hypotheses fo r two reasons. F i r s t , a formulation of r i v a l hypotheses, which would represent propositions derived from various established t h e o r e t i c a l orientations, would require d e t a i l e d research into these orientations to insure that such r i v a l hypotheses would indeed represent the correct viewpoint. Such study would require a volume of work that would be out of the scope of t h i s study. Second, the goal of t h i s study i s to compare the ground rules of psychotherapeutic r e l a t i o n s h i p , developed from the work with adults and adolescents by Robert Langs, with those of children, the achievement of which does not require the introduction of r i v a l hypotheses. I t would seem l o g i c a l , however, that any discrepancies i n the ground rules between the two populations which may emerge from a study would indeed represent a r i v a l hypothesis and a s t a r t i n g point for future studies. The discussion of r e s u l t s does include a t e s t by inference of one c r i t i c a l r i v a l hypothesis which states that the reaction of the c l i e n t , following the same break i n the frame, w i l l be opposite to that stated by the Langsian hypothesis. I consider that t h i s t e s t provides the necessary i n f e r e n t i a l proof and that i t i s a c r i t i c a l and acceptable argument i n the research of phenomena which are open to detailed empirical observation but are not open to s t r i c t l y c o ntrolled experimental manipulations 26 (e.g., Jaynes, 1957). The study i s a multiple case study of three children, two boys (ages 5 and 11) and one g i r l (age 6). Transcripts of t h e i r sessions (four sessions per child) of i n d i v i d u a l psychotherapy at a public mental health centre were analyzed with respect to the c r i t i c a l ingredients of t h e i r narratives and behaviours that comprise unconscious responses of c l i e n t s i n psychotherapy. Langs' theories were applied to data analyses by using predictions for a c l i e n t ' s reaction to each s p e c i f i c modification i n the frame as a hypothesis for each session. In t h i s way the present multiple case study answered some of the "how" and the why" questions as proposed by Yin (Yin, 1984), a l b e i t i n a lim i t e d way. Since t h i s study attempted to search for the same universal p r i n c i p l e s involved i n the reaction of human beings to modifications of ground rules, as proposed by Langs' theories, the s t a t i s t i c a l l y meaningful number of subjects i s i r r e l e v a n t . According to the theory employed, and according to the basic requirement of science, every case must eventually show obedience to a universal p r i n c i p l e , i n t h i s case the universal p r i n c i p l e of human unconscious reactions to the modifications i n the ground rules of psychotherapy. I t i s true, however, that a larger number of children, e s p e c i a l l y a greater var i e t y of ages for both genders, would add strength to t h i s study, just as any one 27 discrepancy would put the theory into question. As Robert Yin writes: "...the case study, l i k e the experiment, does not represent a * sample', and the investigator's goal i s to expand and generalize theories (analytic generalisation) and not to enumerate frequencies ( s t a t i s t i c a l generalization)" (Yin, 1984, p.21). The most important reason for not making use of conventional s t a t i s t i c a l methods to evaluate data i n t h i s study i s the f a c t that such methods can be applied only to phenomena of which the order of the events i s i r r e l e v a n t and can be changed at random. In contrast, the phenomenon of the psychotherapeutic i n t e r a c t i o n i s a process comprised of a d e f i n i t e sequence of events and there i s a causal r e l a t i o n s h i p between them. Sequential occurrence of events i n psychotherapy follows the second law of thermodynamics which states, among other things, that time i s u n i d i r e c t i o n a l for a l l known universe and that processes are i r r e v e r s i b l e . The study involved explanation of causal l i n k s i n sessions on the basis of Langs' theories. The subject of study are not i n d i v i d u a l c l i e n t s , but t h e i r communications, conscious and unconscious, during therapy sessions. Evidence was sought i n the t r a n s c r i p t data. Where available, the unconscious v a l i d a t i o n of c l i e n t s as defined by Langs (1976) was considered. 28 C o n f i d e n t i a l i t y of the c l i e n t s i s maintained by having deleted a l l personally i d e n t i f i a b l e information before t r a n s c r i p t s of sessions were recorded. I t i s my opinion that such procedure does not l i m i t t h i s study because the theory, on which hypotheses are based, i s concerned with universal reactions of a l l humans, that i s , c l i e n t s of a l l ages and both genders which have been found by Langs' research not to be affected by c u l t u r a l , socio-economic, and other extraneous variables. C o l l e c t i o n of Data Data are: (a) verbatim t r a n s c r i p t s of ver b a l i z a t i o n s and behaviours of the c l i e n t and therapist that occur during the session, written from memory a f t e r each session, within three hours a f t e r the sessions, and (b) the information concerning any person or action r e l a t e d to the therapy that occurs between sessions or that e x i s t s before the s t a r t i n g of treatment, which determines the state of the frame. E f f o r t was made to include a l l verbal material from a session. The writing of such t r a n s c r i p t s from memory involves p r a c t i c e and i t i s subject of f a i l u r e of subjective r e c a l l to some degree, however, the t r a n s c r i p t s have been found s u f f i c i e n t l y r e l i a b l e i n two ways. One session was audio-recorded and transcribed from memory; the r e s u l t i n g two tr a n s c r i p t s were then compared and were found almost i d e n t i c a l . Omissions were found to be minor: they were d e t a i l s of themes and images, peripheral to the core meanings communicated by the c l i e n t . The second way involved the investigation of the l o g i c a l sequence of the respective narratives as i t i s done i n the process of tra n s c r i b i n g of sessions as well as during the actual data analysis; i n both instances, discrepancies i n responses became obvious and r e c a l l of d e t a i l s followed. Some f a i l u r e i n t o t a l r e c a l l of sessions involved i n tr a n s c r i p t i o n from memory i s no doubt i n e v i t a b l e and does l i m i t the available data. I t i s my opinion and experience that such f a i l u r e s are more l i k e l y to be omissions of d e t a i l s than d i s t o r t i o n s of conveyed meaning. Thus, present data may be considered incomplete rather than di s t o r t e d and i n v a l i d . Sessions were not audio or video recorded (with the exception of session 14 of the case number 4) for therapeutic reasons. Recording has been found di s r u p t i v e to the therapeutic process (e.g., Langs, 1982) and was not done on e t h i c a l grounds. Recording would also disrupt the c l a r i t y of the ef f e c t s of other modifications i n the frame on the c l i e n t ' s unconscious communications (confounding variables) for research purposes by adding yet another t r i g g e r . Good t r a n s c r i p t s from memory have been found a r i c h source of data for many c l i n i c a l researchers. Such t r a n s c r i p t s have represented an adequate source of data for Robert Langs (Langs, 1976, 1976a, 1978, 1979, 1980, 1981) who was able to use them to the extent that they yielded predictable r e s u l t s which are the goal of every s c i e n t i f i c endeavour. Before actual analysis of t r a n s c r i p t s , but a f t e r the termination of treatment of a l l children, parental consent was obtained by way of a l e t t e r explaining the goals of the study (see Appendix I) and by requesting the parent to sign a consent form (see Appendix I I ) . 31 CHAPTER TWO ANALYSIS OF DATA Case One, Session One The F i r s t Session - Establishment of the Ground Rules Background information on the c l i e n t . The c l i e n t i s a f i v e year old Caucasian boy, l i v i n g with h i s divorced mother and older s i s t e r . His father has had only sporadic contact with the c l i e n t . The c l i e n t has been referr e d to the mental health centre one and a h a l f years ago by h i s mother for the following reasons: the c l i e n t was d i f f i c u l t to control, he was overdependent on her, could not get along with h i s s i s t e r , showed paranoid anxiety, masturbated i n day care, grabbed other c h i l d r e n by t h e i r genitals and had nightmares. His teachers i n the daycare centre complained that they could no longer manage the c h i l d . He came to the mental health centre day programme four times a week for three hours where he played with other four and f i v e year old children with a s i m i l a r degree of emotional d i f f i c u l t i e s . He also receives i n d i v i d u a l speech therapy by a registered speech therapist for unclear pronunciation. The c l i e n t was driven by t a x i from h i s day care centre to the mental health centre. His mother was contacted by h i s day programme teacher and offered a once weekly i n d i v i d u a l psychotherapy with the author of t h i s study. His mother accepted and the c l i e n t has been driven to the sessions by t a x i and missing hal f an hour of h i s day programme once a week. The therapist agreed to meet the c l i e n t at the entrance of the day programme, to walk him to the consultation room, to have a 35 minute sessions i n a consultation room and to walk him back to the day programme room a f t e r the session.the author walked the c l i e n t back to the day programme room. The author never had personal contact with h i s parents or s i b l i n g . State of the Frame The F i r s t Session. This i s the c l i e n t ' s f i r s t session. He has never seen h i s therapist before. He was t o l d by h i s day programme teacher that he w i l l "come to play alone with a woman therapist i n a play-room before school". The therapist meets the c l i e n t i n front of h i s preschool and i s witness to a dialogue between the c l i e n t and h i s teacher about h i s moving into a new house. The therapist introduces herself and the c l i e n t follows her to the consultation room. The therapist had no contact with the c l i e n t ' s family and did not p a r t i c i p a t e i n the conversation with his teachers. The f a c t that the therapist works at the centre where the c l i e n t goes to pre-school i s a break i n the frame, i t represents the presence of t h i r d parties to treatment. 33 Hypothesis According to Langs' theory, the c l i e n t ' s material w i l l r e f l e c t the moment-to-moment i n t e r a c t i o n and w i l l therefore organise around the t r i g g e r s of the current r e l a t i o n s h i p , that i s , the r e l a t i o n s h i p with the therapist. The hypothesised t r i g g e r s to which the c l i e n t w i l l be t r y i n g to adapt i n the session w i l l be r e l a t e d to the ground rules of h i s therapy. According to Langs' theory, the goal of the f i r s t session i s (a) to e s t a b l i s h the nature of the c l i e n t ' s emotional d i f f i c u l t i e s (a s i l e n t evaluation), (b) to convey to the c l i e n t that the therapist can help the c l i e n t (verbal), (c) to handle resistances (to explain to the c l i e n t how frame issues influence the a b i l i t y to communicate), (d) to handle any i n i t i a l breaks i n the therapeutic frame (to secure the frame), (e) to e s t a b l i s h the therapeutic contract , and (f) to obtain a sense of the c l i e n t ' s communicative s t y l e (Langs, 1982). The establishment of the therapeutic contract, that i s , explaining to the c l i e n t the e x p l i c i t ground rules of therapy, i s c l e a r l y the most important task of the therapist i n t h e i r f i r s t session. U n t i l the therapist s p e c i f i e s the ground rules of the therapy (the frame), the c l i e n t w i l l experience uncertainty about hi s r e l a t i o n s h i p with the therapist and hi s material w i l l r e f l e c t t h i s uncertainty (Langs, 1985b) i n the following way: (a) the emergence of negative h u r t f u l images, possibly accompanied with (b) a manifest or disguised representation of the beginning of therapy, (c) a d e r i v a t i v e model of r e c t i f i c a t i o n , and (d) communicative resistance. Conversely, Langs 1 theory predicts that any r e c t i f i c a t i o n of the uncertainty, that i s a securing of the frame, w i l l be r e f l e c t e d i n the c l i e n t ' s material d i r e c t l y following such r e c t i f i c a t i o n i n the form of unconscious v a l i d a t i o n of the therapist's intervention: (a) interpersonal v a l i d a t i o n i n the form of the emergence of a p o s i t i v e and constructive image ( i . e . , i n t r o j e c t i o n by the c l i e n t of the well functioning t h e r a p i s t ) , and (b) cognitive v a l i d a t i o n i n the form of the emergence of new, unanticipated meaning i n symbolic, therefore unconscious, form (Langs, 1985). The establishment, or lack of, the ground rules of therapy i s a t r i g g e r that w i l l take precedence over the background t r i g g e r of t h i r d party contact e s p e c i a l l y since t h i s contact i s by implication rather than d i r e c t . I t i s therefore predicted that the c l i e n t w i l l react mainly to the on-going development of the frame. The t h e r a p i s t f a i l u r e to e x p l i c i t l y state the ground rules of therapy at the beginning of the session i s predicted to r e s u l t i n behavioral and communicative resistance while her e x p l i c i t establishment of the frame w i l l r e s u l t i n reducing such 35 resistance. Walking with the c l i e n t outside the consultation room i s a deviation of the privacy of treatment as the therapist has contact with he c l i e n t outside of the consultation room. I t i s predicted that t h i s f i r s t contact w i l l not be experienced as overly negative because the c l i e n t did not know the way to the consultation room and because hi s teacher i s not r e g u l a r l y there to take him to h i s session. Data Upon entering, the c l i e n t goes to the f i r s t thing i n front of him and, without looking around, s t a r t s taking out m i l i t a r y vehicles and s o l d i e r s and placing them facing each other. Soldiers and tanks shoot at one another. Then he takes out a truck and a t r a i n , p i l e s small cars on them and moves them back and f o r t h several times. While playing, he does no look at the therapist. F i r s t Intervention. F i f t e e n minutes into the session, the therapist intervenes, "I see you are playing something. Your play has meaning. I t would be h e l p f u l to you i f you would t e l l me about your play - i f you would t e l l me what i s going on i n your play." The c l i e n t answers, " I t , s war" and continues to play i n the same vein. Second Intervention. Twenty minutes into the session, the therapist intervenes by saying, "Today, 36 downstairs, you t o l d your teacher that a big truck was taking and moving your s t u f f to your new house. In your play, you also have a big truck and a t r a i n moving many cars from place to place. Perhaps seeing me for the f i r s t time and your coming here instead of to your preschool downstairs was l i k e a big move for you. In your play, there i s war, there i s danger. Perhaps you also f e e l l i k e being i n a war, perhaps you f e e l i t i s dangerous for you i n here." The c l i e n t takes the space shuttle, lands i t i n the war area, then f l i e s i t out. Then he asks, "Can I use the sandbox?" Third Intervention. The therapist answers, "Yes, you can play with any toys i n t h i s room." The c l i e n t then takes out a c i r c u l a r fence, locks i t s gate and puts up so l d i e r s i n i t . The therapist asks, "What i s happening i n your play?" and the c l i e n t answers, "This i s no-war place." Soon, he takes them out of the sand tray again and s t a r t s to bury a l l cars and s o l d i e r s i n the sand. The therapist asks, "What i s happening?" The c l i e n t answers, "Everyone i s hiding. The bad guys and the good guys are hiding. 1 1 Fourth Intervention. The therapist intervenes, saying, "Today, downstairs, you asked your teacher how d i d she know about your moving, you were wondering who t o l d her. Also, you didn't know, what w i l l be happening to you here, with me, people i n the preschool did not t e l l you. 37 Not knowing makes you f e e l a f r a i d and makes you want to hide, you f e e l l i k e i n a war. You don't know me, you don't know i f I am a bad person or a good person." The c l i e n t suddenly finds a small piece of straw, puts i t i n the sand over the buried cars and s o l d i e r s and says, "This i s for breathing, so they can breathe." The c l i e n t then takes a l l cars out of the sand. For the f i r s t time, he looks the therapist s t r a i g h t i n the eyes and asks, "How long w i l l I be here?" F i f t h intervention. The therapist answers, "You w i l l be here for a l i t t l e more than h a l f an hour. Then, I w i l l take you back to your preschool. You w i l l come here once a week, every Wednesday, for a l i t t l e more than half an hour." The c l i e n t s t a r t s looking for other toys: takes out two winding toys and winds them, watches them as they turn, then puts them back. Five minutes before end of the session, he goes to the window, says, "Puppets!" and picks up a spiderman and a lady bug. He makes an eating sound and says, "The lady bug i s eating his head" and puts them back. The therapist t e l l s the c l i e n t that the time i s up, " I t i s time to go back to your preschool". The c l i e n t looks at the therapist with wide eyes, goes to the sandbox, s t a r t s cleaning up the cars and s o l d i e r s . The therapist says, "Our time i s up, you don't have to clean up." The c l i e n t goes to the door, opens i t , hesitates for 38 a moment then turns the r i g h t way and leads the way. The therapist walks with him l e t t i n g him open a l l the doors. When he reaches the preschool door he enters. Data Analysis The most important t r i g g e r for t h i s f i r s t session i s the beginning of therapy, that i s , the f i r s t session. This t r i g g e r i s represented i n remote de r i v a t i v e form: moving of truck and t r a i n i s an image of going places. The same image i s also a close d e r i v a t i v e representation of the f a c t that the therapist brought the c l i e n t to the consultation room v i a long and winding corridors as represented i n the play by moving vehicles back and fo r t h . Resistance was i n evidence since the c l i e n t said but two words before the therapist's f i r s t intervention and he did not look around the room or explore i t s contents u n t i l a f t e r the f i f t h intervention. This intervention defines the time, place and frequency of sessions and therefore represents a securing of the frame. The meaning of the therapist's f a i l u r e to e s t a b l i s h the frame at the beginning of the session i s expressed symbolically (unconsciously) by the c l i e n t i n the negative  theme of h i s play, that i s i n the war (It's war.) and i n the confusion and violence (observable i n the manner of play). The universal meaning of war i s represented by the themes of struggle, danger, violence, and confusion. This theme i s shared by the implication of the dangers of therapy f o r the c l i e n t i n the absence of rules of conduct for the therapist and the c l i e n t . The c l i e n t ' s unconscious perception of the current state of h i s therapy and of h i s therapist actions ( f a i l u r e to define the frame) i s therefore a v a l i d perception. The t r i g g e r of the therapist walking with the c l i e n t along several corridors to the consultation room was represented i n disguise i n the image of the moving of the truck and the t r a i n which i s a close representation of t h i s t r i g g e r . The same image also represented the beginning of therapy, that i s , moving to a new place, which i s a remote representation of t h i s t r i g g e r . There was no model of r e c t i f i c a t i o n i n the c l i e n t ' s material. Other t r i g g e r s are, as always, interventions of the therapist of which the most important are those that concern frame issues, whether frame deviations or frame securing (Langs •, 1976) . In t h i s session, there are two tr i g g e r s (interventions) that represent securing two aspects of the frame. The second intervention. I t defines the objects i n the consultation room that the c l i e n t can touch ( i . e . , a l l toys) thus defining some boundaries of treatment. This frame securing; intervention i s immediately followed by the c l i e n t ' s p o s i t i v e theme of d e f i n i t e boundaries represented by the s o l d i e r s being safe behind a fence (no-war place) delineating the space where danger and confusion are kept out. The theme of the good and the bad being hidden i s mainly a negative image and represents well the experience by the c l i e n t of h i s not knowing what the therapist i s hiding, of h i s uncertainty regarding the r e l a t i o n s h i p with the therapist because the ground rules have not yet been established while one of the rules (privacy), had already been modified. Third intervention The emergence of the b r i e f p o s i t i v e image (good guys) i s a reaction of the c l i e n t to the therapist's t h i r d intervention which states one ground r u l e . Fourth intervention. Only a f t e r the therapist explains the c l i e n t ' s fear of uncertainty regarding h i s therapy, does the strong p o s i t i v e image of the straw that enables the buried s o l d i e r s to breathe emerge. The c l i e n t i s communicating that he i s now f e e l i n g free and i s able to ask a d i r e c t question about the duration of h i s session, which represents a ground ru l e issue for h i s therapy. I t also shows that the c l i e n t indeed had the issue of the ground rules of therapy on h i s mind, rather than issues related to his l i f e outside therapy. F i f t h intervention. After the therapist defines the time, duration, and location of h i s therapy there i s the f l e e t i n g image of toys that work (the c l i e n t winds and watches two winding toys turn) which represents a weak interpersonal v a l i d a t i o n by the c l i e n t of the therapist intervention. This p o s i t i v e image i s immediately followed by the h u r t f u l image of someone b i t i n g someone's head o f f and then by another h e l p f u l and p o s i t i v e theme of the c l i e n t volunteering to help and clean up a f t e r h i s play. According to Langs' theory, the therapist should not command the c l i e n t to come to session, which i s what the therapist had done by saying, "you w i l l come". The image of the b i t i n g of the head represents the therapist who has harmed the c l i e n t by implying the use of force. Also, the purpose and manner of his therapy, that i s helping the c l i e n t with h i s d i f f i c u l t i e s by t a l k i n g about h i s play, was not explained properly, as i t should have been done at the very beginning of the f i r s t session. The c l i e n t ' s behavioral resistance i s r e f l e c t e d i n hi s r e l a t i v e s i l e n c e . His communicative resistance i s moderately strong as he does represent the major t r i g g e r and does communicate the unconscious meaning i n powerful images. The communicative resistance also shows i n h i s s i l e n t play as he obviously has a story to t e l l but does not communicate i t to the therapist. Discussion The most important aspect of the Langsian p r e d i c t i o n regarding the h u r t f u l e f f e c t on the c l i e n t by the uncertainty about the establishment of the ground rule s of therapy i n the f i r s t session was correct as the t r i g g e r was represented i n derivative form and powerful negative images did emerge i n the c l i e n t ' s material, e s p e c i a l l y early i n the session. Decoding the c l i e n t ' s material i n l i g h t of the two immediate t r i g g e r s as well as c l i e n t ' s conscious questions show that the c l i e n t was working over, unconsciously and consciously, these major t r i g g e r s f o r the session. The verbal material from the c l i e n t was scarce which i s a sign of communicative resistance i n the presence of insecure frame as predicted by the theory. Frame t r i g g e r s were represented i n derivative form and there were two instances of interpersonal unconscious v a l i d a t i o n by the c l i e n t of therapist's interventions. Case One, Session Two Change of Rooms and Therapist's Contact with the C l i e n t outside of the Consultation Room The State of The Frame Change of rooms. Before t h i s second session, the therapist was informed that the consultation room that she had used for the f i r s t session with the c l i e n t w i l l no longer be available to her. This second session w i l l take place i n another room containing almost i d e n t i c a l toys, an observation mirror, and a microphone on the wall. The change of rooms represents, according to Langs' theory, a modification i n the ground ru l e regarding the set loc a t i o n for a l l sessions. Contact outside consultation room. The therapist was asked by the c l i e n t ' s teachers i n day programme to bring the c l i e n t to the swimming pool a f t e r the session. Contact with the teachers and with the c l i e n t outside the consultation room also represents a deviation i n the ground ru l e that l i m i t s contact between therapist and c l i e n t to the consultation room alone. Also, the therapist explained to the c l i e n t the change i n consultation rooms on the way to the session which i s another contact outside the privacy of the room. Hypotheses According to Langs' theory the two deviations i n the ground rules w i l l represent two most important t r i g g e r s fo r the c l i e n t ' s unconscious reactions. The c l i e n t w i l l be working over the unconscious implications of these two t r i g g e r s and w i l l represent them either manifestly or else i n a disguised manner i n h i s material. Deviations i n the frame are considered traumatic for the c l i e n t and the emerging images following the two t r i g g e r s w i l l be negative and h u r t f u l . The theory also predicts that a model of r e c t i f i c a t i o n may emerge i n the material. Communicative resistance i s expected. Data The c l i e n t a r r i v e s by t a x i , the therapist greets him and walks with him to the consultation room which i s on the next f l o o r . Passing by the door of the room where the f i r s t session was held, the therapist explains that they can no longer use t h i s room because someone else w i l l be using i t . The therapist then takes the c l i e n t to another consultation room. Inside the room, the c l i e n t does not look around, goes str a i g h t to the sand tray and puts several buildings into i t . He then adds two bridges, two tunnels and a truck. He runs the truck up a ramp on the top of a building. F i r s t intervention. The therapist says, "I would l i k e to explain what we are doing here. We are doing what i s c a l l e d therapy. Therapy helps you with your problems. Your teacher t o l d me that you have bad dreams sometimes, that you are sometimes a f r a i d of things, that you don't f e e l well sometimes. I t would be h e l p f u l to you i f you would t e l l me s t o r i e s about your play and t h i s i s how we w i l l work." While the therapist i s t a l k i n g , the c l i e n t stops playing and he l i s t e n s i n t e n t l y . He then takes out more cars and buildings. The therapist says, "You are playing. Can you t e l l me a story about your play." The c l i e n t answers immediately, "This house i s on top of another house and t h i s truck i s backing up to d e l i v e r f u r n i t u r e . They are moving into a new house. The c l i e n t plays some more, the therapist asks about the story and the c l i e n t says, " t h i s car broke the bridge and i t f e l l and t h i s car i s going into the garage because i t i s going to r a i n outside and t h i s truck i s just going into the tunnel. 45 Second intervention. At t h i s point the therapist intervenes, saying, " You are t e l l i n g me about people moving to a new place, about things being broken and f a l l i n g and about cars going into shelter before r a i n . Today, we moved into another room because the other one was busy. Perhaps you f e e l l i k e something i n your therapy was broken because of t h i s move and perhaps you f e e l you need s h e l t e r . " The c l i e n t then s t a r t s to whistle as he plays with more cars. Buildings are turned over and then put back s t r a i g h t . The therapist asks about what i s happening i n h i s play, and the c l i e n t says, "Everybody i s moving, they have to b u i l d new houses for everybody." Third intervention. The therapist says, "You are t e l l i n g me about moving and about new places which must be b u i l t . We are i n a new playroom today, we are s t a r t i n g something new i n t h i s new room. We w i l l stay here - we w i l l not have to move again. We w i l l come here every Wednesday and you w i l l have therapy with me f o r 35 minutes each time and then I w i l l take you to the swimming pool so you can swim with your c l a s s . " The c l i e n t takes away a few cars and s t a r t s putting busses into the sand tray. The therapist asks what i s happening and the c l i e n t says, "The bus i s coming into the people's place. This i s a people's place now, i t i s another place." He then takes away the buildings and plays with a boat and a car. The therapist asks what i s happening, and the c l i e n t says, "This guy," pointing to the boat, " i s looking for him, i s going a f t e r him", pointing to the car. Then he f l i e s a helicopter and crashes i t , then he crashes a boat. When asked about what was happening, the c l i e n t says, "They are f i g h t i n g , everyone i s f i g h t i n g . " He s t a r t s to pour sand over the scene and says that "Rain i s f a l l i n g . " Moving the buses he says, "These are stuck and the t r a f f i c h e l i c o p t e r i s t e l l i n g them that they cannot go because they have f l a t t i r e s , they are not allowed to go." Fourth intervention. The therapist intervenes, saying, "I t o l d you that you and I w i l l be staying i n t h i s room and you f e l t that we were i n another place, the people's place, and you were t e l l i n g me about cars crashing and r a i n f a l l i n g , about buses who were not allowed to go because they had f l a t t i r e s . Perhaps you f e e l I am not allowed to do something because I am helpless, l i k e a bus with f l a t t i r e s . " The c l i e n t pours more sand over the scene and asks, "How long w i l l I stay here?" The therapist r e p l i e s that he w i l l stay f i f t e e n more minutes, then he w i l l go swimming. The c l i e n t s t a r t s to overturn buildings and to crash cars i n a slow and cont r o l l e d way. He says, "Rain i s flooding everybody and cars are crashing and the war boss i s t e l l i n g them to stop f i g h t i n g . " He slowly destroys the town ad asks, "How long u n t i l I go swimming?" The therapist r e p l i e s that i t seven more minutes. The c l i e n t drops sand over the town saying, "This i s cement, the giant i s making very hard cement, he i s crushing i t and dropping i t . Everyone i s dead." F i f t h intervention. The therapist intervenes, "I t o l d you about staying here for 35 minutes and them going swimming and there i s something that made you very angry with me." The c l i e n t asks, "How long now?" The therapist responds by saying that she w i l l t e l l him when the time i s up. The c l i e n t then plays with the sand u n t i l the end. The therapist t e l l s the c l i e n t that the time i s up. He looks at h i s sandy hands and asks, "Can I wash my hands?" The therapist r e p l i e s that she w i l l show him the sink outside. The c l i e n t looked shocked and said slowly, "Outside?" The therapist then takes the c l i e n t to the sink f i r s t , then to the swimming pool. Data Analysis The f i r s t t r i g g e r , the moving into another consultation room which exists before the session begins, i s represented by a t h i n l y disguised image of "they are moving into a new house". The second t r i g g e r , therapist's contact outside the consultation room, occurs during the session when the therapist mentions taking the c l i e n t to his swimming c l a s s . The c l i e n t reacts immediately to t h i s t r i g g e r and represents i t by the more heavily disguised image of the bus going into anther, people's, place. The representation of the f i r s t t r i g g e r i s followed 48 by the negative image of breaking f a l l i n g as well as by the b r i e f p o s i t i v e of seeking shelter i n a garage and i n a tunnel mixed with negative images of threat (rain outside). The images of breaking and f a l l i n g i s a v a l i d l y perceived meaning of the therapy for the c l i e n t , which has been broken i n continuity and experienced as a f a l l because of the change i n rooms. Model of r e c t i f i c a t i o n i s expressed i n the condensed image of seeking shelter from outside threat which implies the c l i e n t ' s wish that t h i s new room provides him with shelter. After the second intervention, which was b a s i c a l l y correct, the c l i e n t reacted with the p o s i t i v e  images of people constructing something new as well as with evidence of p o s i t i v e a f f e c t (whistling) which i s i n agreement with Langs• theory. Third intervention. t h i s intervention i s informative and i s considered correct except for the l a s t part where the therapist t e l l s the c l i e n t that she w i l l take him to the swimming pool a f t e r the session. I t represents, according to Langs' theory, an a n t i c i p a t i o n of a break i n the frame, that i s of contact with t h i r d p a r t i e s (his cl a s s at swimming). The therapist not only announces that she w i l l have outside contact with the c l i e n t and l i k e l y also with his teachers and classmates, t h i s t o p i c i s introduced u n i l a t e r a l l y be the therapist. According to Langs' theory such u n i l a t e r a l introduction of a subject by a therapist r e f l e c t the therapist's fear of a secure frame (adherence to the i d e a l frame). The mention of going swimming has the function to break the contact with the immediate discussion, as i n i t i a t e d by the c l i e n t , to the outside of the room. This l a s t part of the intervention was therefore expected to t r i g g e r i n the c l i e n t negative images of force and violence. The evidence for a disguised representation of the  t r i g g e r of the therapist intrusion into the c l i e n t ' s private world (his preschool class at swimming) i s i n the image of a bus coming into another, people's place. The c l i e n t ' s unconsciously perceives the therapist as "looking for him" and "following him" which ends i n the negative images of f i g h t i n g and of dangerous r a i n . There i s a model of r e c t i f i c a t i o n present i n the material i n the form of someone i n authority ( t r a f f i c helicopter) " i s t e l l i n g " someone of not being "allowed to go" somewhere because there i s something wrong with i t ( f l a t t i r e s ) which c a r r i e s the raw massage of the c l i e n t that the therapist should not be allowed to go with him to the swimming pool because i t i s wrong. Fourth intervention. t h i s intervention i s incorrect because i t does not i d e n t i f y the t r i g g e r (going to the swimming pool). As the therapist does not follow the c l i e n t ' s model to r e c t i f y the anticipated act the c l i e n t expects that the therapist w i l l go through with her promise and he f e e l s that the therapist i s dangerous. The material that follows the fourth intervention does indeed show that the c l i e n t immediately reacts with anxiety regarding h i s stay i n therapy. He asks a question about the length of his stay which i s r e l a t e d to the therapist taking him swimming. As the therapist s t i l l does not recognise the unconscious meaning of t h i s c l i e n t ' s question and answers i t on a manifest l e v e l (in a non-interpretative way that does not explain the c l i e n t ' s anxiety) the c l i e n t responds with negative themes of violence (war), destruction (crashes) and loss of control (flood). The c l i e n t then communicates a model of r e c t i f i c a t i o n with the image of the "war boos who t e l l s people to stop f i g h t i n g " . The narrative i s followed by a manifest  t r i g g e r i n the question which mentioned swimming d i r e c t l y . According to Langs' theory, the c l i e n t does indeed keep on t r y i n g to a l e r t the therapist to the impending deviation i n the frame. Evidence that the c l i e n t i s communicating d e r i v a t i v e l y and i s not concerned with the l i t e r a l issue of the time l e f t u n t i l he goes swimming can also bee seen i n the f a c t that the response by the therapist to the question's manifest meaning (how long) does not s a t i s f y the c l i e n t , he asks again and again while h i s narrative contains more negative themes of destruction followed by 51 the death of everyone. In fact, a f t e r the session, the c l i e n t was i n no hurry to get to the swimming pool and he dragged hi s feet going there. F i f t h intervention. The therapist's response i s i n the same vein as the previous intervention and the session ends without any insight into the immediate t r i g g e r by either the c l i e n t or the therapist. Discussion The hypotheses regarding the e f f e c t of the deviations i f the frame on the c l i e n t ' s subsequent material were correct i n the three important areas: (a) the emergence of negative images, (b) the presence of d e r i v a t i v e and manifest representation of the t r i g g e r s , and (c) d e r i v a t i v e models of r e c t i f i c a t i o n . There are no p o s i t i v e images i n evidence i n the c l i e n t ' s material a f t e r the t h i r d intervention which i s considered a b a s i c a l l y correct explanation by Langs' theory and which i s b r i e f l y followed by a p o s i t i v e image of building something new. When pleas for r e c t i f i c a t i o n of the frame by the c l i e n t go unanswered by the therapist the c l i e n t either stops communicating or else p e r s i s t s with h i s message. Also, according to Langs' theory, a correct i n t e r p r e t a t i o n by the therapist (second intervention) was followed by the p o s i t i v e images and p o s i t i v e a f f e c t . Overall, the predictions formed on the basis of Langs' theory were found correct for t h i s session. Case One - Session Three C l i e n t ' s Lateness, Contact with Third Parties, and Extension of the Session State of the Frame Cl i e n t ' s lateness. The c l i e n t i s brought ten minutes la t e by the t a x i driver. The therapist takes the c l i e n t s t r a i g h t to the consultation room. Contact with t h i r d p a r t i e s . On the way they pass several groups of people, adult out-patients who t a l k loudly i n the corridor and the c l i e n t and therapist almost t r i p over t h e i r feet several times. This i s the c l i e n t ' s second time going to the same consultation room and he remembers a l l the turns of the corrid o r s . In front of the consultation room, the therapist reads to him the sign on the door and explains, "Occupied means we w i l l be using the room." Extension of the session. The therapist extends the session ten minutes past the appointed time on the grounds that the c l i e n t was not responsible for h i s lateness due to h i s young age (five) and because he had no control over the t a x i d r i v e r . Hypotheses According to Langs' theory, the three breaks i n the frame w i l l a f f e c t the c l i e n t i n a negative way. I t i s predicted that he w i l l represent a l l t r i g g e r s i n eithe r d e r i v a t i v e or manifest form and that he w i l l communicate 53 symbolically the meaning these t r i g g e r s have fo r him. I t i s also predicted that the c l i e n t w i l l show resistance because of the frame breaks and that he might present a de r i v a t i v e model of r e c t i f i c a t i o n for the breaks i n the frame of h i s therapy. Since two breaks i n the frame occurred before the session, i t i s predicted that the c l i e n t w i l l s t a r t the session with h i s unconscious communication r e l a t e d to these two t r i g g e r s and w i l l work over the implications of the t h i r d t r i g g e r (extension of the session) subsequent to i t s occurrence. According to the basic precept of Langs 1 theory, the themes and images of the implications of the t r i g g e r s w i l l match the universal themes and images of such actions. Data The c l i e n t goes st r a i g h t to the sand box and does not take o f f h i s jacket. He looks calm and uses slow and c o n t r o l l e d movements, which i s d i f f e r e n t from h i s l a s t session. He goes to the sand tray and puts i n a building, three buses, a bridge, a "pet store", and a h e l i c o p t e r on the roof of the pet store. The therapist asks the c l i e n t to t e l l her a story about his play. The c l i e n t looks at the therapist and answers immediately, "The buses are making tracks, so they can go through t h i s bus stop. This i s a bus stop (the b u i l d i n g ) . The man i s waiting for the bus because i t takes so long." The c l i e n t plays by moving 54 the buses slowly. The therapist asks about what i s happening i n the play now. The c l i e n t answers immediately, "This i s a passage way for buses and t h i s i s another passageway for cars." He i s making a sand wall d i v i d i n g the two paths, and running the bus and the car p a r a l l e l to each other. He then drives one bus over the bridge and s t a r t s putting s o l d i e r s , aiming p i s t o l s at one another i n the sandbox, next to the bus s t a t i o n . Then, a bulldozer digs a "hole i n the ground". The therapist asks what i s happening i n the story. The c l i e n t answers immediately, "They are f i g h t i n g . He has put the s o l d i e r s i n , but i s not moving any and none f a l l . The c l i e n t continues, "Sometimes they come to t h i s part of town, and they f i g h t . Sometimes they come, and sometimes they don't come." F i r s t intervention. F i f t e e n minutes into the session, the therapist says, "Today you were brought i n to the session ten minutes l a t e by the t a x i d r i v e r . In your play, there was a man waiting for the bus which took too long, j u s t l i k e you were waiting for the t a x i . Then, I was taking you along the corridors to get to t h i s room and we passed many people, i t was l i k e a bus load of people. Being brought l a t e to the session and passing so many people i n the corridor i s l i k e f i g h t i n g to you. I was making you f e e l badly inside, l i k e you were i n a f i g h t . You made two separate passageways for the bus and for the 55 car: you would l i k e me to f i n d a way , a passageway to t h i s room, so that you would not have to go past so many people. 1 1 The c l i e n t immediately takes out a bulldozer and st a r t s meticulously to pat the sand smooth. While doing t h i s , he s t a r t s to whistle and continues to whistle on and o f f through the remaining of the session. The ther a p i s t asks the c l i e n t about what i s happening now. The c l i e n t says, " I t i s patting down the ground. I t i s making the ground smooth." The same bulldozer made a hole i n the ground i n the beginning of the session, so i t i s safe to assume that the bulldozer i s repairing the hole now. The c l i e n t makes another separating sand wall and runs buses and cars p a r a l l e l to one another. Second intervention. The therapist says, "Next time you come here, I w i l l take you another way to t h i s room, so that you w i l l not have to pass so many people. Also, i f the t a x i d r i v e r i s la t e for your session again, you w i l l have your session just as long, i t w i l l not be shorter because the driver i s l a t e . Today, you were ten minutes l a t e , so you w i l l stay here the same 35 minutes as before. We w i l l end the session ten minutes l a t e r than usual. 1 1 At about twenty-five minutes into the session, the c l i e n t takes a bus and runs i t slowly, then stops i t . In front of i t goes slowly an ambulance. The therapist asks what i s happening i n h i s play. The c l i e n t answers, "The bus stopped because i t was the bus stop. The ambulance went i n front of the bus." He then goes to the shelves and gets small p l a s t i c b a l l s . Starts dropping them, one by one, very evenly a l l over the sandbox. He says, "The bombs are f a l l i n g a l l over the place." Then he goes to the shelves and takes out a nurse, a worker with a shovel, then s i t s down on the f l o o r , and s t a r t s playing with the h o s p i t a l figures. A l i t t l e l a t e r , he gets up, takes out two h o s p i t a l beds, more nurses, a wheel chair, puts them a l l i n the sand box between the standing s o l d i e r s . The therapist ask about the story and the c l i e n t r e p l i e s , "He (the soldier) gets shot, so he must go to the bed (puts the s o l d i e r on another bed), t h i s one also gets shot and he must go on a wheel chair (the c l i e n t puts him there, then drives the beds and the wheelchair slowly to the side of the box. Third intervention. Today, I t o l d you about your session being always the same length of time and about the new way I w i l l take you to t h i s room. What I t o l d you made you f e e l good, just l i k e the bulldozer which made the ground smooth, but i t also made you f e e l bad, l i k e the s o l d i e r s being shot and then taken to be helped by the nurses. The c l i e n t takes some of the s o l d i e r s out of the sand tray. Then, he goes to the shelves and looks for something for a long time. F i n a l l y , he brings out road signs, water hydrants, telephone poles and positions the bulldozer with the res t of the toys. The ther a p i s t asks what i s happening i n h i s play. The c l i e n t answers, "The workers are f i x i n g up the c i t y . " He continues to put signs a l l over the c i t y , the telephone poles on each side of the bridge, whistling while playing. The therapist t e l l s the c l i e n t that t h e i r time i s up and she gets up. The c l i e n t looks a b i t surprised and asks, "Am I going swimming now?" The therapist answers, "Yes, I am taking you there." The c l i e n t s t a r t s going towards the door, shaking sand from his hands. Outside the consultation room, he goes the r i g h t way and walks ahead of the therapist. Near the swimming pool, he takes o f f h i s jacket, puts i t on h i s head and makes a funny face, smiling at the therapist. The therapist says, "Let's go." He goes, but stops at the next pole and swings around i t , smiling. The therapist says, "Let's go". When the c l i e n t ' s teacher can be seen, the therapist says good bye to the c l i e n t and he runs to h i s teacher. After the session, two teachers from the c l i e n t ' s day programme t o l d the therapist that the c l i e n t "seemed a d i f f e r e n t c h i l d a f t e r the t h i r d session: he was much calmer and they had no trouble with him". Data Analysis The three current t r i g g e r s for t h i s session are 58 represented i n der i v a t i v e form. The t r i g g e r of coming f o r the session l a t e because the t a x i was l a t e picking the c l i e n t up from h i s daycare centre, was represented by the close de r i v a t i v e of the man who " i s waiting for bus who i s taking so long". The t r i g g e r of the therapist taking the c l i e n t along the corridors where the out-patients were waiting and r e s t r i c t i n g the passage on the way to the session was represented i n close derivative form by the image of the buses which "are making tracks so they can go through t h i s bus stop"; the out-patients were i n f a c t delivered to the centre by s p e c i a l buses which were parked i n front of the Centre and the c l i e n t must have seen them before. The making of the tracks "so they can go through the bus stop" i s reaction by the c l i e n t to the walk past the crowd of patients and i s also a v a l i d perception of the therapist as having d i f f i c u l t y to bring the c l i e n t to the session. The t r i g g e r of the extension of the session was represented by a distant derivative which a sign of greater communicative resistance i n the c l i e n t . The image of "the bus had to stop because i t was the bus stop" and "the ambulance went i n front of the bus" represents two aspects of the extension. The t r i g g e r representation of the extension i n the image of an ambulance which "went i n front of the bus" i s a derivative representation. The theme of "the bus had to stop because i t was the bus stop" 59 i s a model of r e c t i f i c a t i o n saying that the therapist must stop the session at the agreed time (bus stop). The image of the ambulance which t e l l s of someone sick and needy which i s a v a l i d perception of the therapist who i s perceived as needing t h i s extension for s i c k reasons. The representation of t h i s t r i g g e r did appear r i g h t a f t e r the therapist announced that h i s current session w i l l be extended by ten minutes. The representation of the f i r s t two t r i g g e r s as close derivatives represents l i t t l e communicative resistance on the part of the c l i e n t which i s explained by Langs' theory by the f a c t that neither the lateness of the t a x i d r i v e r nor the presence of the waiting crowds i n the corridors were actions taken by the therapist although the therapist i s responsible for what happens to the c l i e n t while she i s with him. Both representations emerged i n the c l i e n t ' s material r i g h t at the beginning of the session, as predicted. The t h i r d t r i g g e r was represented with considerable disguise which i s a sign, according to Langs' theory, that the action by the therapist (extension) was more traumatic fo r the c l i e n t . The s e l f - s e r v i n g function of the extension by the therapist i s e s p e c i a l l y traumatic to the c l i e n t s and i t i s usually heavily disguised because the c l i e n t s f e e l hopeless i n the face of such actions (Langs, 1982). The therapist acknowledged, a f t e r some introspection following the session, that she feared that a 25 minute session would not cover enough material to be used for the purpose of her study of the session. The c l i e n t ' s perception of the needy therapist was therefore v a l i d . The f a c t that s therapist would do something to the c l i e n t to s a t i s f y her own needs i s i n f a c t sick, again a v a l i d perception by the c l i e n t . Langsian prediction regarding the emergence of negative images i n the presence of the breaks i n the frame was correct: the negative themes of the s o l d i e r s f i g h t i n g and the bulldozer digging a hole i n the ground emerged r i g h t at the beginning of the session. The themes show that the two t r i g g e r s represented dangers i n h i s therapy and that the therapist was dangerous to the c l i e n t . F i r s t intervention. I t explained to the c l i e n t the meaning of h i s unconscious communication to the t h e r a p i s t i n a b a s i c a l l y correct manner and i t was immediately followed by the p o s i t i v e and constructive image of a repair, the "machine making the ground smooth" where the hole was before. The c l i e n t ' s a f f e c t also changed from the expression of worry (in the f i g h t i n g scene) to cheerfulness (whistling). This c l i e n t ' s message i s only the interpersonal v a l i d a t i o n of the intervention ( i n t r o j e c t i o n of the well functioning therapist) and i t lacks the cognitive v a l i d a t i o n which can be explained by the f a c t that the therapist did not propose any 61 r e c t i f i c a t i o n of the breaks. The c l i e n t represents h i s model of r e c t i f i c a t i o n of the dangerous aspect of the way he was brought to the session by building two separate passageways fo r the buses and f o r the cars (for the c l i e n t and therapist separate from fo r the out-patients). He repeated the same model i n the material immediately following the f i r s t intervention which mentions the need for a safer path to the session but does not propose an actual r e c t i f i c a t i o n . According to Langs* theory, a model of r e c t i f i c a t i o n i n the c l i e n t ' s material must be followed by a r e c t i f i c a t i o n by the therapist i n a c t u a l i t y , i t cannot be interpreted "away" because the cause of the c l i e n t ' s emotional disturbance ( i . e . , the experience analogous to being i n a f i g h t and to being dug into) i s "an external danger s i t u a t i o n to which the therapist has s i g n i f i c a n t l y contributed" (Langs, 1982, p. 38) and therefore the response by the therapist "must include both the cessation of t h i s contribution to the patient's s u f f e r i n g and an i n t e r p r e t a t i o n of the nature of the symptom " (Langs, 1982, p.38). Second intervention. I t r e c t i f i e s the break i n the frame rel a t e d to the passing of the out-patients by promising a d i f f e r e n t route. However, the intervention also announces a new break i n the frame: the extension of the session beyond the appointed time by ten minutes. The intervention i s immediately followed by the destructive image of the bombs are " f a l l i n g a l l over the place" and the images of sickness (shot s o l d i e r , h o s p i t a l beds and wheels c h a i r s ) . The emergence of some p o s i t i v e images of helping figures (nurses, doctors and worker with a tool) i s explained by the correctness of the f i r s t part of the second intervention, the promise to r e c t i f y one break i n the frame. The worker with the shovel i s e s p e c i a l l y poignant because the shovel i s a t o o l used to r e p a i r ground and shows that the c l i e n t i s using the same theme of dangerous ground with which the c l i e n t expressed the same t r i g g e r , the dangers of walking along those corridors, which he i s working over unconsciously. Third intervention. I t mostly misses the c l i e n t ' s unconscious message, although there i s acknowledgement of the h u r t f u l e f f e c t s on the c l i e n t of the extension of the session. The intervention does not include the necessary r e c t i f i c a t i o n of the break i n the frame ( i . e . , ending the session at the appointed time) and i s predictably followed by a model of r e c t i f i c a t i o n . The c l i e n t introduces the images of rules that must be followed by common convention (road signs), provisions fo r stopping the spread of destruction (water hydrant) and new l i n e s of communication (telephone poles). His verbal explanation of his play scene givers a c l e a r model of  r e c t i f i c a t i o n t e l l i n g that "the workers are f i x i n g up the c i t y " . The c l i e n t ' s play scene, which t e l l s that something that was destroyed needs to be fix e d , i s also a cle a r a l b e i t non-verbal model of r e c t i f i c a t i o n . Discussion The hypothesis regarding the e f f e c t s of the breaks i n the frame were found correct. According to Langs' theory, the three breaks i n the frame were indeed followed by (a) the emergence of negative images, (b) the presence of deri v a t i v e representation of t r i g g e r s , and (c) d e r i v a t i v e models of r e c t i f i c a t i o n . P o s i t i v e and constructive images i n the c l i e n t ' s material (interpersonal unconscious validation) did follow the correct aspects of the f i r s t and t h i r d interventions. Langsian theory i s based on extensive empirical studies which have shown the e x q u i s i t e l y s e n s i t i v e unconscious v a l i d perceptions of adults and adolescents. In t h i s session, i n addition to v a l i d perception of t h i s old c l i e n t of the breaks i n the frame, there i s one p a r t i c u l a r l y amazing perception: almost exactly at the moment of the appointed time the session should have ended, the f i v e year old c h i l d says, "the bus had to stop because i t was the bus stop" a f t e r the therapist had explained to him that t h i s p a r t i c u l a r session w i l l be extended past the appointed time. Over a l l , Langsian hypotheses were found correct. 64 Case One - Session Six Cl i e n t ' s Lateness, Missed Session, and Forced Termination of Treatment State of the Frame Cl i e n t ' s lateness. According to Langs' theory, lateness of either c l i e n t or therapist i s a break i n the ground r u l e that states that the session must s t a r t at the appointed time. The c l i e n t was brought to the session 20 minutes l a t e by the t a x i d r i ver. Since the transportation by t a x i was arranged through the c l i e n t ' s day programme at the Centre, there i s some implied r e s p o n s i b i l i t y the therapist has i n t h i s matter although she was not d i r e c t l y involved i n the arrangement. Missed session. Last week's session was cancelled by the c l i e n t ' s mother because they were away on holiday. Two weeks ago, the therapist had t o l d the c l i e n t that she w i l l be there for h i s session even though h i s school w i l l be closed for the holiday. According to theory, the c l i e n t ' s absence from the previous session at a time when the therapist was present i s a break i n the ground r u l e which states that the c l i e n t i s responsible for a l l sessions for which the therapist i s present. Forced termination of treatment. This session i s the one before l a s t f or the c l i e n t because the therapist i s leaving the Centre. The approaching forced termination of the c l i e n t ' s treatment i s a break i n the ground r u l e 65 s t a t i n g that the therapist i s responsible for t r e a t i n g the c l i e n t for as long as the c l i e n t needs the treatment. Such terminations are a common occurrence i n the c l i n i c a l s e t t i n g and one of the more traumatic breaks i n the frame for the c l i e n t (Langs, 1976, 1982). Overall, there i s one current (lateness) and two powerful background breaks i n the frame. Hypotheses A l l three breaks i n the frame are strong of which the forced termination of treatment i s the most traumatic for the c l i e n t . I t i s therefore predicted that the most traumatic break i n the frame w i l l be the most powerful organiser of the c l i e n t ' s material i n t h i s session. I t i s predicted that forced termination w i l l be represented as well as worked over symbolically and that negative, destructive images and themes w i l l be predominant i n the session. Since the major t r i g g e r for t h i s session i s termination i t i s predicted that the images w i l l r e f l e c t t h i s very theme of destructive ending. A model of r e c t i f i c a t i o n may emerge and resistance i s predicted. Data As the c l i e n t i s brought i n 2 0 minutes l a t e , the therapist learns that there was a confusion at the s t a t i o n and several other children are l a t e for school. The c l i e n t entered with h i s jacket over h i s head. He did not notice the therapist u n t i l she said "Hello" twice. The 66 c l i e n t kept h i s head covered but found h i s way to the consultation room. Inside the room, he l e t s h i s jacket o f f h i s head, but does not take i t o f f . He goes s t r a i g h t to the sand tray and s t a r t s to play. His face i s painted i n black so that he looks l i k e a cat or a dog. He i s d r i v i n g a bus over a bridge, then i t stops and he then l i n e s up about twenty cars i n a row. The therapist asks about the story of his play and the c l i e n t says, "The buses are l i n i n g up i n a long line-up and the people are getting o f f the bus. Lots of buses are l i n i n g up", he then makes the l i n e up of cars even longer. The c l i e n t then takes an ambulance, makes the sound of the si r e n , and drives i t . He takes out a h o s p i t a l bed, puts a person on i t , puts both on the ambulance and drives i t with the sound of the s i r e n . The therapist again asks about the story of h i s play and the c l i e n t answers immediately, "The ambulance i s going to the h o s p i t a l . The man i s already dead and he i s going to the h o s p i t a l " . He takes out another person, puts i t next to a building, drives the ho s p i t a l bed to the building and buries the man i n the h o s p i t a l bed. The therapist asks about h i s story, and the c l i e n t s says, "The ambulance i s going to the s h e r i f f . The s h e r i f f buries the man because he was dead". F i r s t intervention. Today, i n your play, you made a very long l i n e up of cars and there were people getting o f f a bus. Today, the t a x i d r i v e r brought you here very l a t e . For you i t was l i k e waiting i n a l i n e up f o r the t a x i . Also, l a s t week you did not come here, i t was Easter holiday. In your play, there was a dead person and the ambulance brought him to the ho s p i t a l - perhaps your being brought here l a t e and your missing a session l a s t week made you f e e l l i k e dead. Also, the s h e r i f f buried the dead person i n your play, and you were burying you face, u n t i l we came i n here. Perhaps you f e l t l i k e you needed to hide, to be buried, because you f e l t l i k e dead. The c l i e n t thinks for a while, then takes out a r o l l e r and makes a road over the bridge, where the f i r s t bus had gone before. He works on the road and builds i t a l l around the place. While he i s playing, he i s singing a song with the words, "where to f i n d " something". The therapist asks about h i s story and the c l i e n t says, "People are making the road f l a t and smooth". The he takes out a block and puts i t next to the road, takes out road signs, puts them besides the road and takes out an indian totem pole. The therapist asks about h i s story and the c l i e n t says, "This i s the gas st a t i o n (pointing to the block) f o r the cars to have gas and t h i s i s the road signs. He then takes out the t r a i l e r parts of several combined vehicles with the engine parts are missing and puts several small cars on the t r a i l e r s . The therapist asks about h i s play and the c l i e n t says, "They would l i k e to go with the 68 t r a i l e r s , but they cannot. (Pause.) Do you know where i s the other part of t h i s ? " The c l i e n t then takes another t r a i l e r part without the engine. He puts a person on the t r a i l e r and puts both into the sandbox. Second intervention. The therapist says, "Last session, I reminded you that next week i s you l a s t session here with me and then you took out many t r a i l e r s but they were a l l missing the engines. The road was there and the gas s t a t i o n was there, but there was no engines to drive the t r a i l e r s . You asked me i f I knew where i s the front part. Also, you sang something about where to f i n d something. Perhaps you are thinking about your l a s t session, my not coming here any more. I make you f e e l l i k e a t r a i l e r who cannot go anywhere. I make you f e e l l i k e I don't give you the energy to move". The c l i e n t takes out a bulldozer, a worker with a hard-hat, and puts another road sign next to the road. The bulldozer works on the road. The therapist asks about h i s play and the c l i e n t says, "The t r a c t o r i s f i x i n g the road and the worker i s putting up a sing". Third intervention. I t i s now the end of session and the therapist asks the c l i e n t ' s permission to speak to h i s mother to remind her about the therapist's leaving the Centre and to inform her that the therapist would be w i l l i n g to continue with the c l i e n t ' s therapy i n her private o f f i c e . The therapist b r i e f l y mentions to the 69 c l i e n t that he showed anxiety through the communication of themes rel a t e d to the termination of h i s treatment. The c l i e n t agrees and the therapist announces the end of the session. The c l i e n t s leaves r i g h t away, again putting h i s coat over h i s head u n t i l he reaches his day programme room. Data Analysis The c l i e n t ' s unconscious communication s t a r t s with the c l i e n t covering h i s head and walking r i g h t past the therapist. Although not a verbal communication i t i s a cl e a r negative image of someone (the therapist) not there (for the c l i e n t ) . This i s a very remote representation of  the t r i g g e r of termination of therapy r e f l e c t i n g the theme of disappearing, of not being there any more, therefore of ending. The remoteness of representation as well as the f a c t that the communication was not verbal was predicted as resistance i n view of the power of the traumatic t r i g g e r . The resistance was more behavioral (silence) than communicative (there was meaning i n h i s behaviour). The f a c t that the c l i e n t intended to not see the therapist, who waited for him, speaks for a gross behavioral resistance by the c l i e n t , who didn't want to come to the session. The c l i e n t ' s being brought l a t e to the session i s represented i n the image of "the busses are l i n i n g up i n a long l i n e up" which i s a close t r i g g e r  representation. The therapist learned that several other children were brought l a t e by other t a x i d r i v e r s and the cars were indeed l i n i n g up to pick up and to d e l i v e r the children. As the therapist involvement was only minimal i n causing the c l i e n t ' s lateness ( i t was only implied as f a r as the therapist worked at the Centre which had made the transportation arrangements for the c l i e n t ) , the t r i g g e r was not as traumatic for the c l i e n t and the communicative resistance was minimal. The misses previous session has no t r i g g e r  representation i n the verbal material. Langsian ground rules were derived empirically from unconscious communications of adult patients. In the case of a missed session for which the therapist was present the patients u n i v e r s a l l y expressed the need to be responsible (to pay) for such sessions or else t h e i r mature independent functioning would be jeopardised. In the case of a c h i l d who cannot earn money to pay for h i s sessions, such r e s p o n s i b i l i t y obviously rests with the parent. I t i s my opinion that t h i s matter cannot be studied p r o f i t a b l y i n a c l i n i c a l s e t t i n g where several powerful breaks i n the frame e x i s t i n almost every session and thus obscure any images and themes related to t h i s currently less traumatic t r i g g e r . A clear study of t h i s break i n the frame could be better examined i n the secure frame environment of private p r a c t i c e . The very f i r s t images that emerge i n the material are the extreme negative images of the ultimate destruction (death). The compelling negative theme of someone who i s offered help (put on a h o s p i t a l bed and driven to the h o s p i t a l i n an ambulance with the siren) but the help came too l a t e (the person i s already dead and i s being buried) i s a moving expression by the c l i e n t of h i s experience of the pending forced termination of h i s treatment. The c l i e n t i s expressing h i s v a l i d perception of h i s therapy where he i s for the moment offered help but i t i s already too late (termination w i l l happen). The same theme i s also a v a l i d unconscious perception by the c l i e n t of the therapist, who i s given the chance of being h e l p f u l (ambulance) but who i s already dead for the c l i e n t ( w i l l not come back). According to Langs' theory, c l i e n t s express p a r t i c u l a r l y compelling themes and images i n the presence of very traumatic breaks i n the frame, of which forced termination i s one example, and such images have been found to be v a l i d perception, rather than d i s t o r t e d fantasies, of the' therapist•s actions (Langs, 1976, 1982, 1985,...). The f i r s t intervention. The explanation i s b a s i c a l l y incorrect because the therapist does not explain the highly destructive images i n the l i g h t of the major t r i g g e r (forced termination) and therefore neither admits her traumatic action which i s causing s u f f e r i n g for the c l i e n t , nor does she o f f e r a r e c t i f i c a t i o n of the matter 72 (possible continuation of treatment). According to prediction, there i s a model of  r e c t i f i c a t i o n present i n the material following the f i r s t intervention: the cars can have gas, but s t i l l cannot go because the connections to the engines are missing. There i s also a more disguised image, having the function of a model of r e c t i f i c a t i o n , of the road signs which implies an appeal to r u l e s . The message i n the model can be abstracted as "what good i s the therapy (fuel for cars) i f there i s no connection to the therapist (missing linkage of t r a i l e r s to the engine parts) and i t a l l has something to do with rules (road signs) which say that therapy can stop when the c l i e n t i s healed and must not be forced. The model of r e c t i f i c a t i o n was c a l l e d to the therapist's attention by the d i r e c t question by the c l i e n t , "do you know where i s the other part of t h i s ? " implying that i t i s the therapist's job to f i n d the solution. The second intervention. The explanation given to the c l i e n t was somewhat correct as i t did r e l a t e the material to the forced termination of treatment and i t did imply some r e s p o n s i b i l i t y of the therapist for the termination. However, the intervention misses the important message embedded i n the c l i e n t ' s model of r e c t i f i c a t i o n and i t does not r e l a t e the now recognised t r i g g e r of termination to the previously communicated highly destructive themes i n the material of the c l i e n t . According to Langs' theory, such intervention w i l l be followed by p a r t i a l v a l i d a t i o n i n the form of some p o s i t i v e image. This intervention was indeed followed by the constructive image of the t r a c t o r that i s f i x i n g the road and the worker that i s putting up a sign which represents interpersonal v a l i d a t i o n and i s an i n t r o j e c t i o n of a p o s i t i v e act of the therapist. There was no cognitive v a l i d a t i o n , however, as the c l i e n t was not given complete explanation of h i s unconscious experience of termination of h i s treatment. Discussion The above Langsian hypotheses were found correct. The material involved extremely traumatic theme of death, the hopeless theme of help coming too l a t e , and an appeal to rules, and for connection with the therapist. Also according to prediction, the communicative resistance was strong, r e f l e c t i n g the danger the c l i e n t perceived i n t h i s therapy. There was only one p o s i t i v e theme i n the session ("the t r a c t o r i s f i x i n g the road") following the p a r t i a l l y correct i n t e r p r e t a t i o n included i n the second intervention. 74 Case Two, Session One: Family Meeting, Presence of Staff Member, and Observation Mirror Background Information on the C l i e n t The c l i e n t i s a s i x years old Chinese g i r l l i v i n g with her natural parents and a younger s i b l i n g . She was referred to the Centre by her mother who was concerned about her not speaking with anybody other than the immediate family and grandparents since she began to speak at the age of one. The only exception was a Chinese g i r l f r i e n d with whom the c l i e n t began to speak a f t e r two years of s i l e n t play. The c l i e n t ' s mother had taken her to several mental health professionals within the past three years, however the treatment received was not long-term and the symptom of e l e c t i v e mutism persisted. A minor complaint was also the c l i e n t ' s reluctance to eat. The mother reported that she had force fed the c l i e n t including slapping her since she was one. The c l i e n t was raised mainly by her maternal grand-mother since the age of one. The parents emphasized that the grandparents greatly favoured the c l i e n t ' s younger brother. The main family concern was the c l i e n t ' s s i l e n c e at school where she showed above average a b i l i t y and s k i l l i n a l l subjects where she could communicate i n writing. 75 State of the Frame Family Meeting. Any contact with t h i r d party i s considered a powerful break i n the frame since t o t a l c o n f i d e n t i a l i t y , t o t a l privacy, and one-to-one contact i n treatment are modified. The above information about the c l i e n t was obtained during the f i r s t contact of the therapist with the c l i e n t at a meeting with the complete family and a s t a f f therapist present. The meeting was conducted by the s t a f f therapist while the present therapist remained t o t a l l y s i l e n t (except for the i n i t i a l and parting greetings). The c l i e n t did not speak and did not make any eye contact with either therapists. Presence of s t a f f member. In addition to break i n the frame, the presence of another therapist can be confusing to the c l i e n t who w i l l not be ce r t a i n of the therapeutic r o l e of her therapist. Observation mirror. The p o s s i b i l i t y of being observed by someone who cannot be seen or heard constitutes a powerful break i n the frame with a l t e r a t i o n s i n c o n f i d e n t i a l i t y privacy, and one-to-one r e l a t i o n s h i p i n treatment. The fact that the c l i e n t (and, i n t h i s case, the therapist) can never know who i s observing and whether the observation i s taking place adds an uncertain and confusing element to treatment. 76 Hypotheses Family meeting. In the presence of such powerful break i n the frame, i t i s predicted that the c l i e n t w i l l react to t h i s t r i g g e r with negative images of mistrust of the therapist, of not being held well i n therapy, and of danger. The fac t that the therapist was s i l e n t during the family interview may have a somewhat modifying e f f e c t on the c l i e n t , thus lessening her mistrust of the therapist because the therapist did not a c t i v e l y sought or give information concerning the c l i e n t i n the presence of others. Presence of s t a f f member. On the basis of the theory, i t i s predicted that the same type of powerful reactions by the c l i e n t as were predicted i n r e l a t i o n to the family meeting w i l l be observed. An added factor i s predicted however, since the c l i e n t w i l l be confused about the r o l e and purpose of a member of the s t a f f and consequently about the ro l e and purpose of her therapist. Negative themes and images related to danger, mistrust, poor holding, and uncertain i d e n t i t y . Observation mirror. I t i s predicted that t h i s powerful break i n the frame w i l l exert the same type of strong reactions i n the c l i e n t as the two breaks i n the frame above with the added e f f e c t on the c l i e n t of the hidden, unseen danger as represented by the possible hidden observer behind the observation mirror. since the therapist had no control over who could enter the adjacent observation room, the present p r e d i c t i o n considers the e f f e c t on the c l i e n t of the p o s s i b i l i t y of being observed. In a l l , the background t r i g g e r s of the family meeting, the presence of the s t a f f therapist, and the current t r i g g e r of the observation mirror are expected to exert a strong influence on the c l i e n t . I t i s predicted that the e f f e c t of these t r i g g e r s w i l l r e s u l t i n e f f o r t s by the c l i e n t to a l e r t the therapist to the gravity of t h e i r implications and to o f f e r to the therapist models of r e c t i f i c a t i o n . In the presence of major breaks i n the frame, sings of resistance are predicted. Data The c l i e n t enters the consultation room and goes stra i g h t to a d o l l house. She picks up several figures i n the house, looks at them and puts them back i n s i l e n c e . F i r s t intervention. Ten minutes into the session, the therapist s t a r t s commenting about her play by v e r b a l i z i n g what the c l i e n t did, for example, "I see that you are holding a baby d o l l " . The c l i e n t gathers a family of four and places them s i t t i n g around the kitchen table. F i f t e e n minutes into the session, the therapist makes another observation, "I see that you are holding a super-hero that looks l i k e Superman". The c l i e n t looks at the therapist, and says, " I t ' s Batman." She holds the figure up for the therapist to see and says, "My brother has a 78 Batman. X have Barbies". A l i t t l e l a t e r , the c l i e n t says, "I have many clothes fo r them". She then plays with the d o l l s putting them " i n t h e i r r i g h t places" i n the d o l l house, each i n t h e i r own room. Then, she says that "grandpa i s taking the baby out for a walk i n the s t r o l l e r " and the baby "must f i n d h i s own way from the kitchen into the bedroom" and the baby "goes to sleep". She puts the baby i n bed alone i n h i s bedroom. The therapist occasionally echoes her words, l i k e "must f i n d h i s own way". The c l i e n t ' s play looks l i k e a quiet exploration of the d o l l house. Twenty minutes into the session, the c l i e n t goes to the sand-tray and smiles at the sight of the dinosaurs on the shelves. In the sand, she makes a "mountain with one door and two windows". As she takes out the dinosaurs, she t e l l s the therapist that she has seen the f i l m "Land Before Time" and she gives the dinosaurs names from the f i l m . She takes Sharptooth (a dangerous and v i o l e n t tyrannosaurs i n the film) and explains that he "crashed through the window and into the mountain and hides h i s head". She leaves Sharptooth inside the mountain. She then c a l l s a "whale h e l p f u l " as i t helps L i t t l e Foot. There i s "an ocean, but the L i t t l e Foot i s s t i l l t h i r s t y because he cannot drink the water". She places "the mother of L i t t l e Foot" on her side next to the mountain and pronounces her "dead" (in the f i l m , the mother dies 79 due to f a t a l i n j u r i e s i n f l i c t e d by Sharptooth). Occasionally the therapist asks about "what i s happening i n the story now". The c l i e n t then looks for Spike for a while (in the f i l m , he cannot t a l k because he i s just a baby), but she "cannot f i n d i t " . She says, "There i s no Spike!" The c l i e n t does not take any of the avai l a b l e small dinosaurs to stand for Spike. Then, a car makes a road but f a l l s into the ocean. The Big Fish, however, helps him out. She then takes "Sara and her f r i e n d " who are going to "the v a l l e y " and places them at the opposite side of the sand-tray, away from L i t t l e Foot. She says, " L i t t l e Foot also must go to the v a l l e y but i t i s a long, long, long way to the v a l l e y " and she does not move L i t t l e Foot, who " i s a l l alone". She then takes "a careless car" that runs quickly from the L i t t l e Foot towards the v a l l e y and "crashes into others" several times along the way. Then, the therapist announces the end of the session. Departing, the therapist notices that there was someone i n the observation room adjacent to the consultation room. Data Analysis The therapist did not l e t the c l i e n t i n i t i a t e the session, but started to speak f i r s t , ten minutes into the session. The main reason for speaking f i r s t was that the therapist d i d not at a l l expect the c l i e n t to speak, 80 e s p e c i a l l y not i n the f i r s t session. The therapist's verbalized observations of the c l i e n t ' s play, a f t e r the i n i t i a l ten minutes of silence, were neutral enough to not s h i f t the c l i e n t ' s free play s u b s t a n t i a l l y and cannot be considered a c r i t i c a l t r i g g e r for the c l i e n t ' s subsequent expressions. I t i s of course a matter of speculation whether the c l i e n t would have started to speak on her own had the therapist not intervened. Regarding f i r s t sessions, Langs' theory requires the therapist to define the terms of treatment f o r the c l i e n t . This had been done during the family meeting by the s t a f f therapist but not d i r e c t l y by the present therapist i n the privacy of the f i r s t i n d i v i d u a l session. F i r s t intervention. The therapist's intervention was non-interpretative and therefore not appropriate, however, i t did not carry any negative meaning and i t did imply that the therapist was both interested i n the c l i e n t ' s play and that she expected the c l i e n t to t a l k about her play. The f a c t that the c l i e n t a c t u a l l y started to speak i n the session, even though the therapist did not e x p l i c i t l y ask for a story, i s a sign of rapid a l l e v i a t i o n of her symptom of e l e c t i v e mutism within the therapeutic s i t u a t i o n . I t i s not within the scope of t h i s text to discuss the reasons behind t h i s improvement as proposed by Langs' theory. The f a c t that the c l i e n t started to speak i s a sign of a reduced behavioral resistance to treatment 81 and an expression of some measure of t r u s t i n the therapist. As predicted, the therapist was probably not held wholly responsible by the c l i e n t for the breaks i n the frame. The c l i e n t mentions one t r i g g e r manifestly, her brother, and another t r i g g e r representation, the family of four s i t t i n g around the kitchen table. Both r e f e r to the presence of her family during the c l i e n t ' s f i r s t contact with her therapist. The f a c t that the brother i s greatly favoured by the c l i e n t ' s grand-parents may have something to do with the c l i e n t ' s emphasis and therefore her great s e n s i t i v i t y to h i s presence at the family meeting. In the l i g h t of t h i s t r i g g e r , the c l i e n t gives a c l e a r message i n the form of a model of r e c t i f i c a t i o n saying that her brother should be taken out of her therapy as the baby was taken out of the house by h i s grand-father. Another model  of r e c t i f i c a t i o n i s represented i n the c l i e n t ' s very f i r s t words about the separate toys for her brother (Batman) and for her (Barbies). This choice of the image of toys as representing the c l i e n t ' s therapy i s connected to the term "play-therapy" used at the family meeting and to the statement given to the c l i e n t ' s parents during that meeting by the s t a f f therapist that the c l i e n t w i l l be going with the present therapist "into a room with l o t s of toys". The c l i e n t unconsciously t e l l s the therapist that as f a r as her psychotherapy i s concerned, she and her 82 brother should be separate. The image of the "grandfather who takes the baby out" i s a disguised t r i g g e r representing the presence of the s t a f f psychologist at the family meeting who was i n h i s s i x t i e s and had grey ha i r . When the c l i e n t places a l l d o l l s i n " t h e i r r i g h t places" i n the d o l l house, she expresses yet another model of r e c t i f i c a t i o n by saying that people should have separate therapies as d o l l s must have t h e i r separate rooms i n the house. Another model of  r e c t i f i c a t i o n i s i n the image of the baby r e s t i n g alone i n h i s bedroom, expressing the c l i e n t ' s wish to have a r e s t f u l place i n her therapy, separate from her family. Another disguised model of r e c t i f i c a t i o n l i e s i n the image of the baby who must f i n d h i s own way to get r e s t which speaks for the need to be independent and to be away from the family to achieve r e s t i n s p i t e of the f a c t that the c l i e n t i s a young c h i l d (baby). According to the theory, the c l i e n t ' s comment applies to both, the therapist and the c l i e n t and i s therefore considered a v a l i d perception of the therapist. In retrospect, the therapist indeed became aware of her own strong need f o r an environment that would leave her independent of both the family and the s t a f f and provide her with a private space i n which to t r e a t the c l i e n t . I t i s extremely i n t e r e s t i n g that t h i s c l i e n t s t a r t s her f i r s t i n d i v i d u a l session with an abundance of models 83 of r e c t i f i c a t i o n and not with encoded perceptions or with reactions to these perceptions (which follow l a t e r i n the session). The fac t that her major symptom i s pervasive e l e c t i v e mutism may have something to do with t h i s unusual reversal of sequence as i t expresses a strong i n i t i a l communicative resistance to expressing her perceptions. However, further elaboration of t h i s phenomenon l i e s outside the scope of t h i s study and w i l l not be discussed further. When the c l i e n t moves to the sand-tray, the f i r s t thing she does i s a "mountain with a door and two windows", which i s a representation of the t r i g g e r of the set t i n g of the consultation room which included one window and one observation mirror. The observation mirror was i n fact b u i l t l i k e a window including a window s i l l . The dinosaur crashing through the window of the mountain and hiding there i s a very compelling and condensed negative  image implying v i o l e n t intrusion into someone's space with the purpose to hide something. I t i s both a v a l i d  perception by the c l i e n t of the dangerous space and of the v i o l e n t aspect of the therapist using a room with the observation mirror as well as a v a l i d perception of the therapist as hiding something from the c l i e n t (the p o s s i b i l i t y of the presence of a person behind the observation mirror) which i s again perceived by the c l i e n t as a dangerous and v i o l e n t act. 84 The c l i e n t continues with a b r i e f p o s i t i v e image of a he l p f u l whale which can be explained as a v a l i d perception of the therapist as not altogether destructive f o r the moment, which may be an unconscious understanding on the part of the c l i e n t that the therapist i s nevertheless t r y i n g to help the c l i e n t and i s not e n t i r e l y responsible fo r the breaks i n the frame. The c l i e n t goes on to the compelling negative image of someone small who remains t h i r s t y i n spite of the abundance of water ( L i t t l e Foot remains t h i r s t y because he cannot drink) which i s another v a l i d perception of the therapist who i s o f f e r i n g help (helpful whale) to the c l i e n t but the c l i e n t cannot make use of t h i s help. The reaction of the c l i e n t to the non-he l p f u l and dangerous therapist i s that the c l i e n t cannot receive the help (remains t h i r s t y ) i n s p i t e of av a i l a b l e therapy (water). The c l i e n t then continues with the extreme of negative images. The dead mother expresses her v a l i d  perception of the therapist who i s l i k e dead for her i n her function as a therapist because she i s not an e f f e c t i v e nurturing figure i n providing help i n therapy which she had promised i n the same ways that mothers i m p l i c i t l y promise nurturing to t h e i r children. The c l i e n t then searches for a character (Spike) who cannot speak and thus the c l i e n t connects her major symptom of e l e c t i v e mutism to the fu n c t i o n a l l y absent therapist (the 85 dead mother) i n the presence of the observation mirror and due to contacts with t h i r d p a r t i e s . The r o l e of the c l i e n t ' s own unavailable and v i o l e n t mother i n the genesis of e l e c t i v e mutism, as i t r e l a t e s to the current r e p e t i t i o n of the childhood trauma i n f l i c t e d on the c l i e n t by the present therapist, w i l l not be discussed here because i t l i e s outside the scope of t h i s study. The negative theme of not being able to f i n d h e r s e l f (cannot f i n d Spike, who i s the character who cannot speak) i s a very compelling theme that r e f l e c t s an impaired sense of the s e l f and of her i d e n t i t y and speaks f o r regression. This theme also contains an unconscious i n t e r p r e t a t i o n to the therapist expressing that the therapist has to recover her i d e n t i t y (find herself) as a functional therapist to be able to help her c l i e n t . Next comes the negative  image of someone f a l l i n g (the car) which indicates that her therapy i s i n jeopardy and that the therapist i s dangerous, followed by the b r i e f p o s i t i v e image of someone coming to the rescue (the big f i s h ) . This can be explained as a model of r e c t i f i c a t i o n where the person i n danger (the car) cannot save herself, but can be saved by a strong therapist (the big f i s h ) . The session continues and the therapist s t i l l does not explain to the c l i e n t her unconscious messages and her compelling pleas for r e c t i f i c a t i o n . The c l i e n t then continues with the despairing negative theme of someone 86 who i s l e f t " a l l alone" while her friends depart towards a desirable place which i s perceived as out of reach (long, long, long way to the valley) which signals depressive symptoms i n the c l i e n t . The negative image of someone reckless causing damage to everything (crashing into everything along the way) i s a v a l i d perception of the therapist causing damage to the c l i e n t i n a l l respects because she i s r e c k l e s s l y allowing the observation to continue and because she had allowed the i n i t i a l contact with the c l i e n t ' s family and the s t a f f t herapist. The mixture of the strongly negative images with the few and b r i e f p o s i t i v e images of h e l p f u l figures (the whale and the big fish) may be i n i t s e l f a negative theme that r e f l e c t s the c l i e n t ' s confusion regarding the r o l e of the therapist and which i s a reaction of the c l i e n t to the perceptions of the therapist as both dangerous and h e l p f u l . The c l i e n t ' s unconscious perceptions of someone observing the session were confirmed as v a l i d a f t e r the session: there was someone i n the adjacent room and the curtains covering the observation mirror were not f u l l y drawn i n that room. Discussion On the whole, a l l Langsian hypotheses for t h i s session were found correct. The p r i n c i p a l organisers of the sessions were the two predicted t r i g g e r s , both major 87 breaks i n the frame: the family meeting with the s t a f f psychologist and the observation mirror. The session was replete with predicted negative images, including the extreme: the image of a dead mother. The images and themes corresponded to the predicted ones of poor holding (dead mother, the mountain that cannot withstand attack), i n t r u s i o n (Sharptooth crashes into the mountain), confusion regarding roles and i d e n t i t y (no Spike), violence (violent crash, destructive car, and death), and danger (presence of the v i o l e n t Sharptooth). The predicted mistrust of the therapist shows i t s e l f i n the extreme form of t o t a l nurturing f a i l u r e i n the image of the dead mother, which stands for the therapist who can give nothing good to the c l i e n t . This image of the therapist i s somewhat modified by the b r i e f p o s i t i v e images of someone h e l p f u l , as predicted. The c l i e n t ' s desire and hope for improvement i s r e f l e c t e d i n the great number of models of r e c t i f i c a t i o n expressed i n t h i s session. The p o s i t i v e image of the h e l p f u l therapist was a v a l i d perception because the therapist had t r i e d , a l b e i t i n vain, to have the observation mirror covered and the adjacent room locked during her sessions. Also, the therapist did decide, on her own, not to p a r t i c i p a t e v e r b a l l y i n the family meeting and was thus able to reduce exposing and betraying the c l i e n t . The p r e d i c t i o n that 88 the mistrust of the therapist w i l l be modified by the therapist's good intentions was correct. The predicted confusion of the c l i e n t regarding the therapist's intentions can also be considered correct, although i t s expression was disguised. As predicted, there were signs of behavioral resistance. Communicative resistance was minimal as r e f l e c t e d i n the r i c h l y coalescing network of the c l i e n t ' s verbal expressions. The communicative resistance was mainly evident i n the more heavy disguise of some images and i n the high degree of condensation of the material. Overall, the hypotheses that were formed on the basis of the universal implications of the two powerful t r i g g e r s , as they apply to adults, were found correct. Case Two - Session Two Background Triggers, Observation Mirror, and Interruption of the Session State of the Frame Background t r i g g e r s . The background t r i g g e r s are those breaks i n the frame that have not been r e c t i f i e d and that continue to be active. For t h i s session, such t r i g g e r s are the contact with t h i r d p a r t i e s and the observation mirror. The c l i e n t ' s mother brings the c l i e n t to the waiting room where she and the c l i e n t ' s brother wait f o r the session to end. While the three of them wait for the therapist to come and escort the c l i e n t to the 89 consultation room, several members of the s t a f f as well as other c l i e n t s and t h e i r parents usually t a l k to one another. The observation mirror i s s t i l l not covered and the adjacent observation room i s l e f t unlocked. Interruption of the session. About 15 minutes into the session, someone unlocked the door of the consultation room and proceeded to open i t when the therapist got hold of the door. The c l i e n t did not see the person but heard the turning of the key and the short apology. Such interruption by a t h i r d party i s a break i n the frame and therefore a current t r i g g e r . The s p e c i f i c s of extra-sessional contacts of the c l i e n t with s t a f f and other c l i e n t s were not known to the therapist, however, such contacts were unavoidable and beyond the therapist's control. In addition to p o t e n t i a l break i n c o n f i d e n t i a l i t y and privacy of treatment at the time of the interruption of a session, such in t e r r u p t i o n i s u n i v e r s a l l y perceived as a v i o l e n t act directed towards the c l i e n t (Langs, 1985a). Hypotheses Contact with t h i r d p a r t i e s . Universal unconscious implications of the therapist's contact with t h i r d p a r t i e s to treatment, either d i r e c t l y (as i n the family meeting and i n greeting and l i s t e n i n g to the mother and brother before each session), or else i n d i r e c t l y through the therapist's connection with the s t a f f and other c l i e n t s 90 of the centre, involve a dangerous q u a l i t y to the therapist and the therapeutic experience, mistrust of the therapist, and a sense of betrayal. Since t h i s i s a background t r i g g e r that has not been r e c t i f i e d for three weeks, and because there was no explanation given to the c l i e n t of her compelling unconscious messages regarding contact with t h i r d p a r t i e s during the previous session, i t i s predicted that the c l i e n t w i l l show her mistrust of the therapist by increasing her resistance to treatment by showing behavioral resistance (silence) and may show signs of giving up t r y i n g to communicate to the therapist her concerns by increasing her communicative resistance (verbalizations that do not carry unconscious meaning). The c l i e n t may react to the f a c t that her numerous models of r e c t i f i c a t i o n of the broken frame were not heard by giving up her e f f o r t s Langs, 1976). Interruption of the session. This i s a current t r i g g e r as i t occurs during the session. Since the person intruding did not a c t u a l l y enter the consultation room, because the c l i e n t did not see the intruder, and since the therapist immediately put a stop to the opening of the door, i t i s predicted that the perceived violence of such interru p t i o n of a session w i l l be modified and perceived by the c l i e n t as a moderately dangerous and moderately v i o l e n t act. The fear of the c l i e n t that such an act could be repeated i n the future i s predicted e s p e c i a l l y since the therapist did not promise to the c l i e n t any actions that would ensure the prevention of future attempts to enter her session. Since t h i s i s the f i r s t such intrusion, i t i s predicted that the c l i e n t w i l l react to i t unconsciously and that her communicative resistance for communicating her expressions regarding t h i s t r i g g e r w i l l be minimal. Data On the way to the session, the c l i e n t takes out of her pocket a chestnut and shows i t to the therapist. As soon as she enters the consultation room, the c l i e n t says that she had found i t i n front of her house. She then looks for some time at the paints, but does not touch them. She goes to the d o l l house, which i s i n disarray and says that i t i s "a mess". She then goes to the sand box but does not play there. She seems at a los s . She then goes back to the paints and s t a r t s pointing to ordinary objects (scissors, tape, paints, paper) while asking the therapist questions l i k e "What i s t h i s ? " . The c l i e n t then s t a r t s painting. At t h i s moment, about 20 minutes into the session, someone s t a r t s to unlock the door of the consultation room and the therapist quickly gets up and prevents the person from opening the door more that a few inches. The c l i e n t cannot see the person but she can hear the key and a word of apology. The c l i e n t stops painting, looks at the therapist and says, "My brother was mean to the baby." F i r s t intervention. The therapist says, "Can you t e l l me more?" The c l i e n t continues, "He took the r u l e r i n h i s hand and wanted to h i t the baby but didn't h i t the baby, j u s t pretended. (Pause) My grandfather was very mad." Second intervention. The therapist says, "When that person wanted to open the door you f e l t frightened. I t was l i k e your brother who wanted to h i t the baby, you f e l t l i k e that person wanted to come i n and h i t you. You f e e l angry with me." The c l i e n t continues to paint i n s i l e n c e and does not look at the therapist . Then, she says, "I w i l l paint a picture for you." When she i s f i n i s h e d , she explains her painting, "This i s me, t h i s i s you and t h i s i s the d o l l house, and t h i s i s the window of the d o l l house." She then gets up and observes what the therapist i s wearing, but then uses the colours the therapist was wearing at the time of the previous session. The c l i e n t makes a second painting by dipping her chestnut i n paint and then r o l l i n g i t on the paper i n a l l d i r e c t i o n s and without commentary. The therapist announces the end of the session and t e l l s the c l i e n t that she w i l l keep her paintings i n the consultation room. The c l i e n t says "O.K.", smiles and leaves. 93 Data Analysis The c l i e n t s t a r t s to communicate nonverbally with the therapist outside the consultation room (showing the chestnut) which i s an extra-sessional contact with the therapist l i k e l y to be seen by t h i r d p a r t i e s . Inside, the c l i e n t s t a r t s the session by mentioning one disguised  representation of a t r i g g e r : something that was r e l a t e d to her home (chestnut) was brought into her session. This i s a representation of t h i r d party contact (family) and of the extra-sessional contact (she shows the chestnut outside the room). The c l i e n t then neither plays nor does she communicate ver b a l l y with the therapist. She seems at a loos f o r what to do or say. Her behavioral resistance (silence) l a s t s for almost 20 minutes while her verbalizations are i n the form of questions that do not carry images or themes (communicative re s i s t a n c e ) . Her comment that the d o l l house i s a mess i s an unconscious comment to the therapist that her therapy and her therapist are a mess because of the contact with t h i r d p a r t i e s and represents a negative image. This statement i s followed by t r i v i a l questions which can be explained as an unconscious perception, a negative  image. of the therapist who knows nothing, who i s t r i v i a l and by implication avoids the important issues. F i r s t intervention. Right a f t e r the i n t e r r u p t i o n of the session, the c l i e n t t e l l s a story that contains a negative image of the threat of an unprovoked attack on someone defenceless (brother wanted to h i t the baby) by a nasty person (brother was mean), which made the c l i e n t and the therapist angry (grand-father was mad), a representation of the t r i g g e r of the unlocking of the door with a key (the r u l e r i n the brother's hand), and the outcome of the unlocking of the door (brother j u s t pretended to h i t the baby). Second intervention. The therapist gives a predominantly correct explanation of the c l i e n t ' s unconscious message. I t i d e n t i f i e s the t r i g g e r (attempt to enter the session), the theme (the threat of violence), the outcome (violence was only pretended), and a f f e c t (anger). I t u n i l a t e r a l l y introduces another a f f e c t (fright) which the c l i e n t does not mention while i t does not mention the helplessness of the c l i e n t and the therapist which i s part of the image of a baby. I t i s also very l i k e l y that the therapist intervened too soon and should have waited to get more of a story from the c l i e n t to provide the therapist with more material on which to base her intervention. The c l i e n t did not include any model of r e c t i f i c a t i o n i n her message, however, i t i s possible that she would have done so had the therapist not interrupted. The c l i e n t continues with a s e l f i n i t i a t e d o f f e r to do something for the therapist (a painting) which may be the c l i e n t ' s response ( i n t r o j e c t i o n of the therapist) to the therapist's u n i l a t e r a l introduction of f r i g h t , something l i k e , " I f the therapist i s a f r a i d I w i l l soothe her with a present", and " I f the therapist can do things u n i l a t e r a l l y , so can I". The c l i e n t ' s o f f e r i s a heavily  disguised image of a g i f t , a heavily disguised model of  r e c t i f i c a t i o n that c a l l s for the c l i e n t and therapist to be alone i n the room, i t contains a t h i n l y disguised  background t r i g g e r i n the image of the window of the house (observation mirror), as well as a disguised model of  r e c t i f i c a t i o n i n the image of only one window (the d o l l house had several windows, and the consultation room had one r e a l window and an observation mirror b u i l t as a window). The same painting also conveys another heavily  disguised theme involving change i n the therapist: the c l i e n t looks but does not apply the colours of the current dress of the therapist, instead she uses the exact colours of dress the therapist was wearing before. The theme i s so heavily disguised that i t i s highly speculative to analyze i t s meaning. What i t can be said i s that i t deals with the therapist and with the c l i e n t ' s needs to change something about her. As a negative theme i t may convey that the therapist i s s t i l l the same as l a s t time and has not changed for the better i n s p i t e of her d i f f e r e n t 96 clothes. As a model of r e c t i f i c a t i o n i t may c a l l f or a session that i s not interrupted, as the previous session was not interrupted. The presence of communicative resistance i s very notable i n the c l i e n t ' s communications and i s almost impenetrable when the c l i e n t goes on and finger paints her chestnut and the paper. Here, the regression evident i n her graphic expression and i n her t o t a l s i l e n c e i s a sign of strong resistances. Discussion The c l i e n t s t a r t s the session with a break i n the frame (extra-sessional contact with the therapist) which i s i n i t s e l f a resistance to treatment. She did react to t h i r d party contact with communicative and behavioral resistances which implied her mistrust of the therapist as predicted. There were few strong negative images except for the characterisation of the state of her therapy as a mess and of the therapist herself as a mess. There were few and weak e f f o r t s at r e c t i f i c a t i o n on the part of the c l i e n t , as predicted. Right a f t e r the immediate t r i g g e r (interruption) the c l i e n t did present the t r i g g e r and the predicted implications of the t r i g g e r which i s a sign of diminished resistance, as was predicted. I t was also predicted that the c l i e n t w i l l express her fear of future interruptions because the therapist did not propose any r e c t i f i c a t i o n s . This p r e d i c t i o n was not correct and the reasons may be several. One reason may be due to the f a c t that the therapist interrupted the c l i e n t with her second intervention and the c l i e n t was not given a chance to complete her message. Another reason may be that the therapist complicated the s i t u a t i o n with her u n i l a t e r a l introduction of f r i g h t into the session which confused the c l i e n t . The c l i e n t did however stop communicating i n derivatives which i s a sign of increased resistance. These speculations could be tested i n the subsequent session. From the t h e o r e t i c a l and c l i n i c a l points of view, t h i s p a r t i c u l a r p r e d i c t i o n has less weight that the above correct predictions as i t does not c o n f l i c t with the above predictions. Overall, the p r e d i c t i o n based on Langs' theory were found correct for t h i s session. Case Two, Session Three Contact with Parents, Change of Time, and Noise State of the Frame Contact with parents. A few days before t h i s session, the c l i e n t ' s mother c a l l e d the therapist and asked for an e a r l i e r session because i t would be more convenient for her as there was no school for the c l i e n t that day. The therapist t r i e d to r e t a i n the regular time but the mother i n s i s t e d that she would not bring the c l i e n t to session i f the therapist would not change the time. The therapist agreed to make the time change. The c l i e n t would obviously know about the contact between the 98 therapist and her mother. Change of time. The therapist agreed to change the time for t h i s session and thus broke the frame. Secure frame includes f i x e d time for a l l sessions. The unconscious implications of a change i n the time include a sense of uncertainly and mistrust of the therapist i n addition to the implications applicable to a l l breaks i n the frame. This p a r t i c u l a r change i n time, requested by the c l i e n t ' s mother and agreed upon a f t e r i t was c l e a r that the mother would not bring the c l i e n t to the session i f the therapist did not oblige, i s an i n t e r e s t i n g example of a break i n the frame that i s not i n i t i a t e d by the c l i e n t (as i s the case i n adults) and that was done i n order to give the c l i e n t a session at a l l that week which i s part of secure frame. The implication of t h i s kind of break i n the frame f o r a young c h i l d , where the parent i s s o l e l y responsible for the break, may be determined by the d i f f e r e n t i a l between the damage done to the c l i e n t by the change of time and the benefit done to the c l i e n t by giving her a session at a l l . Noise. Shortly a f t e r the beginning of t h i s session, there was loud t a l k and laughter heard from the adjacent room which i s connected to the consultation room with therapist observation mirror. Both, t a l k i n g to the c l i e n t ' s mother on the telephone and the loud presence of people i n the adjacent room represent contact with t h i r d p a r t i e s to treatment ( i f the c l i e n t can hear the people, they too can hear the c l i e n t ) and a major break i n the frame with implication for c o n f i d e n t i a l i t y and privacy of treatment. Hypotheses Contact with parents and change of time. This i s yet another instance of the therapist's contact with the c l i e n t ' s parents and i t i s therefore predicted that the c l i e n t w i l l either heavily disguise her communications regarding t h i s issue of privacy and c o n f i d e n t i a l i t y or else give up and stop t r y i n g altogether which w i l l be observable as a strong resistance, both behaviorally and communicatively and as well as regression. Since some contact with the parents of small c h i l d r e n i s i n e v i t a b l e and since t h i s p a r t i c u l a r contact was i n i t i a t e d by the parents and not the therapist, I propose that such breaks i n the frame must be treated as complex and intertwined issues i n each i n d i v i d u a l case and not as a c l e a r issue as i t i s i n the case of adults. With t h i s mind, I propose that open unconscious communication regarding t h i s issue (weak communicative resistance) would mean that the c l i e n t benefits from t h i s session more that she i s damaged by the therapist's contact with the parent regarding the change of time. In case any p o s i t i v e images emerge i n the material of the c l i e n t i n r e l a t i o n to g i v i n g 100 the c l i e n t t h i s session, even though that meant a change i n time as well as contact with the parent, would indicate to me that the c l i e n t did benefit from the session. I propose that the determining factor for deciding whether such changes are to be made rather than c a n c e l l i n g the session altogether would depend on the c l i e n t ' s model of r e c t i f i c a t i o n . Such models obviously come a f t e r the f a c t for a p a r t i c u l a r c l i e n t , however, an abundance of evidence i n t h i s respect would d i c t a t e a general r u l e i n such s i t u a t i o n s . Research of secure frame therapy would o f f e r the best opportunity for the analysis of t h i s phenomenon because major traumatic t r i g g e r s , common i n the c l i n i c s e t t i n g , would not i n t e r f e r e with the observation of the break i n the frame under discussion. Just before the session, the therapist t e l l s the c l i e n t ' s mother, i n the presence of the c l i e n t , that she would l i k e her to bring the c l i e n t every week at the o r i g i n a l l y agreed upon time. Setting of a f i x e d time i s considered a securing of the frame. Before entering the consultation room, the therapist hangs an "occupied" sign on the door and explains i t to the c l i e n t . This action i s intended to keep people away from the session and i s therefore a securing of the frame. According to the theory, the securing of the frame w i l l lead to the emergence of p o s i t i v e images. Noise. I t i s predicted that the c l i e n t w i l l react to 101 t h i s t r i g g e r because i t i s rel a t e d to the basic issues of privacy and c o n f i d e n t i a l i t y . Since the noise came from the adjacent room with the observation mirror, the implication for the c l i e n t may be important. This i s the second threat to the session from people outside the consultation room i n a row. I t i s predicted, following findings of c l i n i c a l studies i n adults (Langs, 1976), that the c l i e n t may show signs of regression and depression as a r e s u l t of giving up on the therapist who i s not capable to provide the c l i e n t with a safe therapeutic space. The therapist had secured the frame by putting the "occupied: sign on the door yet was unable to prevent people from disturbing the session. This may r e s u l t i n the c l i e n t perceiving the therapist as helpless and i n e f f e c t i v e and in the c l i e n t herself f e e l i n g helpless and i n e f f e c t i v e . Data In the consultation room, the c l i e n t appears r e s t l e s s , she goes from place to place and does not begin to play with anything. After several minutes, she s t a r t s pointing to toys painting u t e n s i l s and asking questions "What i s t h i s ? " about items that she knew well. Ten minutes into the session, loud t a l k and laughter of several people comes from the adjacent room. I t i s so loud that the therapist can no longer hear the c l i e n t . The c l i e n t asks, "Why are the people laughing?". F i r s t intervention. The therapist answers, "I don't 102 know." The c l i e n t walks around the room several times. Second intervention. The therapist says, "The loud t a l k i n g and laughing bothers me, I think i t bothers you too." The c l i e n t looks away and says s o f t l y and slowly, " I t i s very quiet here today." Third intervention. The therapist (astonished) waits a l i t t l e , then answers, " I t seems to me that you f e e l that you and I are quiet here today because i t i s so noisy outside." The c l i e n t stops, looks at the therapist and writes on the blackboard the names of her family, reads them to the therapist and then erases the writin g . She then goes to the sand tray and t a l k s while she plays, "This i s a l i t t l e mountain. And t h i s i s Spike (the c l i e n t places the f i l m character who cannot speak on top of the mountain)". Her movements are very slow and gentle. She puts trees a l l around Spike i n a c i r c l e . Fourth intervention. The therapist says, "There are trees around Spike. Spike i s safe i n s i d e . " The c l i e n t i n s t a n t l y changes her pace and s t a r t s to move very quickly: she puts several cars, buses, t r a i n s , and buildings l i n e d up i n the tray. F i f t h intervention. The therapist says, " I t i s very busy around Spike with cars, buses, t r a i n s , and buildings. I see Spike i s alone on the mountain behind the trees." The c l i e n t looks at the therapist and says very q u i e t l y , "Spike i s scared." 103 Sixth intervention. The therapist says, "Spike i s scared of the people around him and so he hides behind the trees. Maybe you were scared, too, when you were i n the room together with your family the very f i r s t time and maybe you are scare now because people are so loud outside t h i s room. Maybe that i s why you could not t a l k to me today and maybe that i s why you f e l t that i s was quiet i n here today - we didn't t a l k . " The stops and l i s t e n s at the therapist, then she s t a r t s digging to make "a l i t t l e swimming pool" at the other end of the sand tray. Seventh intervention. The therapist says, "You made a l i t t l e swimming pool but Spike i s fa r away from the pool." The c l i e n t looks at the therapist and says, very softly,* "Yes. Very f a r away." Then, the therapist announces the end of the session. Data Analysis The c l i e n t begins the session anxious and cannot play. This i s a sign of behavioral resistance (silence) and strong communicative resistance that on some l e v e l appears to be fear of free association since i t i s possible to make some speculations upon observing s i l e n t play but one cannot make any meaning out of asking simple questions. As predicted, the c l i e n t did react to parental contact with severe anxiety and defensiveness. The qu a l i t y of her questions speaks for regression ( t r i v i a l questions) and of the c l i e n t ' s sense of uncertainty. 104 Right before the session, there were two instances of securing of the frame, namely the request for regular agreed upon time for the sessions and the sign on the consultation room door. A l l instances of securing of the frame also induce anxiety i n the c l i e n t s i n the manner of claustrophobic anxieties (Langs, 1982). In t h i s case, the c l i e n t may have been reacting to both, the breaking and the securing of the frame. Since the therapist d i d not explain to the c l i e n t her resistance i n the l i g h t of these t r i g g e r s i t i s not possible to judge the hypothesis since the unconscious v a l i d a t i o n of the c l i e n t i s missing. According to Langs 1 theory however, a break i n the frame w i l l be the major organiser of the c l i e n t ' s material. The c l i e n t reacts to the noise from outside immediately with a question which i s a r e f l e c t i o n of communicative resistance, as was predicted. I t i s also a manifest mention of the current t r i g g e r , namely the noisy people i n the adjacent room. The second intervention regarding the bothersome noise i s followed by the astonishing response by the c l i e n t that i t was "quiet" which i s a very vague message. I t does, however, involve a disagreement with the therapist. Taken as a symbolic communication i t says that the c l i e n t and the are not communicating even though they may be saying words. The t h i r d intervention i s followed by the c l i e n t ' s w r iting down the names of her family, which i s another 105 manifest mention of the t r i g g e r of family contact as well as an encoded t r i g g e r representation of any t h i r d party contact. This i s followed by a moving story of someone who cannot t a l k (Spike) who i s l i k e the e l e c t i v e mute c l i e n t as well as l i k e the c l i e n t who has d i f f i c u l t y speaking to the therapist i n t h i s session. The emphasis i s on things l i t t l e ( l i t t l e mountain) and helpless (Spike i s a baby) which represents the perceptions of helplessness i n both the c l i e n t and the therapist. As predicted, the therapist was seen by the c l i e n t as helpless i n establishing a private and c o n f i d e n t i a l space for the c l i e n t i n spite of her putting up a sign. The story i s interrupted by the therapist several times and the interventions are premature. The s i x t h intervention i s mainly correct and i s followed by unconscious v a l i d a t i o n by the c l i e n t : she makes a swimming pool for Spike (a p o s i t i v e image) and a cognitive v a l i d a t i o n (Spike cannot reach the pool) concerning the c l i e n t ' s s i t u a t i o n i n therapy. The essence of the c l i e n t ' s story i s that there i s good therapy avai l a b l e but the c l i e n t cannot use i t because she i s scared by the therapist's contact with the parents and by the presence of people i n the observation room. The two compelling negative images are those of being a f r a i d (and therefore i n danger) and helpless and of something good that i s out of reach. The one p o s i t i v e 106 image i s that of the presence of a pool. The p o s i t i v e image i s , according to theory, an i n t r o j e c t i o n of the c l i e n t of the well functioning therapist who secured the frame. There i s no clear model of r e c t i f i c a t i o n i n t h i s session except for the very remote and nonverbal theme of separateness as i s seen i n the placement of trees i n a c i r c l e around Spike which separates Spike from the busy t r a i n s , cars, busses, and buildings. Another such remote model of r e c t i f i c a t i o n i s the act of writing the names of the family on the board and then erasing them; i t speaks of removing her family from her therapy. Discussion There was l i t t l e verbal material i n t h i s session, however a l l prediction regarding the material were correct. The s c a r c i t y of verbal of material i s i n i t s e l f a sign of major resistance and regression, as predicted. There were no representations of the change i n time of the session and no clear themes or images rel a t e d to t h i s t r i g g e r . I t i s therefore not possible to analyze or draw any conclusions regarding t h i s issues. The d e l i c a t e issue regarding parental questionable but adamant requests for a change i n time for a session remains unanswered by the analysis of t h i s session. As noted above, to f i n d the ground ru l e for young children, research of material from secure frame therapy would be required to avoid 107 confounding of variables. Case Two, Session Four Therapy of Parents by C l i e n t ' s Therapist State of the Frame Therapy with parents. After the previous session, the therapist was asked, by the s t a f f , to s t a r t weekly therapy with the c l i e n t ' s parents together with another therapist. The therapist had one session with the parents before the present session. The present therapist therefore d i d not see the c l i e n t before the session with her parents and did not inform the c l i e n t about i t . The couple's therapy was led by another therapist and the present therapist was mainly s i l e n t during the session. According to the theory any contact, and i n p a r t i c u l a r therapy, with parents i s a break i n the frame of the c l i e n t ' s therapy. Hypotheses Therapy with any member of the c l i e n t ' s family has been found harmful to the c l i e n t (Langs, 1982) since i t represents ongoing and unavoidable breaks i n c o n f i d e n t i a l i t y of treatment. I t i s therefore predicted that the c l i e n t w i l l react strongly to t h i s break i n the frame of her therapy. Since contact with her parents has been an ongoing problem (background trigger) f o r the c l i e n t from the beginning of her therapy, and since she had t r i e d i n vain to a l e r t the therapist to the harmful 108 e f f e c t s of t h i s contact by communicating numerous perceptions and models of r e c t i f i c a t i o n , i t i s predicted that the c l i e n t w i l l show strong communicative and behavioral resistance by heavily disguising her messages and by silen c e s . Regression of the c l i e n t i s also predicted for the same reasons. I f there i s any verbal unconscious communication, i t i s predicted that i t w i l l centre around t h i s t r i g g e r and that strong negative images w i l l emerge. Data In the consultation room, the c l i e n t goes s t r a i g h t to the black board and writes the names of her family, reading out loud as she goes along. Then, she erases the names. She then writes the name of her f r i e n d and says to the therapist, "She i s my fr i e n d . She would l i k e to come with me and play i n here." F i r s t intervention. The therapist says, "She i s your f r i e n d and she would l i k e to come here with- you. The time you spend i n here with me i s only for you so that you and I can t a l k . " The c l i e n t looks at the therapist and says, "My brother also wants to come here. I t o l d him he cannot come because he i s too l i t t l e . " Second intervention. The therapist says, "Yes, your brother also cannot come here because t h i s therapy i s only fo r you." The c l i e n t does not answer. She takes out several paints and goes to the table. She s t a r t s to paint blotches of colours on paper. She works very slowly and s i l e n t l y . The therapist asks about the pictures and the c l i e n t t e l l s only what i s obvious l i k e , " t h i s i s the sun" or " t h i s i s a cloud". After a while, about 30 minutes into the session, the c l i e n t takes a fresh sheet of paper and paints on i t with white paint. She says, "I want to t r y white to see i f i t shows. No. (Pause.) I t looks l i k e to eat but i s n ' t . " Third intervention. The therapist says, " I t looks l i k e you know that paint i s n ' t to eat." The c l i e n t looks at the therapist and says, "I know because i t ' s to paint. (Pause.) Paint i s poison." The c l i e n t then s t a r t s to draw, but soon ends up s c r i b b l i n g u n t i l the end of the session. Data Analysis The c l i e n t s t a r t s her session with a manifest a l l u s i o n to the tr i g g e r by writing the names of her parents. She erases the names which can be considered a heavily disguised model of r e c t i f i c a t i o n saying that her parents should be removed from her therapy. I t has been found that adults and adolescents unconsciously f e e l that family members, with whom the therapist has contact, are somehow present i n the c l i e n t ' s therapy (Langs, 1982). The c l i e n t then t e l l s about someone who would l i k e to come with her to her therapy session which i s another, less disguised, t r i g g e r representation of the s t a f f therapist, 110 who i s viewed as "a f r i e n d " of the present therapist and generally represents the presence of someone known to the c l i e n t i n her therapy. F i r s t intervention. The therapist intervenes and t e l l s the c l i e n t that her f r i e n d cannot come. The c l i e n t continues to p e r s i s t i n her e f f o r t s to communicate the same message and t e l l s of a member of her family (brother), who wants to come, but that she, the c l i e n t , already t o l d him that he cannot come (too l i t t l e ) . She also t e l l s that there i s a reason for not being allowed to come. This encoded message i s less disguised as i t mentions d i r e c t l y a family member who wants to come to therapy. This message i s therefore closer to the t r i g g e r of her parents being present i n her therapy than the c l i e n t ' s f i r s t message. The s p e c i f i c example of the reason which the c l i e n t gives for a t h i r d party not being allowed to come to therapy does not apply l i t e r a l l y , however as a remote derivative, the message i s that a v a l i d reason does e x i s t . The message therefore includes a model of r e c t i f i c a t i o n which says that family members should not be allowed i n therapy with the same ther a p i s t for a good reason. Second intervention. The second intervention s t i l l does not explain i n decoded form to the c l i e n t what she i s t r y i n g to communicate to her therapist and the therapist does not promise that she w i l l no longer see her parents i n therapy. However, the therapist does say e x p l i c i t l y , that her friends and her brother cannot come and t h i s i s a ce r t a i n degree of securing of the frame by the therapist even though the c l i e n t did not request, i n any s p e c i f i c terms, a break i n the frame. In a sense, the therapist o f f e r s the c l i e n t something (a promise not to allow her fr i e n d and her brother to come to therapy) other than what the c l i e n t i s asking for (her parents out of therapy). The c l i e n t stops t a l k i n g for a while which i s a sign of behavioral resistance. Later, she comments about the obvious i n her paintings i n a way that c a r r i e d l i t t l e encoded communication which i s a sign of communicative  resistance. The c l i e n t then t e l l s about wanting to t r y to di s t i n g u i s h two s i m i l a r things (white paint on white paper). This encoded message i s a heavily disguised perception of the therapist regarding her ap p l i c a t i o n of contradictory l o g i c related to the contact with the family: the therapist does not allow the c l i e n t ' s f r i e n d and brother to come to therapy but she does allow treatment of her parents. The c l i e n t ' s decoded message (perception of the therapist) i s that the therapist i s making a d i s t i n c t i o n between two of the same things: therapy with a fr i e n d or a brother i s the same thing as therapy with parents, just l i k e white paper i s of the same colour as white paint and one d i s t i n g u i s h between the two. As noted, t h i s message i s heavily disguised and therefore 112 open to speculation. Heavily disguised and implied i n t h i s comment i s also a model of r e c t i f i c a t i o n saying that the therapist should not continue to t r y making a d i s t i n c t i o n between two of the same things, that i s , that the therapist should t r e a t the issue of therapy with parents as she tr e a t s therapy with a f r i e n d or brother. The implied message may be stated as saying that the therapist must not tre a t her parents for the same reasons that she does not allow her fr i e n d and brother to come to therapy with the c l i e n t . The c l i e n t then adds that something appears l i k e something good, but i s not, i t i s i n fac t poison which i s a strong negative image of a deception and of the danger of being harmed or k i l l e d . The c l i e n t i s t e l l i n g the therapist that her therapy has turned into poison f o r her, that i t looks deceptively l i k e nurturing (good to eat) but i s i n fac t dangerous (poison) for the c l i e n t . This i s also a cle a r model of r e c t i f i c a t i o n saying that the therapist should not do what must not be done (paint i s to paint, not to eat) and that to eat paint would be dangerous to health (paint i s poison). The decoded message, as i t rel a t e s to her therapy and her parents, t e l l s that the therapist i s harming the c l i e n t with dangerous therapy because she i s t r e a t i n g her parents. By condensation, there might also be a very heavily disguised t r i g g e r of the observation mirror i n the theme 113 of "wanting to t r y to see i f i t shows". However, i t i s so remote and vague that i t w i l l not be discussed further. There were no noises coming from the adjacent observation room that session and the therapist had no reason to suspect that there was anybody there. Third intervention. The therapist s t i l l does not explain the c l i e n t ' s encoded messages, she does not admit the destructive e f f e c t s on the c l i e n t of the therapy with the c l i e n t ' s parents (poison) and she does not promise to end therapy with them (securing of the frame). The c l i e n t ' s reaction i s that of silence (resistance) and aimless action ( s c r i b b l i n g ) . Since the c l i e n t i s capable of drawing well and of enjoying i t , the s i l e n t s c r i b b l i n g can also be considered regression. Discussion The session contained scarce, condensed, and heavily disguised material. As predicted, the c l i e n t did employ strong resistances, behavioral and communicative, and did centre her e f f o r t s on the central t r i g g e r of her parents' therapy by her therapist. The t r i g g e r was represented i n encoded form (friend and brother wanting to come to therapy) as well as manifestly (writing of her parents names). The negative image of threat to health (poison) was strong and there were models of r e c t i f i c a t i o n directed towards the removal of parents from her therapy and towards the a l e r t i n g the therapist to apply her own l o g i c 114 to t h i s issue. Overall, the hypotheses based on the Langs' theory were found correct. Case Three, Session One: Contact with Family, Insurance, and Observation Mirror Background Information on the C l i e n t The c l i e n t i s an eleven year old boy attending a public elementary school. He has three younger s i b l i n g s . Presenting symptoms included: st e a l i n g , e s p e c i a l l y food, hoarding food, enuresis, occasional l y i n g , s e n s i t i v i t y to c r i t i c i s m , being avoided by peers, s e t t i n g f i r e s and poor performance at a school. Two years p r i o r to r e f e r r a l , the c l i e n t was tested at the Centre by the s t a f f psychologist and was found above average i n c r e a t i v i t y and i n t e l l i g e n c e . He was also described as cooperative and eager to please. His s i s t e r and h i s parents had received services at the centre. These services as well as the c l i e n t ' s treatment, were paid i n t o t a l by the p r o v i n c i a l government insurance plan. State of the Frame Contact with family, s t a f f , and school. The f i r s t contact the therapist had with the c l i e n t was at a family interview conducted at the Centre by a s t a f f nurse who introduced the therapist and recommended to the parents that the c l i e n t be treated i n i n d i v i d u a l sessions for s i x months. The therapist was mostly s i l e n t during the family interview. Any contact of the therapist with persons 115 involved with the c l i e n t i s considered a break i n the frame: the i d e a l ground ru l e for the f i r s t contact states that the c l i e n t contacts the therapist d i r e c t l y . Third party contacts represent a v i o l a t i o n of both privacy and c o n f i d e n t i a l i t y of treatment and are powerful breaks i n the i d e a l frame. Insurance payment. In the area where the c l i e n t l i v e s , a l l p s y c h i a t r i c and mental health centre services are free of charge i n contrast to services provided by psychologists and counsellors i n private p r a c t i c e . According to Langs' theory, insurance payments, e s p e c i a l l y the keeping of the c l i e n t ' s records, v i o l a t e both privacy and c o n f i d e n t i a l i t y of treatment and are therefore powerful breaks i n the frame. Observation Mirror. The consultation room was equipped with a very large and uncovered observation mirror. The mirror i t s e l f was of unusual proportions and shape and the function of the mirror ( a v a i l a b i l i t y of observation of the c l i e n t and therapist by unseen t h i r d parties) i s a powerful break i n the frame, v i o l a t i n g both privacy and c o n f i d e n t i a l i t y of treatment. The observation mirror was complemented by a large microphone i n f u l l view. The therapist had i n a c t u a l i t y no control over the use of either the observation mirror or the audio transmission. 116 Hypotheses This f i r s t i n d i v i d u a l session i s replete with powerful breaks i n the frame. On the basis of Langs' theory, i t i s hypothesised that the c l i e n t w i l l react to these breaks with unconscious communication revealing destructive images of danger (a consequence of a l l breaks i n the frame), with themes of betrayal and not t r u s t i n g (contact with parents and s t a f f , and insurance payment), and iatrogenic paranoia (observation mirror and microphone). Since t h i s c l i e n t i s eleven years old, and because he had been observing h i s parents and s i s t e r r e ceiving services at the Centre without paying for them, i t i s hypothesised that the e f f e c t of t h i s deviation on h i s unconscious communication w i l l be the same as that found for adults. I t i s expected that the implications of free services may have powerful implications for the c l i e n t i n view of h i s important r e f e r r i n g symptom, that i s , s t e a l i n g (taking f o r f r e e ) . The introduction of the frightening aspect of the p o s s i b i l i t y of being seen but not seeing (observation mirror) as well as of being heard but not hearing (microphone) i s anticipated to e f f e c t iatrogenic paranoia i n the c l i e n t . Images i n d i c a t i v e of paranoia (pursuit by dangerous forces) are predicted i n the material. I t i s predicted that the c l i e n t w i l l disguise h i s messages 117 (remote derivatives) because the s i t u a t i o n i s very dangerous fo r him and because the c l i e n t senses that therapist has l i t t l e control over most breaks i n the frame with l i t t l e hope for actual r e c t i f i c a t i o n (the therapist had been introduced as a student). Symbolic representations of the breaks i n the frame are expected although i t i s l i k e l y that they w i l l be disguised i n view of the presence of the many dangers. Models or r e c t i f i c a t i o n may emerge. Since the c l i e n t ' s symptoms seem to r e f l e c t a neurotic rather than borderline pathology, i t i s predicted that he w i l l not f e e l overly hopeless i n t h i s f i r s t session, even i n the face of so many powerful breaks i n his f i r s t session, and w i l l t r y to help rather than to harm the therapist (Langs, 1982, Searles, 1965). There are other frame breaks present i n t h i s session (change of therapy rooms, break i n the anonymity of therapist introduced as student, and the intention of writ i n g down the session from memory for supervision purposes) however, i t i s predicted that the power of the above three major breaks w i l l obscure the c l a r i t y of the unconscious messages related to these other breaks i n the frame. Data The c l i e n t came by himself to the waiting room and walked with the therapist to the consultation room. On 118 the way, he started to t a l k quickly about h i s f r i e n d , "Me and my f r i e n d found a typewriter i n the park and then we went to some other place because people were watching." Upon entering the room he quickly glanced around and then started to play with t r a i n tracks. He was making and remaking the tracks, they always ended up open ended so that the t r a i n s he ran repeatedly f e l l o f f . He was t a l k i n g very f a s t and looking s t r a i g h t at the therapist. He said, "My f r i e n d can change channels by pressing d i f f e r e n t numbers on the type writer." He then took a new-looking toy s o l d i e r out of his pocket and showed i t to the therapist, "I found i t i n the park; he was ju s t l y i n g there and so I took i t . (Pause.) Me and my f r i e n d are working on a bomb. If you connect two sides, e l e c t r i c i t y goes into capacitors and then you can make contact and i t i s a bomb!" (Pause.) F i r s t intervention. The therapist asked, "What could you use the bomb for?" The c l i e n t answered, "To blow up the school." (Pause.) Second intervention. The therapist asked, "What could happen then, i f there were no school?" The c l i e n t answered, "I could play." (Pause.) Third intervention. The therapist asked, "Where would you play?" the c l i e n t answered, "In my f o r t . Me and my f r i e n d made a fort-house. I t was r e a l l y big and there was a sof t , thick mattress for two people. The f o r t 119 was made of huge plywood and a l l was made of a bin." (His voice was f u l l of admiration and pride.) Fourth intervention. The therapist said, " I t sounds l i k e a wonderful fort-house." The c l i e n t responded, "But the r a i n made i t a l l soggy and i t took a long, long time to dry. We cannot use i t u n t i l i t d r i e s . " F i f t h intervention. The therapist said, "You had made a be a u t i f u l f o r t where you can play with your f r i e n d but the r a i n spoiled i t and you cannot use i t now". The c l i e n t responded, "I saw a movie, those guys, they had eight cars, they robbed a bank and the p o l i c e i n one slow car was a f t e r them, then the guys they blew up the car with a bomb, and POUFFE!, they took l o t s of money, they stacked a l l bags of money into one big bag. They had l o t s of money." Sixth intervention. The therapist asked, "I wonder what the robbers would want to use the money f o r . " The c l i e n t answered, "I don't know. They would buy things." Seventh intervention. The therapist said, "I wonder what other things the guys could have done to get money, besides robbing a bank." The c l i e n t answered, "They could get a loan. But, that would be a big loan." (While t a l k i n g , the c l i e n t continues to connect t r a i n tracks into open-ended loops so that the t r a i n cars repeatedly run o f f the tracks and overturn.) Eight intervention. The therapist said, "I see that 120 the t r a i n runs o f f the tracks again and again. I wonder i f the t r a i n could use tracks i n the shape of a c i r c l e , then i t could keep on going." The c l i e n t started to connects the tracks into a large c i r c l e while the therapist continued with the intervention, "Today, you t o l d me about your f r i e n d and the type writer, about your f o r t and about the movie." At that point, the c l i e n t completed the c i r c l e of tracks, but then quickly opened i t up into to a U-shape. He ran the t r a i n slowly on the tracks then suddenly, he l e t i t d e r a i l and "flew" i t about two feet away and through the window of a d o l l house where the t r a i n smashed into furniture and d o l l s inside. He said, "Oops" and smiled but did not set the overturned d o l l s s t r a i g h t . The c l i e n t then spent several minutes looking at d e t a i l s of the d o l l house with an occasional comment, l i k e , "Oh, a t o i l e t , but no drain," or "Two sinks". The c l i e n t then gives a baby-doll a milk b o t t l e and places the mother facing away from the baby, looking out the window. Ninth intervention. The therapist intervened, "I see that the mother i s looking out the window and cannot see the baby." The c l i e n t responded immediately, "The baby i s asleep" then got up and declared that he had see "everything i n the house". He put away the t r a i n tracks, got up and to the sand tray, "I want to play i n the sand." He then took out h i s toy, the s o l d i e r he had found i n the 121 park, and placed i t face down i n the sand, saying, "This i s the desert". He then b u i l t a high c i r c u l a r fence around the s o l d i e r . Then, he smiled when he found trees and put many inside the fence. Tenth intervention. The therapist said, "I cannot see the s o l d i e r , he i s hidden by the trees." The c l i e n t commented, " I t ' s a sanctuary." The therapist continues, " I t i s a safe place for the so l d i e r , nobody can come i n and harm the s o l d i e r . " The c l i e n t responded very emphatically (as i f correcting the th e r a p i s t ) , "And, nobody can cut down the trees!" The therapist continued, " I t i s a sanctuary for the s o l d i e r and for the trees". The c l i e n t continued, "The s o l d i e r wears camouflage, the people cannot see him". The therapist continued, "Just l i k e you" (the c l i e n t wore a m i l i t a r y type fatigue top). He responded i n an eager voice and looking s t r a i g h t at the therapist, "Top i s O.K., but they can see my pants. I have other pants with blotches and when I wear them people cannot see me i n the bushes. I t ' s camouflage. I can hide!" Eleventh intervention. The therapist intervened, "You can be safe when people cannot see you." The c l i e n t l i s t e n e d i n t e n t l y , then immediately took l i o n s and placed then e n c i r c l i n g the sanctuary. The he placed a "family of elephants" i n the sand which were pursued by more l i o n s and a rhinoceros. He moved the l i o n s ' legs and explained 122 that "they are going to attack the elephants". He placed a polar bear i n the water, "two black panthers were attacking a sheep", and two snakes were "hidden" i n the sand. Twelfth intervention. The therapist said, "The jungle animals are ready to attack the elephants. The so l d i e r i s safe." The c l i e n t ' s face became very tense and he moved the toys with more speed. He moved the li o n s closer to the elephants, then he took the elephants and placed them i n the sanctuary and moved the black panthers to "eat the trees". The therapist continued, "Perhaps the li o n s w i l l not attack the elephants and the sheep now". The c l i e n t stopped to l i s t e n , then put a g i r a f f e next to the sanctuary fence, "The g i r a f f e i s eating a tree (growing inside the sanctuary)". At t h i s point, the session ended on time and the c l i e n t l e f t . Data Analysis The c l i e n t s t a r t s to communicate with the therapist before they enter the consultation room about f i n d i n g a recording device i n one place and then going to another place to avoid being watched. This communication can be explained as an unconscious communication of many layered meaning. As a representation of a t r i g g e r i s a close deri v a t i v e of the move from one place where people watched ( i . e . the family interview i n the previous session) to a 123 more private place (a play room alone with the t h e r a p i s t ) . The same communication also serves as a representation of another t r i g g e r related to c o n f i d e n t i a l i t y issue, namely the presence of recording of personal information (at the family meeting, the interviewing nurse asked about school records to be sent to her by the c l i e n t ' s parents while holding the c l i e n t ' s f i l e i n p l a i n view). On the way to the family interview, the c l i e n t passes the s t a f f secretary who was typing c l i e n t s ' f i l e s i n p l a i n view. The i n i t i a l communication from the c l i e n t r e l a t e s to the theme of changes and i s considered heavily disguised. Next, the c l i e n t communicates the negative theme of s t e a l i n g ("it was just l y i n g there and so I took i t " ) of a toy i n the park which i s a remote de r i v a t i v e of what the therapist was doing, by implication of her connection with the Centre, namely, s t e a l i n g and making use of the private information which belonged to the c l i e n t as well as f o r her use as a student. This f i r s t communication i s a c l e a r negative image of the t r i g g e r and shares the theme of i l l e g a l i t y and destructiveness of the action by the therapist. According to Langs' theory the therapist i s held responsible for the t o t a l i t y of the treatment by the c l i e n t which include a l l actions by the Centre as they r e l a t e to the treatment. The destructiveness of the t r i g g e r i s emphasized by the negative theme of building a 124 bomb that can explode and blow up the school. F i r s t and second interventions. These two intervention are not int e r p r e t i v e , however they seem to follow the c l i e n t ' s l i n e of thought. The c l i e n t ' s response of being able to play a f t e r school has been blown up i s considered a model of r e c t i f i c a t i o n by the c l i e n t , with the meaning of getting r i d of his school records ("blow up the school") i n the possession of the Centre as a prerequisite for h i s play therapy ("play"). Third and fourth interventions. The interventions were again not int e r p r e t i v e and the therapist d i d not follow the c l i e n t ' s model of r e c t i f i c a t i o n of getting r i d of h i s personal records. I t was predicted that the c l i e n t may t r y harder to a l e r t the therapist to t h i s issue as well as show signs of giving up on the therapist or else t r y to harm the therapist. Data show, that the c l i e n t made a more elaborate e f f o r t at communicating to the therapist with h i s model of r e c t i f i c a t i o n . The c l i e n t t e l l s of building a good fort-house with s o f t mattress f o r two people, which was ruined by r a i n and cannot be used before i t d r i e s . This model i s a clea r d e r i v a t i v e appeal to the therapist to make his therapy private and co n f i d e n t i a l without the presence of t h i r d p a r t i e s ("mattress for two people"). I t i s also shows the therapist that there cannot be any therapy f o r him u n t i l t h i s i s corrected ("we cannot use i t before i t d r i e s " ) . 125 F i f t h intervention. This i s yet another non-in t e r p r e t i v e intervention by the therapist and the c l i e n t responds to i t by changing the top i c . His negative theme i s c l e a r l y a destructive and v i o l e n t one ("blew up the car with a bomb") and an i l l e g a l one ("robbed a bank"). The topic shares the same theme with the t r i g g e r , namely the theme of taking personal records i l l e g a l l y without interference from the law ( i . e . , of robbers getting away with t h e i r plunder and getting r i d of the law). There i s no more e f f o r t s at r e c t i f i c a t i o n by the c l i e n t , and the p r e v a i l i n g of crime over law shows that the c l i e n t i s currently giving up on the therapist's a b i l i t y to r e c t i f y the break i n the frame, as predicted by the theory. This same negative image of s t e a l i n g and getting away with i t also serves at the representation of the t r i g g e r of insurance coverage. The c l i e n t i s , i n e f f e c t , s t e a l i n g money from a central fund of the government insurance plan ("the bank") and getting away with i t (the p o l i c e car chasing the robbers i s destroyed). Sixth and seventh interventions. Both are non-in t e r p r e t i v e interventions which w i l l discourage the c l i e n t i n h i s e f f o r t s to communicate meaningfully with the therapist. As predicted by the theory, the c l i e n t i s l i k e l y to give up h i s e f f o r t s and to shown signs of communicative resistance. Data show, that the c l i e n t i s no longer communicating spontaneously and r i c h l y , but i s 126 t r y i n g to answer i r r e l e v a n t questions. In h i s play, the c l i e n t continuously shows signs of f r u s t r a t i o n with the therapist, by not succeeding to connect the t r a i n tracks and by repeatedly running the t r a i n o f f the tracks. This i s a non-verbal (therefore non-conclusive) evidence f o r the c l i e n t ' s i n t r o j e c t i o n of the therapist i n a b i l i t y to "connect" the c l i e n t ' s themes to the t r i g g e r s . Eight intervention. Another non-interpretative intervention leads the c l i e n t to follow the therapist's i n s t r u c t i o n (connect the tracks into a c i r c l e ) but to end d e r a i l i n g the t r a i n again, and crashing i t into a house f u l l of d o l l s . There are no models of r e c t i f i c a t i o n i n evidence. There are themes of destructiveness and v i o l e n t i n t r u s i o n (crash through the window). The communicative  resistance i s i n evidence as the c l i e n t no longer v e r b a l l y communicates i n r i c h s t o r i e s with themes. There i s one tentative p o s i t i v e image of the mother who gave the baby the b o t t l e , but them turned away. This i s explained by the theory with the f a c t that the therapist was h e l p f u l to the c l i e n t on some l e v e l by conducting the session i n privacy and by not introducing further breaks i n the frame. The therapist i s however seen as someone who turned away from the c l i e n t , which i s a negative image representing a v a l i d perception of the therapist who did not understand and make use of the c l i e n t ' s unconscious communications. There i s some reference to the window, for the second 127 time i n t h i s session (eight intervention), which may be a representation of the t r i g g e r of the observation mirror. The themes rel a t e d to the window are negative i n both cases. Playing i n the sand box, the c l i e n t communicates a negative image of a s o l d i e r l y i n g on h i s face i n the desert. I t i s an image that represents the c l i e n t ' s v a l i d perception of h i s current r e l a t i o n s h i p with h i s therapist, namely that the therapist i s non-communicative (l y i n g face down) as she does not t a l k about what the c l i e n t i s t r y i n g to convey and that h i s therapy i s barren (desert). Tenth intervention. The therapist makes yet another non-interpretative intervention. The function of the communication i s not destructive for the c l i e n t and the c l i e n t changes topic and communicates again i n r i c h derivatives a model of r e c t i f i c a t i o n . The c l i e n t presents the therapist with a compelling theme of a sanctuary, where no harm can be done (nobody can cut down the trees) and where one i s safe from being watched (the people cannot see him). The c l i e n t eagerly accepts the therapist's connection of the play image to the c l i e n t himself with another model of r e c t i f i c a t i o n with the image of himself being capable of hiding from being seen by the people. The model i s yet another appeal by the c l i e n t to the therapist to provide a sanctuary for him where t h i r d 128 pa r t i e s would be prevented from i n t e r f e r i n g with h i s therapy. I t seems that the c l i e n t has picked up the therapist's e f f o r t s to understand h i s unconscious communications because the c l i e n t i s now communicating again with r i c h images and his communicative resistance has diminished. Eleventh and twelfth interventions. The therapist's intervention i s a weak attempt at i n t e r p r e t a t i o n . I t i s correct i n the sense that i t addresses the c l i e n t ' s need for privacy and c o n f i d e n t i a l i t y , but i t remains general and promises no actual r e c t i f i c a t i o n by the therapist. Theory would predict p a r t i a l v a l i d a t i o n by the c l i e n t and more e f f o r t s by the c l i e n t to reach the therapist communicatively. The c l i e n t again changes t o p i c and presents strongly negative themes of powerful predators ready to attack weaker beings (lions and a rhinoceros ready to attack a family of elephants; panthers attacking a sheep; and l i o n s e n c i r c l i n g the sanctuary). These themes are c l e a r l y persecutory as they express imminent threat of violence for those exposed (sheep) as well as for those i n a sanctuary (elephants and the s o l d i e r ) . There i s a model of r e c t i f i c a t i o n i n the theme of the black panther turning away from threatening the sheep and eating the trees instead. I t suggests that the therapist should be s a t i s f i e d with such g r a t i f i c a t i o n s that do not harm the c l i e n t (sheep). Another model of r e c t i f i c a t i o n 129 i s presented with the image of the elephants being placed into the sanctuary (where one i s not seen) suggesting that the therapist should put a stop to the interferences of t h i r d p a r t i e s and provide a private and c o n f i d e n t i a l treatment (a sanctuary) instead. The therapist's l a s t intervention (Perhaps the l i o n s w i l l not attack the elephants and the sheep now) i s not only non-interpretative, i t i s also has the function of a r e f u t a l of the v a l i d i t y of the c l i e n t ' s perception of a threat to h i s therapy. The c l i e n t ' s response i s , as predicted by the theory, non-validating, i t does not extend his deeper understanding of the issue, and i t i s i n the form of a negative image of something that i s used for protection ( i . e . , trees inside the sanctuary can hide the s o l d i e r from being seen from outside) being destroyed from outside ( g i r a f f e eating from outside of the fence). The same image of watching over the fence can also serve as a distant representation of the t r i g g e r , that i s of the observation mirror. The negative theme of destruction of the sheltering trees ( g i r a f f e eating away trees inside the sanctuary) i s the c l i e n t ' s response to t h i s t r i g g e r : the observation mirror destroys the privacy of h i s treatment. The distant representation of the tr i g g e r i s a sign of some communicative resistance. Discussion The o v e r a l l predictions regarding the presence of 130 several major breaks i n the frame was correct: the c l i e n t did communicate destructive images and themes of danger. The predictions made on the basis of the knowledge of t r i g g e r s that had existed before the session were a l l correct. The f i r s t two t r i g g e r s , that i s contact with t h i r d p a r t i e s to treatment, were well represented i n the c l i e n t ' s material. The c l i e n t ' s reactions to these t r i g g e r s , i n terms of themes and images, also followed t h e o r e t i c a l predictions. Themes were negative and t h e i r meaning was shared with the universal meaning of such t r i g g e r s . The s p e c i f i c prediction regarding the unconscious implications of insurance payments for h i s treatment and of the c l i e n t ' s records i n r e l a t i o n to the c l i e n t ' s symptom of s t e a l i n g was also correct; the c l i e n t was strongly s e n s i t i v e to t h i s issue and communicated a v i v i d story of bank robbers getting away with the loot. The representation of the t h i r d t r i g g e r , the presence of the observation mirror i n the consultation room, i s moderately disguised, yet the implications of the dangers of being watched were v i v i d l y portrayed. As predicted, there are several compelling models of r e c t i f i c a t i o n present i n the c l i e n t ' s material. The v i c i s s i t u d e s of the c l i e n t ' s communicative resistances followed the moment-to-moment in t e r a c t i o n between the c l i e n t and the therapist by diminishing when the therapist understood h i s unconscious communication and increased when she did not understand. Case Three, Session Two Observation Mirror, Touching Toys and Background Triggers State of the Frame Observation mirror. The c l i e n t i s s t i l l being seen by the therapist i n the consultation room with the large observation mirror. According to theory, the c l i e n t ' s privacy and c o n f i d e n t i a l i t y are modified which constitutes a serious break i n the frame. Touching toys. The i d e a l frame allows no physical contact with either the c l i e n t or the c l i e n t ' s possessions. Both are considered a v i o l a t i o n of the i m p l i c i t ground rules and boundaries of therapy because they v i o l a t e the c l i e n t ' s private space. Contact with t h i r d p a r t i e s and insurance payments. The background tr i g g e r s which had occurred before the f i r s t session (contact with t h i r d p a r t i e s and free treatment) have not been corrected although there were no further modifications of the frame i n these areas. Hypotheses The observation mirror without covers represents a constant threat that the c l i e n t w i l l be seen by unseen parti e s which i s a powerful t r i g g e r with unconscious implications of danger of being exposed, and of betrayal by the therapist. To be seen but not to see the observer i s considered a s i t u a t i o n which can t r i g g e r iatrogenic 132 paranoia i n the c l i e n t (Langs> 1976). The therapist's touching of the c l i e n t ' s possessions i s considered a powerful t r i g g e r according to the theory (Langs, 1976). I t i s predicted that the c l i e n t w i l l unconsciously communicate to the therapist that such touching i s wrong and that i t i s harmful to the c l i e n t . Since the therapist had not noticed that the c l i e n t forgot h i s own toy i n the consultation room at the end of the previous session, the therapist has kept the toy for a week ( u n t i l the session under discussion) i n addition to her touching h i s toy. I t i s predicted that such keeping of h i s toy w i l l have an adverse impact on the c l i e n t and that t h i s impact w i l l be communicated symbolically to the therapist. According to theory, these t r i g g e r s w i l l exert t h e i r influence on the c l i e n t ' s unconscious communications, however, the currently present t r i g g e r (observation mirror) i s considered the most powerful. I t i s therefore predicted that the c l i e n t ' s unconscious material w i l l be organised around the observation mirror. Since the therapist has not r e c t i f i e d t h i s break i n the frame (the mirror i s s t i l l not covered), the c l i e n t i s l i k e l y to show communicative resistance and mistrust towards the therapist. Data The c l i e n t comes f i v e minutes l a t e and t e l l s the 133 therapist , i n the h a l l , that he "almost forgot about the session" because he was writing something on the computer. In the consultation room, the c l i e n t goes to the observation mirror, puts his face r i g h t next to the glass and says' "I can see curtains on the other side!" Then, he takes o f f h i s wrist watch and puts i t i n h i s pocket. F i r s t intervention. The therapist gives back to the c l i e n t the toy s o l d i e r he had forgotten l a s t time. The c l i e n t takes the s o l d i e r and drops i t , face down, i n the sand tray. The c l i e n t says, "Thanks. My f r i e n d l e f t h i s knapsack on the ground at school and h i s teacher stumbled over i t and took i t away from my f r i e n d and she said that he can walk home without i t . So, he walked 15 minutes to X Street, then he turned around and had to walk a l l the way back to school. " Second intervention. The therapist said, "I wonder i f what happened to your f r i e n d i s l i k e what happened to you when I took your s o l d i e r and kept i t and-brought i t back to you today." The c l i e n t makes no d i r e c t response and s t a r t s to play with d o l l s representing doctors, nurses and patients. His play shows no clear theme. He takes d o l l s out of a box, one by one, and r i g h t away throws them back into the box. He then abandons the d o l l s and turns to LEGO blocks. He takes out a plan and s t a r t s to b u i l d something. He looks defiant and does not look at the therapist. 134 Third intervention. 20 minutes into the session, the therapist says, " I t seems that you have trouble t a l k i n g to me today. I wonder i f something happened i n here that makes i t d i f f i c u l t for you to t a l k . " The c l i e n t answers immediately, "I don't know. Nothing that I know of." Fourth intervention. The therapist said, "Today, the f i r s t thing you did was to go to the observation mirror and you t o l d me that you can see curtains on the other side. Then, you had trouble t a l k i n g to me. I wonder i f you are a f r a i d that someone might be watching you from the other side of the mirror." The c l i e n t lowers h i s head and smiles. He then s t a r t s to b u i l d something out of LEGO very quickly. I t turns out to be a house with a door and two s p e c i a l windows: the glass panes have shutters on both sides: the inside and the outside. The c l i e n t opens and closes the shutters several times. As he i s completing the roof of the house, the sessions ends. The c l i e n t puts on h i s wrist watch, takes h i s toy s o l d i e r , and leaves. Data Analysis The c l i e n t ' s lateness and the f a c t that he almost forgot about the session i s a sign of behavioral resistance which i s considered i n t e r a c t i o n a l by the theory and occurs when there are major breaks i n the frame (Langs, 1976). The observation mirror i s represented  manifestly (I can see the curtains on the other s i d e ) . 135 Since the therapist makes her f i r s t intervention r i g h t a f t e r the c l i e n t ' s f i r s t communication i n the session, h i s de r i v a t i v e reaction w i l l apply to the f i r s t intervention. F i r s t intervention. The c l i e n t comments, i n symbolic form, on the therapist's taking, keeping and returning of his toy s o l d i e r . The negative theme of h i s story about the school f r i e n d and h i s knapsack i s that of being punished (by the teacher) for a mistake and of the confusion that such punishment brings (his f r i e n d walked for 15 minutes to a street and then turned around and walked back to school). The theme i s not f u l l y developed and there are signs of communicative resistance as the c l i e n t stops t a l k i n g and has no c l e a r theme i n h i s play. Second intervention. The therapist's intervention i s an attempt at interpretation, however, there i s no c l e a r admission by the therapist that her action was not appropriate and no admission that her action caused the c l i e n t to f e e l confused. The c l i e n t ' s indicator>(his lateness because he almost forgot about hi s session) i s not explained i n the l i g h t of the therapist's action and the intervention was not validated by the c l i e n t . Only a very vague negative theme can be i d e n t i f i e d i n the non-verbal play that follows the intervention. The c l i e n t (the doll-patient) finds the i n t e r a c t i o n with the helping professionals (dolls representing doctors and nurses) useless (for h i s play) and abandons h i s e f f o r t at 136 communicating a story (drops the d o l l s back into the box). His unorganised play with the d o l l s representing help professionals i s also a r e f l e c t i o n of the c l i e n t ' s confusion, which i s a consequence of h i s i n t r o j e c t i o n of the confusing function of the therapist action of taking and keeping h i s toy and i s therefore a non-verbal and vague v a l i d perception of the therapist. The c l i e n t continues to show resistance and the change of toys (LEGO) s t i l l does not bring a verbal story with a c l e a r theme. Third intervention. This i s an attempt at connecting the c l i e n t ' s resistance with the therapy, but i t i s not a s u f f i c i e n t explanation (interpretation) to the c l i e n t of what the therapist did. The c l i e n t does, however, react v e r b a l l y and i t seems that h i s main message i s that i t i s the therapist who has the r e s p o n s i b i l i t y to know what i s going on i n h i s sessions. Fourth intervention. This i s a s u f f i c i e n t l y correct i n t e r p r e t a t i o n as i t connects the t r i g g e r (observation mirror) with the c l i e n t ' s indicator (trouble communicating with the therapist) and explains the unconscious meaning of the t r i g g e r to the c l i e n t (his fear of being watched). According to theory, t h i s intervention would receive a v a l i d a t i o n from the c l i e n t i f i t i s followed by a r e c t i f i c a t i o n i n a c t u a l i t y by the therapist (Langs, 1982). Since the therapist did not r i g h t away cover the mirror the c l i e n t ' s fear cannot be diminished. 137 The c l i e n t did smile which shows some degree of interpersonal v a l i d a t i o n ( i n t r o j e c t i o n of well functioning t h e r a p i s t ) , however hi s resistance continued. His non-verbal communication (building the windows with shutters on both sides of the panes) i s quite eloquent, however, and i t does show that the c l i e n t i s indeed working over the unconscious meaning of the observation mirror. His play theme i s a clear non-verbal model of r e c t i f i c a t i o n . The c l i e n t i s t e l l i n g the therapist to cover the observation mirror also from the inside of the consultation room so that nobody can watch him. Since he played i n s i l e n c e , his i m p l i c i t message i s that he cannot t a l k before t h i s i s r e c t i f i e d . The f a c t that the c l i e n t did not forget to take back his toy and that he put his wrist watch back on i s another non-verbal form of interpersonal v a l i d a t i o n of the therapist's l a s t intervention. The c l i e n t shows that he i s , at the moment, functioning well as a consequence of i n t r o j e c t i n g a therapist who gave a p a r t i a l l y correct i n t e r p r e t a t i o n . There was no cognitive v a l i d a t i o n which i s explained by the fact that the therapist did not r e c t i f y the break i n the frame. Discussion As predicted, the c l i e n t ' s symbolic material did centre around the presence of the observation mirror as the major t r i g g e r for t h i s session. Its implications were 138 negative and were mainly r e f l e c t e d i n the c l i e n t ' s resistance, both communicative and behavioral. The c l i e n t ' s negative reaction to the therapist's taking of h i s toy was also as predicted. The impact of the background t r i g g e r s was not c l e a r i n t h i s session. The c l i e n t mentioned these t r i g g e r s neither manifestly nor i n d e r i v a t i v e form. The implications of these t r i g g e r s were mainly r e f l e c t e d i n the c l i e n t ' s resistance to therapy. I t can be t e n t a t i v e l y proposed that his model of r e c t i f i c a t i o n (double shutters for the windows) may also apply to keeping a l l t h i r d p a r t i e s out of h i s therapy. Case Three, Session Three: Change of Consultation Room, Elimination of the Observation Mirror, and Occupied Sign State of the Frame After the l a s t session, i n which the c l i e n t gave the therapist a clear model of r e c t i f i c a t i o n to .cover the observation mirror, the therapist was able to arrange for another consultation room without an observation mirror. The change i n the rooms i s considered a break i n the frame while the elimination of the observation mirror i s an act of securing the frame. The therapist placed an "occupied" sign on the door of the new room i n the presence of the c l i e n t . This i s an act of securing the frame (privacy), however, the implication of the need for such a sign i s 139 the acknowledgement that there i s danger from the outside of the room. Hypotheses The change of rooms. Any change i n the physical environment i s considered by the theory an impingement on the frame (Langs, 1982). The change of rooms i s a break i n the frame and some adverse reaction i s predicted. Since t h i s change was c a r r i e d out with the purpose to correct another deviation (to eliminate the observation mirror) and therefore to secure the frame, i t i s predicted that the impact of t h i s t r i g g e r on the c l i e n t w i l l be less powerful than that of the securing of the frame. Elimination of the observation mirror. The elimination of the observation mirror was proposed by the c l i e n t himself i n his unconscious model of r e c t i f i c a t i o n i n the previous session. Since the therapist acted i n accordance with the c l i e n t ' s unconscious plea, the therapist has i n e f f e c t secured the frame of the c l i e n t ' s therapy. I t i s therefore predicted that the new consultation room w i l l have a b e n e f i c i a l e f f e c t on the c l i e n t and i t i s expected that the c l i e n t w i l l react with p o s i t i v e images and themes which w i l l express a sense of safety. the complicating factor i d the f a c t that the therapist did not explain to the c l i e n t , by decoding h i s own model of r e c t i f i c a t i o n , that he was harmed by the observation mirror. 140 Occupied sign. This sign gives a double message to the c l i e n t . I t a l e r t s him to the presence of danger fr,om the outside and i t of f e r s protection of the privacy of h i s treatment. I t i s predicted that the c l i e n t w i l l react to t h i s sign with both p o s i t i v e and negative images rel a t e d to safety. Data On the way to the session, the therapist stops i n front of the consultation room door and says, "We w i l l be in another room today, without the mirror." She puts an "occupied" sign on the door. Upon entering, the c l i e n t walks around the room picking up various toys, one by one, and placing them back i n place. He says, "Holly!" and "Wow!" several times and looks pleased. The c l i e n t places several toys i n water and seems to enjoys watching them swim. The c l i e n t rubs h i s thigh and says, "My leg hurts a l i t t l e . This g i r l at school h i t me l i k e t h i s (shows how) and i t s t i l l hurts a l i t t l e . " He then goes back to the toy shelves. F i r s t intervention. The therapist says, "We are i n a new room today. You looked pleased, but perhaps our moving here also hurts you a l i t t l e . " The c l i e n t shrugs, then goes quickly to a toy box and s t a r t s s e l e c t i n g animal figures. He then places them i n the sand tray. As he plays, the therapist asks about the story i n h i s play and the c l i e n t explains as he goes along. He places "the big 141 elephant and the small elephant ins i d e " a round fence with a gate. There i s "another small elephant with one ear missing" j u s t outside the fence. The c l i e n t then places several winged creatures on the outside around the fence as well as several "adult l i o n s playing with c h i l d l i o n s " inside t h e i r own fenced place. Second intervention. The therapist says, "I see that i n your play today you are using some of the same animals that you have used i n your previous session. The story i n your play i s very d i f f e r e n t , though. Today, the elephants are not out i n the open any more and are not i n danger of being attacked. They are inside t h e i r own fenced place and so are the l i o n s . The l i o n s are no longer dangerous, they are playing with t h e i r children. Can you t e l l me more about your story." While the therapist speaks, the c l i e n t i s nodding. The c l i e n t says, " These (the winged creatures) are guardians." He then places one guardian inside the elephant place and says, "This guardian i s guarding the door so that the mother elephant does not open the gate with her long trunk so that the baby elephant doesn't go out of the fence." Third intervention. About f i v e minutes before the end of the session, the therapist says, "Today, we are i n t h i s new room, and I put a sign on the door to keep people from coming i n here. I t seems to me that your story t e l l s 142 me that you f e e l well guarded i n here and that you f e e l safe being here just l i k e the baby elephant f e e l s safe with h i s mother. I t seems that you f e e l that there i s no more danger from outside, i n your play, even the l i o n s are now playing behind t h e i r own fence. Perhaps you f e e l safe also because there i s no mirror i n t h i s room." The c l i e n t looks at the therapist for a long time, then he puts into the sand tray three large figures, saying, "And these are the leaders of the guardians. So the elephants are safe." The therapist announces the end of the session and the c l i e n t leaves on time. Data Analysis The therapist intervened before the c l i e n t and she entered the consultation room by announcing the change i n rooms. The c l i e n t ' s response i s therefore considered to be a response to her intervention and to the f a c t that the c l i e n t found himself i n a new room. The f a c t that the c l i e n t explored the room, looking and sounding pleased gives tentative proof to the hypothesis that the absence of the observation mirror w i l l have a b e n e f i c i a l e f f e c t on the c l i e n t . The c l i e n t ' s f i r s t verbal response i s about being hurt "a l i t t l e " by someone. This message can be explained i n the l i g h t of the t r i g g e r of change of rooms which had just occurred. F i r s t intervention. The intervention i s mostly correct as i t does r e l a t e the t r i g g e r (change of rooms) to 143 the hurt of the c l i e n t . I t i s however not complete as i t does not place the r e s p o n s i b i l i t y for the change on the therapist . The c l i e n t responds to t h i s intervention with a shrug (undecided opinion) and with a negative image of something missing ("the small elephant with one ear missing"). Verbally, the c l i e n t responds with a mixed theme of a couple (big and small elephant) inside t h e i r own protected place (fenced place), representing the p o s i t i v e image, of an outside danger kept at bay (l i o n s i n t h e i r own fenced place), and with a p o s i t i v e image of something made innocuous ("adult l i o n s playing with c h i l d l i o n s " ) . This l a s t , p o s i t i v e image i s a powerful expression of the c l i e n t ' s feelings of being free (lions playing) and of being protected (elephants inside t h e i r own fence, apart from the elephants). Second intervention. The intervention i s non-i n t e r p r e t a t i v e and does not further the c l i e n t ' s understanding. However, i t does seem to further the c l i e n t ' s story t e l l i n g . There i s a representation of the  t r i g g e r of the sign on the door i n d e r i v a t i v e form i n the image of the "guardian guarding the door". The theme of hi s story i s that of the necessity for protection (guardian inside) of the c h i l d (baby elephant) from h i s own caretaker's (mother elephant) careless i n c l i n a t i o n ("to open the gate with her long trunk") to expose the c h i l d to outside danger ("so the baby elephant does not go 144 out"). The theme can be interpreted as the c a r r i e r of messages on two l e v e l s . One i s that of the c l i e n t ' s unconscious perception of the function of the "occupied" sign on the door as a guardian protecting the baby (client) against the outside danger (people passing by, perhaps wanting to watch the c l i e n t through the observation mirror) as much as from h i s own mother (therapist), who had exposed the c l i e n t to danger before (observation mirror i n the f i r s t two sessions). The other l e v e l of meaning i s that of a model of  r e c t i f i c a t i o n offered by the c l i e n t to the therapist with the plea to provide for a safe place for him where the entrance to the consultation room would be secured and danger from the outside eliminated. Both l e v e l s of communications involve images of the need for protection and safety. Third intervention. This intervention i s p a r t l y correct. I t does connect the c l i e n t ' s story to the immediate r e a l i t y of his therapy (the sign on the door and the elimination of observation mirror), however, i t does not explain the c l i e n t ' s unconscious perception of the therapist as dangerous (the dangerous mother elephant). The therapist does not accept and inte r p r e t to the c l i e n t her r e s p o n s i b i l i t y to make hi s therapy safe f o r him. Also, the intervention does not touch upon the secure 145 frame issues related to the c l i e n t ' s anxiety i n the currently secure therapeutic frame. This intervention d i d receive unconscious interpersonal v a l i d a t i o n from the c l i e n t ("elephants are safe" and the presence of "the leaders"), but not unconscious cognitive v a l i d a t i o n . Such response by the c l i e n t i s i n accordance with he theory. Discussion The i d e n t i f i e d t r i g g e r s for the session were the two breaks i n the frame and one securing of the frame. A l l three t r i g g e r s were being worked over by the c l i e n t as i s evident by the representation of one t r i g g e r , by the themes rel a t e d to safety versus danger and by the model of r e c t i f i c a t i o n present i n the c l i e n t ' s material. According to theory, the currently present t r i g g e r , which i s witnessed by both parties to treatment needs not be represented i n the c l i e n t ' s material to consider i t as the active t r i g g e r for the c l i e n t ' s material (Langs, 1985). Interpretations related to such t r i g g e r s have consistently resulted i n validated responses by adult c l i e n t s . Such v a l i d a t i o n i s also evident i n the current material i n the from of the interpersonal v a l i d a t i o n by the c l i e n t i n t h i s session. Overall, the hypotheses were correct. 146 Case Three, Session Fourteen Audio recording, Family Meeting, and Change i n the Consultation Room State of The Frame Audio recording. The therapist recorded the session with a tape recorder with the purpose to use the recording for s e l f learning. Such recording i s considered a major break i n the frame involving c o n f i d e n t i a l i t y and privacy of treatment as well as s e l f - r e v e l a t i o n by the therapist who needs to learn and therefore f e e l s inadequate. Family meeting. The s t a f f nurse arranged to meet with the c l i e n t ' s family to inform them about how the c l i e n t was doing i n therapy and to inquire about the c l i e n t ' s current l e v e l of functioning at home and at school. The therapist was absent from the meeting due to i l l n e s s . Such meeting represents contact with t h i r d party to treatment. I t i s another major break i n the frame involving c o n f i d e n t i a l i t y and privacy. Even though she was not present at the meeting, the therapist works at the centre and i s by implication also involved. The therapist i s wholly responsible for the c l i e n t ' s treatment and therefore also for t h i s break i n the frame. Change i n the consultation room. The walls of the consultation room had been painted a f t e r the l a s t session and the smell of paint was s t i l l strong. Any change i n the physical environment i s considered a break i n the 147 frame and therefore has an adverse e f f e c t on the c l i e n t . However, such changes have been found to exert a less powerful influence on the c l i e n t than breaks i n the frame rela t e d to c o n f i d e n t i a l i t y and privacy of treatment (Langs, 1982). Hypotheses Audio recording. Since t h i s break i n the frame involves c o n f i d e n t i a l i t y and privacy of treatment and because i t i s a currently active t r i g g e r i t i s predicted that t h i s w i l l be the major organiser of the c l i e n t ' s material (Langs, 1985a). I t i s hypothesized, according to the theory, that a l l such breaks by the therapist s t i r up themes of destructiveness, of unsafe environment, and of dangerous therapist. I t i s also predicted that resistances w i l l be present because treatment has become dangerous for the c l i e n t (Langs, 1982). Family meeting. Although the therapist was not present at the meeting, the predicted e f f e c t on the c l i e n t i s the same as for a l l v i o l a t i o n s of c o n f i d e n t i a l i t y and privacy of treatment. I t i s predicted, however, that t h i s meeting w i l l have a less powerful e f f e c t on the c l i e n t than the audio-recording of session because i t i s not a current t r i g g e r and because the therapist was not d i r e c t l y involved. Since the family meeting was requested by the s t a f f of the Centre, i t i s i m p l i c i t l y seen as s e l f serving, and such tr i g g e r s usually t r i g g e r strong defences 148 and resistances i n the c l i e n t s (Langs, 1967). Chancre i n the consulting room. Such t r i g g e r s , that do not involve the fix e d frame issues, are second order organizers of the c l i e n t ' s material as they are less damaging to the therapy (Langs, 1982). I t i s hypothesized that the above two tr i g g e r s w i l l exert a much greater influence on the c l i e n t than painting of the walls. Data As soon as the c l i e n t enters the rooms, he s n i f f s , grimaces and looks around, then at the therapist. F i r s t intervention. The therapist says, "The smell i s from the newly painted walls." The c l i e n t answers, "I know. I saw a l l the toys p i l e d up out i n the h a l l when I was here l a s t Friday." Second intervention. The therapist says, "I would l i k e to ask you something. I have brought a tape recorder. Would i t be a l l r i g h t with you i f I taped your session. I would l i k e to understand you better. I would take the tape home and hear the session again. I would be the only person to l i s t e n to the tape." The c l i e n t answers "What s h a l l I say?". The therapist responds, "Anything you l i k e . I could understand you better and I could help you with your problems better i f you could t e l l me about what you are playing." The c l i e n t says, "O.K." Third intervention. The therapist says, "I w i l l show you the recorder", she plugs the tape recorder into the 149 wall, and she places i t about two meters away from both of them. The c l i e n t says, "I have a recorder j u s t l i k e t h i s , only bigger, i t has a l i t t l e thing on the r i g h t . " The c l i e n t then describes h i s recording device and looks nervous. He then unfolds a mat with a picture of roads and f i e l d s and s t a r t s building a town and d r i v i n g cars on the road. The c l i e n t coughs, looks at the therapist and says, "I have a cold". As he continues to play, he says, "This i s a farm with c a t t l e and the farmer has a dog, so the c a t t l e won't go on the road or into the r i v e r . " The c l i e n t then places a "junky car" i n front of a " r i c h mans's enormous house" and a " t r a i l e r pulled by a truck" i n front of another house. Then he makes a truck crash into the wall. The therapist asks what happened and he answers, "A drunk dr i v e r crashed into the wall and then the p o l i c e car took the driver away". The c l i e n t then crashes the same car again, and "the p o l i c e puts the car away "into the junk yard". The c l i e n t then takes away the house and the t r a i l e r . The therapist asks about h i s play and the c l i e n t answers, "The p o l i c e have taken h i s property away because he did something wrong, you know, so that he w i l l not do i t again". Fourth intervention. The therapist asks, "To prevent him from doing more damage?" The c l i e n t inspects licence plates on the cars: "This one cannot drive because he does 150 not have the licence plate. This (the c l i e n t points to a building) i s the j a i l , i t ' s next to the fence so that they cannot go out, but the cars can go into parking through the gate". Then he places a clock on the road " j u s t so that they can see the time from here and here and here" (the c l i e n t points to three d i r e c t i o n s ) . The c l i e n t s t a r t s to b u i l d bridges and run cars under them, but abandons the play and takes the bridges away. F i f t h intervention. The therapist says, "I brought a tape recorder here today. In your play you talked about a drunk dr i v e r crashing into a wall and p o l i c e taking him and h i s property to the junk yard. I t i s l i k e t h i s f or you here. I am l i k e a drunk driver, irresponsible and causing a crash for both of us. And i t i s dangerous for you here, l i k e the c a t t l e that needs to be guarded not to go i n to the road". The c l i e n t looks down, picks up a block and says, "Weird". He then s t a r t s to b u i l d t a l l and precarious towers with blocks. When he builds the f i r s t one, he looks at the therapist , hesitates, then pushes i t to topple over i n the d i r e c t i o n of the therapist . The c l i e n t says, "I l e t i t f a l l so that i t didn't damage here and here, i t f e l l only here" and he points to the road where the car crashed. Then, he builds another, t a l l e r tower, measures i t s height and the distance of f a l l i n g , then l e t s i t f a l l . A few blocks land on the therapist's 151 feet. The c l i e n t says, "I measured the distance so that the tower w i l l f a l l exactly here". He then takes four cars, makes them "stuck i n a t r a f f i c jam" i n the same spot on the road where the crash occurred. He makes another, yet t a l l e r tower, makes i t dense and strong i n the middle, l e t s i n f a l l , saying, "the middle f e l l exactly on the t r a f f i c jam" and again a few blocks land on the therapist's feet. Sixth intervention. The therapist says, "You measured that the tower would f a l l exactly on the t r a f f i c jam, and i t did, and three blocks landed on my feet". The c l i e n t takes three cars, and inspects t h e i r licence plates, saying, "This one does not have the licence plate". The c l i e n t shows the therapist the blank license plate, saying, "and t h i s one also, only t h i s one has a licence plate." Seventh intervention. The therapist says, "Some cars don't have any licence plates so, they are not allowed to drive". The c l i e n t doesn't say anything but looks pensive. The therapist announces the end of the session. Data Analysis F i r s t intervention. the therapist intervenes before the c l i e n t i s allowed the opportunity to say anything which makes the intervention a non-interpretive one, a u n i l a t e r a l introduction of a topic by the therapist. The intervention contains unconscious implications of a poorly functioning therapist who has trouble with tension 152 control, who needs help and who p r o j e c t i v e l y i d e n t i f i e s into the c l i e n t (Langs, 1985a). The c l i e n t responds with s h i f t i n g the emphasis, introduced by the therapist, from "the painted walls" to " l a s t Friday" and "toys i n the h a l l " . In l i g h t of the one major t r i g g e r which existed before the session, the c l i e n t ' s message t e l l s the therapist that the c l i e n t i s working over something that happened l a s t Friday and that something about l a s t Friday was wrong (toys from the consultation room must not be i n the h a l l ) . The c l i e n t ' s response contains an a l l u s i o n to manifest t r i g g e r (family meeting l a s t Friday), a negative emotion of disgust (the c l i e n t grimaces) of something that i s outside (toys p i l e d up outside) of where i t belongs (toys belong i n the consultation room). In l i g h t of the t r i g g e r of the family meeting, the c l i e n t ' s message i s a v a l i d perception of the meeting as well as a heavily disguised model of r e c t i f i c a t i o n expressing the opinion that h i s therapy does not belong i n another room (in the h a l l ) and with other people (toys p i l e d up). Second intervention. The c l i e n t i s interrupted again by the therapist and therefore not allowed the opportunity to enlarge on h i s reaction with unconscious communication regarding the t r i g g e r of the family meeting. The second intervention by the therapist i s a request for permission to tape the session. The c l i e n t answers with another 153 question ("What s h a l l I say?") which shows h i s confusion regarding the request as well as a lack of a c l e a r approval. After the therapist's explanation of her (manifest) reasons for taping, the c l i e n t agrees ( on a manifest level) to co-operate ("O.K."). Third intervention. After the therapist shows the c l i e n t the recording device, he responds with a manifest  t r i g g e r (mentions his tape recording device) and symptomatically with anxiety. His mention of "a cold" i s also a d e r i v a t i v e negative image of sickness therefore t e l l i n g the therapist that the immediate t r i g g e r (recording of h i s session) i s making him crazy. Next, the c l i e n t gives the model of r e c t i f i c a t i o n i n the image of a safeguard from wandering into dangerous places (the dog guarding the c a t t l e ) . The therapist does not respond to these short but compelling unconscious messages: she neither interprets nor does she r e c t i f y the break i n the frame by stopping the recording. In l i g h t of the t r i g g e r of the family meeting, the " c a t t l e wandering" can represent a v a l i d perception of the family meeting as a place where family and s t a f f was behaving as mindless c a t t l e i n need of a "guard dog" (a f o r c e f u l safeguard) to keep them i n cheque to prevent injury and drowning (the busy road and the r i v e r ) , which i s a model of r e c t i f i c a t i o n . The image of the mindless c a t t l e i s a negative image as i s the image of the 154 dangerous road and the implied image of drowning i n the r i v e r . The c l i e n t responds with an elaborate negative theme involving negative images of junk and junk-yard, a drunk dr i v e r and a car crash. The c l i e n t ' s v a l i d perception of the therapist i s of someone crazy, s e l f destructive, and out of control (drunk driver) who destroyed something i n h i s therapy (crashed the car). The c l i e n t ' s model of  r e c t i f i c a t i o n i s i n his message: the therapist (police) must "take away" the tape recorder (the drunk driv e r ' s property) to prevent the continuation of the recording of recording ("so that he w i l l not do i t again"), which i s turning h i s therapy into a worthless process ("junk"). It i s i n t e r e s t i n g that another v a l i d perception of the therapist as a " r i c h man" so well represents the current misuse of the inequality of s o c i a l positions of the c l i e n t versus the therapist (the c l i e n t never c l e a r l y agrees to the use of the tape recorder on a manifest l e v e l , yet the therapist pays no attention) as well as implying the therapist's possession of material goods (tape recorder) rather than i n t e l l e c t u a l a b i l i t y (proper therapy through psychological means). Fourth intervention. Following the c l i e n t ' s compelling model of r e c t i f i c a t i o n , the therapist s t i l l does not stop recording and instead asks a question which the c l i e n t does not answer. Instead, the c l i e n t ' s 155 communication becomes more disguised (the messages become less clear) which i s a sign of communicative resistance i n the presence of danger (Langs, 1982) . However, i t i s possible to discern two heavily disguised models of  r e c t i f i c a t i o n involving the p r o h i b i t i o n of an i l l e g a l act ("cannot drive" without a licence) and the presence of safeguards (the presence of a j a i l and a fence so "they cannot go out"). The c l i e n t i s t e l l i n g the therapist that recording i s i l l e g a l and should be eliminated by force since she i s not stopping i t v o l u n t a r i l y . The mention of the clock i s even more obscure. F i f t h intervention. The therapist intervenes c o r r e c t l y , although the i n t e r p r e t a t i o n i s not complete. The c r i t i c a l omission i s the f a c t that the therapist does not follow the c l i e n t ' s pleas for r e c t i f i c a t i o n and does not stop recording of the session. Such intervening i s seen by c l i e n t s as a crazy act and the therapist i s experienced as s p l i t and not to be trusted (Langs, 1985a). Since the therapist has t o t a l control over the use of the recording and yet i s not stopping to act d e s t r u c t i v e l y , the therapist's current destructive acting out (using the tape recorder i n place of psychological means of treatment) w i l l be introjected by the c l i e n t , who has given up helping the therapist and the c l i e n t might t r y to harm the therapist (Langs, 1985a). In response, the c l i e n t stops communicating c l e a r l y 156 and uses acting out (pushing the tower to f a l l on the s i t e of the crash) and surface communication that does not carry d e r i v a t i v e meaning (themes and images) i n place of the r i c h derivative, communication which he used up to t h i s point i n the session. His b r i e f comment, "weird" i s a b r i e f d e r i v a t i v e expression of h i s perception of the therapist as crazy and of the c l i e n t ' s reaction ( f e e l i n g crazy) to the therapist i n t h i s s i t u a t i o n . Both are destructive images. The c l i e n t pushes more towers to f a l l towards the therapist and on the therapist's foot which are more signs of acting out and e f f o r t s to harm the therapist. Taken as a derivative, the c l i e n t ' s comment that he "measured the distance so that the tower w i l l f a l l exactly here" (meaning on the therapist) i s the c l i e n t ' s v a l i d  perception of the therapist as someone who continues to harm the c l i e n t on purpose which i s a destructive image. The negative image of a t r a f f i c jam i s used i n i s o l a t i o n and cannot be interpreted other that as being a perception of something negative. Sixth intervention. The therapist points out to the c l i e n t i n d i r e c t l y that he i s t r y i n g to harm the therapist. This intervention i s incomplete, i t does not point to the r e s p o n s i b i l i t y of the therapist for her destructiveness, and again i s not followed by r e c t i f i c a t i o n (stoping the recording). The c l i e n t responds with t h i n derivatives 157 c a l l i n g attention again to the i l l e g a l i t y of recording (no licence p l a t e s ) , which i s a negative image. Seventh intervention. The intervention i s non-i n t e r p r e t i v e and brings nothing new to the c l i e n t ' s understanding. The c l i e n t responds with s i l e n c e which can be explained, among other things, as an i n t r o j e c t i o n of the therapist who i s " s i l e n t " about the traumatic t r i g g e r and does nothing to stop harming the c l i e n t . On the whole, the hypotheses for t h i s session were a l l correct. The p r i n c i p l e organizer of the c l i e n t ' s material was indeed the audio-recording of the session. The themes and images were a l l negative and corresponded to universal implications of such breaks i n the frame. The c l i e n t ' s perceptions of the therapist were v a l i d i n the l i g h t of the implications of the t r i g g e r . There were several compelling models of r e c t i f i c a t i o n and increasing signs of resistance by the c l i e n t . The c l i e n t reacted to the t r i g g e r of the family meeting only b r i e f l y and with considerable disguise. The disguised reaction was c o r r e c t l y predicted and the s p a r s i t y of derivative material concerning t h i s t r i g g e r , as opposed to the predicted more powerful reaction by the c l i e n t , can be explained by the f a c t that the therapist not only interrupted the c l i e n t ' s v e rbalizations with her question regarding the permission to record, but she also started to a c t u a l l y audio-record the session thus introducing another powerful t r i g g e r . The powerful destructive images i n t h i s session were c o r r e c t l y predicted and i n accordance with the universal implications of the two powerful t r i g g e r s . 159 CHAPTER THREE DISCUSSION OF RESULTS Discussions of i n d i v i d u a l sessions yielded the o v e r a l l and general conclusion that the i n d i v i d u a l hypotheses, as formulated for each session on the basis of the state of the frame and following Langs' communicative theories, were correct. There are some examples of p a r t i a l discrepancies between a formulated hypothesis and the r e s u l t (data) which were discussed s p e c i f i c a l l y f o r each session. These examples are considered the consequence of the incomplete q u a l i t y of the a v a i l a b l e verbal material and are not departures from the theories. I n s u f f i c i e n t volume of the verbal material was i n some instances very l i k e l y a consequence of the therapist's premature interventions with which she cut o f f the c l i e n t ' s flow of material. Discrepancies were also manifested i n examples where too many t r i g g e r s had the e f f e c t of r e s u l t i n g i n material of which the meaning was confusing: such material did not coalesce c l e a r l y and was d i f f i c u l t to make i n t e l l i g i b l e , which i s i n accordance with Langs' theories. Coalescing meaning makes possible, and i s indispensable for, a cl e a r analysis of the t r i g g e r under inves t i g a t i o n (e.g., Langs, 1982). In other 160 examples the discrepancies between the formulated hypotheses and the data were due to a lack of unconscious meaning (lack of derivatives) as the c l i e n t expressed himself or herself i n terms of f l a t material (e.g., t r i v i a l questions). In such cases, resistances were predominant i n the c l i e n t and the p a r a l l e l hypotheses that predicted i n t e r a c t i o n a l resistances were indeed found correct. Testing a c r i t i c a l r i v a l hypothesis. Nowhere i n the material of a l l sessions were there indications of findings contradictory to Langs' theories regarding the ground rules and boundaries of the psychotherapeutic r e l a t i o n s h i p - the frame. In t h i s study, an important r i v a l hypothesis i s proposed by the introduction of the following hypothetical s i t u a t i o n : the emergence, i n the c l i e n t ' s material, of meaning that would be d i a m e t r i c a l l y opposite to what i s predicted by the affirmative, that i s Langsian, hypothesis. One example of such a r i v a l hypothesis would be the hypothetical s i t u a t i o n i n which strong p o s i t i v e and h e l p f u l images and themes of t r u s t and good holding would emerge i n a sessions where a break i n the frame was active. There was no such finding i n t h i s study. Another example of a basic contradiction with Langs' theories would be the hypothetical s i t u a t i o n i n which an act of securing of the frame by the therapist, which 161 complied with a corresponding model of r e c t i f i c a t i o n by the c l i e n t , would be followed by material of the c l i e n t containing exclusively strong negative and destructive images and themes i n d i c a t i v e of mistrust and poor holding. There was no such f i n d i n g i n t h i s study. Yet another example of a c r i t i c a l r i v a l hypothesis would be the hypothetical s i t u a t i o n i n which the c l i e n t ' s material that follows a breaking of the frame would contain a commentary that would c a l l f or the continuation of the break i n the frame. There was no evidence of such a f i n d i n g from the data. To simplify the l o g i c behind the above arguments regarding the most important r i v a l hypothesis, l e t B represent a break i n the frame, l e t R represent the reaction of the c h i l d to B as predicted by Langs' theories, and l e t -R represent the r i v a l hypothesis i n l i g h t of B, having the c h a r a c t e r i s t i c s to predict the opposite of R. This study showed that a l l variables of B (as represented i n the data) led to R and that none of B led to -R. Following the same notation: any other r i v a l hypothesis (0), o r i g i n a t i n g i n another t h e o r e t i c a l orientation, would need to show a p a r a l l e l r e s u l t : a l l variables of B would need to lead to 0 and no variables of B must lead to -0. This would be one adequate way of conducting a study that would intend to show that there 162 e x i s t s another theory comprising a set of r i v a l hypotheses which can s a t i s f y the evidence found i n these, or any other, c l i n i c a l data. In the predominant number of sessions, models of r e c t i f i c a t i o n were c o r r e c t l y predicted. In the few cases where no such models emerged i n the c l i e n t ' s material, the complementary aspects of the hypotheses, that i s , the predictions of signs of resistances and of the c l i e n t ' s giving up h i s or her e f f o r t s to communicate to the therapist models of r e c t i f i c a t i o n , were found correct. This phenomenon i s most c l e a r l y observed by looking at the sessions i n sequence: the f i r s t sessions were replete with negative images and themes and contained c l e a r models of r e c t i f i c a t i o n : the material contained predicted components of a c l i e n t ' s reaction to a frame break and resistances were minimal. In l a t e r sessions however, that i s , i n the presence of persistent (unrectified) breaks i n the frame, there was evidence that the c l i e n t was, gradually and increasingly, giving up h i s or her e f f o r t s to a l e r t the therapist to the meaning of the break, which was c o r r e c t l y predicted by Langs' theories. According to Langs' theory, a current break i n the frame w i l l always be the central organiser of the c l i e n t ' s material (the material w i l l coalesce around t h i s trigger) which was indeed the finding i n t h i s study for a l l sessions. Evidence for t h i s was sought, and found, i n the 163 c l i e n t ' s material i n (a) the presence of the manifest or represented t r i g g e r , i n (b) the presence of negative images and themes, i n (c) the emergence of models of r e c t i f i c a t i o n , and i n (d) the presence of themes that represent v a l i d perceptions of the therapist's act (the s p e c i f i c break i n the frame). As discussed i n "Limitations of the Study" i n Chapter One, the complete understanding of the e f f e c t s of frame deviations can only be achieved i f a v a i l a b l e c l i n i c a l material includes frame-securing interventions by the therapist. As noted, t h i s study involved therapy under conditions of persistent breaks i n the frame and the therapist secured the frame only i n three instances (case one, session three; case two, session three; and case four, session three). Overall, t h i s study was thus able to y i e l d only the r e s u l t s of the f i r s t part of a complete analysis, that i s , the analysis of the c l i e n t ' s reaction i n the l i g h t of the s p e c i f i c break i n the frame. The second part, that i s , the analysis of the c l i e n t ' s reaction which follows the act of securing of the frame by the therapist i n the way that was expressed by the c l i e n t i n h i s or her model of r e c t i f i c a t i o n , was possible only i n the three instances of securing of the frame. Each of the three instances represents conclusive evidence of the p r e d i c t i v e value of Langs' theories with respect to children and therefore 164 conclusive evidence of three aspects of the basic t h e s i s of t h i s study. The f i n a l proof of the correctness and u n i v e r s a l i t y of the c h i l d therapeutic frame, as proposed by Langs' theories, would be found i n i d e n t i f y i n g a large number of models of r e c t i f i c a t i o n , expressed by the c l i e n t s , which would be followed by securing of the frame and which would, i n turn, be followed by unconscious v a l i d a t i o n by the c l i e n t s . Interpersonal v a l i d a t i o n (the emergence of p o s i t i v e images and themes) would show evidence of the b e n e f i c i a l e f f e c t s on the c l i e n t of the securing of the frame: images of restored t r u s t - a reversal from the previously expressed mistrust, as well as of c l e a r interpersonal boundaries - a reversal from v i o l a t e d and blurred boundaries, would emerge. Cognitive v a l i d a t i o n would r e f l e c t not only the therapeutic q u a l i t y of the process for the c h i l d (symptomatic improvement), but would also show further evidence that the c h i l d had indeed been reacting to the i d e n t i f i e d break i n the frame and that i t s meaning fo r childr e n i s the same as the one predicted by Langs' theories. As noted, the study contains three examples of such complete analysis. They provide three instances of conclusive proof for the correctness of the basic proposition of t h i s thesis, namely, that the frame for 165 children i n psychotherapy i s the same as the frame defined by Langs for adult and adolescent c l i e n t s . An empirically derived, complete set of rules of the c h i l d frame can only be determined on the basis of complete analysis of data obtained from secure frame psychotherapy and t h i s study yielded rigorous proof for three types of breaks i n the frame: contact with t h i r d p arties, observation mirror, and changing the time for sessions adversely influence the process of c h i l d psychotherapy by providing evidence of the constructive e f f e c t s of the r e c t i f i c a t i o n of these breaks. Further studies of secure frame psychotherapy are needed to complete the set of ground rules and boundaries of c h i l d psychotherapy by empirical means. 166 REFERENCES Alexander, F. (1954). Some quantitative aspects of psychoanalytic technique. Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp. 297-299. New York: Jason Aronson. An i s f e l d , L. S. (1984). The therapist's d i s a b i l i t y as an adaptive context. In J. Raney (Ed.), Listening and interpreting . Jason Aronson: New York. Ba l i n t , A. & B a l i n t M. (1968). On transference and countertransference. Abstracted i n R. Langs, The  therapeutic i n t e r a c t i o n . Vol.1, pp. 62-63. New York: Jason Aronson. Bejerholm, L. & Windahl, G. (1984). A comparison of Langs* Interactional frame and Schafer's new language for psychoanalysis. In J. Raney (Ed.), Listening and interpreting . New York: Jason Aronson. Berman, L. (1949). Countertransference and attitudes of the analysis i n the therapeutic process. Abstracted i n R. Langs, The therapeutic  i n t e r a c t i o n . New York: Jason Aronson. Brown, R. D. & Krausz, R. (1984). The patient's unconscious perception of the therapist's 167 disruptions. In J . Raney (Ed.), Listening and int e r p r e t i n g . New York: Jason Aronson. Cheifetz, L. G. (1984). Framework v i o l a t i o n s i n psychotherapy with c l i n i c patients. In J . Raney (Ed.), Listening and inte r p r e t i n g . New York: Jason Aronson. Dorpat, T. L. (1984). The technique of questioning. In J. Raney (Ed.), Listening and in t e r p r e t i n g . New York: Jason Aronson. Dorpat, T. L. (1987). Unconscious perception - Day residue and dreaming. The Yearbook of Psychoanalysis and Psychotherapy. 2, pp. 3 4-47. E i s s l e r , K. R. (1953). The e f f e c t of the structure of the ego on psychoanalytic technique. Journal  of the American Psychoanalytic Association. 1, pp. 104-143. E i s s l e r , K. R. (1974). On some t h e o r e t i c a l and techn i c a l problems regarding the payment of fees for psychoanalytic treatment. International  Review of Psycho-Analysis. 1, 73-101. Fair b a i r n , W. R. (1957). Freud, the psycho-analytic method and mental health. Abstracted i n R. Langs, The therapeutic in t e r a c t i o n , Vol.1, pp. 157-158. New York: Jason Aronson. Ferenczi, S. (1921). The further development of an 168 active therapy i n psycho-analysis. Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp.43-44. New York: Jason Aronson. Freud, A. (1954). Discussion. The widening scope of indications for psychoanalysis. Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp.119- 120. New York: Jason Aronson. Freud, S. (1912). Recommendations to physicians p r a c t i s i n g psycho-analysis. Abstracted i n R. Langs, The therapeutic in t e r a c t i o n , Vol. 1, pp.33-34. New York: Jason Aronson. Freud, S. (1919). Lines of advances i n psycho-a n a l y t i c therapy. Abstracted i n R. Langs, The  therapeutic in t e r a c t i o n , Vol. 1, pp.41-42. New York: Jason Aronson. G i l l , M. M. (1984). Robert Langs on technique: a c r i t i q u e . In J. Raney (Ed.), Listening and  inte r p r e t i n g . New York: Jason Aronson. Glover, E. (1955). The technique of psycho-analysis. Abstracted i n R. Langs, The  therapeutic i n t e r a c t i o n . Vol. 1, pp.128-132. New York: Jason Aronson. Greenacre, P. (1954). The r o l e of transference. Abstracted i n R. Langs, The therapeutic  i n t e r a c t i o n . Vol. 1, pp.115-116. New York: Jason Aronson. 169 Greenacre, P. (1959). Certain technical problems i n the transference r e l a t i o n s h i p . Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp.194-196. New York: Jason Aronson. Greenson, R. R. (1965). The working a l l i a n c e and the transference neurosis. Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp.281-282. New York: Jason Aronson. Grotstein, J. S. (1984). The higher implications of Langs' contributions. In J. Raney (Ed.), Listening; and interpreting . New York: Jason Aronson. Hawking, S. W. (1988). A b r i e f h i s t o r y of time. Toronto: Bantam books. Hodges, A. G. (1984). The Langsian approach to acting out. In J. Raney (Ed.), Listening and  inter p r e t i n g . New York: Jason Aronson. Jacobson, E. (1954). Transference problems i n the psychoanalytic treatment of severely depressive patients. Abstracted i n R. Langs, The  therapeutic i n t e r a c t i o n . Vol. 1, pp.116-117. New York: Jason Aronson. Jaynes, E. T. (1957). Information theory and s t a t i s t i c a l mechanics. Physical Review. 106. pp. 620-630. Khan, M. M. R. (1960). Regression and integration 170 i n the an a l y t i c s e t t i n g . Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp.212-214. New York: Jason Aronson. Khan, M. M. R. (1969). On the c l i n i c a l provision of f r u s t r a t i o n s , recognitions, and f a i l u r e s i n the a n a l y t i c s i t u a t i o n . Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp.401-404. New York: Jason Aronson. Korn, S. & Carmignani, R. P. (1987). Process notes as deriv a t i v e communication about the supervisory f i e l d . J . Raney (Ed.), Listening and  int e r p r e t i n g . New York: Jason Aronson. Langs, R. (1976). The bipersonal f i e l d . New York: Aronson. Langs, R. (1975). The patient's unconscious perceptions of the therapist's errors. In R. Langs, Technigue i n t r a n s i t i o n , pp. 139-154. New York: Jason Aronson. Langs. R. (1976). The bipersonal f i e l d . New York: Jason Aronson. Langs, (1976a). The therapeutic inte r a c t i o n s . Vol. 1. New York: Jason Aronson. Langs, (1976b). The therapeutic inte r a c t i o n s . V ol. 2. New York: Jason Aronson. Langs, R. (1978). The l i s t e n i n g process. New York: Jason Aronson. 171 Langs, R. (1978a). V a l i d a t i o n and the framework of the therapeutic s i t u a t i o n . Contemporary Psychoanalysis. 14, pp. 98-125. Langs, R. (1979). The supervisory experience. New York: Jason Aronson. Langs, R. (1979a). The therapeutic environment. New York: Jason Aronson. Langs, R. (1979b). Interventions i n the bipersonal f i e l d . Contemporary Psychoanalysis. 15, pp. 1-54. Langs, R. (1979c). The adaptational-interactional dimension of countertransference. Contemporary Psychoanalysis. 14, pp. 502-533. Langs, R. (1979d). Interactions: the realm of transference and countertransference. New York: Jason Aronson. Langs, R. (1980). Truth therapy / l i e therapy._ International Journal of Psychoanalytic Psychotherapy. 8, 3-34. Langs, R. (1981). Resistances and interventions: the nature of therapeutic work. New York: Jason Aronson. Langs, R. (1982). Psychotherapy, a basic text. New York: Aronson. Langs, R. (1982a). Supervisory c r i s e s and dreams from supervisees, contemporary Psychoanalysis. _ 172 18, pp. 575-612. Langs, R, (1983). Unconscious communication i n everyday l i f e . New York: Aronson. Langs, R. (1984). Freud's Irma dream and the o r i g i n of psychoanalysis. Psychoanalytic Review. Langs, R. (1984). The contributions of the adaptational-interactional approach to c l a s s i c a l psychoanalysis. Analytic Psychotherapy and Psychopatholocry, 1, 21-47. Langs, R. (1985). Workbooks for Psychotherapists: Vol. 1, understanding unconscious communication. Emerson, NJ: Newconcept Press. Langs, R. (1985a). Workbooks for psychotherapists:  Vol. 2, Listening and formulating. Emerson, NJ: Newconcept Press. Langs, R. (1985b). Workbooks for psychotherapists: Vol.3, Intervening and v a l i d a t i n g . Emerson, NJ: Newconcept Press. Langs, R. (1985c). A communicative c r i t i q u e - a response to Emanuel Peterfreund. Contemporary Psychoanalysis, 21, pp. 626-636. Langs, R. (1985d). The communicative approach and the future of psychoanalysis. Contemporary Psychoanalysis, 21, pp. 403-423. Langs, R. (1985e). The f i r s t session. The yearbook of Psychoanalysis and Psychotherapy, 1, pp. 125-173 150. Langs, R. (1986). C l i n i c a l issues a r i s i n g from a new model of the mind. Contemporary Psychoanalysis. 22, pp. 418-444. Langs, R. (1989). Reactions of supervisees (and supervisors) to new l e v e l s of psychoanalytic discovery and meaning. Contemporary Psychoanalysis. 25. pp. 76-96. Langs, R. (1989a). A systems theory for psychoanalysis. Contemporary Psychoanalysis. 25, pp. 371-392. Lubin, M. (1984). Views on neurosis, l i s t e n i n g , and cure: a discussion on G i l l ' s comment on Langs. J. Raney (Ed.), Listening and  int e r p r e t i n g . New York: Jason Aronson. Milner, M. (1952). Aspects of symbolism i n comprehension of the non-self. Abstracted i n R. Langs, The therapeutic in t e r a c t i o n . Vol. 1, pp. 94-96. New York: Jason Aronson. Nacht, S. & Viderman, S. (1960). The pre-object universe i n the transference s i t u a t i o n . Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp. 22 0-221. New York: Jason Aronson. Raney, J. (1984). N a r c i s s i s t i c defensiveness and the communicative approach. J . Raney (Ed.), 174 Listening and interpreting . New York: Jason Aronson. Raney, J . (1987). Discussion: the well tempered supervisor. The Yearbook of Psychoanalysis and Psychotherapy, 2, pp.85-93. Rangell, L. (1969). The intrapsychic process and i t s analysis: a recent l i n e of thought and i t s current implications. Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp. 412-413. New York: Jason Aronson. Reich, A. (1958). Symposium: a s p e c i a l v a r i a t i o n of technique. Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp. 180-181. New York: Jason Aronson. Searles, H. F. (1965). Collected papers on schizophrenia and related subjects. New York: International U n i v e r s i t i e s Press. Searles, H. F., (1975). The patient as therapist to his analyst. In P. L. Giovacchini (Ed.), T a c t i c s and techniques of psychoanalytic therapy. New York: Jason Aronson. S i l v e r s t e i n , E. A. (1984). Langsian theory and countertransference. J. Raney (Ed.), Listening and int e r p r e t i n g . New York: Jason Aronson. Stone, L. (1954). The widening scope of indications for psychoanalysis. Abstracted i n R. 175 Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp. 117-119. New York: Jason Aronson. Strachey, J. (1934). The nature of the therapeutic action of psychoanalysis. Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp. 53-56. New York: Jason Aronson. Szasz, T. (1962). The problem of privacy i n t r a i n i n g analysis: selections from a questionnaire study of psychoanalytic practices and opinions. Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, pp. 257-258. New York: Jason Aronson. Szasz, T. (1980). Sex by p r e s c r i p t i o n . Garden City, New York: Anchor Press/Doubleday. Tarachow, S. (1962). Interpretation and r e a l i t y i n psychotherapy. Journal of Psychoanalysis, 43. pp. 377-387. Tarnower, W. (1966). Extra-analytic contacts between the analyst and the patient. Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, p. 323. New York: Jason Aronson. Vlosky, M. (1984). Community mental health, c l i e n t s ' r i g h t s , and the therapeutic frame. J. Raney (Ed.), Listening and int e r p r e t i n g . New York: Jason Aronson. Winnicott, D. W. (1954). Metapsychological and 176 c l i n i c a l aspects of regression within the psycho-analytic set-up. Abstracted i n R. Langs, The therapeutic i n t e r a c t i o n . Vol. 1, p. 127-128. New York: Jason Aronson. Yin, R. K. (1984). Case study research. Beverly H i l l s : Sage. 177 APPENDIX I THE UNIVERSITY OF BRITISH COLUMBIA Department of Counselling Psychology Faculty of Education 5780 Toronto Road Vancouver, B.C. Canada V6T 1L2 Dear Parent or Guardian, I am a candidate for M.A. i n Counselling Psychology at U.B.C. doing a study under the professional supervision of Dr. Larry Cochran, of Counselling Psychology at U.B.C. I had been working with your c h i l d at the Mental Health Centre under the professional supervision of Dr. John A l l a n of U.B.C. Department of Counselling Psychology. Part of my work would also be part of my magistral research study on the symbolic expressions of children i n play therapy. The study i s e n t i t l e d : "Extra-Conscious Communication of Children i n Playtherapy - Analysis of Variables Pertaining to the Ground Rules of the Therapeutic Relationship". The study i s the r e s u l t of my i n t e r e s t i n how children express meaning i n symbolic form i n t h e i r play and how children can portray and r e f l e c t i n t h e i r play the moment-to-moment r e l a t i o n s h i p with the therapist. This study w i l l be based on the analysis of t r a n s c r i p t s of the sessions of your children which w i l l describe the 179 APPENDIX II THE UNIVERSITY OF BRITISH COLUMBIA Department of Counselling Psychology Faculty of Education 5780 Toronto Road Vancouver, B.C. Canada, V6T 1L2 Faculty Advisor: Dr. Larry Cochran, T e l . : 822-6139 PARENTAL CONSENT FORM A p r i l 1991 I do / do not consent for my c h i l d to have t r a n s c r i p t s of h i s or her play therapy sessions avail a b l e for analysis by Vesna Bonac, master's candidate i n Counselling Psychology, U.B.C., i n the research study on symbolic expressions of children i n play-therapy, and I acknowledge the receipt of t h i s form. I understand that my c h i l d ' s c o n f i d e n t i a l i t y and anonymity are insured i n a l l phases of the study and i n the r e s u l t i n g report. I understand that ALL personal information w i l l be removed from t r a n s c r i p t s BEFORE the study begins. I understand that the study w i l l y i e l d thematic descriptions of children's play and play t a l k without i d e n t i f y i n g the c h i l d . 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0053721/manifest

Comment

Related Items