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

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Unconscious Communication  o f C h i l d r e n i n Psychotherapy:  A n a l y s i s o f S e s s i o n s With Respect t o V a r i a b l e s P e r t a i n i n g t o L a n g s i a n Ground Rules o f P s y c h o t h e r a p e u t i c R e l a t i o n s h i p by Vesna A. Bonac B. A., Vassar C o l l e g e , 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 C o u n s e l l i n g  Psychology)  We accept t h i s t h e s i s as conforming t o t h e r e q u i r e d standard  THE UNIVERSITY OF BRITISH COLUMBIA November 1991 (c)  Vesna A. Bonac, 1991  In  presenting this  degree  at the  thesis  in  University of  partial  fulfilment  of  of  department  this or  thesis for by  his  or  requirements  British Columbia, I agree that the  freely available for reference and study. I further copying  the  representatives.  an advanced  Library shall make  it  agree that permission for extensive  scholarly purposes may be her  for  It  is  granted  by the  understood  that  head of copying  my 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  DE-6 (2/88)  jo  Septehiber  /^/  ABSTRACT  The c e n t r a l t h e s i s o f t h i s study says t h a t t h e ground r u l e s and boundaries o f t h e p s y c h o t h e r a p e u t i c r e l a t i o n s h i p (the frame), as d e f i n e d by Robert Langs f o r a d u l t s and a d o l e s c e n t s , a r e t h e same f o r c h i l d r e n .  T r a n s c r i p t s from  memory o f v e r b a l i s a t i o n and behaviours from 12 s e s s i o n s o f c h i l d r e n i n i n d i v i d u a l psychotherapy were a n a l y z e d w i t h the purpose t o t e s t Langsian communicative p s y c h o a n a l y t i c hypotheses.  Unconscious communications  were a n a l y z e d i n  accordance w i t h Langs' t h e o r i e s t o determine t h e impact o f the s t a t e o f t h e frame on c h i l d r e n .  The dependent  v a r i a b l e , unconscious communication,  was a n a l y z e d w i t h  r e s p e c t t o t h e f o l l o w i n g n i n e independent v a r i a b l e s o f t h e frame:  (a) change i n therapy rooms, (b) audio r e c o r d i n g o f  session,  (c) missed s e s s i o n s and h o l i d a y s ,  contact t h i r d parties,  (e) d i s r u p t i o n o f s e s s i o n ,  e x t e n s i o n and time r e d u c t i o n of s e s s i o n , mirror,  ( f ) time  (g) o b s e r v a t i o n  (h) f o r c e d t e r m i n a t i o n of treatment, and ( i )  touching toys. triggers,  The a n a l y s i s o f data was l i m i t e d t o : (a)  (b) p o l a r i t y o f themes and images, (c)  perceptions of the t h e r a p i s t , and  (d) t h e r a p i s t ' s  (d) models o f r e c t i f i c a t i o n ,  (e) v i c i s s i t u d e s o f r e s i s t a n c e s .  This i s a limited,  m u l t i p l e case e m p i r i c a l study o f 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 setting.  The p r o c e s s of unconscious  v a l i d a t i o n and n o n - v a l i d a t i o n by t h e c l i e n t was used t o determine t h e c o r r e c t n e s s of i n d i v i d u a l hypotheses,  which  were formed f o r each s e s s i o n on t h e b a s i s of t h e s t a t e of the frame. C o n c l u s i v e e m p i r i c a l proof of t h e e f f e c t s of t h r e e types of breaks i n t h e frame on t h e p r o c e s s o f c h i l d psychotherapy  i s presented: c o n t a c t w i t h t h i r d  parties,  o b s e r v a t i o n m i r r o r , and changing t h e time f o r s e s s i o n s a d v e r s e l y i n f l u e n c e t h e process of c h i l d  psychotherapy.  These t h r e e f i n d i n g s were made p o s s i b l e because t h e a v a i l a b l e data i n c l u d e d t h e b r e a k i n g as w e l l as s e c u r i n g of  t h e frame which p e r m i t t e d t h e e x e c u t i o n of complete  Langsian a n a l y s i s .  Each of t h e t h r e e i n s t a n c e s r e p r e s e n t s  a p i e c e of c o n c l u s i v e evidence of t h e p r e d i c t i v e v a l u e of Langs' t h e o r y r e g a r d i n g c h i l d r e n and t h e r e f o r e c o n c l u s i v e evidence of t h e t h r e e a s p e c t s of the b a s i c t h e s i s of t h i s study.  The a n a l y s i s of data r e v e a l e d t h a t t h e i n d i v i d u a l  Langsian hypotheses  were c o r r e c t i n a l l i n s t a n c e s .  a n a l y s i s a l s o r e v e a l e d t h a t none of t h e data would  The satisfy  a r i v a l h y p o t h e s i s which would propose an outcome o p p o s i t e to  Langsian hypotheses.  A l i m i t a t i o n of t h e study i s t h e  f a c t t h a t t h e m a j o r i t y of a v a i l a b l e data c o n t a i n e d m a t e r i a l t h a t allowed o n l y p a r t i a l Langsian a n a l y s i s of the impact of t h e frame on t h e c h i l d . secure frame psychotherapy  Further studies of  a r e needed t o complete  the s e t  of ground r u l e s and boundaries of c h i l d psychotherapy by e m p i r i c a l means.  TABLE OF CONTENTS ABSTRACT TABLE OF CONTENTS ACKNOWLEDGEMENTS CHAPTER ONE INTRODUCTION  ii V vii 1 1  Review o f L i t e r a t u r e  1  Purpose o f t h e Study  8  O b j e c t i v e s o f t h eStudy  10  Definitions  10  Research Methods  14  Validity  19  Reliability  21  L i m i t a t i o n s o f t h e Study  21  Procedures  24  C o l l e c t i o n o f Data  28  CHAPTER TWO ANALYSIS OF DATA  31 31  Case One, S e s s i o n One  31  Case One, S e s s i o n Two  42  Case One, S e s s i o n Three  52  Case One, S e s s i o n S i x  64  Case Two, S e s s i o n One  74  Case Two, S e s s i o n Two  88  Case Two, S e s s i o n Three  97  vi Case Two, S e s s i o n Four  107  Case Three, S e s s i o n One  114  Case Three, S e s s i o n Two  131  Case Three, S e s s i o n Three  138  Case Three, S e s s i o n Fourteen  146  CHAPTER THREE DISCUSSION OF RESULTS  159 159  REFERENCES  166  APPENDIX I  177  L e t t e r o f Contact APPENDIX I I P a r e n t a l Consent Form  177 179 179  vii  ACKNOWLEDGEMENTS  I would l i k e t o express my g r a t i t u d e t o my t h e s i s committee, Dr. L a r r y Cochran and Dr. John A l l a n o f U n i v e r s i t y o f B r i t i s h Columbia, and Dr. Marc McKee o f I l l i n o i s School o f P r o f e s s i o n a l Psychology, f o r t h e i r support, encouragement, guidance, and p a t i e n c e . Without t h e c l i n i c a l f i n d i n g s and d i s c o v e r i e s o f Dr. Robert Langs t h i s study would not have e x i s t e d . I thank my c l i e n t s who had t r u s t e d my e f f o r t s and without whom t h i s study would not be p o s s i b l e . I would l i k e t o thank my f a m i l y f o r t h e i r h e l p 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  o r i e n t a t i o n s conduct therapy f o l l o w i n g 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 r u l e s and boundaries o f conduct and  thus m a i n t a i n d i f f e r e n t c o n d i t i o n s  f o r and a p p l y d i f f e r e n t  means i n t h e treatment o f t h e i r c l i e n t s . lay  and p r o f e s s i o n a l , on t h e s u b j e c t  the ground r u l e s on t h e t h e r a p e u t i c scarce.  L i t e r a t u r e , both  of the influences of process i s r e l a t i v e l y  The i s s u e of d e t e r m i n i n g which t h e r a p i s t '  behaviours, t h a t d e f i n e t h e ground r u l e s and boundaries o f the t h e r a p e u t i c and  r e l a t i o n s h i p (the frame) a r e c o n s t r u c t i v e  which a r e d e s t r u c t i v e t o treatment i s an important one  i n a p p l i e d psychology and a c r i t i c a l one i n t h e moment-tomoment t h e r a p e u t i c  interaction.  the t h e o r y o f t h e r a p e u t i c  The i s s u e i s c e n t r a l t o  technique.  Review o f L i t e r a t u r e The  reported  and i m p l i e d ground r u l e s o f therapy, as  they appear i n c l i n i c a l papers and i n works on t e c h n i q u e , r e v e a l a very wide range o f behaviours by both t h e r a p i s t s and  clients:  from s t r i c t adherence t o 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 p h y s i c a l c o n t a c t , (e.g.,  and so f o r t h  i n c l a s s i c a l p s y c h o a n a l y s i s ) t o psychotherapy i n  2 p u b l i c and s e x u a l c o n t a c t . S i n c e the g o a l of t h i s study i s t o l i m i t e d way,  compare, i n a  the unconscious communications of c h i l d r e n  w i t h the unconscious r e a c t i o n s of a d u l t s and a d o l e s c e n t s , as r e p o r t e d i n the p s y c h o a n a l y t i c s t u d i e s of the t h e r a p e u t i c p r o c e s s , the review of l i t e r a t u r e w i l l limited  t o authors who  communications. of  be  c o n s i d e r unconscious  References t h a t i n v o l v e the communication  i m p l i e d and p r e - c o n s c i o u s meaning or those t h a t d e f i n e  "unconscious" d i f f e r e n t l y from the p s y c h o a n a l y t i c d e f i n i t i o n w i l l be omitted because  communication o t h e r  than unconscious i s of p e r i p h e r a l r e l e v a n c e t o t h i s and because  i t would not c o n t r i b u t e t o the  nature of the p r e s e n t study. limited  study  comparative  References w i l l be t h e r e f o r e  t o p s y c h o a n a l y t i c l i t e r a t u r e w i t h emphasis on the  works of Robert  Langs.  The i s s u e of ground r u l e s has been brought up several psychoanalytic writers.  by  The f i r s t p s y c h o a n a l y s t  t o d e s c r i b e the ground r u l e s and boundaries of the p s y c h o t h e r a p e u t i c r e l a t i o n s h i p was  Freud  (1912)  who  s t r e s s e d the importance of the a n a l y s t ' s adherence neutrality effects  and a b s t i n e n c e and who  of unpaid treatment.  to  r e c o g n i s e d the harmful  In 1919,  Freud  (1919)  recommended s e v e r a l m o d i f i c a t i o n s i n h i s p r e v i o u s l y h e l d b e l i e f s which may  have h e l d an important i n f l u e n c e on  l a t e r p s y c h o a n a l y s t s who  advocated such m o d i f i c a t i o n s .  3 The p s y c h o a n a l y t i c modifications  w r i t e r s who  various  i n technique i n c l u d e such famous and  i n f l u e n t i a l psychoanalysis  as  Alexander  (1968), Berman (1949), E i s s l e r Fairbairn  recommended  (1957), Frank  (1953), F e r e n c z i  (1956), Anna Freud  (1955), Greenson (1965), Jacobson and W i n n i c o t t (1958).  (1954), B a l i n t (1921),  (1954), G l o v e r  (1954), Stone  (1954),  Most of t h e i r recommendations were  proposed i n r e l a t i o n t o treatment of more s e v e r e l y p a t i e n t s who  were c o n s i d e r e d  psychoanalysis Strachey  ill  poor c a n d i d a t e s f o r  proper. (1934) was  one of the f i r s t p s y c h o a n a l y s t s  t o c a u t i o n a g a i n s t d e v i a t i o n s i n t e c h n i q u e from the ground r u l e s proposed by Freud i n 1912. observations  He based h i s  on the important i n c o r p o r a t i v e  i d e n t i f i c a t i o n s o f the p a t i e n t w i t h the a n a l y s t emphasized the i n t e r a c t i o n a l nature of the  and  therapeutic  relationship. Eissler  (1953) emphasized adherence t o the o r i g i n a l  ground r u l e s but proposed t h a t some d e v i a t i o n s (parameters) are j u s t i f i e d when the b a s i c model o f t e c h n i q u e i s not s u f f i c i e n t when t r e a t i n g p a t i e n t s whose the p a t i e n t ' s ego i s s e v e r e l y d y s f u n c t i o n a l and cannot modified  by i n t e r p r e t a t i o n s .  E i s s l e r d i d p o i n t out,  however, t h a t such m o d i f i c a t i o n s may on the p a t i e n t ' s t r a n s f e r e n c e  be  have l a s t i n g e f f e c t s  and t h a t such e f f e c t s may  not be undone by i n t e r p r e t a t i o n s .  4 Eissler  (1974) wrote e x t e n s i v e l y about t h e payment o f  f e e s f o r treatment.  He f e l t t h a t t h i r d p a r t y payments  need not c r e a t e c o m p l i c a t i o n s .  He recommended t h a t t h e  treatment o f s e v e r e l y depressed p a t i e n t s and c h i l d r e n should and  be continued  when t h e t h i r d p a r t y r e f u s e s t o pay  t h a t such p a t i e n t s should  not be charged f o r missed  hours. He observed t h a t payment by f o r treatment government agencies has powerful e f f e c t s on p a t i e n t s . However, he c o n s i d e r e d  i t p o s s i b l e t o a n a l y z e most  insured  patients i f the c o n f i d e n t i a l i t y of p a t i e n t s ' communications was guaranteed. Another important c o n t r i b u t i o n was made by W i n n i c o t t (1954) who d i s c u s s e d  extensively the influence of the  management of t h e ground r u l e s of therapy on h i s p a t i e n t s . He was one o f t h e f i r s t a n a l y s t s t o demonstrate t h e i n h e r e n t t h e r a p e u t i c q u a l i t i e s o f t h e secure frame. observed t h a t d e v i a t i o n s i n t h e ground r u l e s  create  s e r i o u s r e s i s t a n c e s i n t h e p a t i e n t t h a t cannot be before  He  analyzed  the deviation i s r e c t i f i e d .  Khan (1960, 1969) e l a b o r a t e d  on W i n n i c o t t ' s  ideas and  s t a t e d t h a t t h e frame i s i n essence t h e 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 t h e a n a l y t i c s e t t i n g , t h e t r a n s f e r e n c e , and i n t e r p r e t a t i o n s . He b e l i e v e d t h a t those m o d i f i c a t i o n s i n t e c h n i q u e t h a t enable t h e t h e r a p i s t t o f u n c t i o n as a supplementary ego t o t h e p a t i e n t a r e e s s e n t i a l t o therapy  5 t o enable t h e necessary  regression.  Greenacre (1954) departed from t h e m a j o r i t y o f psychoanalytic  w r i t e r s who defended d e v i a t i o n s i n  t e c h n i q u e and advocated g e n e r a l  adherence t o t h e b a s i c  ground r u l e s o f a n a l y s i s except i n s i t u a t i o n s o f c r i s e s . The  p r i n c i p a l reason f o r her stance was t h e n e c e s s i t y t o  safeguard t h e t r a n s f e r e n c e by t h e r a p i s t ' s a c t i o n s .  t h a t must remain uncontaminated  She b e l i e v e d t h a t  i n t e r f e r e with the therapeutic  modifications  a l l i a n c e , damage t h e  p a t i e n t ' s autonomy, on some l e v e l repeat pathogenic i n t e r a c t i o n s , and p r e c l u d e  earlier  analysis.  In  a d d i t i o n , she observed t h a t d e v i a t i o n s may be f o l l o w e d by severe d i s t u r b a n c e s  i n t h e p a t i e n t and a l s o , t h a t  d e v i a t i o n s may be damaging t o t h e t h e r a p i s t . cautioned  t h e r a p i s t s t h a t t h e unconscious i s a powerful  f o r c e n o t t o be t r e a t e d An  She  lightly.  important c o n t r i b u t i o n t o t h e d i s c u s s i o n o f ground  r u l e s was made by M i l n e r  (1952) who s t u d i e d t h e importance  of i l l u s i o n i n t h e a n a l y t i c s i t u a t i o n . the t e m p o r a l - s p a c i a l  She observed t h a t  frame o f t h e a n a l y t i c r e l a t i o n s h i p  makes p o s s i b l e t h e development o f t h e t r a n s f e r e n c e i l l u s i o n and t h a t the frame i s e s s e n t i a l f o r t h e 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 e x t e n s i v e l y on t h e ground  r u l e s r e l a t e d t o p r i v a c y and c o n f i d e n t i a l i t y o f treatment. H i s p o s i t i o n i s t h a t t o t a l p r i v a c y i s t h e hallmark o f t h e  6 psychoanalytic  treatment and t h a t any m o d i f i c a t i o n i n t h i s  r u l e changes t h e very b a s i s o f t h e t h e r a p e u t i c of  qualities  psychoanalysis. Some authors (e.g., Nacht and Viderman, 1960; Reich,  1958;  F a i r b a i r n , 1957) advocated d i g r e s s i o n s  n e u t r a l i t y f o r c e r t a i n p a t i e n t s , others  from  observed t h a t  n e u t r a l i t y must be maintained f o r t h e b e n e f i t o f t h e patient  (e.g., Langs, 1982; R a n g e l l ,  1969; Tarachow,  1962). Contact between p a t i e n t and t h e r a p i s t o u t s i d e o f treatment i s c o n s i d e r e d  d i s r u p t i v e by Greenacre  (1959)  w h i l e Tarnower (1966) b e l i e v e s t h a t such meetings may provide  important m a t e r i a l f o r a n a l y s i s even though he  recognised  t h a t they e x e r t a powerful e f f e c t on t h e  p a t i e n t . Throughout h i s w r i t i n g s Langs m a i n t a i n s t h e p o s i t i o n t h a t c o n t a c t between p a t i e n t and t h e r a p i s t must be c o n f i n e d t o t h e therapy s e s s i o n even a f t e r treatment has  been completed because any such c o n t a c t  undermines  t h e r a p e u t i c work. A systematic psychoanalytic  review o f p r a c t i c a l l y a l l e x i s t i n g  w r i t i n g s t h a t d e a l w i t h t h e frame brought  Robert Langs (Langs, 1976a, 1976b) t o t h e c o n c l u s i o n  that  i n t h e 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 t o i n v e s t i g a t e t h e unconscious meaning o f a m o d i f i c a t i o n i n technique f o r e i t h e r the p a t i e n t or the a n a l y s t " (Langs, 1976b, p. 413). H i s c e n t r a l c r i t i c i s m  concerns  7 the f a c t t h a t t h e w r i t e r s r a r e l y r e p o r t e d information  that contains  r a r e l y considered  complete  data on t h e frame and t h a t they  t h e m o d i f i c a t i o n i n t h e frame as t h e  t r i g g e r f o r t h e p a t i e n t ' s subsequent m a t e r i a l i n t h e i r evaluations  of modifications.  S i n c e t h e authors made  v i r t u a l l y no attempt t o " s p e c i f i c a l l y i n v e s t i g a t e t h e unconscious meanings o f a m o d i f i c a t i o n i n t e c h n i q u e f o r e i t h e r p a t i e n t or the analyst"  (Langs, 1976b), Langs  b e l i e v e s t h a t they have i n e f f e c t n e g l e c t e d  to investigate  the i m p l i c a t i o n s i n r e a l i t y o f a m o d i f i c a t i o n s  i n the  frame. Langs' e m p i r i c a l s t u d i e s have shown t h a t  systematic  a n a l y s i s o f unconscious communications from p a t i e n t s i s o n l y p o s s i b l e when complete data from s e s s i o n s a r e available.  Years o f such e m p i r i c a l i n v e s t i g a t i o n s (Langs,  1975,  1976, 1978,1978a, 1979, 1979a, 1979b, 1979c, 1979d,  1980,  1981, 1982a, 1984, 1989) y i e l d e d t h e d i s c o v e r y  of a  u n i v e r s a l human need f o r s p e c i f i c ground r u l e s and boundaries i n any t h e r a p e u t i c r e l a t i o n s h i p , whether psychoanalysis extensive  o r psychotherapy.  empirical research  H i s d e t a i l e d and  i n human communication,  c o n s c i o u s and p a r t i c u l a r l y unconscious, has brought many new and unexpected d i s c o v e r i e s i l l u m i n a t i n g v a r i o u s of meaning and v a r i o u s relationships.  l e v e l s of experiencing  His research  levels  o f human  r e s u l t e d i n the e m p i r i c a l l y  found ground r u l e s and boundaries o f t h e t h e r a p e u t i c  8 r e l a t i o n s h i p which he termed the frame. Langs (1985b) has  e m p i r i c a l l y d e f i n e d the f o l l o w i n g  b a s i c elements of the ground r u l e s f o r p s y c h o a n a l y s i s f o r psychotherapy of a d u l t s and  adolescents:  (a)  t h e r a p i s t ' s n e u t r a l i t y , (b) t h e r a p i s t ' s anonymity, t o t a l p r i v a c y of treatment, treatment,  (f) s p e c i f i e d  and  c o n s i s t e n t l e n g t h of s e s s i o n s ,  (g) s p e c i f i e d  and  and  time of s e s s i o n s , and  c o n s i s t e n t frequency of  Purpose of the  (c)  (d) t o t a l c o n f i d e n t i a l i t y  (e) s i n g l e s e t f e e ,  c o n s i s t e n t appointed  and  (h)  of  specified  sessions.  Study  Of c r i t i c a l  importance t o the p r e s e n t  study i s Langs•  d i s c o v e r y of the u n i v e r s a l overwhelming i n f l u e n c e of b a s i c t h e r a p e u t i c c o n t r a c t , e x p l i c i t and  implicit,  the  on  the  c l i e n t s ' unconscious communications i n psychotherapy (Langs, 1976).  T h i s d i s c o v e r y has  important i m p l i c a t i o n s  f o r the p r a c t i c a l conduct of p s y c h o t h e r a p i s t s , terms of t h e i r adherence t o a b a s i c t h e r a p e u t i c as w e l l as i n terms of the way  both i n contract  they l i s t e n t o t h e i r  clients. The  present  l i m i t e d comparative study w i l l make a  s m a l l c o n t r i b u t i o n t o the area of c h i l d psychotherapy much as i t can  as  i l l u m i n a t e c h i l d r e n ' s unconscious r e a c t i o n s  t o those t h e r a p i s t ' s behaviours and v e r b a l i z a t i o n s t h a t c o n s t i t u t e m o d i f i c a t i o n s i n the frame as d e f i n e d by theory.  The  f i n d i n g s of t h i s study may  Langs'  contribute to  the  9 growing l i t e r a t u r e o f c l i n i c a l evidence t h a t c a l l s f o r a r e v i s i o n i n t h e technique o f psychotherapy as p r a c t i s e d by most c h i l d p s y c h o t h e r a p i s t s .  Comparable e m p i r i c a l  r e s e a r c h w i t h c h i l d r e n has not been p u b l i s h e d  even though  the Langsian communicative approach t o psychotherapy w i t h c h i l d r e n i s p r a c t i s e d by many contemporary psychotherapists  i n t h e c l i n i c a l and p r i v a t e s e t t i n g s .  P u b l i c a t i o n o f any c l i n i c a l m a t e r i a l i s a break i n t h e frame and i s not p r a c t i s e d by those t h e r a p i s t s who m a i n t a i n a secure frame f o r t h e i r c l i e n t s . psychoanalytic  According t o  t h e o r i e s o f psychology, psychopathology has  i t s most important r o o t s i n i n f a n c y and c h i l d h o o d .  Langs  (e.g., Langs, 1982) has found e m p i r i c a l l y t h a t modifications  i n t h e ground r u l e s o f therapy evoke  c o n s c i o u s and unconscious memories o f important  historical  precedence f o r t h e c l i e n t .  breaking  The t h e r a p i s t , when  the ground r u l e s o f p s y c h o t h e r a p e u t i c repeats  relationship,  i n some way t h e o r i g i n a l trauma f o r t h e c l i e n t as  he o r she  repeats,  on some l e v e l , the same type o f  i n t e r a c t i o n t h a t had o r i g i n a l l y c l i e n t ' s present  contributed to the  problem.  I t would l o g i c a l l y f o l l o w , t h a t t h e same ground r u l e s of psychotherapy t h a t apply t o a d u l t s a l s o apply t o children. study.  This i s also the basic p r o p o s i t i o n of t h i s  10 O b j e c t i v e s o f t h e Study The  o b j e c t i v e s o f t h i s study are:  (a) t o i n v e s t i g a t e  the e f f e c t s o f t h e m o d i f i c a t i o n s i n t h e frame on t h e unconscious communication o f c h i l d r e n i n psychotherapy, (b) t o compare such e f f e c t s with e x i s t i n g e m p i r i c a l f i n d i n g s o f r e s e a r c h w i t h a d u l t s , and (c) t o d i s c u s s t h e results. The  f o l l o w i n g independent v a r i a b l e s , p e r t a i n i n g t o  the ground r u l e s o f the p s y c h o t h e r a p e u t i c w i l l be i n v e s t i g a t e d :  (a) change o f therapy rooms, (b)  audio r e c o r d i n g o f s e s s i o n , holidays, parents,  relationship,  (c) missed s e s s i o n s and  (d) t h e r a p i s t ' s c o n t a c t with t h e c h i l d ' s (e) i n t e r r u p t i o n o f s e s s i o n ,  and time r e d u c t i o n o f s e s s i o n ,  ( f ) time  (g) o b s e r v a t i o n  extension mirror,  (h) f o r c e d t e r m i n a t i o n o f treatment, and ( i ) t o u c h i n g toys. Definitions Terminology used i n t h i s study f o l l o w s d e f i n i t i o n s developed by Langs (e.g., Langs, 1982, 1985) f o r s e v e r a l reasons.  Since Langs* d e f i n i t i o n s have been  o p e r a t i o n a l i z e d w i t h i n t h e context  of h i s e m p i r i c a l  r e s e a r c h o f t h e t h e r a p e u t i c process,  the presentation of  r e s e a r c h o f unconscious communication can be made much c l e a r e r and more u s e f u l i f the same terminology a l l authors.  The present  i s used by  study i s a l i m i t e d and c o n f i n e d  r e p l i c a t i o n study o f Langs' r e s e a r c h a p p l i e d t o a  d i f f e r e n t population (children).  To p r o v i d e an e f f e c t i v e  and i n t e l l i g i b l e comparison o f t h e f i n d i n g s o f Langs w i t h the r e s u l t s o f t h i s study I c o n s i d e r i t b e s t t h a t t h e t e r m i n o l o g y be t h e same.  The terms used by Langs a r e  mostly d e s c r i p t i v e and common t o a l l t e x t s i n psychology (e.g., t r i g g e r , model o f r e c t i f i c a t i o n ) .  When Langs'  t e r m i n o l o g y d i f f e r s from t h a t o f other authors i t i s u s u a l l y because Langs had found t h a t t h e p r o c e s s i n q u e s t i o n d e s c r i b e s a d i f f e r e n t phenomenon and r e q u i r e s a s e p a r a t e term  (e.g., communicative r e s i s t a n c e ) .  The t h r e e broadest and most important  definitions  used i n t h e communicative r e s e a r c h i n v o l v e : (a) t h e therapeutic relationship, communication, and  (b) t h e p r o c e s s o f unconscious  (c) t h e process o f unconscious  validation,  (d) decoding. Langs (1982) g i v e s t h e f o l l o w i n g d e f i n i t i o n o f t h e  t h e r a p e u t i c r e l a t i o n s h i p , formulated on t h e b a s i s o f h i s c l i n i c a l observations: The t h e r a p e u t i c a l r e l a t i o n s h i p embraces a l l components, c o n s c i o u s and unconscious, p a t h o l o g i c a l and n o n p a t h o l o g i c a l , o f t h e i n t e r a c t i o n between p a t i e n t and t h e r a p i s t . F o r t h e p a t i e n t , t h e t h e r a p e u t i c a l r e l a t i o n s h i p i n v o l v e s both t r a n s f e r e n c e and n o n t r a n s f e r e n c e components, w h i l e f o r t h e t h e r a p i s t i t i n v o l v e s c o u n t e r t r a n s f e r e n c e and n o n c o u n t e r t r a n s f e r e n c e elements.  (p. 746)  A c c o r d i n g t o Langs, t h e most awesome marvel i n t h e p r o c e s s o f human communication " i s t h e a b i l i t y o f t h e human mind t o express i t s e l f s i m u l t a n e o u s l y on two d i s t i n c t , and y e t i n t e r c o n n e c t e d , l e v e l s o f meaning" (Langs, 1983),  c o n s c i o u s and unconscious.  communication i s a c t i v a t e d c o n f l i c t and danger.  Unconscious  (triggered) i n s i t u a t i o n s of  The m a n i f e s t message o f an  unconscious communication i s t h e c a r r i e r o f t h e raw message which had been encoded through t h e use o f t h e primary p r o c e s s mechanisms o f displacement and s y m b o l i z a t i o n , d i s c o v e r e d by Sigmund Freud i n 1900 ( c i t e d i n Langs,  1985).  The unconscious meanings and f u n c t i o n s o f a m a n i f e s t e x p r e s s i o n can be conveyed  o n l y through l a t e n t  (encoded)  messages and can be c o n s c i o u s l y understood o n l y by decoding t h e m a n i f e s t e x p r e s s i o n i n l i g h t o f t h e t r i g g e r (stimulus) t h a t had evoked  i t as t h e sender o f t h e message  (e.g., t h e c l i e n t ) i s engaged i n e f f o r t s a t a d a p t a t i o n t o such t r i g g e r s Decoding  (e.g., t h e r a p i s t ' s  interventions).  i n v o l v e s t h e undoing o f t h e primary p r o c e s s  mechanisms o f displacement and s y m b o l i z a t i o n .  The b a s i c  endeavour i n a n a l y z i n g t h e message i s t o i d e n t i f y t h e theme shared by t h e two l e v e l s of communication, and unconscious.  conscious  The b e s t v e h i c l e s f o r d e r i v a t i v e  (encoded) communication have been found t o be "narratives,  images, memories, and dreams" (Langs,  1985).  Decoded messages r e v e a l the unconscious i m p l i c a t i o n s  of  the t r i g g e r t h a t had s e t them o f f and c e n t r e p r i m a r i l y upon unconscious v a l i d p e r c e p t i o n s  ( r a t h e r 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 b a s i s f o r e x p l a n a t i o n s  ( i n t e r p r e t a t i o n s ) o f f e r e d by the t h e r a p i s t t o the c l i e n t . I t has been one of Langs' most important d i s c o v e r i e s  to  f i n d t h a t 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 o f t h r e e messages i n the c l i e n t ' s communication:  (a)  c o g n i t i v e v a l i d a t i o n i n the form of " r e v e l a t i o n of f r e s h encoded m a t e r i a l . . . w h i c h extends the i n t e r p r e t a t i o n i n a unique and unexpected interpersonal  fashion"  (Langs, 1985);  (b)  v a l i d a t i o n i n the form o f the emergence o f  " p o s i t i v e and c o n s t r u c t i v e l y f u n c t i o n i n g  figures"  (Langs,  1985), which r e p r e s e n t the c l i e n t ' s i n t r o j e c t i o n of a well-functioning  t h e r a p i s t ; and  (c) c o n s c i o u s  u n d e r s t a n d i n g and working through by the c l i e n t . Resistance i s defined  as "any impediment w i t h i n  p a t i e n t t o the work of psychotherapy or a n a l y s i s " i s " o f t e n based on c o n t r i b u t i o n patient"  (Langs, 1982,  are the o b s t a c l e s  p. 740).  t h a t are d i s c o v e r e d  of the c l i e n t ' s m a t e r i a l .  and i t  from both t h e r a p i s t Communicative  the  and  resistances  through an  analysis  In the presence of such  r e s i s t a n c e s the v e r b a l m a t e r i a l c o n t a i n s unconscious meaning. simultaneously  limited  I t i s p o s s i b l e t o observe  gross b e h a v i o r a l r e s i s t a n c e t o therapy -  the c l i e n t wants t o leave therapy, and  little  communicative r e s i s t a n c e - the c l i e n t t e l l s r i c h  stories  and  represents  stimulus  for  the communication.  the t r i g g e r t h a t has Behavioral  impediments t o p s y c h o t h e r a p e u t i c d i r e c t behaviours and 1982,  p.741) and  a c t e d as the resistances  are  work t h a t "appear i n the  a s s o c i a t i o n s of the p a t i e n t "  (Langs,  they i n c l u d e s i l e n c e s , d i s r u p t i o n s of  s e s s i o n , e f f o r t s towards premature t e r m i n a t i o n ,  and  the  the  like. Research Methods In t h i s study the only dependent v a r i a b l e i s the unconscious r e a c t i o n by the c l i e n t  (the meaning  and  s t r u c t u r e of t h e i r unconscious communications) t o s p e c i f i c modifications independent v a r i a b l e s .  the  i n the frame, which r e p r e s e n t The  the  s t a t e of the frame d e f i n e s  the c o n t r o l l e d environment ( i . e . , known c o n s t a n t s ) which makes p o s s i b l e the o b s e r v a t i o n which i s e v a l u a t e d  on the b a s i s of the unconscious  v a l i d a t i o n process described frame i s any  of the dependent v a r i a b l e  above.  A m o d i f i c a t i o n i n the  i n a p p r o p r i a t e m o d i f i c a t i o n by e i t h e r  t h e r a p i s t or c l i e n t  (Langs, 1985).  Previous  research  (e.g., Langs, 1967)  shows t h a t any m o d i f i c a t i o n i n the  ground r u l e s always i n f l u e n c e s unconscious communication  15 of t h e c l i e n t i n an e x q u i s i t e l y s e n s i t i v e and c o n s i s t e n t , t h e r e f o r e p r e d i c t a b l e , way. Following  t h e c e n t r a l t h e s i s o f t h i s study t h a t t h e  b a s i c ground r u l e s o f psychotherapy which apply t o a d u l t s a l s o apply t o c h i l d r e n , each s i n g l e h y p o t h e s i s r e g a r d i n g  a  c h i l d ' s unconscious r e a c t i o n t o a s p e c i f i c m o d i f i c a t i o n i n the frame ( t r i g g e r ) was formulated i n terms o f t h e u n i v e r s a l r e a c t i o n o f a d u l t s and a d o l e s c e n t s ,  as found  e m p i r i c a l l y by Langs, under t h e heading "Hypotheses". c h i l d ' s a c t u a l r e a c t i o n was f i r s t  The  r e c o r d e d under t h e  heading "Data", then analyzed under t h e heading "Data a n a l y s i s " , and l a s t i t was compared w i t h t h e i n i t i a l h y p o t h e s i s under t h e heading " D i s c u s s i o n " . is therefore  analyzed and d i s c u s s e d  separately.  d i s c u s s i o n o f f i n d i n g s from a l l s e s s i o n s the heading " D i s c u s s i o n  of Results"  Each  session The  i s included  i n Chapter Three.  I have used data from my psychotherapy s e s s i o n s three  under  with  c h i l d r e n who were r e f e r r e d t o me a t a p u b l i c mental  health centre.  I have made t h e f o l l o w i n g  basic  assumptions t h a t a r e a l s o t h e b a s i c assumptions o f Langs' research,  namely: (a) t h a t t h e r e  e x i s t s unconscious  communication between t h e p a r t i c i p a n t s o f t h e t h e r a p e u t i c i n t e r a c t i o n , and (b) t h a t such unconscious communication p e r t a i n s t o t h e moment-to-moment i n t e r a c t i o n i n t h e s e s s i o n between t h e p a r t i c i p a n t s . Specifically,  I made p r e d i c t i o n s o f t h e e f f e c t s o f  the m o d i f i c a t i o n s  i n the frame on the  unconscious  communication of a c h i l d f o r each s e s s i o n on the b a s i s the f o l l o w i n g f u n c t i o n s of the s p e c i f i c a s p e c t s of  of  the  frame on the p s y c h o t h e r a p e u t i c p r o c e s s as e m p i r i c a l l y e s t a b l i s h e d by The  Langs:  secure frame - o f f e r s b a s i c t r u s t , c l e a r  i n t e r p e r s o n a l boundaries, support f o r r e a l i t y testing,  sound h o l d i n g  anxiety:  r e s p o n s i b i l i t y and  claustrophobic ... The  containment.  confinement t h a t produce  259)  frame - o f f e r s b a s i c m i s t r u s t ,  i n t e r p e r s o n a l boundaries, d i s t u r b a n c e s testing.  Sources of  a n x i e t i e s , f e a r s of l o o s i n g c o n t r o l  (Langs, 1985b, p. deviant  and  Sources of i n a p p r o p r i a t e  impaired  in reality  gratification:  s e r v e s as a b a s i s f o r p a t h o l o g i c a l defense v i a merger,  o f f e r s counterphobic and  defenses, and  manic-fusion  escape from e x p e r i e n c e d 1985b, p.  subjective  madness.  (Langs,  259)  Following  Langs' theory, the most important a s p e c t s  of unconscious meaning of a n a r r a t i v e are found i n the f o l l o w i n g components of the c l i e n t ' s : themes and s i g n s of  images,  (c) models of r e c t i f i c a t i o n ,  and  (b) (d)  resistances.  Triggers. everything respect  (a) t r i g g e r s ,  Langs' found t h a t "without  t h a t a t h e r a p i s t does and  exception,  does not do  in  t o the psychotherapy of a p a r t i c u l a r p a t i e n t i s an  adaptation-evoking context f o r the p a t i e n t " p.  (Langs, 1985a,  13). A d a p t a t i o n - e v o k i n g c o n t e x t s a r e t r i g g e r s t h a t  evoke unconscious communication from c l i e n t s .  The  t h e r a p i s t ' s management o f t h e frame i n v o l v e s t h e "core r e l a t i o n s h i p between p a t i e n t and t h e r a p i s t and t h e b a s i c holding  and c o n t a i n i n g  efforts"  q u a l i t i e s of the t h e r a p i s t ' s  (Langs, 1985a, p. 14) and t h i s i s why "the  i n t e r v e n t i o n s t h a t p e r t a i n t o t h e ground r u l e s o f treatment always take precedence f o r t h e p a t i e n t " 1985a, p. 14) over a l l other  (Langs,  interventions.  A c c o r d i n g t o Langs' theory, a break i n t h e frame w i l l always be t h e c e n t r a l o r g a n i s e r and  of the c l i e n t ' s  i t w i l l u s u a l l y be mentioned m a n i f e s t l y  e l s e w i l l be r e p r e s e n t e d i n encoded form symbolically) Searles discovered  (indirectly,  (1965,) and Langs (1976) independently f o r unconscious  of e x q u i s i t e v a l i d i t y and complexity.  to the s e l f  ( d i r e c t l y ) or  w i t h v a r i o u s degrees o f d i s g u i s e .  t h e human c a p a c i t y  symbolically  material  perceptions  I t i s communicated  (the language o f unconscious communication) (dreams) and t o o t h e r s i n spontaneous  n a r r a t i v e s . I t has been Langs' important c o n t r i b u t i o n t o discover  e m p i r i c a l l y t h a t a d u l t c l i e n t s i n psychotherapy  u n c o n s c i o u s l y communicate almost e x c l u s i v e l y v a l i d perceptions  o f t h e t h e r a p i s t when they a r e faced w i t h a  break i n t h e frame.  In t h i s study, themes and images i n  the c h i l d r e n ' s m a t e r i a l were s u b j e c t i v e l y e v a l u a t e d i n  18 t h i s r e s p e c t and c h a r a c t e r i s e d as e i t h e r v a l i d or e l s e f a n t a s y  perceptions  (misperceptions).  P o l a r i t y of themes and images.  In t h i s study, data  a n a l y s i s i n c l u d e s an a b s t r a c t i o n o f t h e themes o r images i n t h e c l i e n t ' s m a t e r i a l t o determine t h e p o l a r i t y as e i t h e r p o s i t i v e o r negative  themes and images.  E f f o r t was  made t o determine t h e u n i v e r s a l meaning o f a p a r t i c u l a r n a r r a t i v e and t o a s s i g n i t e i t h e r a c o n s t r u c t i v e and helpful  ( p o s i t i v e ) meaning o r e l s e a d e s t r u c t i v e and  harmful  (negative)  According  meaning.  t o Langs' theory,  breaks i n t h e frame a r e  harmful t o c l i e n t s and generate n e g a t i v e  images and themes  i n t h e i r n a r r a t i v e s w h i l e a c t i o n s by t h e t h e r a p i s t t h a t secure the frame ( e s p e c i a l l y when such s e c u r i n g  followed a  s p e c i f i c model o f r e c t i f i c a t i o n by t h e 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 n e g a t i v e  images and themes a r e c o n s i d e r e d expression  evidence f o r t h e  of the c l i e n t ' s i n t r o j e c t i o n of the t h e r a p i s t  who i s f u n c t i o n i n g w e l l and o f t h e t h e r a p i s t who i s functioning poorly, r e s p e c t i v e l y . Models o f r e c t i f i c a t i o n .  According  t o t h e theory,  when f a c e d w i t h t h e t r i g g e r o f a break i n t h e frame t h e c l i e n t u s u a l l y i n c l u d e s a theme t h a t i s communicated t o the t h e r a p i s t as a model t o r e c t i f y t h e break i n t h e frame.  Such models a r e always communicated  symbolically  (with d e r i v a t i v e s ) because t h e c l i e n t i s not aware  19 (unconscious) o f t h e t r i g g e r and o f i t s e f f e c t s on him o r her.  Some models a r e c l e a r w h i l e some a r e d i s g u i s e d and  e f f o r t i s made i n t h i s study t o s u b j e c t i v e l y e v a l u a t e t h e degree o f d i s g u i s e  f o r each example.  Langs'  shows t h a t c l i e n t s u s u a l l y communicate  research  c o m p e l l i n g models  of r e c t i f i c a t i o n t o t h e t h e r a p i s t as soon as a new break i n t h e frame o c c u r s . I f t h e t h e r a p i s t does not understand t h e c l i e n t ' s unconscious messages and does not e x p l a i n  (interpret)  its  meaning t o t h e c l i e n t and i f t h e t h e r a p i s t does not f o l l o w w i t h a r e c t i f i c a t i o n o f t h e break i n r e a l i t y , t h e c l i e n t u s u a l l y g i v e s up h i s o r h e r e f f o r t s and shows s i g n s o f non-therapeutic regression resistances  and r e g r e s s i o n s  and r e s i s t a n c e .  In t h i s study,  w i l l be i d e n t i f i e d and  connection with the t h e r a p i s t ' s  interventions  discussed.  Validity 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 h i g h because t h e dependent v a r i a b l e being e v a l u a t e d i s measured d i r e c t l y , r a t h e r by u s i n g  another dependent v a r i a b l e  t e s t ) w i t h which t h e r e i s an assumed  (e.g., a  than  standardized  linear relation.  The  r e l i a b i l i t y o f t h e d e f i n i t i o n s i s a l s o c o n s i d e r e d t o be h i g h because t h e technique o f d e t e r m i n i n g t h e emergence o f e i t h e r p o s i t i v e (constructive)  or negative  figures i n the c l i e n t ' s narrative straightforward.  (destructive)  i s r e l a t i v e l y simple and  Determination o f themes does  require  some p r a c t i c e and I have s t u d i e d t h e workbooks (Langs, 1985,  1985a,  1985b).  Langsian unconscious v a l i d a t i o n (as d e f i n e d will  above)  be used whenever a p p l i c a b l e , t h a t i s whenever a  r e c t i f i c a t i o n and a c o r r e c t e x p l a n a t i o n implications  of a modification  of the  o f t h e ground r u l e s was  a c t u a l l y o f f e r e d by t h e t h e r a p i s t t o t h e c l i e n t and unconscious v a l i d a t i o n o f such e x p l a n a t i o n 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 nonvalidation client will  o f the t h e r a p i s t ' s  followed. unconscious  interventions  by t h e  a l s o be taken i n t o account.  T h i s study i s not a t e s t o f Langs• methods used i n his  c l i n i c a l research  t h a t y i e l d e d t h e r u l e s o f t h e frame  w i t h 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 limited  comparative a n a l y s i s t h a t uses t h e same b a s i c methodology so t h a t r e s u l t s can be compared. In t h e l i t e r a t u r e d i s c u s s i n g Bejerholm & Windahl,  1984; G i l l ,  Langs' works (e.g., 1984; G r o t s t e i n , 1984;  Hodges, 1984; L u b i n 1984; S i l v e r s t e i n , 1984;)  t h e r e has  been no r e f u t a l o f e i t h e r r e l i a b i l i t y o r v a l i d i t y o f e i t h e r the constructs  o r t h e methods employed by Langs.  W r i t e r s who a p p l i e d h i s methodology t o t h e a n a l y s i s o f t h e c l i e n t ' s material  i n psychotherapy  Brown & Krausz, 1984; C h e i f e t z ,  (e.g., A n i s f e l d , 1984;  1984; Dorpat, 1984, 1987;  Keene, 1984; Korn & Carmignani, 1987; Raney, 1984, 1987; V l o s k y , 1984) came t o c o n c l u s i o n s  t h a t were i n accordance  w i t h Langs•  theory.  Reliability R e l i a b i l i t y of the study r e s t s on my  s k i l l t o decode  unconscious communication and thus t o r e p l i c a t e the method of a n a l y s i s used by Langs i n h i s c l i n i c a l  studies.  I have been s t u d y i n g the method f o r s e v e r a l years c o n f i d e n t t h a t I can r e l i a b l y , w i t h i n a l l o w a b l e  basic  and  I  am  l i m i t s of  e r r o r , f o l l o w the p r i n c i p l e s of Langsian methodology. L i m i t a t i o n s of the Study The  proposed study i s l i m i t e d i n the f o l l o w i n g ways:  1. Data are l i m i t e d t o the m a t e r i a l of s e s s i o n s at  a p u b l i c mental h e a l t h 2. The  3.  The  centre.  author of t h i s study was  s e s s i o n s used as  the t h e r a p i s t i n a l l  data.  number of s e s s i o n s i s l i m i t e d t o 12,  number of cases i s l i m i t e d t o t h r e e with case.  (A f o u r t h case had  the p r o p o s a l for  - two  The  5.  four sessions  been planned and was  the per  included i n  e v e n t u a l l y not  granted.)  cases i n v o l v e uneven r e p r e s e n t a t i o n of gender  boys and  5,6,and  and  f o r t h i s study, however, the p a r e n t a l consent  p u b l i c a t i o n was 4.  held  one  girl  and uneven r e p r e s e n t a t i o n of age  11. The  sessions selected for a n a l y s i s i n t h i s  from a p o o l of more than  40 s e s s i o n s , are those  t h a t were t r a n s c r i b e d i n t h e i r e n t i r e t y and t h a t the c l e a r e s t and  richest derivative material.  study  sessions contain  -  22 6. The  a n a l y s i s of data i s l i m i t e d t o the most  c r i t i c a l components of unconscious messages of t r i g g e r s , p e r c e p t i o n s ,  p o l a r i t y of images and  models of r e c t i f i c a t i o n and 7.  The  study a p p l i e d incomplete method of  instances.  1976a, 1978,  1979,  on the c l i e n t i n a l l  i d e a l and  f o r the a n a l y s i s of frame d e v i a t i o n s includes  1976,  complete method  can o n l y be  applied  frame-securing  i n t e r v e n t i o n s by the t h e r a p i s t . includes:  analysis  A c c o r d i n g t o Langs (1975,  1980), the  i f available material  themes,  resistances).  of the e f f e c t s of frame d e v i a t i o n s but t h r e e  (determination  Such complete a n a l y s i s  (a) the a n a l y s i s of c l i e n t ' s m a t e r i a l  l i g h t of the s p e c i f i c frame break and  i n the  - following  the  r e s t o r a t i o n of the secure frame by the t h e r a p i s t complying w i t h 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 s e c u r i n g the frame which f o l l o w s the t h e r a p i s t ' s s e c u r i n g  of  of  the  frame. In t h i s way, information  the a n a l y s i s of data y i e l d s not only  the  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 t o do  about the break, but a l s o the  something  important i n f o r m a t i o n  e f f e c t on the c l i e n t a f t e r the frame has Complete a n a l y s i s p r o v i d e s c l e a r and  been  convincing  of  the  restored. evidence  f o r the f o l l o w i n g : the s p e c i f i c break i n the frame, which was  defined  as the  independent v a r i a b l e i n the  initial  h y p o t h e s i s , i s i n f a c t t h e same break i n frame which t h e client i s reacting to.  The e m p i r i c a l p r o o f then l i e s i n  the evidence p r o v i d e d by t h e r e a c t i o n of t h e c l i e n t which f o l l o w s t h e r e c t i f i c a t i o n o f t h a t same break i n t h e frame. I f t h e c l i e n t were r e a c t i n g t o some o t h e r than h y p o t h e s i z e d break  i n t h e frame (and s e v e r a l breaks were  indeed contemporary i n a l l s e s s i o n s i n t h i s s t u d y ) , then the r e c t i f i c a t i o n o f t h e h y p o t h e s i z e d break would n o t generate unconscious v a l i d a t i o n by t h e c l i e n t and t h e c l i e n t would c o n t i n u e t o r e a c t a d v e r s e l y t o t h e c r i t i c a l and u n r e c t i f i e d break. p r o v i d e d by complete  The same e m p i r i c a l  evidence  a n a l y s i s a l s o provides the proof f o r  Langsian h y p o t h e s i s t h a t t h e c l i e n t was not r e a c t i n g t o some o t h e r type o f s t i m u l u s which i s not a break  i n the  frame. Only w i t h complete  a n a l y s i s can t h e c o n s t r u c t i v e  e f f e c t s o f t h e s e c u r i n g of t h e frame be f u l l y  empirically  v a l i d a t e d and o n l y i n t h i s way can t h e r u l e s f o r secure frame therapy o f c h i l d r e n be e m p i r i c a l l y d e r i v e d . The p r e s e n t study used data t h a t 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 , r e p l e t e w i t h v a r i o u s breaks i n t h e frame. The data were r e c o r d e d from therapy s e s s i o n s by a t h e r a p i s t who r a r e l y secured t h e frame. of  The u n d e r s t a n d i n g  t h e e f f e c t s o f t h e breaks i n t h e frame, as p r e s e n t e d i n  t h i s study, i s t h e r e f o r e a l i m i t e d understanding and t h e f i n a l d e f i n i t i o n o f the complete  s e t o f r u l e s o f t h e frame  of c h i l d psychotherapy i s t h e r e f o r e not p o s s i b l e i n t h i s study. Procedures According psychologist,  t o Robert Y i n  (Yin, 1984), an  experimental  the core of the s c i e n t i f i c method i s not  e x p e r i m e n t a t i o n per se, but the u s e f u l 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 , d e f i n e d the t a s k of s c i e n c e t o "the d i s c o v e r y  be  of laws t h a t w i l l enable us t o p r e d i c t  events " (Hawking, 1988,  p.173).  The  present  study, a  l i m i t e d r e p l i c a t i o n study, f o l l o w s the b a s i c p r e c e p t s  of  the methodology e s t a b l i s h e d 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 (Langs, 1976,  1978,  1979,  1980,  1981)  hypotheses  by d i s c u s s i n g  t e s t i n g the s p e c i f i c p r o p o s i t i o n s o f f e r e d by t h e r a p i s t s : t e s t i n g hypotheses a g a i n s t from c l i e n t s and the f o r m u l a t i o n  and  supervised  sequential  material  employing unconscious v a l i d a t i o n y i e l d e d of p a t t e r n s  t h a t c r y s t a l l i z e d i n t o the  r u l e s t h a t comprise the frame. r e q u e s t e d by a l l c l i e n t s ,  frame,  unconsciously  involved r e c t i f i c a t i o n  harmful a c t i o n s by t h e r a p i s t s . the secure frame and  The  The  rules that  comprise  the f i n d i n g s t h a t d e s c r i b e  e f f e c t s of the m o d i f i e d  the  frame thus enable t o p r e d i c t  u n i v e r s a l l y the unconscious r e a c t i o n s of c l i e n t s s p e c i f i c modifications  of  i n the  frame.  to  I have omitted the e v a l u a t i o n of r i v a l hypotheses f o r two  reasons.  First,  which would r e p r e s e n t  a formulation  of r i v a l  hypotheses,  p r o p o s i t i o n s d e r i v e d from  various  e s t a b l i s h e d t h e o r e t i c a l o r i e n t a t i o n s , would r e q u i r e d e t a i l e d research  i n t o these o r i e n t a t i o n s t o i n s u r e t h a t  such r i v a l hypotheses would indeed r e p r e s e n t viewpoint.  the  correct  Such study would r e q u i r e a volume of work t h a t  would be out of the scope of t h i s  study.  Second, the g o a l of t h i s study i s t o compare the ground r u l e s of p s y c h o t h e r a p e u t i c from the work w i t h a d u l t s and  r e l a t i o n s h i p , developed  adolescents  by Robert Langs,  w i t h those of c h i l d r e n , the achievement of which does not r e q u i r e the i n t r o d u c t i o n of r i v a l hypotheses. seem l o g i c a l , however, t h a t any ground r u l e s between the two  discrepancies  populations  from a study would indeed r e p r e s e n t  I t would i n the  which may  emerge  a r i v a l hypothesis  and  a s t a r t i n g point for future studies. The  d i s c u s s i o n of r e s u l t s does i n c l u d e a t e s t by  i n f e r e n c e of one  c r i t i c a l r i v a l h y p o t h e s i s which s t a t e s  t h a t the r e a c t i o n of the c l i e n t , i n the frame, w i l l be o p p o s i t e Langsian hypothesis.  and  acceptable  t o t h a t s t a t e d by  I consider  the necessary i n f e r e n t i a l proof  f o l l o w i n g the same break  that t h i s t e s t and  the provides  that i t i s a c r i t i c a l  argument i n the r e s e a r c h  of phenomena which  are open t o d e t a i l e d e m p i r i c a l o b s e r v a t i o n  but are  not  open t o s t r i c t l y c o n t r o l l e d experimental m a n i p u l a t i o n s  26 (e.g., Jaynes,  1957).  The study i s a m u l t i p l e case study o f t h r e e c h i l d r e n , two boys (ages 5 and 11) and one g i r l  (age 6 ) .  T r a n s c r i p t s o f t h e i r s e s s i o n s (four s e s s i o n s p e r c h i l d ) o f i n d i v i d u a l psychotherapy a t a p u b l i c mental h e a l t h c e n t r e were a n a l y z e d w i t h r e s p e c t t o t h e c r i t i c a l  ingredients of  t h e i r n a r r a t i v e s and behaviours t h a t comprise responses o f c l i e n t s i n psychotherapy.  Langs'  unconscious theories  were a p p l i e d t o data a n a l y s e s by u s i n g p r e d i c t i o n s f o r a c l i e n t ' s r e a c t i o n t o each s p e c i f i c m o d i f i c a t i o n i n t h e frame as a h y p o t h e s i s f o r each s e s s i o n . In  t h i s way t h e p r e s e n t m u l t i p l e case study answered  some o f t h e "how" and the why" q u e s t i o n s as proposed by Yin  ( Y i n , 1984), a l b e i t i n a l i m i t e d way.  Since t h i s  study attempted t o s e a r c h f o r t h e same u n i v e r s a l p r i n c i p l e s i n v o l v e d i n t h e r e a c t i o n o f human beings t o m o d i f i c a t i o n s o f ground r u l e s , as proposed by Langs' theories, the s t a t i s t i c a l l y is irrelevant.  meaningful number o f s u b j e c t s  A c c o r d i n g t o t h e t h e o r y employed, and  a c c o r d i n g t o t h e b a s i c requirement o f s c i e n c e , every case must e v e n t u a l l y show obedience t o a u n i v e r s a l  principle,  i n t h i s case t h e u n i v e r s a l p r i n c i p l e o f human unconscious r e a c t i o n s t o t h e m o d i f i c a t i o n s i n t h e ground r u l e s o f psychotherapy. of  I t i s t r u e , however, t h a t a l a r g e r number  c h i l d r e n , e s p e c i a l l y a g r e a t e r v a r i e t y o f ages f o r both  genders, would add s t r e n g t h t o t h i s study, j u s t as any one  27 d i s c r e p a n c y would put the t h e o r y i n t o q u e s t i o n . As Robert Y i n w r i t e s : "...the case study, l i k e the experiment,  does not  r e p r e s e n t a * sample', and the i n v e s t i g a t o r ' s g o a l i s to  expand and g e n e r a l i z e t h e o r i e s ( a n a l y t i c  g e n e r a l i s a t i o n ) and not t o enumerate f r e q u e n c i e s (statistical  generalization)"  (Yin, 1984,  p.21).  The most important reason f o r not making use of c o n v e n t i o n a l s t a t i s t i c a l methods t o e v a l u a t e data i n t h i s study i s the f a c t t h a t such methods can be a p p l i e d o n l y t o phenomena of which the o r d e r of the events i s i r r e l e v a n t and can be changed a t random. of  In c o n t r a s t , the phenomenon  the p s y c h o t h e r a p e u t i c i n t e r a c t i o n i s a p r o c e s s  comprised  of a d e f i n i t e sequence of events and t h e r e i s a  c a u s a l r e l a t i o n s h i p between them. of  events i n psychotherapy  Sequential occurrence  f o l l o w s the second  law of  thermodynamics which s t a t e s , among other t h i n g s , t h a t i s u n i d i r e c t i o n a l f o r a l l known u n i v e r s e and p r o c e s s e s are  time  that  irreversible.  The study i n v o l v e d e x p l a n a t i o n of c a u s a l l i n k s i n s e s s i o n s on the b a s i s of Langs' t h e o r i e s . study are not i n d i v i d u a l c l i e n t s , but  The s u b j e c t of  their  communications, c o n s c i o u s and unconscious, d u r i n g therapy sessions.  Evidence was  sought  i n the t r a n s c r i p t d a t a .  Where a v a i l a b l e , the unconscious v a l i d a t i o n of c l i e n t s d e f i n e d by Langs (1976) was  considered.  as  28 C o n f i d e n t i a l i t y o f t h e c l i e n t s i s m a i n t a i n e d by having deleted a l l p e r s o n a l l y i d e n t i f i a b l e  information  b e f o r e t r a n s c r i p t s o f s e s s i o n s were r e c o r d e d .  I t i s my  o p i n i o n t h a t such procedure does not l i m i t t h i s because t h e theory,  study  on which hypotheses a r e based, i s  concerned w i t h u n i v e r s a l r e a c t i o n s o f a l l humans, t h a t i s , c l i e n t s o f a l l ages and both genders which have been found by Langs' r e s e a r c h  not t o be a f f e c t e d by c u l t u r a l ,  socio-  economic, and other extraneous v a r i a b l e s . C o l l e c t i o n o f Data Data a r e : and  (a) verbatim t r a n s c r i p t s o f v e r b a l i z a t i o n s  behaviours o f t h e c l i e n t and t h e r a p i s t t h a t occur  during the session,  s e s s i o n , w r i t t e n from memory a f t e r each  w i t h i n t h r e e hours a f t e r t h e s e s s i o n s ,  the i n f o r m a t i o n  concerning  and (b)  any person o r a c t i o n r e l a t e d t o  the therapy t h a t occurs between s e s s i o n s o r t h a t e x i s t s before  t h e s t a r t i n g o f treatment, which determines t h e  s t a t e o f t h e frame.  E f f o r t was made t o i n c l u d e a l l v e r b a l  m a t e r i a l from a s e s s i o n . The  w r i t i n g o f such t r a n s c r i p t s from memory i n v o l v e s  p r a c t i c e and i t i s s u b j e c t o f f a i l u r e o f s u b j e c t i v e  recall  t o some degree, however, t h e 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. recorded  One s e s s i o n was a u d i o -  and t r a n s c r i b e d from memory; t h e r e s u l t i n g two  t r a n s c r i p t s were then compared and were found almost identical.  Omissions were found t o be minor: they were  d e t a i l s o f themes and images, p e r i p h e r a l t o t h e c o r e meanings communicated by t h e c l i e n t .  The second way  i n v o l v e d t h e i n v e s t i g a t i o n o f t h e l o g i c a l sequence o f t h e r e s p e c t i v e n a r r a t i v e s as i t i s done i n t h e p r o c e s s o f t r a n s c r i b i n g o f s e s s i o n s as w e l l as d u r i n g t h e a c t u a l data analysis;  i n both i n s t a n c e s , d i s c r e p a n c i e s i n responses  became obvious and r e c a l l o f d e t a i l s f o l l o w e d . Some f a i l u r e i n t o t a l r e c a l l o f s e s s i o n s i n v o l v e d i n t r a n s c r i p t i o n from memory i s no doubt l i m i t the a v a i l a b l e data.  i n e v i t a b l e and does  I t i s my o p i n i o n and e x p e r i e n c e  t h a t such f a i l u r e s a r e more l i k e l y t o be omissions o f d e t a i l s than d i s t o r t i o n s o f conveyed  meaning.  Thus,  p r e s e n t data may be c o n s i d e r e d incomplete r a t h e r than d i s t o r t e d and i n v a l i d . S e s s i o n s were not audio o r v i d e o r e c o r d e d (with t h e e x c e p t i o n o f s e s s i o n 14 o f t h e case number 4) t h e r a p e u t i c reasons.  Recording has been found  t o t h e t h e r a p e u t i c p r o c e s s (e.g., Langs, done on e t h i c a l grounds.  for disruptive  1982) and was n o t  Recording would a l s o d i s r u p t t h e  c l a r i t y o f t h e e f f e c t s o f o t h e r m o d i f i c a t i o n s i n t h e frame on t h e c l i e n t ' s unconscious communications  (confounding  v a r i a b l e s ) f o r r e s e a r c h purposes by adding y e t another trigger.  Good t r a n s c r i p t s from memory have been found a  r i c h source o f data f o r many c l i n i c a l r e s e a r c h e r s . t r a n s c r i p t s have r e p r e s e n t e d an adequate  Such  source o f data  f o r Robert Langs (Langs, 1976, 1976a, 1978, 1979, 1980,  1981)  who  was  a b l e t o use them t o the e x t e n t t h a t they  y i e l d e d p r e d i c t a b l e r e s u l t s which are the g o a l of every s c i e n t i f i c endeavour. Before a c t u a l a n a l y s i s of t r a n s c r i p t s , but a f t e r t e r m i n a t i o n of treatment was  o b t a i n e d by way  the study  the  of a l l c h i l d r e n , p a r e n t a l consent  of a l e t t e r e x p l a i n i n g the g o a l s of  (see Appendix I) and by r e q u e s t i n g the p a r e n t t o  s i g n a consent  form  (see Appendix I I ) .  31 CHAPTER  TWO  ANALYSIS OF DATA  Case One, The  Session  F i r s t S e s s i o n - Establishment  Background i n f o r m a t i o n on the The  One of the Ground  Rules  client.  c l i e n t i s a f i v e year o l d Caucasian  boy,  living  w i t h h i s d i v o r c e d mother and o l d e r s i s t e r .  H i s f a t h e r has  had  The  o n l y s p o r a d i c c o n t a c t with the c l i e n t .  client  has  been r e f e r r e d t o the mental h e a l t h c e n t r e one and a h a l f y e a r s ago by h i s mother f o r the f o l l o w i n g reasons: c l i e n t was  d i f f i c u l t t o c o n t r o l , he was  the  overdependent on  her, c o u l d not get along w i t h h i s s i s t e r ,  showed p a r a n o i d  a n x i e t y , masturbated i n day care, grabbed o t h e r c h i l d r e n by t h e i r g e n i t a l s and had H i s t e a c h e r s i n the  nightmares. daycare c e n t r e complained t h a t  they c o u l d no longer manage the c h i l d .  He came t o the  mental h e a l t h c e n t r e day programme f o u r times a week f o r t h r e e hours where he p l a y e d w i t h other f o u r and old  c h i l d r e n with a s i m i l a r degree of  difficulties.  five  emotional  He a l s o r e c e i v e s i n d i v i d u a l speech  therapy  by a r e g i s t e r e d speech t h e r a p i s t f o r u n c l e a r pronunciation. The  c l i e n t was  d r i v e n by t a x i from h i s day  c e n t r e t o the mental h e a l t h c e n t r e .  year  H i s mother  care was  c o n t a c t e d by h i s day programme t e a c h e r and o f f e r e d a once weekly i n d i v i d u a l psychotherapy w i t h the author of t h i s study.  H i s mother accepted  and the c l i e n t has been d r i v e n  t o the s e s s i o n s by t a x i and m i s s i n g h a l f an hour of h i s day programme once a week. the c l i e n t a t the entrance  The t h e r a p i s t agreed  t o meet  of the day programme, t o walk  him t o the c o n s u l t a t i o n room, t o have a 35 minute s e s s i o n s i n a c o n s u l t a t i o n room and t o walk him back t o the  day  programme room a f t e r the s e s s i o n . t h e author walked the c l i e n t back t o the day programme room. had p e r s o n a l c o n t a c t with h i s p a r e n t s or  The  author  never  sibling.  S t a t e of the Frame The session.  F i r s t Session.  T h i s i s the c l i e n t ' s  first  He has never seen h i s t h e r a p i s t b e f o r e .  t o l d by h i s day programme t e a c h e r t h a t he w i l l  was  "come t o  p l a y alone w i t h a woman t h e r a p i s t i n a play-room school".  He  before  The t h e r a p i s t meets the c l i e n t i n f r o n t of h i s  p r e s c h o o l and  i s witness  t o a d i a l o g u e between the  and h i s t e a c h e r about h i s moving i n t o a new  client  house.  The  t h e r a p i s t i n t r o d u c e s h e r s e l f and the c l i e n t f o l l o w s her t o the c o n s u l t a t i o n room.  The t h e r a p i s t had no c o n t a c t  with  the c l i e n t ' s f a m i l y and d i d not p a r t i c i p a t e i n the c o n v e r s a t i o n with h i s t e a c h e r s . t h e r a p i s t works a t the  The  f a c t t h a t the  c e n t r e where the c l i e n t goes t o  p r e - s c h o o l i s a break i n the frame, i t r e p r e s e n t s presence of t h i r d p a r t i e s t o  treatment.  the  33 Hypothesis According  t o 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 therefore organise  around the t r i g g e r s of the  r e l a t i o n s h i p , t h a t i s , the r e l a t i o n s h i p w i t h therapist.  The  will  current the  h y p o t h e s i s e d t r i g g e r s t o which the  client  w i l l be t r y i n g t o adapt i n the s e s s i o n w i l l be r e l a t e d t o the ground r u l e s of h i s therapy. According  t o Langs' theory,  the g o a l of the  first  s e s s i o n i s (a) t o e s t a b l i s h the nature of the  client's  emotional d i f f i c u l t i e s  (b)  (a s i l e n t e v a l u a t i o n ) ,  convey t o the c l i e n t t h a t the t h e r a p i s t can h e l p client  ( v e r b a l ) , (c) t o handle r e s i s t a n c e s  frame i s s u e s i n f l u e n c e the a b i l i t y  communicate),  (d) t o handle any  contract  , and  (e) t o e s t a b l i s h  (f) t o o b t a i n a sense of  the c l i e n t ' s communicative s t y l e (Langs, 1982). establishment  to  i n i t i a l breaks i n the  frame (to secure the frame),  the t h e r a p e u t i c  the  (to e x p l a i n t o  the c l i e n t how  therapeutic  to  of the t h e r a p e u t i c  The  contract, that i s ,  e x p l a i n i n g t o the c l i e n t the e x p l i c i t ground r u l e s of therapy, i s c l e a r l y the most important t a s k of therapist in their f i r s t  the  session.  U n t i l the t h e r a p i s t s p e c i f i e s the ground r u l e s of therapy  (the frame), the c l i e n t w i l l  experience  u n c e r t a i n t y about h i s r e l a t i o n s h i p w i t h the t h e r a p i s t his  the  material w i l l r e f l e c t t h i s uncertainty  and  (Langs, 1985b)  i n the f o l l o w i n g way:  (a) the emergence of  h u r t f u l images, p o s s i b l y accompanied w i t h or d i s g u i s e d r e p r e s e n t a t i o n  negative (b) a m a n i f e s t  of the b e g i n n i n g 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)  predicts that  any  communicative r e s i s t a n c e . Conversely, Langs  1  theory  r e c t i f i c a t i o n of the u n c e r t a i n t y ,  that i s a securing  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  of  material  d i r e c t l y f o l l o w i n g 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 t h e r a p i s t ' s i n t e r v e n t i o n : (a) i n t e r p e r s o n a l 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  c o n s t r u c t i v e 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 w e l l f u n c t i o n i n g t h e r a p i s t ) , and  (b)  c o g n i t i v e v a l i d a t i o n i n the form of the emergence of  new,  u n a n t i c i p a t e d meaning i n symbolic, t h e r e f o r e form  unconscious,  (Langs, 1985). The  establishment,  or l a c k of, the ground r u l e s of  therapy i s a t r i g g e r t h a t w i l l take precedence over background t r i g g e r of t h i r d p a r t y c o n t a c t t h i s contact  the  especially since  i s by i m p l i c a t i o n r a t h e r than d i r e c t .  It is  t h e r e f o r e p r e d i c t e d t h a t the c l i e n t w i l l r e a c t mainly t o the on-going development of the frame.  The  therapist  f a i l u r e t o e x p l i c i t l y s t a t e the ground r u l e s of therapy a t the b e g i n n i n g of the s e s s i o n i s p r e d i c t e d t o r e s u l t i n behavioral  and  establishment  communicative r e s i s t a n c e w h i l e her of the frame w i l l r e s u l t i n r e d u c i n g  explicit such  35 resistance. Walking w i t h the c l i e n t o u t s i d e the c o n s u l t a t i o n room i s a d e v i a t i o n of the p r i v a c y of treatment as t h e r a p i s t has  the  c o n t a c t w i t h he c l i e n t o u t s i d e of  c o n s u l t a t i o n room.  I t i s predicted that t h i s  the  first  c o n t a c t w i l l not be experienced as o v e r l y n e g a t i v e the c l i e n t d i d not know the way and  because h i s teacher  to h i s  because  t o the c o n s u l t a t i o n room  i s not r e g u l a r l y t h e r e t o t a k e  him  session.  Data Upon e n t e r i n g , the c l i e n t goes t o the f i r s t t h i n g i n f r o n t of him  and,  without l o o k i n g around, s t a r t s t a k i n g  out m i l i t a r y v e h i c l e s and each other.  s o l d i e r s and p l a c i n g them f a c i n g  S o l d i e r s and tanks shoot a t one  Then he t a k e s out a t r u c k and them and moves them back and p l a y i n g , he does no  a t r a i n , p i l e s small cars f o r t h s e v e r a l times.  Your p l a y has meaning.  i f you would t e l l me  t e l l me  "I see you  and  are  about your p l a y - i f you  continues  playing  I t would be h e l p f u l t o  what i s going on i n your p l a y . "  answers, " I t , s war"  While  F i f t e e n minutes i n t o the  s e s s i o n , the t h e r a p i s t i n t e r v e n e s ,  you  on  look a t the t h e r a p i s t .  F i r s t Intervention.  something.  another.  The  would  client  t o p l a y i n the same  vein. Second I n t e r v e n t i o n .  Twenty minutes i n t o the  s e s s i o n , the t h e r a p i s t i n t e r v e n e s  by s a y i n g ,  "Today,  36 downstairs, you t o l d your t e a c h e r t h a t a b i g t r u c k was t a k i n g and moving your s t u f f t o your new house.  In your  p l a y , you a l s o have a b i g t r u c k and a t r a i n moving many c a r s from p l a c e t o p l a c e .  Perhaps s e e i n g me f o r t h e f i r s t  time and your coming here i n s t e a d o f t o your p r e s c h o o l downstairs was l i k e a b i g move f o r you. t h e r e i s war, t h e r e i s danger.  I n your p l a y ,  Perhaps you a l s o f e e l  like  b e i n g i n a war, perhaps you f e e l i t i s dangerous f o r you i n here." the the  The c l i e n t takes t h e space s h u t t l e ,  war area, then f l i e s i t out.  lands i t i n  Then he asks, "Can I use  sandbox?" Third Intervention.  The t h e r a p i s t answers,  can p l a y w i t h any t o y s i n t h i s room." takes out a c i r c u l a r soldiers  in it.  your p l a y ? " place."  The c l i e n t then  fence, l o c k s i t s gate and puts up  The t h e r a p i s t asks, "What i s happening i n  and t h e c l i e n t answers,  " T h i s i s no-war  Soon, he takes them out o f t h e sand t r a y a g a i n  and s t a r t s  t o bury a l l c a r s and s o l d i e r s  t h e r a p i s t asks, "What i s happening?" "Everyone i s h i d i n g . hiding.  "Yes, you  i n t h e sand.  The c l i e n t  The  answers,  The bad guys and t h e good guys a r e  11  Fourth I n t e r v e n t i o n .  The t h e r a p i s t  intervenes,  s a y i n g , "Today, downstairs, you asked your t e a c h e r how d i d she know about your moving, you were wondering who t o l d her.  A l s o , you d i d n ' t know, what w i l l be happening t o you  here, w i t h me, people i n t h e p r e s c h o o l d i d 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 t o h i d e , you f e e l l i k e i n a war.  You don't know me,  know i f I am a bad person or a good person."  you  The  don't  client  suddenly f i n d s a s m a l l p i e c e of straw, puts i t i n the sand over the b u r i e d c a r s and s o l d i e r s and says, " T h i s i s f o r b r e a t h i n g , so they can breathe." all  c a r s out of the sand.  The c l i e n t then t a k e s  For the f i r s t time, he l o o k s  the t h e r a p i s t 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 t h e r a p i s t answers, "You  be here f o r a l i t t l e more than h a l f an hour. take you back t o your p r e s c h o o l .  Then, I w i l l  You w i l l come here once  a week, every Wednesday, f o r a l i t t l e more than h a l f hour."  will  an  The c l i e n t s t a r t s l o o k i n g f o r o t h e r t o y s : t a k e s  out two winding t o y s and winds them, watches them as they t u r n , then puts them back.  F i v e minutes b e f o r e end of the  s e s s i o n , he goes t o the window, says, "Puppets!"  and  picks  up a spiderman  and a lady bug. He makes an e a t i n g sound  and says, "The  lady bug i s e a t i n g h i s head" and puts them  back. The t h e r a p i s t t e l l s the c l i e n t t h a t the time i s up, "It  i s time t o go back t o your p r e s c h o o l " .  The  client  l o o k s a t the t h e r a p i s t w i t h wide eyes, goes t o the sandbox, s t a r t s c l e a n i n g up the c a r s and s o l d i e r s .  The  t h e r a p i s t says, "Our time i s up, you don't have t o c l e a n up."  The c l i e n t goes t o the door, opens i t , h e s i t a t e s f o r  38 a moment then t u r n s t h e r i g h t way and l e a d s t h e way.  The  t h e r a p i s t walks w i t h him l e t t i n g him open a l l t h e doors. When he reaches t h e p r e s c h o o l  door he e n t e r s .  Data A n a l y s i s The most important t r i g g e r f o r t h i s f i r s t the beginning  o f therapy, t h a t i s , t h e f i r s t  This t r i g g e r i s represented  session i s  session.  i n remote d e r i v a t i v e form:  moving o f t r u c k and t r a i n i s an image o f going p l a c e s . The same image i s a l s o a c l o s e d e r i v a t i v e r e p r e s e n t a t i o n o f the f a c t t h a t t h e t h e r a p i s t brought t h e c l i e n t t o t h e c o n s u l t a t i o n room v i a long and winding c o r r i d o r s as represented  i n t h e p l a y by moving v e h i c l e s back and f o r t h .  Resistance  was i n evidence s i n c e t h e c l i e n t s a i d but  two  words b e f o r e t h e t h e r a p i s t ' s f i r s t  did  n o t look around t h e room o r e x p l o r e  a f t e r the f i f t h  intervention.  i n t e r v e n t i o n and he i t s contents  until  This intervention defines  the time, p l a c e and frequency o f s e s s i o n s and t h e r e f o r e represents  a s e c u r i n g o f t h e frame.  The meaning o f t h e t h e r a p i s t ' s f a i l u r e t o e s t a b l i s h the frame a t t h e beginning symbolically  o f t h e s e s s i o n i s expressed  (unconsciously)  by t h e c l i e n t i n t h e n e g a t i v e  theme o f h i s p l a y , t h a t i s i n t h e war ( I t ' s war.) and i n the c o n f u s i o n play).  and v i o l e n c e  (observable  i n t h e manner o f  The u n i v e r s a l meaning o f war i s r e p r e s e n t e d  themes o f s t r u g g l e , danger, v i o l e n c e , and c o n f u s i o n . theme i s shared by t h e i m p l i c a t i o n o f t h e dangers o f  by t h e This  therapy f o r t h e c l i e n t i n t h e absence o f r u l e s o f conduct f o r t h e t h e r a p i s t and t h e c l i e n t . unconscious p e r c e p t i o n and  o f t h e c u r r e n t s t a t e o f h i s therapy  of h i s t h e r a p i s t actions  i s therefore a v a l i d The along  The c l i e n t ' s  ( f a i l u r e t o d e f i n e t h e frame)  perception.  t r i g g e r of the t h e r a p i s t walking with the c l i e n t  s e v e r a l c o r r i d o r s t o t h e c o n s u l t a t i o n room was  represented  i n d i s g u i s e i n t h e image o f t h e moving o f t h e  t r u c k and t h e t r a i n which i s a c l o s e r e p r e s e n t a t i o n o f this trigger.  The same image a l s o r e p r e s e n t e d t h e  b e g i n n i n g o f therapy, t h a t i s , moving t o a new p l a c e , which i s a remote r e p r e s e n t a t i o n  of t h i s t r i g g e r .  There  was no model o f r e c t i f i c a t i o n i n t h e c l i e n t ' s m a t e r i a l . Other t r i g g e r s are, as always, i n t e r v e n t i o n s o f t h e t h e r a p i s t o f which t h e most important a r e those t h a t concern frame i s s u e s , whether frame d e v i a t i o n s o r frame securing  (Langs•,1976) .  In t h i s s e s s i o n , t h e r e a r e two  triggers  (interventions) that represent  s e c u r i n g two  a s p e c t s o f t h e frame. The  second i n t e r v e n t i o n .  I t defines the objects i n  the c o n s u l t a t i o n room t h a t t h e c l i e n t can touch  (i.e., a l l  toys) thus d e f i n i n g some boundaries o f treatment.  This  frame securing; i n t e r v e n t i o n i s immediately f o l l o w e d c l i e n t ' s p o s i t i v e theme o f d e f i n i t e boundaries by t h e s o l d i e r s being  represented  s a f e behind a fence (no-war  d e l i n e a t i n g t h e space where danger and c o n f u s i o n  by t h e  place) a r e kept  out.  The  theme of the good and  mainly a n e g a t i v e image and  the bad  b e i n g hidden i s  r e p r e s e n t s w e l l the  experience  by the c l i e n t of h i s not knowing what the t h e r a p i s t i s hiding,  of h i s u n c e r t a i n t y  regarding  the r e l a t i o n s h i p w i t h  the t h e r a p i s t because the ground r u l e s have not y e t e s t a b l i s h e d w h i l e one  of the r u l e s  ( p r i v a c y ) , had  been  already  been m o d i f i e d . Third intervention  The  emergence of the  brief  p o s i t i v e image (good guys) i s a r e a c t i o n of the c l i e n t the t h e r a p i s t ' s t h i r d i n t e r v e n t i o n which s t a t e s one  to  ground  rule. Fourth i n t e r v e n t i o n . explains  the c l i e n t ' s f e a r of u n c e r t a i n t y  therapy, does the  therapist regarding  s t r o n g p o s i t i v e image of the  enables the b u r i e d  i s now  session, therapy.  The  f e e l i n g f r e e and  a d i r e c t q u e s t i o n about the d u r a t i o n  of  his  straw t h a t  s o l d i e r s t o breathe emerge.  i s communicating t h a t he t o ask  Only a f t e r the  client  i s able  his  which r e p r e s e n t s a ground r u l e i s s u e f o r h i s I t a l s o shows t h a t the c l i e n t indeed had  i s s u e of the ground r u l e s of therapy on h i s mind, than i s s u e s r e l a t e d t o h i s l i f e o u t s i d e F i f t h intervention. time, d u r a t i o n ,  and  rather  therapy.  A f t e r the t h e r a p i s t  defines  and  winding t o y s turn) which r e p r e s e n t s a weak  interpersonal  the  l o c a t i o n of h i s therapy t h e r e i s the  f l e e t i n g image of t o y s t h a t work (the c l i e n t winds watches two  the  v a l i d a t i o n by the c l i e n t of the  therapist  intervention.  T h i s 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 c l i e n t v o l u n t e e r i n g t o h e l p and According  t o Langs' theory,  of  the  c l e a n up a f t e r h i s p l a y .  the t h e r a p i s t should  not  command the c l i e n t t o come t o s e s s i o n , which i s what the t h e r a p i s t had  done by s a y i n g ,  "you  w i l l come". The  of the b i t i n g of the head r e p r e s e n t s  image  the t h e r a p i s t who  harmed the c l i e n t by i m p l y i n g the use  of f o r c e .  Also,  purpose and manner of h i s therapy, t h a t i s h e l p i n g  has the  the  c l i e n t w i t h 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 p l a y , was  not e x p l a i n e d p r o p e r l y , as i t should have been done a t  the v e r y beginning The his  of the f i r s t  session.  c l i e n t ' s behavioral resistance i s r e f l e c t e d i n  relative silence.  His communicative r e s i s t a n c e i s  moderately s t r o n g as he does r e p r e s e n t  the major t r i g g e r  and does communicate the unconscious meaning i n powerful images.  The  communicative r e s i s t a n c e a l s o shows i n h i s  s i l e n t p l a y as he o b v i o u s l y has  a s t o r y t o t e l l but does  not communicate i t t o the t h e r a p i s t . Discussion The most important aspect  of the L a n g s i a n p r e d i c t i o n  r e g a r d i n g the h u r t f u l e f f e c t on the c l i e n t by u n c e r t a i n t y about the establishment therapy i n the f i r s t was  represented  s e s s i o n was  the  of the ground r u l e s of  c o r r e c t as the t r i g g e r  i n d e r i v a t i v e form and powerful  negative  images d i d emerge i n t h e c l i e n t ' s m a t e r i a l , e s p e c i a l l y early i n the session.  Decoding t h e c l i e n t ' s m a t e r i a l i n  l i g h t o f t h e two immediate t r i g g e r s as w e l l as c l i e n t ' s conscious questions unconsciously the  show t h a t t h e c l i e n t was working over,  and c o n s c i o u s l y ,  these major t r i g g e r s f o r  session. The  v e r b a l m a t e r i a l from t h e c l i e n t was s c a r c e which  i s a s i g n o f communicative r e s i s t a n c e i n t h e presence o f insecure  frame as p r e d i c t e d by t h e theory.  were r e p r e s e n t e d instances  Frame t r i g g e r s  i n d e r i v a t i v e form and t h e r e were two  o f i n t e r p e r s o n a l unconscious v a l i d a t i o n by t h e  c l i e n t of t h e r a p i s t ' s interventions. Case One, S e s s i o n Two Change o f Rooms and T h e r a p i s t ' s  Contact  w i t h t h e C l i e n t o u t s i d e o f t h e C o n s u l t a t i o n Room The  S t a t e o f The Frame Change o f rooms.  Before t h i s second s e s s i o n , t h e  t h e r a p i s t was informed t h a t t h e c o n s u l t a t i o n room t h a t she had  used f o r t h e f i r s t s e s s i o n w i t h t h e c l i e n t w i l l no  longer be a v a i l a b l e t o h e r .  T h i s second s e s s i o n w i l l  take  p l a c e i n another room c o n t a i n i n g almost i d e n t i c a l t o y s , an observation  mirror,  and a microphone on t h e w a l l .  change o f rooms r e p r e s e n t s ,  according  The  t o Langs' theory,  m o d i f i c a t i o n i n t h e ground r u l e r e g a r d i n g  a  the s e t l o c a t i o n  for a l l sessions. Contact o u t s i d e c o n s u l t a t i o n room.  The t h e r a p i s t was  asked by the c l i e n t ' s  t e a c h e r s i n day  programme t o  the c l i e n t t o the swimming p o o l a f t e r the  bring  session.  Contact w i t h the t e a c h e r s and w i t h the c l i e n t o u t s i d e c o n s u l t a t i o n room a l s o r e p r e s e n t s ground r u l e t h a t l i m i t s c o n t a c t  a d e v i a t i o n i n the  between t h e r a p i s t  c l i e n t t o the c o n s u l t a t i o n room alone. t h e r a p i s t explained  Also,  and  the  t o the c l i e n t the change i n  c o n s u l t a t i o n rooms on the way another c o n t a c t  the  t o the s e s s i o n which i s  o u t s i d e the p r i v a c y of the room.  Hypotheses A c c o r d i n g t o Langs' t h e o r y the two ground r u l e s w i l l r e p r e s e n t f o r the c l i e n t ' s  two  deviations  i n the  most important t r i g g e r s  unconscious r e a c t i o n s .  The  client  will  be working over the unconscious i m p l i c a t i o n s of these t r i g g e r s and  w i l l represent  them  either manifestly  e l s e i n a d i s g u i s e d manner i n h i s m a t e r i a l . the frame are c o n s i d e r e d  n e g a t i v e and  hurtful.  or  Deviations  t r a u m a t i c f o r the c l i e n t and  emerging images f o l l o w i n g the two The  model of r e c t i f i c a t i o n may  two  triggers w i l l  in the  be  theory also p r e d i c t s that a emerge i n the  material.  Communicative r e s i s t a n c e i s expected. Data The  c l i e n t a r r i v e s by t a x i , the t h e r a p i s t g r e e t s  and walks w i t h him the next f l o o r . f i r s t s e s s i o n was  him  t o the c o n s u l t a t i o n room which i s on  Passing  by the door of the room where the  h e l d , the t h e r a p i s t e x p l a i n s  t h a t they  can no  longer use t h i s room because someone e l s e w i l l  using i t .  The  be  t h e r a p i s t then takes the c l i e n t t o another  c o n s u l t a t i o n room.  I n s i d e the room, the c l i e n t does not  look around, goes s t r a i g h t t o the sand t r a y and several buildings into i t . t u n n e l s and a t r u c k .  He then adds two  puts  bridges,  He runs the t r u c k up a ramp on  two  the  top of a b u i l d i n g . F i r s t intervention. l i k e t o e x p l a i n what we i s c a l l e d therapy.  The  t h e r a p i s t says,  are doing here.  We  "I would  are doing what  Therapy h e l p s you w i t h your problems.  Your t e a c h e r t o l d me  t h a t you have bad dreams sometimes,  t h a t you are sometimes a f r a i d of t h i n g s , t h a t you f e e l w e l l sometimes. would t e l l me w i l l work."  I t would be h e l p f u l t o you  don't i f you  s t o r i e s about your p l a y and t h i s i s how While the t h e r a p i s t i s t a l k i n g , the  stops p l a y i n g and he l i s t e n s i n t e n t l y .  we  client  He then takes  out  more c a r s and b u i l d i n g s . The me  t h e r a p i s t says,  "You  a s t o r y about your p l a y . "  are p l a y i n g . The  Can  you  c l i e n t answers  immediately, " T h i s house i s on top of another house t h i s t r u c k i s backing moving i n t o a new  up t o d e l i v e r f u r n i t u r e .  house. The  c l i e n t p l a y s some more, the "this  i t f e l l and t h i s c a r i s going  i n t o the garage because i t i s going t o r a i n o u t s i d e t h i s t r u c k i s j u s t going  and  They are  t h e r a p i s t asks about the s t o r y and the c l i e n t says, c a r broke the b r i d g e and  tell  i n t o the  tunnel.  and  45 Second  intervention.  At t h i s point the t h e r a p i s t  i n t e r v e n e s , s a y i n g , " You a r e t e l l i n g me about people moving t o a new p l a c e , about t h i n g s b e i n g broken and f a l l i n g and about c a r s going i n t o s h e l t e r b e f o r e r a i n . Today, we moved i n t o another room because t h e o t h e r one was busy.  Perhaps you f e e l l i k e something  i n your t h e r a p y  was broken because o f 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 t o w h i s t l e as he  p l a y s w i t h more c a r s . put back s t r a i g h t . happening  B u i l d i n g s a r e t u r n e d over and then  The t h e r a p i s t asks about what i s  i n h i s p l a y , and the c l i e n t says, "Everybody i s  moving, they have t o b u i l d new houses Third intervention.  f o r everybody."  The t h e r a p i s t says, "You a r e  t e l l i n g me about moving and about new p l a c e s which must be built.  We a r e i n a new playroom today, we a r e s t a r t i n g  something new i n t h i s new room. w i l l not have t o move a g a i n .  We w i l l s t a y here - we  We w i l l come here every  Wednesday and you w i l l have therapy w i t h me f o r 35 minutes each time and then I w i l l take you t o t h e swimming p o o l so you can swim w i t h your c l a s s . " The c l i e n t t a k e s away a few c a r s and s t a r t s p u t t i n g busses i n t o t h e sand t r a y .  The t h e r a p i s t asks what i s  happening and t h e c l i e n t says, "The bus i s coming i n t o t h e people's p l a c e .  T h i s i s a people's p l a c e now,  another p l a c e . "  He then takes away t h e b u i l d i n g s and  p l a y s w i t h a boat and a c a r .  i t is  The t h e r a p i s t asks what i s  happening, and the c l i e n t says, " T h i s guy," p o i n t i n g t o the boat, " i s l o o k i n g f o r him, i s g o i n g a f t e r p o i n t i n g t o the c a r . crashes i t ,  him",  Then he f l i e s a h e l i c o p t e r and  then he c r a s h e s 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 t o pour sand over t h e  scene and says t h a t "Rain i s f a l l i n g . "  Moving t h e 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 t h a t they cannot go because they have f l a t t i r e s , they are not allowed t o go." Fourth i n t e r v e n t i o n .  The t h e r a p i s t  intervenes,  s a y i n g , "I t o l d you t h a t you and I w i l l be s t a y i n g i n t h i s room and you f e l t t h a t we were i n another p l a c e , t h e people's p l a c e , and you were t e l l i n g me about c a r s c r a s h i n g and r a i n f a l l i n g ,  about buses who  allowed t o go because they had f l a t t i r e s .  were not Perhaps you  f e e l I am not allowed t o do something because I am h e l p l e s s , l i k e a bus w i t h f l a t t i r e s . " more sand over the scene and asks, "How here?"  The c l i e n t pours long w i l l I stay  The t h e r a p i s t r e p l i e s t h a t he w i l l s t a y  more minutes, then he w i l l go swimming.  fifteen  The c l i e n t  starts  t o o v e r t u r n b u i l d i n g s and t o c r a s h c a r s i n a slow and c o n t r o l l e d way.  He says, "Rain i s f l o o d i n g everybody and  c a r s are c r a s h i n g and the war boss i s t e l l i n g them t o s t o p fighting."  He s l o w l y d e s t r o y s the town ad asks, "How  u n t i l I go swimming?"  long  The t h e r a p i s t r e p l i e s t h a t i t seven  more minutes.  The  c l i e n t drops sand over the town  saying,  " T h i s i s cement, the g i a n t 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. t o l d you  The  t h e r a p i s t intervenes,  about s t a y i n g here f o r 35 minutes and  swimming and w i t h me."  c l i e n t asks, "How  long now?"  responds by s a y i n g t h a t she w i l l t e l l him up. The  The  The  angry  therapist  when the time i s  c l i e n t then p l a y s w i t h the sand u n t i l the  end.  t h e r a p i s t t e l l s the c l i e n t t h a t the time i s up.  looks a t h i s sandy hands and The  them g o i n g  t h e r e i s something t h a t made you v e r y  The  "I  asks, "Can  I wash my  t h e r a p i s t r e p l i e s t h a t she w i l l show him  outside.  The  c l i e n t looked  shocked and  "Outside?"  The  sink f i r s t ,  then t o the swimming p o o l .  said  the  He  hands?" sink  slowly,  t h e r a p i s t then takes the c l i e n t t o  the  Data A n a l y s i s The  f i r s t t r i g g e r , the moving i n t o another  c o n s u l t a t i o n room which e x i s t s before i s represented  by a t h i n l y d i s g u i s e d image of "they  moving i n t o a new contact  the s e s s i o n begins,  house".  The  are  second t r i g g e r , t h e r a p i s t ' s  o u t s i d e the c o n s u l t a t i o n room, occurs d u r i n g  the  s e s s i o n when the t h e r a p i s t mentions t a k i n g the c l i e n t  to  his  this  swimming c l a s s .  t r i g g e r and  represents  image of the bus The  The  c l i e n t r e a c t s immediately t o  i t by the more h e a v i l y  going i n t o anther, p e o p l e ' s ,  representation  disguised place.  of the f i r s t t r i g g e r i s f o l l o w e d  48 by the n e g a t i v e image of b r e a k i n g f a l l i n g as w e l l as by the b r i e f  p o s i t i v e of s e e k i n g s h e l t e r i n a garage and i n  a t u n n e l mixed w i t h n e g a t i v e images of t h r e a t outside).  The  images of b r e a k i n g and f a l l i n g  (rain is a validly  p e r c e i v e d meaning of the therapy f o r the c l i e n t , which has been broken i n c o n t i n u i t y and experienced as a  fall  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 s e e k i n g s h e l t e r from o u t s i d e t h r e a t which i m p l i e s the c l i e n t ' s wish t h a t t h i s new shelter.  A f t e r the second  room p r o v i d e s him  i n t e r v e n t i o n , which  with  was  b a s i c a l l y c o r r e c t , the c l i e n t r e a c t e d w i t h the p o s i t i v e images of people c o n s t r u c t i n g something new w i t h evidence of p o s i t i v e a f f e c t  as w e l l as  ( w h i s t l i n g ) which i s i n  agreement w i t h Langs• t h e o r y . Third intervention.  t h i s intervention i s informative  and i s c o n s i d e r e d c o r r e c t except f o r the l a s t p a r t where the t h e r a p i s t t e l l s the c l i e n t t h a t she w i l l take him the swimming p o o l a f t e r the s e s s i o n .  to  I t represents,  a c c o r d i n g t o Langs' theory, an a n t i c i p a t i o n of a break i n the frame, t h a t i s of c o n t a c t w i t h t h i r d p a r t i e s ( h i s c l a s s a t swimming).  The t h e r a p i s t not o n l y announces t h a t  she w i l l have o u t s i d e c o n t a c t w i t h the c l i e n t and  likely  a l s o w i t h h i s t e a c h e r s and classmates, t h i s t o p i c i s i n t r o d u c e d u n i l a t e r a l l y be the t h e r a p i s t .  According to  Langs' t h e o r y such u n i l a t e r a l i n t r o d u c t i o n of a s u b j e c t by  a t h e r a p i s t r e f l e c t the t h e r a p i s t ' s f e a r of a secure frame (adherence t o the swimming has  i d e a l frame).  The  mention of g o i n g  the f u n c t i o n t o break the c o n t a c t w i t h  the  immediate d i s c u s s i o n , as i n i t i a t e d by the c l i e n t , t o outside was  of the room.  T h i s l a s t p a r t of the  intervention  t h e r e f o r e expected t o t r i g g e r i n the c l i e n t  images of f o r c e and The  negative  violence.  evidence f o r a d i s g u i s e d r e p r e s e n t a t i o n  t r i g g e r of the t h e r a p i s t i n t r u s i o n i n t o the p r i v a t e world  (his preschool  image of a bus  of  client's  c l a s s a t swimming) i s i n the  c l i e n t ' s unconsciously perceives and  the  " f o l l o w i n g him"  n e g a t i v e images of f i g h t i n g and  therapist  The  as  which ends i n the  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 p r e s e n t i n the i n the form of someone i n a u t h o r i t y  material  ( t r a f f i c helicopter)  i s t e l l i n g " someone of not being "allowed t o go" because t h e r e  the  coming i n t o another, people's p l a c e .  " l o o k i n g f o r him"  the  somewhere  i s something wrong w i t h 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 t h a t  t h e r a p i s t should not be allowed t o go w i t h him  the  to  the  swimming p o o l because i t i s wrong. Fourth i n t e r v e n t i o n . because i t does not swimming p o o l ) .  t h i s intervention i s incorrect  i d e n t i f y the t r i g g e r (going t o  As the t h e r a p i s t does not  follow  c l i e n t ' s model t o r e c t i f y the a n t i c i p a t e d a c t the expects t h a t the t h e r a p i s t w i l l go through w i t h  "  the the client  her  promise and he f e e l s t h a t the t h e r a p i s t i s dangerous. The  m a t e r i a l t h a t f o l l o w s the f o u r t h i n t e r v e n t i o n does  indeed show t h a t the c l i e n t immediately r e a c t s w i t h anxiety regarding  h i s s t a y i n therapy.  He  asks a  question  about the l e n g t h of h i s s t a y which i s r e l a t e d t o  the  t h e r a p i s t t a k i n g him  still  does not r e c o g n i s e client's  question  swimming.  As the t h e r a p i s t  the unconscious meaning of and  n o n - i n t e r p r e t a t i v e way  this  answers i t on a m a n i f e s t l e v e l t h a t does not e x p l a i n the  anxiety)  the c l i e n t responds w i t h n e g a t i v e  violence  (war), d e s t r u c t i o n  (crashes)  and  (in a  client's  themes of l o s s of c o n t r o l  (flood). The  c l i e n t then communicates a model of  w i t h the image of the fighting". trigger  The  "war  boos who  rectification  t e l l s people t o  n a r r a t i v e i s followed  by  a manifest  i n the q u e s t i o n which mentioned swimming  According  t o Langs' theory,  stop  directly.  the c l i e n t does indeed keep on  trying  t o a l e r t the t h e r a p i s t t o the impending d e v i a t i o n  i n the  frame.  Evidence t h a t the c l i e n t i s communicating derivatively  and  i s not concerned w i t h 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 a l s o bee i n the f a c t t h a t the response by the t h e r a p i s t t o question's  m a n i f e s t meaning (how  the c l i e n t , he asks again and c o n t a i n s more negative  themes  long) does not  seen  the  satisfy  again w h i l e h i s n a r r a t i v e of d e s t r u c t i o n f o l l o w e d  by  51 the death of everyone. c l i e n t was  In f a c t , a f t e r the s e s s i o n ,  i n no h u r r y t o get t o the  dragged h i s f e e t going  swimming p o o l and  The  t h e r a p i s t ' s response i s i n  same v e i n as the p r e v i o u s i n t e r v e n t i o n and  ends without any  he  there.  F i f t h intervention. the  the  i n s i g h t i n t o the  e i t h e r the c l i e n t or the  the  session  immediate t r i g g e r  by  therapist.  Discussion The i f the  hypotheses r e g a r d i n g  the e f f e c t of the  deviations  frame on the c l i e n t ' s subsequent m a t e r i a l  c o r r e c t i n the t h r e e important areas:  (a) the emergence of  n e g a t i v e images, (b) the presence of d e r i v a t i v e manifest representation  of the t r i g g e r s , and  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 .  were  and  (c)  There are no  images i n evidence i n the c l i e n t ' s m a t e r i a l  positive  after  the  t h i r d i n t e r v e n t i o n which i s c o n s i d e r e d a b a s i c a l l y c o r r e c t explanation  by Langs' t h e o r y and  which i s b r i e f l y  by a p o s i t i v e image of b u i l d i n g something When p l e a s f o r r e c t i f i c a t i o n of the  followed  new.  frame by the c l i e n t  unanswered by the t h e r a p i s t the c l i e n t e i t h e r s t o p s communicating or e l s e p e r s i s t s w i t h h i s message.  Also,  a c c o r d i n g t o Langs' theory, a c o r r e c t i n t e r p r e t a t i o n the t h e r a p i s t  (second i n t e r v e n t i o n )  p o s i t i v e images and predictions  positive affect.  was  followed  Overall,  by  by the  the  formed on the b a s i s of Langs' t h e o r y were  found c o r r e c t f o r t h i s  session.  go  Case One - S e s s i o n Three C l i e n t ' s Lateness, Contact w i t h T h i r d and  Parties,  Extension of the Session  S t a t e o f t h e Frame C l i e n t ' s lateness.  The c l i e n t i s brought t e n minutes  l a t e by t h e t a x i d r i v e r .  The t h e r a p i s t t a k e s t h e c l i e n t  s t r a i g h t t o the consultation  room.  Contact w i t h t h i r d p a r t i e s .  On t h e way they pass  s e v e r a l groups o f people, a d u l t o u t - p a t i e n t s loudly  who t a l k  i n t h e c o r r i d o r and t h e c l i e n t and t h e r a p i s t  t r i p over t h e i r f e e t s e v e r a l times.  This  almost  i s the c l i e n t ' s  second time going t o t h e same c o n s u l t a t i o n  room and he  remembers a l l t h e t u r n s o f t h e c o r r i d o r s .  In f r o n t o f t h e  consultation  room, the t h e r a p i s t reads t o him  the door and e x p l a i n s , the  t h e s i g n on  "Occupied means we w i l l be u s i n g  room." Extension of the session.  session  The t h e r a p i s t extends t h e  t e n minutes p a s t t h e appointed time on t h e grounds  t h a t t h e c l i e n t was not r e s p o n s i b l e  f o r h i s lateness  t o h i s young age ( f i v e ) and because he had no c o n t r o l  due over  the t a x i d r i v e r . Hypotheses A c c o r d i n g t o Langs' theory, the t h r e e breaks i n t h e frame w i l l a f f e c t t h e c l i e n t i n a n e g a t i v e way. predicted  It is  t h a t he w i l l r e p r e s e n t a l l t r i g g e r s i n e i t h e r  d e r i v a t i v e o r m a n i f e s t form and t h a t he w i l l communicate  53 symbolically  the meaning these t r i g g e r s have f o r him.  It  i s a l s o p r e d i c t e d t h a t the c l i e n t w i l l show r e s i s t a n c e because of the frame breaks and  t h a t he might p r e s e n t 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 f o r the breaks i n the frame of h i s therapy. S i n c e two session,  breaks i n the frame o c c u r r e d  before  the  i t i s p r e d i c t e d t h a t the c l i e n t w i l l s t a r t  the  s e s s i o n w i t h h i s unconscious communication r e l a t e d t o t h e s e two  t r i g g e r s and  w i l l work over the  the t h i r d t r i g g e r (extension i t s occurrence.  implications  of the s e s s i o n )  subsequent t o  A c c o r d i n g t o the b a s i c p r e c e p t of Langs  t h e o r y , the themes and  images of the  i m p l i c a t i o n s of  t r i g g e r s w i l l match the u n i v e r s a l themes and such  of  1  the  images of  actions.  Data The  c l i e n t goes s t r a i g h t t o the sand box  take o f f h i s j a c k e t .  He  looks calm and  and  uses slow  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 session.  He  goes t o the sand t r a y and  t h r e e buses, a b r i d g e ,  t o t e l l her  The  the t h e r a p i s t and  The  client  answers immediately, "The  bus  stop  (the b u i l d i n g ) .  because i t takes so l o n g . "  The The  man  on  client  looks  at  buses are  making t r a c k s , so they can go through t h i s bus i s a bus  last  a helicopter  t h e r a p i s t asks the  a s t o r y about h i s p l a y .  and  puts i n a b u i l d i n g ,  a "pet s t o r e " , and  the r o o f of the pet s t o r e .  does not  stop.  i s waiting  for  This the  c l i e n t p l a y s by moving  54 the buses s l o w l y . happening  The t h e r a p i s t asks about what i s  i n t h e p l a y now.  immediately,  The c l i e n t answers  " T h i s i s a passage way f o r buses and t h i s i s  another passageway f o r c a r s . "  He i s making a sand w a l l  d i v i d i n g t h e two paths, and running t h e bus and t h e c a r p a r a l l e l t o each o t h e r .  He then d r i v e s one bus over t h e  b r i d g e and s t a r t s p u t t i n g s o l d i e r s , aiming p i s t o l s a t one another i n t h e sandbox, next t o t h e bus s t a t i o n . b u l l d o z e r d i g s a "hole i n t h e ground". what i s happening immediately,  i n the story.  "They a r e f i g h t i n g .  Then, a  The t h e r a p i s t  asks  The c l i e n t answers He has p u t t h e 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  c o n t i n u e s , "Sometimes they come t o t h i s p a r t o f 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  s e s s i o n , t h e t h e r a p i s t says, "Today you were brought i n t o the s e s s i o n t e n minutes  l a t e by t h e t a x i d r i v e r .  In your  p l a y , t h e r e was a man w a i t i n g f o r t h e bus which took t o o long, j u s t l i k e you were w a i t i n g f o r t h e t a x i .  Then, I  was t a k i n g you along t h e c o r r i d o r s t o g e t t o t h i s room and we passed many people, i t was l i k e a bus l o a d o f people. Being brought l a t e t o t h e s e s s i o n and p a s s i n g so many people i n t h e c o r r i d o r i s l i k e f i g h t i n g t o you.  I was  making you f e e l badly i n s i d e , l i k e you were i n a f i g h t . You made two s e p a r a t e passageways f o r t h e bus and f o r t h e  55 c a r : you would l i k e me t o f i n d a way , a passageway t o t h i s room, so t h a t you would not have t o go p a s t so many people.  11  The  c l i e n t immediately takes out a b u l l d o z e r and  s t a r t s meticulously  t o p a t t h e sand smooth. While d o i n g  t h i s , he s t a r t s t o w h i s t l e and continues o f f through t h e remaining o f t h e s e s s i o n .  t o w h i s t l e on and The t h e r a p i s t  asks t h e c l i e n t about what i s happening now. says,  " I t i s p a t t i n g down t h e ground.  ground smooth."  The c l i e n t  I t i s making t h e  The same b u l l d o z e r made a h o l e  i n the  ground i n t h e b e g i n n i n g of t h e s e s s i o n , so i t i s s a f e t o assume t h a t t h e b u l l d o z e r i s r e p a i r i n g t h e h o l e now. c l i e n t makes another s e p a r a t i n g and  sand w a l l and runs buses  c a r s p a r a l l e l t o one another. Second i n t e r v e n t i o n .  you  The  The t h e r a p i s t says,  "Next time  come here, I w i l l take you another way t o t h i s room,  so t h a t you w i l l not have t o pass so many people.  Also,  i f t h e t a x i d r i v e r i s l a t e f o r your s e s s i o n again, you w i l l have your s e s s i o n j u s t as long,  i t w i l l n o t be  s h o r t e r because t h e d r i v e r i s l a t e .  Today, you were t e n  minutes l a t e , so you w i l l s t a y here t h e same 35 minutes as before. usual.  We w i l l end t h e s e s s i o n t e n minutes l a t e r than  11  At about t w e n t y - f i v e  minutes i n t o t h e s e s s i o n , t h e  c l i e n t takes a bus and runs i t slowly,  then stops  i t . In  f r o n t o f i t goes s l o w l y an ambulance. The t h e r a p i s t asks  what i s happening i n h i s p l a y . bus stopped because i t was  the bus s t o p .  went i n f r o n t of the bus."  The  "The  ambulance  He then goes t o the s h e l v e s  and g e t s s m a l l p l a s t i c b a l l s . by one,  The c l i e n t answers,  S t a r t s dropping them,  v e r y evenly a l l over the sandbox.  bombs are f a l l i n g a l l over the p l a c e . "  one  He says,  "The  Then he goes t o  the s h e l v e s and takes out a nurse, a worker w i t h a s h o v e l , then s i t s down on the f l o o r , and s t a r t s p l a y i n g w i t h the hospital figures.  A little  l a t e r , he g e t s up, takes out  two h o s p i t a l beds, more nurses, a wheel c h a i r , puts them all  i n the sand box between the s t a n d i n g s o l d i e r s .  The  t h e r a p i s t ask about the s t o r y and the c l i e n t r e p l i e s , (the s o l d i e r ) g e t s shot, so he must go t o the bed  (puts  the s o l d i e r on another bed), t h i s one a l s o g e t s shot he must go on a wheel c h a i r  "He  and  (the c l i e n t puts him t h e r e ,  then d r i v e s the beds and the w h e e l c h a i r s l o w l y t o the s i d e of the  box.  Third intervention.  Today, I t o l d you about your  s e s s i o n b e i n g always the same l e n g t h of time and about the new  way  I w i l l take you t o t h i s room.  What I t o l d  you  made you f e e l good, j u s t l i k e the b u l l d o z e r which made the ground smooth, but i t a l s o made you f e e l bad,  like  the  s o l d i e r s being shot and then taken t o 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 tray.  Then, he goes t o the s h e l v e s and  looks f o r  sand  something f o r a long time.  Finally,  he b r i n g s out road  s i g n s , water hydrants, telephone p o l e s and p o s i t i o n s t h e b u l l d o z e r with the r e s t of the toys. what i s happening i n h i s p l a y .  The t h e r a p i s t  asks  The c l i e n t answers, "The  workers a r e f i x i n g up t h e c i t y . "  He c o n t i n u e s t o put  s i g n s a l l over t h e c i t y , t h e telephone p o l e s on each s i d e of t h e b r i d g e , w h i s t l i n g w h i l e p l a y i n g .  The t h e r a p i s t  t e l l s t h e c l i e n t t h a t t h e i r time i s up and she g e t s up. The c l i e n t looks a b i t s u r p r i s e d and asks, "Am I going swimming now?" you t h e r e . "  The t h e r a p i s t answers, "Yes, I am t a k i n g  The c l i e n t s t a r t s going towards t h e door,  shaking sand from h i s hands.  Outside t h e c o n s u l t a t i o n  room, he goes t h e r i g h t way and walks ahead o f t h e therapist.  Near t h e swimming p o o l , he t a k e s o f f h i s  j a c k e t , puts i t on h i s head and makes a funny f a c e , s m i l i n g at the t h e r a p i s t .  The t h e r a p i s t says, " L e t ' s go."  He goes, but stops a t t h e next p o l e and swings around i t , smiling. client's  The t h e r a p i s t says, " L e t ' s go".  When t h e  t e a c h e r can be seen, t h e t h e r a p i s t says good bye  t o t h e c l i e n t and he runs t o h i s t e a c h e r . A f t e r t h e s e s s i o n , two t e a c h e r s from t h e c l i e n t ' s day programme t o l d t h e t h e r a p i s t t h a t t h e c l i e n t different  "seemed a  c h i l d a f t e r t h e t h i r d s e s s i o n : he was much  calmer and they had no t r o u b l e w i t h him". Data A n a l y s i s The t h r e e c u r r e n t t r i g g e r s f o r t h i s s e s s i o n a r e  58 r e p r e s e n t e d i n d e r i v a t i v e form.  The t r i g g e r of coming f o r  the s e s s i o n l a t e because the t a x i was c l i e n t up from h i s daycare c l o s e d e r i v a t i v e of the man  c e n t r e , was who  l a t e p i c k i n g the r e p r e s e n t e d by  the  " i s w a i t i n g f o r bus who  is  t a k i n g so l o n g " . The t r i g g e r of the t h e r a p i s t t a k i n g the c l i e n t  along  the c o r r i d o r s where the o u t - p a t i e n t s were w a i t i n g  and  r e s t r i c t i n g the passage on the way  was  t o the s e s s i o n  r e p r e s e n t e d i n c l o s e d e r i v a t i v e form by the image of the buses which "are making t r a c k s so they can go through bus  this  s t o p " ; the o u t - p a t i e n t s were i n f a c t d e l i v e r e d t o the  c e n t r e by s p e c i a l buses which were parked  i n f r o n t of the  Centre and the c l i e n t must have seen them b e f o r e . making of the t r a c k s "so they can go through  The  the bus  stop"  i s r e a c t i o n by the c l i e n t t o the walk p a s t the crowd of p a t i e n t s and  i s a l s o a v a l i d p e r c e p t i o n of the t h e r a p i s t  as having d i f f i c u l t y t o b r i n g the c l i e n t t o the s e s s i o n . The t r i g g e r of the e x t e n s i o n of the s e s s i o n  was  r e p r e s e n t e d by a d i s t a n t d e r i v a t i v e which a s i g n of g r e a t e r communicative r e s i s t a n c e i n the c l i e n t . of "the bus had t o stop because i t was  The  the bus s t o p "  "the ambulance went i n f r o n t of the bus" r e p r e s e n t s a s p e c t s of the e x t e n s i o n .  image and two  The t r i g g e r r e p r e s e n t a t i o n of  the e x t e n s i o n i n the image of an ambulance which "went i n f r o n t of the bus"  i s a derivative representation.  theme of "the bus had t o stop because i t was  The  the bus  stop"  59 i s a model of r e c t i f i c a t i o n s a y i n g t h a t the t h e r a p i s t must stop the s e s s i o n a t the agreed time (bus s t o p ) .  The  of the ambulance which t e l l s of someone s i c k and  needy  which i s a perceived  v a l i d perception  of the t h e r a p i s t who  as needing t h i s e x t e n s i o n  representation  image  is  f o r s i c k reasons.  The  of t h i s t r i g g e r d i d appear r i g h t a f t e r the  t h e r a p i s t announced t h a t h i s c u r r e n t s e s s i o n w i l l  be  extended by t e n minutes. The  representation  d e r i v a t i v e s represents  of the f i r s t two  t r i g g e r s as  close  l i t t l e communicative r e s i s t a n c e  the p a r t of the c l i e n t which i s e x p l a i n e d  by Langs'  on  theory  by the f a c t t h a t n e i t h e r the l a t e n e s s of the t a x i d r i v e r nor the presence of the w a i t i n g crowds i n the c o r r i d o r s were a c t i o n s taken by the t h e r a p i s t although the t h e r a p i s t i s responsible w i t h him.  f o r what happens t o the c l i e n t w h i l e she  Both r e p r e s e n t a t i o n s  emerged i n the  is  client's  m a t e r i a l r i g h t at the b e g i n n i n g of the s e s s i o n ,  as  predicted. The  t h i r d t r i g g e r was  represented  d i s g u i s e which i s a s i g n , a c c o r d i n g  extension  The  considerable  t o Langs' theory,  the a c t i o n by the t h e r a p i s t (extension) f o r the c l i e n t .  with  was  more  s e l f - s e r v i n g f u n c t i o n of  The  to  the  i t i s u s u a l l y h e a v i l y d i s g u i s e d because the  c l i e n t s f e e l hopeless i n the face of such a c t i o n s 1982).  traumatic  the  by the t h e r a p i s t i s e s p e c i a l l y t r a u m a t i c  c l i e n t s and  that  t h e r a p i s t acknowledged, a f t e r some  (Langs,  i n t r o s p e c t i o n f o l l o w i n g the s e s s i o n , t h a t she  feared  that  a 25 minute s e s s i o n would not cover enough m a t e r i a l t o used f o r the purpose of her c l i e n t ' s perception valid.  The  study of the s e s s i o n .  of the needy t h e r a p i s t was  a v a l i d perception  therefore  by the  needs i s i n f a c t s i c k ,  the emergence of  images i n the presence of the breaks i n the  was  c o r r e c t : the n e g a t i v e  and  the b u l l d o z e r d i g g i n g a h o l e  t r i g g e r s represented  t h a t the t h e r a p i s t was F i r s t intervention.  frame  themes of the s o l d i e r s f i g h t i n g i n the ground emerged  r i g h t a t the b e g i n n i n g of the s e s s i o n . t h a t the two  again  client.  Langsian p r e d i c t i o n regarding  and  The  f a c t t h a t s t h e r a p i s t would do something t o  the c l i e n t t o s a t i s f y her own  negative  be  The  themes show  dangers i n h i s therapy  dangerous t o the I t explained  client.  t o the c l i e n t  the  meaning of h i s unconscious communication t o the t h e r a p i s t i n a b a s i c a l l y c o r r e c t manner and f o l l o w e d by the p o s i t i v e and r e p a i r , the h o l e was  immediately  c o n s t r u c t i v e image of a  "machine making the ground smooth" where the  before.  the e x p r e s s i o n cheerfulness  i t was  The  c l i e n t ' s a f f e c t a l s o changed from  of worry ( i n the f i g h t i n g scene) t o  (whistling).  T h i s c l i e n t ' s message i s o n l y  the i n t e r p e r s o n a l 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 w e l l f u n c t i o n i n g t h e r a p i s t ) and i t l a c k s the c o g n i t i v e v a l i d a t i o n which can be e x p l a i n e d the f a c t t h a t the t h e r a p i s t d i d not propose  any  by  61 r e c t i f i c a t i o n of the The  client  breaks.  r e p r e s e n t s h i s model of r e c t i f i c a t i o n  the dangerous aspect of the way session and  by b u i l d i n g two  f o r the c a r s  brought t o  the  separate passageways f o r the  ( f o r the c l i e n t and  from f o r the o u t - p a t i e n t s ) . the m a t e r i a l  he was  He  therapist  repeated the  immediately f o l l o w i n g the  buses  separate  same model i n  first  intervention  which mentions the need f o r a s a f e r path t o the but does not propose an a c t u a l  session  rectification.  A c c o r d i n g t o Langs* theory, a model of i n the c l i e n t ' s m a t e r i a l must be  followed  rectification  by  a  r e c t i f i c a t i o n by the t h e r a p i s t i n a c t u a l i t y , i t cannot interpreted  of  be  "away" because the cause of the c l i e n t ' s  emotional d i s t u r b a n c e being i n a f i g h t and  ( i . e . , the experience analogous t o t o being dug  into)  i s "an  external  danger s i t u a t i o n t o which the t h e r a p i s t has s i g n i f i c a n t l y contributed"  (Langs, 1982,  p.  38)  and  therefore  response by the t h e r a p i s t "must i n c l u d e both the of t h i s c o n t r i b u t i o n t o the p a t i e n t ' s  the cessation  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 i n t e r v e n t i o n .  I t r e c t i f i e s the break i n  frame r e l a t e d t o the p a s s i n g of the o u t - p a t i e n t s promising a d i f f e r e n t route. a l s o announces a new the  However, the  break i n the  the  by  intervention  frame: the e x t e n s i o n of  s e s s i o n beyond the appointed time by t e n minutes.  The  i n t e r v e n t i o n i s immediately f o l l o w e d by the  destructive  image of the bombs are " f a l l i n g a l l over the p l a c e "  and  the images of s i c k n e s s  and  wheels c h a i r s ) .  The  (shot s o l d i e r , h o s p i t a l beds  emergence of some p o s i t i v e images of  h e l p i n g f i g u r e s (nurses, i s explained  doctors  by the c o r r e c t n e s s  and worker w i t h a t o o l ) of the f i r s t p a r t of  second i n t e r v e n t i o n , the promise t o r e c t i f y one the frame.  The  worker w i t h the s h o v e l  poignant because the s h o v e l ground and  break i n  is especially  i s a t o o l used t o r e p a i r  shows t h a t the c l i e n t i s u s i n g the same theme  of dangerous ground w i t h which the c l i e n t expressed same t r i g g e r , the dangers of walking along c o r r i d o r s , which he  i s working over  Third intervention.  unconsciously. client's  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 e x t e n s i o n The  i n t e r v e n t i o n does not  the  those  I t mostly misses the  unconscious message, although t h e r e  session.  the  i n c l u d e the  of  necessary  r e c t i f i c a t i o n of the break i n the frame ( i . e . , ending s e s s i o n a t the appointed time) and by a model of  rectification.  The  introduces  client  new  followed  (road s i g n s ) , p r o v i s i o n s  the spread of d e s t r u c t i o n  l i n e s of communication  explanation  i s predictably  the  the images of r u l e s t h a t must  be f o l l o w e d by common convention f o r stopping  the  (water hydrant)  (telephone p o l e s ) .  His  and  verbal  of h i s p l a y scene g i v e r s 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 t h a t "the workers are f i x i n g up  the  city".  The c l i e n t ' s p l a y scene, which t e l l s t h a t  something t h a t was  d e s t r o y e d needs t o be f i x e d , i s a l s o a  c l e 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 h y p o t h e s i s r e g a r d i n g the e f f e c t s of the breaks i n the frame were found c o r r e c t . the t h r e e breaks  A c c o r d i n g t o Langs' t h e o r y ,  i n the frame were indeed f o l l o w e d by  the emergence of n e g a t i v e images,  (b) the presence  d e r i v a t i v e r e p r e s e n t a t i o n of t r i g g e r s , and models of r e c t i f i c a t i o n .  (a)  of  (c) d e r i v a t i v e  P o s i t i v e and c o n s t r u c t i v e images  i n the c l i e n t ' s m a t e r i a l ( i n t e r p e r s o n a l unconscious v a l i d a t i o n ) d i d f o l l o w the c o r r e c t a s p e c t s of the  first  and t h i r d i n t e r v e n t i o n s . Langsian theory i s based on e x t e n s i v e e m p i r i c a l s t u d i e s which have shown the e x q u i s i t e l y unconscious  sensitive  v a l i d p e r c e p t i o n s of a d u l t s and  adolescents.  In t h i s s e s s i o n , i n a d d i t i o n t o v a l i d p e r c e p t i o n of t h i s o l d c l i e n t of the breaks  i n the frame, t h e r e i s one  p a r t i c u l a r l y amazing p e r c e p t i o n : almost  e x a c t l y a t the  moment of the appointed time the s e s s i o n should have ended, the f i v e year o l d c h i l d says, "the bus had t o stop because i t was  the bus s t o p " a f t e r the t h e r a p i s t  had  e x p l a i n e d t o him t h a t t h i s p a r t i c u l a r s e s s i o n w i l l extended p a s t the appointed time. hypotheses were found  correct.  Over a l l ,  be  Langsian  64 Case One - S e s s i o n S i x C l i e n t ' s Lateness, Missed Session,  and Forced  T e r m i n a t i o n o f Treatment S t a t e o f t h e Frame Client's lateness.  According  t o Langs'  theory,  l a t e n e s s o f e i t h e r c l i e n t o r t h e r a p i s t i s a break i n t h e ground r u l e t h a t s t a t e s t h a t t h e s e s s i o n must s t a r t a t t h e appointed time.  The c l i e n t was brought t o t h e s e s s i o n  minutes l a t e by t h e t a x i d r i v e r .  20  Since t h e t r a n s p o r t a t i o n  by t a x i was arranged through t h e c l i e n t ' s day programme a t the Centre, t h e r e  i s some i m p l i e d r e s p o n s i b i l i t y t h e  t h e r a p i s t has i n t h i s matter although she was not d i r e c t l y i n v o l v e d i n t h e arrangement. Missed s e s s i o n .  L a s t week's s e s s i o n was c a n c e l l e d by  the c l i e n t ' s mother because they were away on h o l i d a y . Two weeks ago, t h e t h e r a p i s t had t o l d t h e c l i e n t t h a t she w i l l be t h e r e f o r h i s s e s s i o n even though h i s s c h o o l be c l o s e d f o r t h e h o l i d a y .  According  c l i e n t ' s absence from t h e p r e v i o u s the t h e r a p i s t was present  t o theory, t h e  s e s s i o n a t a time when  i s a break i n t h e ground r u l e  which s t a t e s t h a t the c l i e n t i s r e s p o n s i b l e sessions  for a l l  f o r which t h e t h e r a p i s t i s p r e s e n t .  Forced t e r m i n a t i o n one  will  before  o f treatment.  This session i s the  l a s t f o r the c l i e n t because t h e t h e r a p i s t i s  l e a v i n g t h e Centre.  The approaching f o r c e d t e r m i n a t i o n o f  the c l i e n t ' s treatment i s a break i n t h e ground r u l e  65 s t a t i n g t h a t the t h e r a p i s t i s r e s p o n s i b l e  f o r t r e a t i n g the  c l i e n t f o r as long as the c l i e n t needs the Such t e r m i n a t i o n s s e t t i n g and  one  f o r the c l i e n t  treatment.  are a common occurrence i n the  of the more t r a u m a t i c (Langs, 1976,  O v e r a l l , t h e r e i s one  clinical  breaks i n the  frame  1982).  current  powerful background breaks i n the  ( l a t e n e s s ) and  two  frame.  Hypotheses A l l t h r e e breaks i n the frame are s t r o n g of which forced termination the c l i e n t .  of treatment i s the most t r a u m a t i c  the for  I t i s t h e r e f o r e p r e d i c t e d t h a t 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 m a t e r i a l  predicted that forced termination  i n t h i s session.  It is  w i l l be r e p r e s e n t e d  as  w e l l as worked over s y m b o l i c a l l y and t h a t  negative,  d e s t r u c t i v e images and themes w i l l be predominant i n the session.  Since the major t r i g g e r f o r t h i s s e s s i o n i s  termination  i t i s p r e d i c t e d t h a t the images w i l l  t h i s v e r y theme of d e s t r u c t i v e ending. r e c t i f i c a t i o n may  emerge and  reflect  A model of  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 , t h e r a p i s t l e a r n s t h a t t h e r e was and  s e v e r a l other  c l i e n t entered  a confusion  a t the  c h i l d r e n are l a t e f o r s c h o o l .  w i t h h i s j a c k e t over h i s head.  n o t i c e the t h e r a p i s t u n t i l she  the station  The He  s a i d "Hello" twice.  did The  not  66 c l i e n t kept h i s head covered but found h i s way c o n s u l t a t i o n room.  t o the  I n s i d e the room, he l e t s h i s j a c k e t  o f f h i s head, but does not take i t o f f . t o the sand t r a y and s t a r t s t o p l a y .  He goes s t r a i g h t  His face i s painted  i n b l a c k so t h a t he looks l i k e a c a t or a dog.  He i s  d r i v i n g a bus over a b r i d g e , then i t s t o p s and he then l i n e s up about twenty  c a r s i n a row.  The t h e r a p i s t  about the s t o r y of h i s p l a y and the c l i e n t says,  asks  "The  buses are l i n i n g up i n a long l i n e - u p and the people are g e t t i n g o f f the bus.  L o t s of buses are l i n i n g up",  he  then makes the l i n e up of c a r s even l o n g e r . The c l i e n t then takes an ambulance, makes the sound of the s i r e n , and d r i v e s i t . puts a person on i t ,  He takes out a h o s p i t a l  puts both on the ambulance and  i t w i t h the sound of the s i r e n .  bed,  drives  The t h e r a p i s t a g a i n asks  about the s t o r y of h i s p l a y and the c l i e n t answers immediately, man  "The ambulance i s going t o the h o s p i t a l .  i s a l r e a d y dead and he i s going t o the h o s p i t a l " .  The He  t a k e s out another person, puts i t next t o a b u i l d i n g , d r i v e s the h o s p i t a l bed t o the b u i l d i n g and b u r i e s the i n the h o s p i t a l bed.  man  The t h e r a p i s t asks about h i s s t o r y ,  and the c l i e n t s says, "The ambulance i s g o i n g t o the sheriff.  The s h e r i f f b u r i e s the man  F i r s t intervention.  because he was  dead".  Today, i n your p l a y , you made a  v e r y l o n g l i n e up of c a r s and t h e r e were people g e t t i n g o f f a bus.  Today, the t a x i d r i v e r brought you here v e r y  late.  For you i t was l i k e w a i t i n g i n a l i n e up f o r t h e  taxi.  A l s o , l a s t week you d i d not come here, i t was  Easter holiday.  In your p l a y , t h e r e was a dead person and  the ambulance brought him t o t h e h o s p i t a l - perhaps  your  b e i n g brought here l a t e and your m i s s i n g a s e s s i o n 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 p l a y , and you were b u r y i n g you face,  u n t i l we came i n here.  needed t o h i d e , t o be b u r i e d ,  Perhaps you f e l t  l i k e you  because you f e l t l i k e dead.  The c l i e n t t h i n k s f o r a w h i l e , then takes out a r o l l e r and makes a road over t h e b r i d g e , where t h e f i r s t bus had gone b e f o r e . all  around  the place.  He works on t h e road and b u i l d s i t While he i s p l a y i n g , he i s s i n g i n g  a song w i t h t h e words, "where t o f i n d "  something".  t h e r a p i s t asks about h i s s t o r y and t h e c l i e n t "People a r e making t h e road f l a t and smooth".  The  says, The he  takes out a b l o c k and puts i t next t o t h e road, t a k e s out road s i g n s , puts them b e s i d e s t h e road and t a k e s out an i n d i a n totem p o l e . The t h e r a p i s t asks about h i s s t o r y and t h e c l i e n t says, " T h i s i s t h e gas s t a t i o n the c a r s t o have gas and t h i s  ( p o i n t i n g t o t h e block) f o r i s t h e road s i g n s .  He then  takes out t h e t r a i l e r p a r t s o f s e v e r a l combined v e h i c l e s w i t h t h e engine p a r t s a r e m i s s i n g and puts s e v e r a l s m a l l c a r s on t h e t r a i l e r s .  The t h e r a p i s t asks about h i s p l a y  and t h e c l i e n t says, "They would l i k e t o go w i t h t h e  68 t r a i l e r s , but they cannot. the o t h e r p a r t o f t h i s ? "  (Pause.)  Do you know where i s  The c l i e n t then t a k e s another  t r a i l e r p a r t without t h e engine.  He puts a person on t h e  t r a i l e r and puts both i n t o t h e sandbox. Second i n t e r v e n t i o n . s e s s i o n , I reminded  The t h e r a p i s t says, " L a s t  you t h a t next week i s you l a s t  session  here w i t h me and then you took out many t r a i l e r s but they were a l l m i s s i n g t h e engines.  The road was t h e r e and t h e  gas s t a t i o n was t h e r e , but t h e r e was no engines t o d r i v e the t r a i l e r s . part.  You asked me i f I knew where i s t h e f r o n t  A l s o , you sang something  something.  about where t o f i n d  Perhaps you a r e t h i n k i n g about your  s e s s i o n , my not coming here any more. l i k e a t r a i l e r who cannot go anywhere.  last  I make you f e e l I make you f e e l  l i k e I don't g i v e you t h e energy t o move". The c l i e n t takes out a b u l l d o z e r , a worker w i t h a hard-hat, and puts another road s i g n next t o t h e road. The b u l l d o z e r works on t h e road.  The t h e r a p i s t asks  about  h i s p l a y and t h e c l i e n t says, "The t r a c t o r i s f i x i n g t h e road and t h e worker i s p u t t i n g up a s i n g " . Third intervention.  I t i s now t h e end o f s e s s i o n and  the t h e r a p i s t asks t h e c l i e n t ' s  p e r m i s s i o n t o speak t o h i s  mother t o remind her about t h e t h e r a p i s t ' s l e a v i n g t h e Centre and t o inform her t h a t t h e t h e r a p i s t would be w i l l i n g t o continue with the c l i e n t ' s private office.  therapy i n h e r  The t h e r a p i s t b r i e f l y mentions t o t h e  69 c l i e n t t h a t he showed a n x i e t y through the communication of themes r e l a t e d t o the t e r m i n a t i o n c l i e n t agrees and session.  The  of h i s treatment.  the t h e r a p i s t announces the end  The  of  the  c l i e n t s leaves r i g h t away, again p u t t i n g h i s  coat over h i s head u n t i l he reaches h i s day  programme  room. Data A n a l y s i s The  c l i e n t ' s unconscious communication s t a r t s w i t h  the c l i e n t c o v e r i n g h i s head and w a l k i n g r i g h t p a s t therapist.  Although not a v e r b a l communication i t i s a  c l e a r negative  image of someone (the t h e r a p i s t ) not  ( f o r the c l i e n t ) .  of d i s a p p e a r i n g , The  of not being t h e r e any  more, t h e r e f o r e  remoteness of r e p r e s e n t a t i o n  r e s i s t a n c e was  than communicative The  (there was  behavioral  The  the s e s s i o n i s r e p r e s e n t e d  The  (silence) behaviour). the  speaks f o r a g r o s s d i d n ' t want t o  c l i e n t ' s being brought l a t e t o i n the image of "the busses are  i n a long l i n e up"  representation.  the  predicted  t o not see  r e s i s t a n c e by the c l i e n t , who  come t o the s e s s i o n .  l i n i n g up  meaning i n h i s  waited f o r him,  of  traumatic  more b e h a v i o r a l  f a c t t h a t the c l i e n t intended  t h e r a p i s t , who  as w e l l as  not v e r b a l was  as r e s i s t a n c e i n view of the power of the The  of  of therapy r e f l e c t i n g the theme  f a c t t h a t the communication was  trigger.  there  T h i s i s a very remote r e p r e s e n t a t i o n  the t r i g g e r of t e r m i n a t i o n  ending.  the  which i s a c l o s e t r i g g e r  t h e r a p i s t learned that several  other  c h i l d r e n were brought l a t e by other t a x i d r i v e r s and c a r s were indeed l i n i n g up t o p i c k up and  t o d e l i v e r the  children.  As the t h e r a p i s t involvement was  i n causing  the c l i e n t ' s l a t e n e s s  ( i t was  the  o n l y minimal  only implied  as  f a r as the t h e r a p i s t worked a t the Centre which had made the t r a n s p o r t a t i o n arrangements f o r the c l i e n t ) , t r i g g e r was  not as t r a u m a t i c  communicative r e s i s t a n c e was The  misses p r e v i o u s  representation  f o r the c l i e n t and  the the  minimal.  s e s s i o n has  no t r i g g e r  i n the v e r b a l m a t e r i a l .  L a n g s i a n ground  r u l e s were d e r i v e d e m p i r i c a l l y from unconscious communications of a d u l t p a t i e n t s . s e s s i o n f o r which the t h e r a p i s t was  In the case of a missed present  the  patients  u n i v e r s a l l y expressed the need t o be r e s p o n s i b l e  (to  pay)  f o r such s e s s i o n s or e l s e t h e i r mature independent functioning who  would be j e o p a r d i s e d .  cannot earn money t o pay  r e s p o n s i b i l i t y obviously  In the case of a c h i l d  for h i s sessions,  such  r e s t s w i t h the p a r e n t .  I t i s my  o p i n i o n t h a t t h i s matter cannot be s t u d i e d 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 s e v e r a l powerful breaks i n the frame e x i s t i n almost every s e s s i o n and images and trigger.  thus obscure  themes r e l a t e d t o t h i s c u r r e n t l y l e s s  any  traumatic  A c l e a r study of t h i s break i n the frame c o u l d  be b e t t e r examined i n the secure frame environment of private practice. The  very f i r s t  images t h a t emerge i n the m a t e r i a l  are  the extreme n e g a t i v e images of the u l t i m a t e d e s t r u c t i o n (death).  The  offered help  c o m p e l l i n g n e g a t i v e theme of someone who (put on a h o s p i t a l bed and d r i v e n t o the  h o s p i t a l i n an ambulance with the s i r e n ) came too l a t e buried)  is  (the person  but the h e l p  i s a l r e a d y dead and  i s being  i s a moving e x p r e s s i o n by the c l i e n t of h i s  experience treatment.  of the pending f o r c e d t e r m i n a t i o n of h i s 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 f o r the moment o f f e r e d h e l p it  i s a l r e a d y too l a t e The  ( t e r m i n a t i o n w i l l happen).  same theme i s a l s o a v a l i d unconscious  by the c l i e n t of the t h e r a p i s t , who being h e l p f u l client  but  (ambulance) but who  ( w i l l not come back).  perception  i s g i v e n the chance of  i s a l r e a d y dead f o r the  A c c o r d i n g t o Langs' theory,  c l i e n t s express p a r t i c u l a r l y c o m p e l l i n g themes and  images  i n the presence of very t r a u m a t i c breaks i n the frame, of which f o r c e d t e r m i n a t i o n i s one example, and  such images  have been found t o be v a l i d p e r c e p t i o n , r a t h e r than d i s t o r t e d f a n t a s i e s , of the' t h e r a p i s t • s a c t i o n s 1976,  1982, The  (Langs,  1985,...).  first  intervention.  The  explanation i s b a s i c a l l y  i n c o r r e c t because the t h e r a p i s t does not e x p l a i n the h i g h l y d e s t r u c t i v e images i n the l i g h t of the major trigger  (forced termination)  and t h e r e f o r e n e i t h e r admits  her t r a u m a t i c a c t i o n which i s c a u s i n g s u f f e r i n g f o r 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 ( p o s s i b l e c o n t i n u a t i o n of According rectification  treatment).  t o p r e d i c t i o n , t h e r e i s a model of present  i n the m a t e r i a l f o l l o w i n g the  i n t e r v e n t i o n : the c a r s can have gas, because the connections  but s t i l l  first  cannot  t o the engines are m i s s i n g .  go There  i s a l s o a more d i s g u i s e d image, having the f u n c t i o n of a model of r e c t i f i c a t i o n , of the road s i g n s which i m p l i e s an appeal t o r u l e s .  The message i n the model can  a b s t r a c t e d as "what good i s the therapy t h e r e i s no c o n n e c t i o n  be  ( f u e l f o r cars) i f  t o the t h e r a p i s t (missing  of t r a i l e r s t o the engine p a r t s ) and  i t a l l has  linkage something  t o do w i t h r u l e s (road signs) which say t h a t therapy stop when the c l i e n t i s healed and must not be The model of r e c t i f i c a t i o n was  can  forced.  c a l l e d t o the t h e r a p i s t ' s  a t t e n t i o n by the d i r e c t q u e s t i o n by the c l i e n t ,  "do  you  know where i s the other p a r t of t h i s ? " i m p l y i n g t h a t i t i s the t h e r a p i s t ' s job t o f i n d the s o l u t i o n . The  second i n t e r v e n t i o n .  the c l i e n t was  The  explanation given  somewhat c o r r e c t as i t d i d r e l a t e  to  the  m a t e r i a l t o the f o r c e d t e r m i n a t i o n of treatment and  i t did  imply some r e s p o n s i b i l i t y of the t h e r a p i s t f o r the termination. important  However, the i n t e r v e n t i o n misses the  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 t e r m i n a t i o n t o the p r e v i o u s l y communicated h i g h l y d e s t r u c t i v e themes i n the m a t e r i a l of the  client.  A c c o r d i n g t o Langs' theory, such i n t e r v e n t i o n w i l l followed  by p a r t i a l v a l i d a t i o n i n the  be  form of some  p o s i t i v e image. This  i n t e r v e n t i o n was  constructive and  indeed f o l l o w e d  the  image of the t r a c t o r t h a t i s f i x i n g the  the worker t h a t i s p u t t i n g up  interpersonal  v a l i d a t i o n and  road  a s i g n which r e p r e s e n t s  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 a c t of the t h e r a p i s t .  There was  v a l i d a t i o n , however, as the c l i e n t was explanation  by  no  cognitive  not g i v e n complete  of h i s unconscious e x p e r i e n c e of  termination  of h i s treatment. Discussion The The  above Langsian hypotheses were found c o r r e c t .  material  involved  extremely t r a u m a t i c theme of death,  the h o p e l e s s theme of h e l p coming too t o r u l e s , and  l a t e , and  an  f o r c o n n e c t i o n w i t h the t h e r a p i s t .  appeal Also  a c c o r d i n g t o p r e d i c t i o n , the communicative r e s i s t a n c e strong, therapy. ("the  r e f l e c t i n g the danger the c l i e n t p e r c e i v e d There was  only one  correct i n t e r p r e t a t i o n included intervention.  in this  p o s i t i v e theme i n the  t r a c t o r i s f i x i n g the road") f o l l o w i n g the i n the  second  was  session  partially  74 Case Two, Family Meeting,  Session  Presence  One:  of S t a f f Member,  and O b s e r v a t i o n M i r r o r Background I n f o r m a t i o n on the C l i e n t The c l i e n t i s a s i x years o l d Chinese g i r l  living  w i t h her n a t u r a l parents and a younger s i b l i n g . r e f e r r e d t o the Centre by her mother who  was  at  the age of one.  the  s i n c e she began t o speak  The o n l y e x c e p t i o n was  a Chinese  f r i e n d w i t h whom the c l i e n t began t o speak a f t e r two of  was  concerned  about her not speaking w i t h anybody o t h e r than immediate f a m i l y and grandparents  She  girl years  s i l e n t play. The c l i e n t ' s mother  had taken her t o s e v e r a l mental  h e a l t h p r o f e s s i o n a l s w i t h i n the p a s t t h r e e y e a r s , however the treatment of  elective  r e c e i v e d was  not long-term and the symptom  mutism p e r s i s t e d .  the c l i e n t ' s r e l u c t a n c e t o e a t .  A minor complaint was  also  The mother r e p o r t e d t h a t  she had f o r c e f e d the c l i e n t i n c l u d i n g s l a p p i n g her s i n c e she was  one.  The c l i e n t was  r a i s e d mainly by her  grand-mother s i n c e the age of one. t h a t the grandparents  maternal  The p a r e n t s emphasized  g r e a t l y favoured the  client's  younger b r o t h e r . The main f a m i l y concern was  the c l i e n t ' s s i l e n c e a t  s c h o o l where she showed above average all  a b i l i t y and s k i l l i n  s u b j e c t s where she c o u l d communicate i n w r i t i n g .  75 S t a t e o f t h e Frame Family Meeting.  Any c o n t a c t w i t h t h i r d p a r t y i s  c o n s i d e r e d a powerful break i n t h e frame s i n c e t o t a l confidentiality, treatment  t o t a l p r i v a c y , and one-to-one c o n t a c t i n  are modified.  The above i n f o r m a t i o n about t h e  c l i e n t was o b t a i n e d d u r i n g t h e f i r s t  contact of the  t h e r a p i s t w i t h t h e c l i e n t a t a meeting w i t h t h e complete f a m i l y and a s t a f f t h e r a p i s t p r e s e n t . conducted  The meeting was  by t h e s t a f f t h e r a p i s t w h i l e t h e p r e s e n t  t h e r a p i s t remained t o t a l l y s i l e n t and p a r t i n g g r e e t i n g s ) .  (except f o r t h e i n i t i a l  The c l i e n t d i d not speak and d i d  not make any eye c o n t a c t w i t h e i t h e r Presence  o f s t a f f member.  the frame, t h e presence  therapists.  In a d d i t i o n t o break i n  o f another t h e r a p i s t can be  c o n f u s i n g t o t h e c l i e n t who w i l l not be c e r t a i n o f t h e therapeutic r o l e of her t h e r a p i s t . Observation mirror.  The p o s s i b i l i t y o f b e i n g  observed by someone who cannot be seen o r heard c o n s t i t u t e s a powerful break i n t h e frame w i t h in  alterations  confidentiality  p r i v a c y , and one-to-one r e l a t i o n s h i p i n treatment. fact that the c l i e n t  The  (and, i n t h i s case, t h e t h e r a p i s t )  can never know who i s o b s e r v i n g and whether t h e o b s e r v a t i o n i s t a k i n g p l a c e adds an u n c e r t a i n and c o n f u s i n g element t o treatment.  76 Hypotheses Family meeting.  In t h e presence o f such powerful  break i n t h e frame, i t i s p r e d i c t e d t h a t t h e c l i e n t r e a c t t o t h i s t r i g g e r with negative  will  images o f m i s t r u s t o f  the t h e r a p i s t , o f n o t being h e l d w e l l i n therapy, and o f danger.  The f a c t t h a t t h e t h e r a p i s t was s i l e n t d u r i n g t h e  family interview  may have a somewhat m o d i f y i n g e f f e c t on  the c l i e n t , thus l e s s e n i n g h e r m i s t r u s t o f t h e t h e r a p i s t because t h e t h e r a p i s t d i d not a c t i v e l y sought o r g i v e information  concerning  t h e c l i e n t i n t h e presence o f  others. Presence o f s t a f f member. theory,  On t h e b a s i s o f t h e  i t i s p r e d i c t e d t h a t t h e same type o f powerful  r e a c t i o n s by t h e c l i e n t as were p r e d i c t e d i n r e l a t i o n t o the f a m i l y meeting w i l l be observed.  An added f a c t o r i s  p r e d i c t e d however, s i n c e t h e c l i e n t w i l l be confused about the r o l e and purpose o f a member o f t h e s t a f f and consequently about t h e r o l e and purpose o f h e r t h e r a p i s t . Negative themes and images r e l a t e d t o danger, m i s t r u s t , poor h o l d i n g ,  and u n c e r t a i n i d e n t i t y .  Observation mirror.  I t i s predicted that  this  powerful break i n t h e frame w i l l e x e r t t h e same type o f s t r o n g r e a c t i o n s i n t h e c l i e n t as t h e two breaks i n t h e frame above w i t h t h e added e f f e c t on t h e c l i e n t o f t h e hidden, unseen danger as r e p r e s e n t e d  by t h e p o s s i b l e  hidden observer behind t h e o b s e r v a t i o n  mirror.  since the  t h e r a p i s t had observation  no c o n t r o l over who  room, the p r e s e n t  c o u l d e n t e r the  p r e d i c t i o n considers  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 In a l l , meeting,  adjacent  the background t r i g g e r s of the  observed.  family  the presence of the s t a f f t h e r a p i s t , and  c u r r e n t t r i g g e r of the o b s e r v a t i o n exert a strong  the  the  m i r r o r are expected t o  i n f l u e n c e on the c l i e n t .  It i s predicted  t h a t 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 t o a l e r t the t h e r a p i s t t o the g r a v i t y of their implications  and  t o o f f e r t o the t h e r a p i s t 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, s i n g s of r e s i s t a n c e are  predicted.  Data The  c l i e n t e n t e r s the c o n s u l t a t i o n room and  s t r a i g h t t o a d o l l house.  She  the house, looks a t them and F i r s t intervention.  goes  p i c k s up s e v e r a l f i g u r e s i n  puts them back i n s i l e n c e .  Ten minutes i n t o the  the t h e r a p i s t s t a r t s commenting about her p l a y  session, by  v e r b a l i z i n g what the c l i e n t d i d , f o r example, "I see you  are h o l d i n g a baby d o l l " .  The  that  c l i e n t gathers a family  of f o u r and p l a c e s them s i t t i n g around the k i t c h e n t a b l e . F i f t e e n minutes i n t o the s e s s i o n , the t h e r a p i s t makes another o b s e r v a t i o n ,  "I see t h a t you  hero t h a t looks l i k e Superman". t h e r a p i s t , and up  says,  The  " I t ' s Batman."  f o r the t h e r a p i s t t o see and  says,  are h o l d i n g a superc l i e n t looks a t She "My  h o l d s the brother  the  figure has  a  78 Batman.  X have B a r b i e s " .  A little f o r them".  l a t e r , the c l i e n t says, "I have many c l o t h e s  She then p l a y s w i t h the d o l l s p u t t i n g them " i n  t h e i r r i g h t p l a c e s " i n the d o l l house, each i n t h e i r room.  own  Then, she says t h a t "grandpa i s t a k i n g t h e baby out  f o r a walk i n t h e s t r o l l e r " and the baby "must f i n d h i s own way  from t h e k i t c h e n i n t o the bedroom" and the baby  "goes t o s l e e p " . bedroom.  She puts the baby i n bed alone i n h i s  The t h e r a p i s t o c c a s i o n a l l y 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 p l a y  looks  l i k e a q u i e t e x p l o r a t i o n of the d o l l house. Twenty minutes i n t o the s e s s i o n , the c l i e n t goes t o the sand-tray and s m i l e s a t the s i g h t of t h e d i n o s a u r s on the s h e l v e s .  In the sand, she makes a "mountain w i t h one  door and two windows".  As she takes out t h e d i n o s a u r s ,  she t e l l s t h e t h e r a p i s t t h a t she has seen t h e f i l m  "Land  Before Time" and she g i v e s the d i n o s a u r s names from t h e film.  She takes Sharptooth  (a dangerous and v i o l e n t  t y r a n n o s a u r s i n the f i l m ) and e x p l a i n s t h a t he "crashed through the window and i n t o the mountain and h i d e s h i s head".  She l e a v e s Sharptooth i n s i d e the mountain.  then c a l l s a "whale h e l p f u l " as i t h e l p s L i t t l e There i s "an ocean, but the L i t t l e Foot i s s t i l l because he cannot d r i n k the water".  She  Foot. thirsty  She p l a c e s "the  mother of L i t t l e Foot" on her s i d e next t o the mountain and pronounces her "dead" ( i n the f i l m , the mother  dies  79 due t o f a t a l i n j u r i e s i n f l i c t e d by  Sharptooth).  O c c a s i o n a l l y the t h e r a p i s t asks about "what i s happening i n the s t o r y  now".  The c l i e n t then looks f o r Spike f o r a w h i l e  ( i n the  f i l m , he cannot t a l k because he i s j u s t a baby), but "cannot  find i t " .  She says, "There i s no S p i k e ! "  she  The  c l i e n t does not take any of the a v a i l a b l e s m a l l d i n o s a u r s to  stand f o r Spike.  i n t o the ocean. She then takes  Then, a c a r makes a road but  falls  The B i g F i s h , however, h e l p s him "Sara and her f r i e n d " who  out.  are going t o  "the v a l l e y " and p l a c e s them a t the o p p o s i t e s i d e of the sand-tray, away from L i t t l e Foot.  She says, " L i t t l e  Foot  a l s o must go t o the v a l l e y but i t i s a long, long, long way  t o 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 c a r e l e s s c a r " t h a t runs from the L i t t l e Foot towards the v a l l e y and o t h e r s " s e v e r a l times along the way. announces the end of the s e s s i o n . t h e r a p i s t n o t i c e s t h a t t h e r e was  quickly  "crashes  into  Then, the t h e r a p i s t  Departing,  the  someone i n the  o b s e r v a t i o n room adjacent t o the c o n s u l t a t i o n room. Data A n a l y s i s The t h e r a p i s t d i d not l e t the c l i e n t i n i t i a t e session,  but s t a r t e d t o speak f i r s t ,  session.  The main reason f o r speaking f i r s t was  the  t e n minutes i n t o the t h a t the  t h e r a p i s t d i d not a t a l l expect the c l i e n t t o 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  v e r b a l i z e d o b s e r v a t i o n s of the c l i e n t ' s p l a y ,  after  the  i n i t i a l t e n minutes of s i l e n c e , were n e u t r a l enough t o s h i f t the c l i e n t ' s f r e e p l a y s u b s t a n t i a l l y and  cannot  not be  c o n s i d e r e d a c r i t i c a l t r i g g e r f o r 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 s t a r t e d t o speak on her had  the t h e r a p i s t not Regarding f i r s t  intervened. sessions,  Langs' t h e o r y r e q u i r e s  t h e r a p i s t t o d e f i n e the terms of treatment f o r the T h i s had  been done d u r i n g  t h e r a p i s t but privacy  first  non-interpretative  and  c a r r y any  t h a t she  play.  The  i n the  session,  discuss  The  therapist's  therefore  not  intervention  appropriate, i t did  was  however, imply  both i n t e r e s t e d i n the c l i e n t ' s  expected the c l i e n t t o t a l k about  her  f a c t t h a t the c l i e n t a c t u a l l y s t a r t e d t o speak  e x p l i c i t l y ask  even though the t h e r a p i s t d i d for a story,  not  i s a s i g n of r a p i d a l l e v i a t i o n  symptom of e l e c t i v e mutism w i t h i n the  situation.  staff  session.  n e g a t i v e meaning and  t h a t the t h e r a p i s t was  of her  client.  f a m i l y meeting by the  individual  F i r s t intervention.  p l a y and  the  the  not d i r e c t l y by the p r e s e n t t h e r a p i s t i n the  of the  i t d i d not  own  therapeutic  I t i s not w i t h i n the scope of t h i s t e x t  to  the reasons behind t h i s improvement as proposed  Langs' t h e o r y .  The  by  f a c t t h a t the c l i e n t s t a r t e d t o speak  i s a s i g n of a reduced b e h a v i o r a l  r e s i s t a n c e t o treatment  81 and an e x p r e s s i o n of some measure of t r u s t i n the therapist.  As p r e d i c t e d , the t h e r a p i s t was  probably  not  h e l d w h o l l y r e s p o n s i b l e by the c l i e n t f o r the breaks  in  the frame. The  c l i e n t mentions one t r i g g e r m a n i f e s t l y , her  b r o t h e r , and another t r i g g e r r e p r e s e n t a t i o n , the f a m i l y of f o u r s i t t i n g around the k i t c h e n t a b l e . presence  of her f a m i l y d u r i n g the c l i e n t ' s f i r s t  w i t h her t h e r a p i s t .  The  contact  f a c t t h a t the b r o t h e r i s g r e a t l y  favoured by the c l i e n t ' s grand-parents to  Both r e f e r t o the  may  have something  do w i t h the c l i e n t ' s emphasis and t h e r e f o r e her g r e a t  s e n s i t i v i t y t o h i s presence  a t the f a m i l y 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 g i v e s 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 s a y i n g t h a t her b r o t h e r should be taken out of her therapy as the baby taken out of the house by h i s g r a n d - f a t h e r . of  Another model  r e c t i f i c a t i o n i s r e p r e s e n t e d i n the c l i e n t ' s v e r y  words about the separate t o y s f o r her b r o t h e r for  her  (Barbies).  was  first  (Batman) and  T h i s c h o i c e of the image of t o y s as  r e p r e s e n t i n g the c l i e n t ' s therapy  i s connected  t o the term  " p l a y - t h e r a p y " used a t the f a m i l y meeting and t o the statement  g i v e n t o the c l i e n t ' s parents d u r i n g t h a t  meeting by the s t a f f t h e r a p i s t t h a t the c l i e n t w i l l  be  going w i t h the p r e s e n t t h e r a p i s t " i n t o a room w i t h l o t s of toys".  The c l i e n t u n c o n s c i o u s l y t e l l s the t h e r a p i s t t h a t  as f a r as her psychotherapy  i s concerned,  she and  her  82 b r o t h e r should be The  separate.  image of the "grandfather who  t a k e s the baby out"  i s a d i s g u i s e d t r i g g e r r e p r e s e n t i n g the presence  of the  s t a f f p s y c h o l o g i s t a t the f a m i l y meeting who  in his  s i x t i e s and had grey h a i r .  was  When the c l i e n t p l a c e s a l l  d o l l s i n " t h e i r r i g h t p l a c e s " i n the d o l l house,  she  expresses y e t another model of r e c t i f i c a t i o n by s a y i n g t h a t people should have separate t h e r a p i e s as d o l l s must have t h e i r s e p a r a t e 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, e x p r e s s i n g the c l i e n t ' s wish t o have a r e s t f u l p l a c e i n her therapy, separate from her f a m i l y . Another d i s g u i s e d 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  which speaks f o r the need t o be independent  t o get r e s t and t o be away  from the f a m i l y t o achieve r e s t i n s p i t e of the f a c t t h a t the c l i e n t i s a young c h i l d  (baby).  A c c o r d i n g t o the  t h e o r y , the c l i e n t ' s comment a p p l i e s t o both, t h e r a p i s t and the c l i e n t and  the  i s therefore considered a  v a l i d p e r c e p t i o n of the t h e r a p i s t .  In r e t r o s p e c t , the  t h e r a p i s t indeed became aware of her own  s t r o n g need f o r  an environment t h a t would l e a v e her independent  of both  the f a m i l y and the s t a f f and p r o v i d e her w i t h a p r i v a t e space  i n which t o t r e a t the I t i s extremely  her f i r s t  client.  interesting that t h i s c l i e n t  starts  i n d i v i d u a l s e s s i o n w i t h an abundance of models  83 of  r e c t i f i c a t i o n and not w i t h encoded p e r c e p t i o n s o r w i t h  r e a c t i o n s t o these p e r c e p t i o n s session).  (which f o l l o w l a t e r i n t h e  The f a c t t h a t her major symptom i s p e r v a s i v e  e l e c t i v e mutism may have something t o do w i t h t h i s r e v e r s a l o f sequence as i t expresses  a strong  unusual  initial  communicative r e s i s t a n c e t o e x p r e s s i n g her p e r c e p t i o n s . However, f u r t h e r e l a b o r a t i o n o f t h i s phenomenon l i e s o u t s i d e t h e scope o f t h i s study and w i l l not be d i s c u s s e d further. When t h e c l i e n t moves t o t h e sand-tray,  the f i r s t  t h i n g she does i s a "mountain w i t h a door and two windows", which i s a r e p r e s e n t a t i o n o f t h e t r i g g e r o f t h e s e t t i n g o f t h e c o n s u l t a t i o n room which i n c l u d e d one window and  one o b s e r v a t i o n m i r r o r .  The o b s e r v a t i o n m i r r o r was i n  f a c t b u i l t l i k e a window i n c l u d i n g a window s i l l .  The  d i n o s a u r c r a s h i n g through t h e window o f t h e mountain and h i d i n g t h e r e i s a very compelling and condensed  negative  image i m p l y i n g v i o l e n t i n t r u s i o n i n t o someone's space w i t h the purpose t o h i d e something.  I t i s both a v a l i d  p e r c e p t i o n by t h e c l i e n t of t h e dangerous space and o f t h e v i o l e n t aspect o f t h e t h e r a p i s t u s i n g a room w i t h t h e o b s e r v a t i o n m i r r o r as w e l l as a v a l i d p e r c e p t i o n o f t h e t h e r a p i s t as h i d i n g something from t h e c l i e n t (the p o s s i b i l i t y o f t h e presence o f a person behind t h e o b s e r v a t i o n m i r r o r ) which i s again p e r c e i v e d by t h e c l i e n t as a dangerous and v i o l e n t a c t .  84 The  c l i e n t c o n t i n u e s with a b r i e f p o s i t i v e image o f a  h e l p f u l whale which can be e x p l a i n e d as a v a l i d  perception  of t h e t h e r a p i s t as not a l t o g e t h e r d e s t r u c t i v e f o r t h e moment, which may be an unconscious  understanding  on t h e  part of the c l i e n t that the t h e r a p i s t i s nevertheless t r y i n g t o h e l p t h e c l i e n t and i s not e n t i r e l y r e s p o n s i b l e f o r t h e breaks i n t h e frame.  The c l i e n t goes on t o t h e  c o m p e l l i n g n e g a t i v e image o f someone s m a l l who remains t h i r s t y i n s p i t e o f the abundance o f water ( L i t t l e  Foot  remains t h i r s t y because he cannot d r i n k ) which i s another v a l i d p e r c e p t i o n o f the t h e r a p i s t who i s o f f e r i n g  help  ( h e l p f u l whale) t o t h e c l i e n t but t h e c l i e n t cannot make use o f t h i s h e l p .  The r e a c t i o n o f t h e c l i e n t t o t h e non-  h e l p f u l and dangerous t h e r a p i s t i s t h a t t h e c l i e n t cannot receive the help therapy The  (remains t h i r s t y ) i n s p i t e o f a v a i l a b l e  (water). c l i e n t then c o n t i n u e s w i t h t h e extreme o f  n e g a t i v e images.  The dead mother expresses  her v a l i d  p e r c e p t i o n o f t h e t h e r a p i s t who i s l i k e dead f o r her i n her f u n c t i o n as a t h e r a p i s t because she i s not an e f f e c t i v e n u r t u r i n g f i g u r e i n p r o v i d i n g h e l p i n therapy which she had promised i n t h e same ways t h a t mothers i m p l i c i t l y promise n u r t u r i n g t o t h e i r c h i l d r e n . c l i e n t then searches  f o r a character  speak and thus t h e c l i e n t connects  The  (Spike) who cannot  her major symptom o f  e l e c t i v e mutism t o t h e f u n c t i o n a l l y absent  t h e r a p i s t (the  85 dead mother) i n the presence  of the o b s e r v a t i o n m i r r o r  due t o c o n t a c t s w i t h t h i r d p a r t i e s . c l i e n t ' s own  and  The r o l e of the  u n a v a i l a b l e 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 t o the c u r r e n t r e p e t i t i o n of the c h i l d h o o d trauma i n f l i c t e d on the  client  by the p r e s e n t t h e r a p i s t , w i l l not be d i s c u s s e d here because i t l i e s o u t s i d e the scope of t h i s  study.  The n e g a t i v e theme of not being a b l e t o f i n d (cannot f i n d Spike, who  i s the c h a r a c t e r who  herself  cannot speak)  i s a v e r y c o m p e l l i n g theme t h a t 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 r e g r e s s i o n . T h i s theme a l s o c o n t a i n s an unconscious  interpretation to  the t h e r a p i s t e x p r e s s i n g t h a t the t h e r a p i s t has t o r e c o v e r her i d e n t i t y  ( f i n d h e r s e l f ) as a f u n c t i o n a l t h e r a p i s t t o  be a b l e t o h e l p her c l i e n t . image of someone f a l l i n g her therapy  Next comes the  negative  (the car) which i n d i c a t e s t h a t  i s i n jeopardy and t h a t the t h e r a p i s t i s  dangerous, f o l l o w e d by the b r i e f p o s i t i v e image of someone coming t o the rescue  (the b i g f i s h ) .  T h i s can  be  e x p l a i n e d 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 h e r s e l f , but can be saved a strong therapist The  by  (the b i g f i s h ) .  s e s s i o n continues and the t h e r a p i s t s t i l l  not e x p l a i n t o the c l i e n t her unconscious compelling pleas f o r r e c t i f i c a t i o n .  The  does  messages and client  then  c o n t i n u e s w i t h the d e s p a i r i n g n e g a t i v e theme of someone  her  86 who i s l e f t  " a l l a l o n e " w h i l e her f r i e n d s depart towards a  d e s i r a b l e p l a c e which i s p e r c e i v e d as out o f r e a c h  (long,  long, long way t o t h e v a l l e y ) which s i g n a l s d e p r e s s i v e symptoms i n t h e c l i e n t .  The n e g a t i v e image o f someone  r e c k l e s s c a u s i n g damage t o e v e r y t h i n g  (crashing into  e v e r y t h i n g along t h e way) i s a v a l i d p e r c e p t i o n o f t h e t h e r a p i s t c a u s i n g damage t o t h e c l i e n t i n a l l r e s p e c t s because she i s r e c k l e s s l y a l l o w i n g t h e o b s e r v a t i o n t o c o n t i n u e and because she had allowed t h e i n i t i a l  contact  w i t h t h e c l i e n t ' s f a m i l y and t h e s t a f f t h e r a p i s t . The mixture  of the s t r o n g l y negative  images w i t h t h e  few and b r i e f p o s i t i v e images o f h e l p f u l f i g u r e s (the whale and t h e b i g f i s h ) may be i n i t s e l f a n e g a t i v e 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 t h e r a p i s t and which i s a r e a c t i o n o f t h e c l i e n t t o t h e p e r c e p t i o n s o f the t h e r a p i s t as both dangerous and helpful. The c l i e n t ' s unconscious  p e r c e p t i o n s o f someone  o b s e r v i n g t h e s e s s i o n were confirmed  as v a l i d a f t e r t h e  s e s s i o n : t h e r e was someone i n t h e adjacent room and t h e c u r t a i n s c o v e r i n g t h e o b s e r v a t i o n m i r r o r were not f u l l y drawn i n t h a t room. Discussion On t h e whole, a l l Langsian s e s s i o n were found c o r r e c t .  hypotheses f o r t h i s  The p r i n c i p a l o r g a n i s e r s o f  the s e s s i o n s were t h e two p r e d i c t e d t r i g g e r s , both  major  87 breaks i n the frame: the f a m i l y meeting w i t h the p s y c h o l o g i s t and  the o b s e r v a t i o n  r e p l e t e with p r e d i c t e d negative  mirror.  The  staff  session  was  images, i n c l u d i n g the  extreme: the image of a dead mother.  The  images  and  themes corresponded t o the p r e d i c t e d ones of poor  holding  (dead mother, the mountain t h a t cannot w i t h s t a n d a t t a c k ) , intrusion  (Sharptooth crashes i n t o the mountain),  confusion  regarding  violence  r o l e s and  i d e n t i t y (no  Spike),  ( v i o l e n t c r a s h , d e s t r u c t i v e c a r , and  danger (presence of the v i o l e n t S h a r p t o o t h ) .  death),  and  The  p r e d i c t e d m i s t r u s t of the t h e r a p i s t shows i t s e l f  i n the  extreme form of t o t a l n u r t u r i n g f a i l u r e i n the image of the dead mother, which stands f o r the t h e r a p i s t who g i v e nothing  good t o the c l i e n t .  t h e r a p i s t i s somewhat m o d i f i e d  T h i s image of  can  the  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 p r e d i c t e d .  The  client's  d e s i r e and hope f o r 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 t h e r a p i s t was  v a l i d perception  because the t h e r a p i s t had  i n v a i n , t o have the o b s e r v a t i o n adjacent  on her own,  b e t r a y i n g the c l i e n t .  Also,  the  the  not t o p a r t i c i p a t e  v e r b a l l y i n the f a m i l y meeting and was exposing and  albeit  m i r r o r covered and  room locked d u r i n g her s e s s i o n s .  t h e r a p i s t d i d decide,  tried,  a  The  thus a b l e t o reduce prediction that  88 the m i s t r u s t of the t h e r a p i s t w i l l be m o d i f i e d t h e r a p i s t ' s good i n t e n t i o n s was confusion  correct.  of the c l i e n t r e g a r d i n g  was  predicted  c o r r e c t , although i t s  disguised.  As p r e d i c t e d , t h e r e were s i g n s of resistance.  The  the  the t h e r a p i s t ' s  i n t e n t i o n s can a l s o be c o n s i d e r e d expression  by  behavioral  Communicative r e s i s t a n c e was  minimal as  r e f l e c t e d i n the r i c h l y c o a l e s c i n g network of the  client's  verbal expressions.  was  mainly e v i d e n t and  The  communicative r e s i s t a n c e  i n the more heavy d i s g u i s e of some images  i n the h i g h degree of condensation of the  material.  O v e r a l l , the hypotheses t h a t were formed on the b a s i s of the u n i v e r s a l i m p l i c a t i o n s of the two  powerful t r i g g e r s ,  as they apply t o a d u l t s , were found c o r r e c t . Case Two  - Session  Two  Background T r i g g e r s , O b s e r v a t i o n M i r r o r , I n t e r r u p t i o n of the  and  Session  S t a t e 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 t h a t have not been r e c t i f i e d t h a t c o n t i n u e t o be a c t i v e .  For t h i s s e s s i o n ,  t r i g g e r s are the c o n t a c t w i t h t h i r d p a r t i e s and observation  mirror.  The  such the  c l i e n t ' s mother b r i n g s the  t o the w a i t i n g room where she and  the c l i e n t ' s  and  client  brother  wait f o r the s e s s i o n t o end.  While the t h r e e of them w a i t  f o r the t h e r a p i s t t o come and  e s c o r t the c l i e n t t o  the  89 c o n s u l t a t i o n room, s e v e r a l members of the s t a f f as w e l l o t h e r c l i e n t s and another.  The  t h e i r parents u s u a l l y t a l k to  observation  the a d j a c e n t o b s e r v a t i o n  mirror  room and  not covered  someone unlocked the door of the  The  c l i e n t d i d not  the t u r n i n g of the key  and  consultation  see the person but  the s h o r t apology.  i n t e r r u p t i o n by a t h i r d p a r t y therefore  and  About 15 minutes i n t o  proceeded t o open i t when the t h e r a p i s t got  of the door.  The  one  room i s l e f t unlocked.  I n t e r r u p t i o n of the s e s s i o n . the s e s s i o n ,  is still  as  hold heard  Such  i s a break i n the frame  and  a current t r i g g e r . s p e c i f i c s of e x t r a - s e s s i o n a l  c l i e n t w i t h s t a f f and  beyond the t h e r a p i s t ' s c o n t r o l . break i n c o n f i d e n t i a l i t y and  the  were u n a v o i d a b l e  the  and  In a d d i t i o n t o p o t e n t i a l  p r i v a c y of treatment a t  i n t e r r u p t i o n of a s e s s i o n ,  i s u n i v e r s a l l y perceived the c l i e n t  of  other c l i e n t s were not known t o  t h e r a p i s t , however, such c o n t a c t s  time of the  contacts  the  such i n t e r r u p t i o n  as a v i o l e n t a c t d i r e c t e d towards  (Langs, 1985a).  Hypotheses Contact w i t h t h i r d p a r t i e s .  Universal  i m p l i c a t i o n s of the t h e r a p i s t ' s c o n t a c t t o treatment, e i t h e r d i r e c t l y and  i n g r e e t i n g and  unconscious  with t h i r d p a r t i e s  (as i n the f a m i l y meeting  l i s t e n i n g t o the mother and  brother  b e f o r e each s e s s i o n ) , or e l s e i n d i r e c t l y through  the  t h e r a p i s t ' s connection  clients  w i t h the s t a f f and  other  90 of the c e n t r e , t h e r a p i s t and t h e r a p i s t , and  i n v o l v e a dangerous q u a l i t y t o the t h e r a p e u t i c  the  experience, m i s t r u s t of  a sense of b e t r a y a l .  S i n c e t h i s i s a background t r i g g e r t h a t has  not  r e c t i f i e d f o r t h r e e weeks, and because t h e r e was explanation  the  g i v e n t o the c l i e n t of her  unconscious messages r e g a r d i n g d u r i n g the p r e v i o u s  session,  been  no  compelling  contact with t h i r d p a r t i e s  i t i s predicted that  the  c l i e n t w i l l show her m i s t r u s t of the t h e r a p i s t by i n c r e a s i n g her r e s i s t a n c e t o treatment by behavioral resistance  ( s i l e n c e ) and may  showing  show s i g n s  of  g i v i n g up t r y i n g t o communicate t o the t h e r a p i s t her concerns by i n c r e a s i n g her communicative r e s i s t a n c e ( v e r b a l i z a t i o n s t h a t do not c a r r y unconscious meaning). The  c l i e n t may  r e a c t t o the f a c t t h a t 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  g i v i n g up her e f f o r t s Langs, 1976). I n t e r r u p t i o n of the s e s s i o n .  This i s a  t r i g g e r as i t occurs d u r i n g the s e s s i o n .  current  S i n c e the  person  i n t r u d i n g d i d not a c t u a l l y enter the c o n s u l t a t i o n room, because the c l i e n t d i d not see the i n t r u d e r , and  since  t h e r a p i s t immediately put a stop t o the opening of door, i t i s p r e d i c t e d t h a t the p e r c e i v e d  by the c l i e n t as a moderately dangerous and The  the  v i o l e n c e of such  i n t e r r u p t i o n of a s e s s i o n w i l l be m o d i f i e d  violent act.  the  and  perceived  moderately  f e a r of the c l i e n t t h a t such an  act  c o u l d be repeated i n t h e f u t u r e i s p r e d i c t e d e s p e c i a l l y s i n c e t h e t h e r a p i s t d i d not promise t o t h e c l i e n t any a c t i o n s t h a t would ensure t h e p r e v e n t i o n attempts t o enter her s e s s i o n .  of future  Since t h i s i s t h e f i r s t  such i n t r u s i o n , i t i s p r e d i c t e d t h a t t h e c l i e n t w i l l to i t unconsciously  react  and t h a t her communicative r e s i s t a n c e  f o r communicating her e x p r e s s i o n s  regarding  this trigger  w i l l be minimal. Data On t h e way t o the s e s s i o n , t h e c l i e n t t a k e s out o f her pocket a chestnut and shows i t t o t h e t h e r a p i s t .  As  soon as she e n t e r s t h e c o n s u l t a t i o n room, t h e c l i e n t  says  t h a t she had found i t i n f r o n t o f her house.  She then  looks f o r some time a t t h e p a i n t s , but does not touch them.  She goes t o the d o l l house, which i s i n d i s a r r a y  and  says t h a t i t i s "a mess".  box  but does not p l a y t h e r e .  She then goes t o t h e sand She seems a t a l o s s .  She  then goes back t o t h e p a i n t s and s t a r t s p o i n t i n g t o ordinary objects  ( s c i s s o r s , tape, p a i n t s , paper) w h i l e  a s k i n g t h e t h e r a p i s t questions The  l i k e "What i s t h i s ? " .  c l i e n t then s t a r t s p a i n t i n g .  At t h i s moment, about 20  minutes i n t o t h e s e s s i o n , someone s t a r t s t o unlock t h e door o f t h e c o n s u l t a t i o n room and t h e t h e r a p i s t q u i c k l y g e t s up and p r e v e n t s t h e person from opening t h e door more t h a t a few inches.  The c l i e n t cannot see t h e person but  she can hear t h e key and a word o f apology.  The c l i e n t  stops p a i n t i n g , looks a t the t h e r a p i s t and b r o t h e r was  "My  mean t o the baby."  F i r s t intervention. t e l l me  says,  more?"  The  The  t h e r a p i s t says,  c l i e n t continues,  "He  "Can  you  took the  ruler  i n h i s hand and wanted t o h i t the baby but d i d n ' t h i t the baby, j u s t pretended.  (Pause)  My  grandfather  was  very  mad." Second i n t e r v e n t i o n .  The  t h e r a p i s t says,  person wanted t o open the door you was  l i k e your b r o t h e r who  f e l t frightened.  and  does not  The  c l i e n t continues  w i l l p a i n t a p i c t u r e f o r you."  She  Then, she  When she  e x p l a i n s her p a i n t i n g , " T h i s i s me,  house."  h i t you.  You  feel  says,  t h i s i s you  and  this  doll  observes what the t h e r a p i s t  i s wearing, but then uses the c o l o u r s the t h e r a p i s t wearing a t the time of the p r e v i o u s The  her  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. announces the end  was  session.  c l i e n t makes a second p a i n t i n g by d i p p i n g  c h e s t n u t i n p a i n t and  "I  i s f i n i s h e d , she  t h i s i s the window of the  then g e t s up and  felt  to paint i n s i l e n c e  look a t the t h e r a p i s t .  i s the d o l l house, and  It  wanted t o h i t the baby, you  l i k e t h a t person wanted t o come i n and angry w i t h me."  "When t h a t  of the s e s s i o n and  The  therapist  t e l l s the c l i e n t  that  she w i l l keep her p a i n t i n g s i n the c o n s u l t a t i o n room.  The  c l i e n t says "O.K.", s m i l e s and  leaves.  93 Data A n a l y s i s The  c l i e n t s t a r t s t o communicate n o n v e r b a l l y  t h e r a p i s t o u t s i d e the c o n s u l t a t i o n room (showing  with the  chestnut) which i s an e x t r a - s e s s i o n a l c o n t a c t w i t h t h e r a p i s t l i k e l y t o be seen by t h i r d p a r t i e s . c l i e n t s t a r t s the s e s s i o n by mentioning one representation  a representation  was  brought i n t o her  the e x t r a - s e s s i o n a l c o n t a c t  r e l a t e d to This i s  (family) and  (she shows the  the  disguised  session.  of t h i r d p a r t y c o n t a c t  the  Inside,  of a t r i g g e r : something t h a t was  her home (chestnut)  the  of  chestnut  o u t s i d e the room). The  c l i e n t then n e i t h e r p l a y s nor does  communicate v e r b a l l y w i t h the t h e r a p i s t . l o o s f o r what t o do or say.  Her  she  She  behavioral  seems a t a  resistance  ( s i l e n c e ) l a s t s f o r almost 20 minutes w h i l e  her  v e r b a l i z a t i o n s are i n the form of q u e s t i o n s  t h a t do  c a r r y images or themes (communicative r e s i s t a n c e ) .  not Her  comment t h a t the d o l l house i s a mess i s an unconscious comment t o the t h e r a p i s t t h a t her therapy and  her  t h e r a p i s t are a mess because of the c o n t a c t w i t h t h i r d p a r t i e s and  represents  a negative  image.  T h i s statement i s f o l l o w e d by t r i v i a l q u e s t i o n s can be e x p l a i n e d  as an unconscious p e r c e p t i o n ,  image. of the t h e r a p i s t who and  by i m p l i c a t i o n avoids First  intervention.  knows nothing,  the  important  Right  who  a  which  negative  is trivial  issues.  a f t e r the  i n t e r r u p t i o n of  the s e s s i o n , the c l i e n t t e l l s a s t o r y t h a t c o n t a i n s negative  a  image of the t h r e a t of an unprovoked a t t a c k  someone d e f e n c e l e s s n a s t y person  (brother wanted t o h i t the baby) by  (brother was  mean), which made the c l i e n t  the t h e r a p i s t angry (grand-father representation w i t h a key  on  was  mad),  outcome of the u n l o c k i n g  and  a  of the t r i g g e r of the u n l o c k i n g  (the r u l e r i n the b r o t h e r ' s  a  of the  hand), and  of the door (brother  door  the  just  pretended t o h i t the baby). Second i n t e r v e n t i o n .  The  therapist gives  predominantly c o r r e c t e x p l a n a t i o n unconscious message.  of the  a  client's  I t i d e n t i f i e s the t r i g g e r  (attempt  t o enter the s e s s i o n ) , the theme (the t h r e a t of v i o l e n c e ) , the outcome ( v i o l e n c e was (anger).  o n l y pretended), and  I t u n i l a t e r a l l y introduces  affect  another a f f e c t  ( f r i g h t ) which the c l i e n t does not mention w h i l e i t does not mention the h e l p l e s s n e s s  of the c l i e n t and  the  t h e r a p i s t which i s p a r t of the image of a baby. I t i s a l s o very  l i k e l y t h a t the t h e r a p i s t i n t e r v e n e d  soon and  have waited t o get more of a s t o r y from  should  the c l i e n t t o p r o v i d e which t o base her  too  the t h e r a p i s t w i t h more m a t e r i a l  intervention.  The  client did  on  not  i n c l u d e 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 p o s s i b l e t h a t she would have done so the t h e r a p i s t not The  had  interrupted.  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 f o r the t h e r a p i s t (a p a i n t i n g )  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 t h e r a p i s t ) the t h e r a p i s t ' s u n i l a t e r a l i n t r o d u c t i o n of something l i k e ,  unilaterally,  fright,  " I f the t h e r a p i s t i s a f r a i d I w i l l  her w i t h a present",  and  " I f the t h e r a p i s t can do  so can I " .  d i s g u i s e d image of a g i f t ,  The  to  soothe things  client's offer i s a heavily  a h e a v i l y d i s g u i s e d model of  r e c t i f i c a t i o n t h a t c a l l s f o r the c l i e n t and be alone i n the room, i t c o n t a i n s  a thinly  therapist to disguised  background t r i g g e r i n the image of the window of the house ( o b s e r v a t i o n m i r r o r ) , as w e l l as a d i s g u i s e d model of r e c t i f i c a t i o n i n the image of o n l y one house had one  s e v e r a l windows, and  r e a l window and  window (the  doll  the c o n s u l t a t i o n room  an o b s e r v a t i o n  had  m i r r o r b u i l t as a  window). The  same p a i n t i n g a l s o conveys another h e a v i l y  d i s g u i s e d theme i n v o l v i n g change i n the t h e r a p i s t : the c l i e n t looks but does not apply the c o l o u r s of the  current  d r e s s of the t h e r a p i s t , i n s t e a d she uses the exact  colours  of d r e s s the t h e r a p i s t was  wearing b e f o r e .  The  theme i s  so h e a v i l y d i s g u i s e d t h a t i t i s h i g h l y s p e c u l a t i v e a n a l y z e i t s meaning.  to  What i t can be s a i d i s t h a t i t d e a l s  w i t h the t h e r a p i s t and w i t h the c l i e n t ' s needs t o change something about her.  As a n e g a t i v e  theme i t may  convey  t h a t the t h e r a p i s t i s s t i l l the same as l a s t time and not changed f o r the b e t t e r i n s p i t e of her d i f f e r e n t  has  96 clothes.  As a model o f r e c t i f i c a t i o n i t may c a l l  s e s s i o n t h a t i s not i n t e r r u p t e d , as t h e p r e v i o u s  for a session  was not i n t e r r u p t e d . The  presence o f communicative r e s i s t a n c e i s v e r y  notable i n the c l i e n t ' s  communications and i s almost  impenetrable when t h e c l i e n t goes on and f i n g e r p a i n t s her c h e s t n u t and t h e paper. her g r a p h i c of s t r o n g  expression  Here, t h e r e g r e s s i o n  evident i n  and i n her t o t a l s i l e n c e i s a s i g n  resistances.  Discussion The  c l i e n t s t a r t s t h e s e s s i o n w i t h a break i n t h e  frame ( e x t r a - s e s s i o n a l c o n t a c t  with the t h e r a p i s t )  i s i n i t s e l f a r e s i s t a n c e t o treatment. t h i r d party contact  She d i d r e a c t t o  w i t h communicative and b e h a v i o r a l  r e s i s t a n c e s which i m p l i e d her m i s t r u s t predicted.  which  o f t h e t h e r a p i s t as  There were few s t r o n g n e g a t i v e images except  f o r t h e c h a r a c t e r i s a t i o n o f t h e s t a t e o f her therapy as a mess and of t h e t h e r a p i s t h e r s e l f as a mess. few  There were  and weak e f f o r t s a t r e c t i f i c a t i o n on t h e p a r t o f t h e  client,  as p r e d i c t e d .  R i g h t a f t e r the immediate t r i g g e r  ( i n t e r r u p t i o n ) t h e c l i e n t d i d p r e s e n t t h e t r i g g e r and t h e predicted diminished  i m p l i c a t i o n s o f t h e t r i g g e r which i s a s i g n o f r e s i s t a n c e , as was p r e d i c t e d .  I t was a l s o p r e d i c t e d t h a t t h e c l i e n t w i l l her  express  f e a r o f f u t u r e i n t e r r u p t i o n s because t h e t h e r a p i s t d i d  not propose any r e c t i f i c a t i o n s .  T h i s p r e d i c t i o n was not  c o r r e c t and due  the reasons may  be s e v e r a l .  One  reason may  t o the f a c t t h a t the t h e r a p i s t i n t e r r u p t e d the  w i t h her  second i n t e r v e n t i o n and  the c l i e n t was  a chance t o complete her message.  client  not  The  These s p e c u l a t i o n s  subsequent s e s s i o n . points  could  increased  be t e s t e d  From the t h e o r e t i c a l and  in  l e s s weight  t h a t the above c o r r e c t p r e d i c t i o n s as i t does not w i t h the above p r e d i c t i o n s .  conflict  O v e r a l l , the p r e d i c t i o n based  on Langs' t h e o r y were found c o r r e c t f o r t h i s  session.  S e s s i o n Three  Contact w i t h Parents, Change of Time, and State  the  clinical  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  Case Two,  which  c l i e n t d i d however s t o p  communicating i n d e r i v a t i v e s which i s a s i g n of resistance.  be  her  u n i l a t e r a l i n t r o d u c t i o n of f r i g h t i n t o the s e s s i o n confused the c l i e n t .  given  Another reason may  t h a t the t h e r a p i s t complicated the s i t u a t i o n w i t h  be  Noise  of the Frame Contact w i t h p a r e n t s .  session,  A few  days b e f o r e t h i s  the c l i e n t ' s mother c a l l e d the t h e r a p i s t  and  asked f o r an e a r l i e r s e s s i o n because i t would be more convenient f o r her as t h e r e was t h a t day. but  The  no  school  c l i e n t to session The  client  t h e r a p i s t t r i e d t o r e t a i n the r e g u l a r  the mother i n s i s t e d t h a t she would not  time.  f o r the  bring  i f the t h e r a p i s t would not  time  the  change  the  t h e r a p i s t agreed t o make the time change.  c l i e n t would o b v i o u s l y  know about the c o n t a c t  between  The the  98 t h e r a p i s t and her mother. Change o f time.  The t h e r a p i s t agreed t o change t h e  time f o r t h i s s e s s i o n and thus broke t h e frame. frame i n c l u d e s f i x e d time f o r a l l s e s s i o n s .  Secure  The  unconscious i m p l i c a t i o n s o f a change i n t h e time i n c l u d e a sense o f u n c e r t a i n l y and m i s t r u s t o f t h e t h e r a p i s t i n a d d i t i o n t o t h e i m p l i c a t i o n s a p p l i c a b l e t o a l l breaks i n the  frame. T h i s p a r t i c u l a r change i n time, r e q u e s t e d by t h e  c l i e n t ' s mother and agreed upon a f t e r i t was c l e a r t h a t the mother would not b r i n g t h e c l i e n t t o t h e s e s s i o n i f the t h e r a p i s t d i d not o b l i g e , i s an i n t e r e s t i n g example o f a break i n t h e frame t h a t i s not i n i t i a t e d by t h e c l i e n t (as i s t h e case i n a d u l t s )  and t h a t was done i n o r d e r t o  g i v e t h e c l i e n t a s e s s i o n a t a l l t h a t week which i s p a r t of secure frame.  The i m p l i c a t i o n o f t h i s k i n d o f break i n  the frame f o r a young c h i l d , where t h e p a r e n t i s s o l e l y responsible  f o r t h e break, may be determined by t h e  d i f f e r e n t i a l between t h e damage done t o t h e c l i e n t by t h e change o f time and t h e b e n e f i t done t o t h e c l i e n t by g i v i n g her a session at a l l . Noise.  Shortly a f t e r the beginning of t h i s  session,  t h e r e was loud t a l k and l a u g h t e r heard from t h e a d j a c e n t room which  i s connected t o t h e c o n s u l t a t i o n room w i t h  t h e r a p i s t observation  m i r r o r . Both, t a l k i n g t o t h e  c l i e n t ' s mother on the telephone and t h e loud presence o f  people i n the adjacent p a r t i e s t o treatment  room r e p r e s e n t  contact with t h i r d  ( i f the c l i e n t can hear the  they too can hear the c l i e n t ) and  people,  a major break i n the  frame w i t h i m p l i c a t i o n f o r c o n f i d e n t i a l i t y and  privacy  of  treatment. Hypotheses Contact w i t h p a r e n t s and  change of time.  This i s yet  another i n s t a n c e of the t h e r a p i s t ' s c o n t a c t w i t h c l i e n t ' s p a r e n t s and  i t i s therefore predicted that  c l i e n t w i l l e i t h e r h e a v i l y d i s g u i s e her regarding  t h i s i s s u e of p r i v a c y and  e l s e g i v e up and  the the  communications  c o n f i d e n t i a l i t y or  stop t r y i n g a l t o g e t h e r which w i l l  be  o b s e r v a b l e as a s t r o n g r e s i s t a n c e , both b e h a v i o r a l l y communicatively and  as w e l l as  and  regression.  S i n c e some c o n t a c t w i t h the p a r e n t s of s m a l l 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  i n i t i a t e d by the p a r e n t s and  was  not the t h e r a p i s t , I propose  t h a t such breaks i n the frame must be t r e a t e d as complex and  intertwined  i s s u e s i n each i n d i v i d u a l case and  a c l e a r i s s u e as i t i s i n the case of a d u l t s .  not  as  With t h i s  mind, I propose t h a t open unconscious communication regarding  t h i s issue  (weak communicative r e s i s t a n c e )  would  mean t h a t the c l i e n t b e n e f i t s from t h i s s e s s i o n more t h a t she  i s damaged by the t h e r a p i s t ' s c o n t a c t w i t h the  regarding  the change of time.  In case any  parent  p o s i t i v e images  emerge i n the m a t e r i a l of the c l i e n t i n r e l a t i o n t o g i v i n g  100 the c l i e n t t h i s s e s s i o n , even though t h a t meant a change i n time as w e l l as c o n t a c t w i t h the parent, would i n d i c a t e t o me  t h a t the c l i e n t d i d b e n e f i t from the  session.  I propose t h a t the d e t e r m i n i n g f a c t o r f o r d e c i d i n g whether such changes are t o be made r a t h e r than c a n c e l l i n g the s e s s i o n a l t o g e t h e r 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 o b v i o u s l y  come a f t e r the  f a c t f o r 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 r e s p e c t would d i c t a t e a g e n e r a l such s i t u a t i o n s .  rule in  Research of secure frame therapy would  o f f e r the b e s t o p p o r t u n i t y  f o r the a n a l y s i s of  phenomenon because major t r a u m a t i c c l i n i c s e t t i n g , would not  this  t r i g g e r s , common i n the  i n t e r f e r e w i t h the  observation  of the break i n the frame under d i s c u s s i o n . J u s t b e f o r e the s e s s i o n , the t h e r a p i s t 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 , t h a t would l i k e her t o b r i n g the c l i e n t every week a t o r i g i n a l l y agreed upon time. considered  she  the  S e t t i n g of a f i x e d time i s  a s e c u r i n g of the frame.  Before e n t e r i n g  the  c o n s u l t a t i o n room, the t h e r a p i s t hangs an " o c c u p i e d " s i g n on the door and intended  explains  i t t o the c l i e n t .  t o keep people away from the s e s s i o n and  t h e r e f o r e a s e c u r i n g of the frame. theory,  This action i s  According  the s e c u r i n g of the frame w i l l  lead to  to  is the  the  emergence of p o s i t i v e images. Noise.  I t i s p r e d i c t e d t h a t the c l i e n t w i l l r e a c t t o  101 t h i s t r i g g e r because i t i s r e l a t e d t o t h e b a s i c i s s u e s o f p r i v a c y and c o n f i d e n t i a l i t y . the adjacent  Since t h e n o i s e came from  room w i t h t h e o b s e r v a t i o n  mirror, the  i m p l i c a t i o n f o r t h e c l i e n t may be important.  This i s the  second t h r e a t t o t h e s e s s i o n from people o u t s i d e t h e c o n s u l t a t i o n room i n a row.  I t i s predicted,  f i n d i n g s of c l i n i c a l studies i n adults  following  (Langs, 1976), t h a t  the c l i e n t may show s i g n s o f r e g r e s s i o n and d e p r e s s i o n  as  a r e s u l t o f g i v i n g up on t h e t h e r a p i s t who i s not c a p a b l e to provide  the c l i e n t with a safe therapeutic  space.  The  t h e r a p i s t had secured t h e frame by p u t t i n g t h e "occupied: s i g n on t h e door y e t was unable t o prevent people from d i s t u r b i n g the session.  T h i s may r e s u l t i n t h e c l i e n t  p e r c e i v i n g t h e t h e r a p i s t as h e l p l e s s and i n e f f e c t i v e and i n t h e c l i e n t h e r s e l f f e e l i n g h e l p l e s s and i n e f f e c t i v e . Data In t h e c o n s u l t a t i o n room, t h e c l i e n t appears r e s t l e s s , she goes from p l a c e t o p l a c e and does not b e g i n t o p l a y w i t h anything.  A f t e r s e v e r a l minutes, she s t a r t s  p o i n t i n g t o t o y s p a i n t i n g u t e n s i l s and a s k i n g  questions  "What i s t h i s ? " about items t h a t she knew w e l l . Ten minutes i n t o t h e s e s s i o n , loud t a l k and l a u g h t e r of s e v e r a l people comes from the adjacent  room.  I t i s so  loud t h a t t h e t h e r a p i s t can no longer hear t h e c l i e n t . The  c l i e n t asks, "Why a r e t h e people F i r s t intervention.  laughing?".  The t h e r a p i s t answers, " I don't  102 know."  The c l i e n t walks around t h e room s e v e r a l  Second i n t e r v e n t i o n .  The t h e r a p i s t says, "The loud  t a l k i n g and l a u g h i n g bothers me, I t h i n k too." "It  i t b o t h e r s you  The c l i e n t looks away and says s o f t l y and s l o w l y ,  i s v e r y q u i e t here today." Third intervention.  a little, you  times.  The t h e r a p i s t  (astonished) w a i t s  then answers, " I t seems t o me t h a t you f e e l  that  and I a r e q u i e t here today because i t i s so n o i s y  outside." writes  The c l i e n t stops,  looks a t t h e t h e r a p i s t and  on t h e b l a c k b o a r d t h e names o f her f a m i l y ,  reads  them t o t h e t h e r a p i s t and then e r a s e s t h e w r i t i n g .  She  then goes t o t h e sand t r a y and t a l k s w h i l e she p l a y s , " T h i s i s a l i t t l e mountain. places  the f i l m character  mountain)".  And t h i s i s Spike (the c l i e n t  who cannot speak on t o p o f t h e  Her movements a r e v e r y slow and g e n t l e .  She  puts t r e e s a l l around Spike i n a c i r c l e . Fourth i n t e r v e n t i o n . t r e e s around Spike.  The t h e r a p i s t says, "There a r e  Spike i s s a f e 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 t o move v e r y quickly: buildings  she puts s e v e r a l c a r s , buses, t r a i n s , and l i n e d up i n the t r a y .  F i f t h intervention.  The t h e r a p i s t says, " I t i s v e r y  busy around Spike w i t h c a r s , buses, t r a i n s , and b u i l d i n g s . I see Spike i s alone on t h e mountain behind t h e t r e e s . " The  c l i e n t looks a t the t h e r a p i s t and says v e r y q u i e t l y ,  "Spike i s s c a r e d . "  103 Sixth intervention. scared  The t h e r a p i s t says,  "Spike i s  o f t h e people around him and so he h i d e s behind t h e  trees.  Maybe you were scared,  room t o g e t h e r  t o o , when you were i n t h e  w i t h your f a m i l y t h e very  f i r s t time and  maybe you a r e s c a r e now because people a r e so loud t h i s room.  outside  Maybe t h a t i s why you c o u l d n o t t a l k t o me  today and maybe t h a t i s why you f e l t t h a t i s was q u i e t i n here today - we d i d n ' t t a l k . "  The stops and l i s t e n s a t  the t h e r a p i s t , then she s t a r t s d i g g i n g t o make "a l i t t l e swimming p o o l " a t t h e other Seventh i n t e r v e n t i o n . a little pool."  end o f t h e sand t r a y . The t h e r a p i s t says,  "You made  swimming p o o l but Spike i s f a r away from t h e The c l i e n t looks a t t h e t h e r a p i s t and says,  softly,* "Yes. Very f a r away."  very  Then, t h e t h e r a p i s t  announces t h e end o f t h e s e s s i o n . Data A n a l y s i s The play. and  c l i e n t begins t h e s e s s i o n anxious and cannot  This i s a sign of behavioral r e s i s t a n c e  (silence)  s t r o n g communicative r e s i s t a n c e t h a t on some l e v e l  appears t o be f e a r of f r e e a s s o c i a t i o n s i n c e i t i s p o s s i b l e t o make some s p e c u l a t i o n s upon o b s e r v i n g  silent  p l a y but one cannot make any meaning out o f a s k i n g questions.  simple  As p r e d i c t e d , t h e c l i e n t d i d r e a c t t o p a r e n t a l  c o n t a c t w i t h severe a n x i e t y and d e f e n s i v e n e s s .  The  q u a l i t y of her questions  (trivial  speaks f o r r e g r e s s i o n  q u e s t i o n s ) and o f t h e c l i e n t ' s sense o f u n c e r t a i n t y .  104 Right  before  the s e s s i o n , t h e r e were two  s e c u r i n g of the frame, namely the request agreed upon time f o r the s e s s i o n s and c o n s u l t a t i o n room door.  claustrophobic c l i e n t may  the  of s e c u r i n g of  i n the c l i e n t s  a n x i e t i e s (Langs, 1982).  the  i n the manner of In t h i s case,  have been r e a c t i n g t o both, the b r e a k i n g  the s e c u r i n g of the frame.  of  for regular  the s i g n on  A l l instances  frame a l s o induce a n x i e t y  instances  the  and  Since the t h e r a p i s t d i d  not  e x p l a i n t o the c l i e n t her r e s i s t a n c e i n the l i g h t of these t r i g g e r s i t i s not p o s s i b l e t o judge the h y p o t h e s i s s i n c e the unconscious v a l i d a t i o n of the c l i e n t According  t o Langs  1  theory  however, a break i n the  w i l l be the major o r g a n i s e r The  i s missing.  of the c l i e n t ' s  c l i e n t r e a c t s t o the n o i s e  from  material.  outside  immediately w i t h a q u e s t i o n which i s a r e f l e c t i o n communicative r e s i s t a n c e , as was  frame  predicted.  of  It i s also a  m a n i f e s t mention of the c u r r e n t t r i g g e r , namely the people i n the adjacent regarding  room.  The  second i n t e r v e n t i o n  the bothersome n o i s e i s f o l l o w e d  by  a s t o n i s h i n g response by the c l i e n t t h a t i t was which i s a very vague message.  communicating even though they may third  "quiet" involve  Taken as a symbolic  communication i t says t h a t the c l i e n t and  The  the  I t does, however,  a disagreement w i t h the t h e r a p i s t .  noisy  the are  not  be s a y i n g words.  i n t e r v e n t i o n i s f o l l o w e d by the  client's  w r i t i n g down the names of her f a m i l y , which i s another  105 m a n i f e s t mention of the t r i g g e r of f a m i l y c o n t a c t  as  as an encoded t r i g g e r r e p r e s e n t a t i o n  party  contact. who  This  i s followed  of any  by a moving s t o r y of someone  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 w e l l as l i k e the c l i e n t who  has  difficulty  speaking t o the t h e r a p i s t i n t h i s s e s s i o n . i s on t h i n g s  little  third  well  ( l i t t l e mountain) and  The  emphasis  helpless  (Spike  i s a baby) which r e p r e s e n t s the p e r c e p t i o n s of helplessness predicted, helpless for  i n both the c l i e n t and  the t h e r a p i s t was  the t h e r a p i s t .  seen by the c l i e n t  i n e s t a b l i s h i n g a p r i v a t e and  As  as  c o n f i d e n t i a l space  the c l i e n t i n s p i t e of her p u t t i n g up a s i g n . The  story i s interrupted  times and  the  intervention  interventions  by the t h e r a p i s t  are premature.  i s mainly c o r r e c t and  several  The  i s followed  sixth by  unconscious v a l i d a t i o n by the c l i e n t : she makes a swimming p o o l f o r Spike validation  (a p o s i t i v e image) and  a  cognitive  (Spike cannot reach the pool) c o n c e r n i n g  c l i e n t ' s s i t u a t i o n i n therapy.  The  essence of  the  the  c l i e n t ' s s t o r y i s t h a t t h e r e i s good therapy a v a i l a b l e the c l i e n t cannot use t h e r a p i s t ' s contact  i t because she  w i t h the p a r e n t s and  of people i n the o b s e r v a t i o n The afraid  two  (and  i s scared  by  by the  but  the  presence  room.  c o m p e l l i n g n e g a t i v e images are those of b e i n g therefore  i n danger) and  something good t h a t i s out  of reach.  h e l p l e s s and The  one  of  positive  106 image i s t h a t of the presence of a p o o l . image i s , a c c o r d i n g  t o theory,  The  positive  an i n t r o j e c t i o n of  c l i e n t of the w e l l f u n c t i o n i n g t h e r a p i s t who  the  secured  the  frame. There i s no c l e a r model of r e c t i f i c a t i o n i n t h i s s e s s i o n except f o r the very remote and  nonverbal theme of  separateness as i s seen i n the placement of t r e e s i n a c i r c l e around Spike which s e p a r a t e s Spike from the busy t r a i n s , c a r s , busses, and  buildings.  Another such remote  model of r e c t i f i c a t i o n i s the a c t of w r i t i n g the names of the f a m i l y on the board and of removing her  then e r a s i n g them; i t speaks  f a m i l y from her  therapy.  Discussion There was  l i t t l e verbal material i n t h i s  however a l l p r e d i c t i o n r e g a r d i n g correct.  The  There were no r e p r e s e n t a t i o n s s e s s i o n and trigger. any  regression,  is in itself  as  predicted.  of the change i n time of  no c l e a r themes or images r e l a t e d t o  the  this  I t i s t h e r e f o r e not p o s s i b l e t o a n a l y z e or draw  conclusions  regarding  the m a t e r i a l were  s c a r c i t y of v e r b a l of m a t e r i a l  a s i g n of major r e s i s t a n c e and  session,  regarding  t h i s issues.  parental questionable  The  d e l i c a t e issue  but adamant r e q u e s t s  change i n time f o r a s e s s i o n remains unanswered by a n a l y s i s of t h i s s e s s i o n .  As noted above,  ground r u l e f o r young c h i l d r e n , r e s e a r c h secure frame therapy would be r e q u i r e d t o  for a the  to f i n d  of m a t e r i a l avoid  the from  107 confounding  of v a r i a b l e s . Case Two,  S e s s i o n Four  Therapy of Parents by C l i e n t ' s T h e r a p i s t S t a t e of the Frame Therapy w i t h p a r e n t s . the t h e r a p i s t was  asked,  by the s t a f f , t o s t a r t  therapy w i t h the c l i e n t ' s therapist.  A f t e r the p r e v i o u s s e s s i o n ,  parents together with  weekly another  The t h e r a p i s t had one s e s s i o n w i t h the p a r e n t s  b e f o r e the p r e s e n t s e s s i o n .  The p r e s e n t t h e r a p i s t  t h e r e f o r e d i d not see the c l i e n t b e f o r e the s e s s i o n w i t h her p a r e n t s and d i d not inform the c l i e n t about i t . couple's therapy was p r e s e n t t h e r a p i s t was  l e d by another t h e r a p i s t and  The  the  mainly s i l e n t d u r i n g the s e s s i o n .  A c c o r d i n g t o the t h e o r y any c o n t a c t , and  in particular  therapy, w i t h parents i s a break i n the frame of the client's  therapy.  Hypotheses Therapy w i t h any member of the c l i e n t ' s been found harmful t o the c l i e n t r e p r e s e n t s ongoing confidentiality  (Langs,  f a m i l y has  1982)  since i t  and unavoidable breaks i n  of treatment.  I t i s therefore predicted  t h a t the c l i e n t w i l l r e a c t s t r o n g l y t o t h i s break i n the frame of her therapy. been an ongoing problem  Since c o n t a c t w i t h her p a r e n t s (background  has  t r i g g e r ) f o r the  c l i e n t from the beginning of her therapy, and s i n c e she had t r i e d i n v a i n t o a l e r t the t h e r a p i s t t o the  harmful  108 e f f e c t s o f t h i s c o n t a c t by communicating numerous perceptions  and models o f r e c t i f i c a t i o n ,  i t i s predicted  t h a t t h e c l i e n t w i l l show s t r o n g communicative and b e h a v i o r a l r e s i s t a n c e by h e a v i l y d i s g u i s i n g h e r messages and  by s i l e n c e s .  Regression of the c l i e n t i s a l s o  p r e d i c t e d f o r t h e same reasons.  I f there  i s any v e r b a l  unconscious communication, i t i s p r e d i c t e d t h a t i t w i l l c e n t r e around t h i s t r i g g e r and t h a t s t r o n g n e g a t i v e  images  w i l l emerge. Data In t h e c o n s u l t a t i o n room, t h e c l i e n t goes s t r a i g h t t o the b l a c k board and w r i t e s t h e names o f her f a m i l y , reading  out loud as she goes along.  Then, she e r a s e s t h e  names.  She then w r i t e s t h e name o f her f r i e n d and says t o  the t h e r a p i s t , "She i s my f r i e n d . She would l i k e t o come w i t h me and p l a y i n here." F i r s t intervention.  The t h e r a p i s t says,  "She i s your  f r i e n d and she would l i k e t o come here with- you. you  The time  spend i n here w i t h me i s o n l y f o r you so t h a t you and  I can t a l k . " "My b r o t h e r  The c l i e n t looks a t t h e t h e r a p i s t and says,  a l s o wants t o come here.  I t o l d him he cannot  come because he i s t o o l i t t l e . " Second i n t e r v e n t i o n . brother  The t h e r a p i s t says,  "Yes, your  a l s o cannot come here because t h i s therapy i s o n l y  f o r you." The c l i e n t does not answer. s e v e r a l p a i n t s and goes t o t h e t a b l e .  She t a k e s out She s t a r t s t o p a i n t  b l o t c h e s o f c o l o u r s on paper. silently. client  She works v e r y s l o w l y and  The t h e r a p i s t asks about t h e p i c t u r e s and t h e  t e l l s o n l y what i s obvious l i k e ,  or " t h i s i s a c l o u d " .  " t h i s i s t h e sun"  A f t e r a w h i l e , about 30 minutes  i n t o t h e s e s s i o n , t h e c l i e n t takes a f r e s h sheet o f paper and p a i n t s on i t w i t h white p a i n t .  She says, " I want t o  t r y white t o see i f i t shows.  (Pause.)  No.  I t looks  l i k e t o e a t but i s n ' t . " Third intervention.  The t h e r a p i s t says, " I t l o o k s  l i k e you know t h a t p a i n t i s n ' t t o e a t . "  The c l i e n t  looks  a t t h e t h e r a p i s t and says, "I know because i t ' s t o p a i n t . (Pause.)  Paint i s poison."  The c l i e n t then s t a r t s t o  draw, but soon ends up s c r i b b l i n g u n t i l t h e end o f t h e session. Data A n a l y s i s The c l i e n t s t a r t s her s e s s i o n w i t h  a manifest  a l l u s i o n t o t h e t r i g g e r by w r i t i n g t h e names o f her parents.  She erases t h e names which can be c o n s i d e r e d a  h e a v i l y d i s g u i s e d model of r e c t i f i c a t i o n s a y i n g t h a t h e r p a r e n t s should be removed from her therapy.  I t has been  found t h a t a d u l t s and a d o l e s c e n t s u n c o n s c i o u s l y f e e l t h a t f a m i l y members, w i t h whom t h e t h e r a p i s t has c o n t a c t , a r e somehow p r e s e n t i n t h e 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 t o come w i t h her t o her therapy s e s s i o n which i s another, d i s g u i s e d , t r i g g e r r e p r e s e n t a t i o n o f the s t a f f  less  therapist,  110 who i s viewed as "a f r i e n d " o f t h e p r e s e n t generally represents  t h e r a p i s t and  t h e presence o f someone known t o t h e  c l i e n t i n h e r therapy. F i r s t intervention.  The t h e r a p i s t i n t e r v e n e s and  t e l l s t h e c l i e n t t h a t her f r i e n d cannot come. continues  The c l i e n t  t o p e r s i s t i n her e f f o r t s t o communicate t h e  same message and t e l l s o f a member o f her f a m i l y ( b r o t h e r ) , who wants t o come, but t h a t she, t h e c l i e n t , already  t o l d him t h a t he cannot come (too l i t t l e ) .  also t e l l s that there come.  i s a reason f o r not being  She  allowed t o  T h i s encoded message i s l e s s d i s g u i s e d as i t  mentions d i r e c t l y a f a m i l y member who wants t o come t o therapy.  T h i s message i s t h e r e f o r e c l o s e r t o t h e t r i g g e r  of her p a r e n t s being present c l i e n t ' s f i r s t message.  i n her therapy than t h e  The s p e c i f i c example o f t h e  reason which t h e c l i e n t g i v e s f o r a t h i r d p a r t y not being allowed t o come t o therapy does not apply  literally,  however as a remote d e r i v a t i v e , t h e message i s t h a t a v a l i d reason does e x i s t .  The message t h e r e f o r e i n c l u d e s a  model o f r e c t i f i c a t i o n which says t h a t f a m i l y members should  not be allowed i n therapy w i t h t h e same t h e r a p i s t  f o r a good reason. Second i n t e r v e n t i o n .  The second i n t e r v e n t i o n  still  does not e x p l a i n i n decoded form t o t h e c l i e n t what she i s t r y i n g t o communicate t o her t h e r a p i s t and t h e t h e r a p i s t does not promise t h a t she w i l l no longer  see h e r p a r e n t s  i n therapy.  However, t h e t h e r a p i s t does say e x p l i c i t l y ,  t h a t her f r i e n d s and her b r o t h e r cannot come and t h i s i s a c e r t a i n degree o f s e c u r i n g o f t h e frame by t h e t h e r a p i s t even though t h e c l i e n t d i d not request, i n any s p e c i f i c terms, a break i n t h e frame.  In a sense, t h e t h e r a p i s t  o f f e r s t h e c l i e n t something (a promise n o t t o a l l o w h e r f r i e n d and her b r o t h e r t o come t o therapy)  o t h e r than what  the c l i e n t i s a s k i n g f o r (her p a r e n t s out o f t h e r a p y ) . The c l i e n t stops t a l k i n g f o r a w h i l e which i s a s i g n of b e h a v i o r a l r e s i s t a n c e . obvious  L a t e r , she comments about t h e  i n her p a i n t i n g s i n a way t h a t c a r r i e d  little  encoded communication which i s a s i g n o f communicative resistance.  The c l i e n t then t e l l s about wanting t o t r y t o  d i s t i n g u i s h two s i m i l a r t h i n g s (white p a i n t on white paper).  T h i s encoded message i s a h e a v i l y d i s g u i s e d  p e r c e p t i o n o f t h e t h e r a p i s t r e g a r d i n g her a p p l i c a t i o n o f contradictory l o g i c r e l a t e d t o the contact with the f a m i l y : t h e t h e r a p i s t does not a l l o w t h e c l i e n t ' s  friend  and b r o t h e r t o come t o therapy but she does a l l o w treatment  o f her p a r e n t s .  The c l i e n t ' s decoded message  (perception of the therapist) i s that the t h e r a p i s t i s making a d i s t i n c t i o n between two o f t h e same t h i n g s : therapy w i t h a f r i e n d o r a b r o t h e r i s t h e same t h i n g as therapy w i t h p a r e n t s , j u s t l i k e white paper i s o f t h e same c o l o u r as white p a i n t and one d i s t i n g u i s h between t h e two. As noted,  t h i s message i s h e a v i l y d i s g u i s e d and t h e r e f o r e  112 open t o s p e c u l a t i o n . H e a v i l y d i s g u i s e d and i m p l i e d i n t h i s comment i s a l s o a model o f r e c t i f i c a t i o n s a y i n g t h a t t h e t h e r a p i s t  should  not c o n t i n u e t o t r y making a d i s t i n c t i o n between two o f the same t h i n g s , t h a t i s , t h a t t h e t h e r a p i s t should  treat  the i s s u e o f therapy w i t h p a r e n t s as she t r e a t s therapy with a f r i e n d or brother.  The i m p l i e d message may be  s t a t e d as s a y i n g t h a t t h e t h e r a p i s t must not t r e a t her p a r e n t s f o r t h e same reasons t h a t she does not a l l o w h e r f r i e n d and b r o t h e r  t o come t o therapy w i t h t h e c l i e n t .  The c l i e n t then adds t h a t something appears l i k e something good, but i s not, i t i s i n f a c t p o i s o n which i s a strong negative  image o f a d e c e p t i o n  of being harmed o r k i l l e d .  and o f t h e danger  The c l i e n t i s t e l l i n g t h e  t h e r a p i s t t h a t her therapy has turned  i n t o poison  t h a t i t looks d e c e p t i v e l y l i k e n u r t u r i n g but  i s i n f a c t dangerous  f o r her,  (good t o eat)  (poison) f o r t h e c l i e n t .  This i s  a l s o a c l e a r model o f r e c t i f i c a t i o n s a y i n g t h a t t h e t h e r a p i s t should  not do what must not be done ( p a i n t i s t o  p a i n t , n o t t o eat) and t h a t t o e a t p a i n t would be dangerous t o h e a l t h  (paint i s poison).  The decoded  message, as i t r e l a t e s t o her therapy and her p a r e n t s , t e l l s t h a t t h e t h e r a p i s t i s harming t h e c l i e n t w i t h dangerous therapy because she i s t r e a t i n g her p a r e n t s . By condensation, t h e r e might a l s o be a very d i s g u i s e d t r i g g e r o f the o b s e r v a t i o n  mirror  heavily  i n t h e theme  113 of "wanting t o t r y t o see i f i t shows". remote and  However, i t i s so  vague t h a t i t w i l l not be d i s c u s s e d  further.  There were no n o i s e s coming from the a d j a c e n t room t h a t s e s s i o n and suspect  the t h e r a p i s t had  t h a t t h e r e was  The  therapist s t i l l  does not  the c l i e n t ' s encoded messages, she does not  the d e s t r u c t i v e e f f e c t s on the  she does not promise t o  therapy w i t h them ( s e c u r i n g of the frame).  The  c l i e n t ' s r e a c t i o n i s t h a t of s i l e n c e ( r e s i s t a n c e ) aimless  action  (scribbling).  of drawing w e l l and  and  Since the c l i e n t i s capable  of e n j o y i n g  can a l s o be c o n s i d e r e d  admit  c l i e n t of the therapy w i t h  the c l i e n t ' s p a r e n t s (poison) and end  no reason t o  anybody t h e r e .  Third intervention. explain  observation  i t , the s i l e n t s c r i b b l i n g  regression.  Discussion The  session contained  disguised material.  scarce,  condensed, and  As p r e d i c t e d , the c l i e n t d i d employ  strong resistances, behavioral  and  communicative, and  c e n t r e her e f f o r t s on the c e n t r a l t r i g g e r of her therapy by her t h e r a p i s t . encoded form  ( f r i e n d and  The  was  The  negative  s t r o n g and  t r i g g e r was  did  parents'  represented  in  b r o t h e r wanting t o come t o  therapy) as w e l l as m a n i f e s t l y names).  heavily  ( w r i t i n g of her  image of t h r e a t t o h e a l t h  parents (poison)  t h e r e were models of r e c t i f i c a t i o n d i r e c t e d  towards the removal of p a r e n t s from her therapy  and  towards the a l e r t i n g the t h e r a p i s t t o apply her own  logic  114 to t h i s issue.  O v e r a l l , t h e hypotheses  Langs' t h e o r y were found  based  on t h e  correct.  Case Three,  S e s s i o n One:  Contact w i t h Family, Insurance,  and O b s e r v a t i o n M i r r o r  Background I n f o r m a t i o n on t h e C l i e n t The c l i e n t i s an e l e v e n year o l d boy a t t e n d i n g a p u b l i c elementary  school.  He has t h r e e younger s i b l i n g s .  P r e s e n t i n g symptoms i n c l u d e d : s t e a l i n g , e s p e c i a l l y  food,  h o a r d i n g food, e n u r e s i s , o c c a s i o n a l l y i n g , s e n s i t i v i t y t o 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 a t a s c h o o l . Two y e a r s p r i o r t o r e f e r r a l , t h e c l i e n t was t e s t e d a t the Centre by t h e s t a f f p s y c h o l o g i s t 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 a l s o  d e s c r i b e d as c o o p e r a t i v e and eager t o p l e a s e .  His s i s t e r  and h i s p a r e n t s had r e c e i v e d s e r v i c e s a t t h e c e n t r e . These s e r v i c e s as w e l l as t h e c l i e n t ' s treatment,  were p a i d i n  t o t a l by t h e p r o v i n c i a l government i n s u r a n c e p l a n . S t a t e o f t h e Frame Contact w i t h f a m i l y , s t a f f , and s c h o o l .  The f i r s t  c o n t a c t t h e t h e r a p i s t had w i t h t h e c l i e n t was a t a f a m i l y i n t e r v i e w conducted  a t the Centre by a s t a f f nurse  who  i n t r o d u c e d t h e t h e r a p i s t and recommended t o t h e p a r e n t s t h a t t h e c l i e n t be t r e a t e d i n i n d i v i d u a l s e s s i o n s f o r s i x months.  The t h e r a p i s t was mostly s i l e n t d u r i n g t h e f a m i l y  interview.  Any c o n t a c t o f t h e t h e r a p i s t w i t h  persons  115 i n v o l v e d w i t h the c l i e n t i s c o n s i d e r e d a break i n the frame: the i d e a l ground r u l e f o r the f i r s t  contact states  t h a t the c l i e n t c o n t a c t s the t h e r a p i s t d i r e c t l y .  Third  p a r t y c o n t a c t s r e p r e s e n t a v i o l a t i o n of both p r i v a c y c o n f i d e n t i a l i t y of treatment  and are powerful  and  breaks i n  the i d e a l frame. Insurance  payment.  In the area where the  client  l i v e s , a l l p s y c h i a t r i c and mental h e a l t h c e n t r e s e r v i c e s are f r e e of charge i n c o n t r a s t t o s e r v i c e s p r o v i d e d  by  p s y c h o l o g i s t s and c o u n s e l l o r s i n p r i v a t e p r a c t i c e . A c c o r d i n g t o Langs' theory, the keeping  insurance payments,  of the c l i e n t ' s r e c o r d s , v i o l a t e both p r i v a c y  and c o n f i d e n t i a l i t y of treatment powerful  especially  and are t h e r e f o r e  breaks i n the frame.  Observation M i r r o r .  The  c o n s u l t a t i o n room  was  equipped w i t h a very l a r g e and uncovered  observation  m i r r o r . The m i r r o r i t s e l f was  proportions  of unusual  shape and the f u n c t i o n of the m i r r o r  and  ( a v a i l a b i l i t y of  o b s e r v a t i o n of the c l i e n t and t h e r a p i s t by unseen t h i r d p a r t i e s ) i s a powerful  break i n the frame, v i o l a t i n g  p r i v a c y and c o n f i d e n t i a l i t y of treatment. m i r r o r was view.  The  both  observation  complemented by a l a r g e microphone i n f u l l  The t h e r a p i s t had  i n a c t u a l i t y no c o n t r o l over  use of e i t h e r the o b s e r v a t i o n m i r r o r or the transmission.  audio  the  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. theory,  On the b a s i s of Langs'  i t i s h y p o t h e s i s e d t h a t the c l i e n t w i l l r e a c t t o  these breaks w i t h unconscious communication r e v e a l i n g d e s t r u c t i v e images of danger (a consequence of a l l breaks i n the frame), w i t h themes of b e t r a y a l and (contact w i t h p a r e n t s and and  i a t r o g e n i c paranoia  s t a f f , and  not t r u s t i n g  insurance  (observation mirror  payment),  and  microphone). Since t h i s c l i e n t i s eleven y e a r s o l d , and had  been o b s e r v i n g  h i s p a r e n t s and  because he  sister receiving  s e r v i c e s a t the Centre without paying f o r them, i t i s h y p o t h e s i s e d t h a t the e f f e c t of t h i s d e v i a t i o n on h i s unconscious communication w i l l be the same as t h a t found for adults.  I t i s expected t h a t the i m p l i c a t i o n s of f r e e  s e r v i c e s may  have powerful i m p l i c a t i o n s f o r 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, t h a t i s , s t e a l i n g (taking f o r f r e e ) . The  i n t r o d u c t i o n of the f r i g h t e n i n g aspect  p o s s i b i l i t y of being mirror)  seen but not s e e i n g  as w e l l as of being heard but not  hearing  Images i n d i c a t i v e of p a r a n o i a  dangerous f o r c e s ) are p r e d i c t e d i n the  the  (observation  (microphone) i s a n t i c i p a t e d t o e f f e c t i a t r o g e n i c i n the c l i e n t .  of  paranoia  ( p u r s u i t by  material.  I t i s p r e d i c t e d t h a t the c l i e n t w i l l d i s g u i s e h i s messages  117 (remote d e r i v a t i v e s ) because t h e s i t u a t i o n i s v e r y dangerous f o r him and because t h e c l i e n t senses t h a t t h e r a p i s t has l i t t l e  c o n t r o l over most breaks i n t h e frame  w i t h l i t t l e hope f o r a c t u a l r e c t i f i c a t i o n had  been i n t r o d u c e d  (the t h e r a p i s t  as a s t u d e n t ) .  Symbolic r e p r e s e n t a t i o n s  o f t h e breaks i n t h e frame  are expected although i t i s l i k e l y t h a t they w i l l be d i s g u i s e d i n view o f t h e presence o f t h e many dangers. Models o r r e c t i f i c a t i o n may emerge.  Since t h e c l i e n t ' s  symptoms seem t o r e f l e c t a n e u r o t i c r a t h e r than b o r d e r l i n e pathology, i t i s p r e d i c t e d t h a t he w i l l n o t f e e l hopeless i n t h i s f i r s t  overly  s e s s i o n , even i n t h e f a c e o f so  many powerful breaks i n h i s f i r s t s e s s i o n , and w i l l t r y t o h e l p r a t h e r than t o harm t h e t h e r a p i s t (Langs, 1982, Searles,  1965).  There a r e other  frame breaks p r e s e n t  i n this  session  (change o f therapy rooms, break i n t h e anonymity o f t h e r a p i s t introduced  as student, and t h e i n t e n t i o n o f  w r i t i n g down t h e s e s s i o n from memory f o r s u p e r v i s i o n purposes) however, i t i s p r e d i c t e d t h a t t h e power o f t h e above t h r e e major breaks w i l l obscure t h e c l a r i t y o f t h e unconscious messages r e l a t e d t o these other breaks i n t h e frame. Data The  c l i e n t came by h i m s e l f  t o t h e w a i t i n g room and  walked w i t h t h e t h e r a p i s t t o t h e c o n s u l t a t i o n room.  On  118 the way, he s t a r t e d t o t a l k q u i c k l y about h i s f r i e n d , "Me and my f r i e n d found a t y p e w r i t e r  i n t h e park and then we  went t o some o t h e r p l a c e because people were watching." Upon e n t e r i n g  t h e room he q u i c k l y g l a n c e d around and then  s t a r t e d t o play with t r a i n tracks. remaking  He was making and  t h e t r a c k s , they always ended up open ended so  t h a t t h e t r a i n s he r a n r e p e a t e d l y t a l k i n g v e r y f a s t and l o o k i n g  fell off.  He was  s t r a i g h t at the t h e r a p i s t .  He s a i d , "My f r i e n d can change channels by p r e s s i n g d i f f e r e n t numbers on t h e type w r i t e r . " new-looking  t o y s o l d i e r out o f h i s pocket and showed i t t o  the t h e r a p i s t ,  " I found i t i n t h e park; he was j u s t l y i n g  t h e r e and so I took i t . (Pause.) working on a bomb.  electricity  and then you can make c o n t a c t  and i t  (Pause.)  F i r s t intervention. you use t h e bomb f o r ? " the s c h o o l . "  Me and my f r i e n d a r e  I f you connect two s i d e s ,  goes i n t o c a p a c i t o r s i s a bomb!"  He then took a  The t h e r a p i s t asked,  "What c o u l d  The c l i e n t answered, "To blow up  (Pause.)  Second i n t e r v e n t i o n .  The t h e r a p i s t asked, "What  c o u l d happen then, i f t h e r e were no s c h o o l ? " answered, " I c o u l d p l a y . " Third intervention. would you p l a y ? "  The c l i e n t  (Pause.) The t h e r a p i s t asked, "Where  t h e c l i e n t answered, "In my f o r t .  and my f r i e n d made a f o r t - h o u s e .  Me  I t was r e a l l y b i g and  t h e r e was a s o f t , t h i c k mattress f o r two people.  The f o r t  119 was made o f huge plywood and a l l was made o f a b i n . " ( H i s v o i c e was f u l l o f a d m i r a t i o n and p r i d e . ) Fourth i n t e r v e n t i o n .  The t h e r a p i s t s a i d , " I t sounds  l i k e a wonderful f o r t - h o u s e . "  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, t o dry.  long  time  We cannot use i t u n t i l i t d r i e s . "  F i f t h intervention.  The t h e r a p i s t s a i d , "You had  made a b e a u t i f u l f o r t where you can p l a y w i t h your f r i e n d but  t h e r a i n s p o i l e d 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 e i g h t c a r s , they robbed a bank and t h e p o l i c e i n one slow c a r was a f t e r them, then t h e guys they blew up t h e c a r w i t h a bomb, and POUFFE!, they took l o t s o f money, they stacked a l l bags o f money i n t o one b i g bag.  They had l o t s  of money." Sixth intervention.  The t h e r a p i s t asked, " I wonder  what t h e robbers would want t o use t h e money f o r . " c l i e n t answered, "I don't know. Seventh i n t e r v e n t i o n . what o t h e r t h i n g s  They would buy t h i n g s . "  The t h e r a p i s t s a i d , " I wonder  t h e guys c o u l d have done t o g e t money,  b e s i d e s r o b b i n g a bank." get a l o a n .  The  The c l i e n t answered, "They  But, t h a t would be a b i g l o a n . "  could  (While  t a l k i n g , t h e c l i e n t c o n t i n u e s t o connect t r a i n t r a c k s open-ended loops so t h a t t h e t r a i n c a r s r e p e a t e d l y  into  run o f f  the t r a c k s and overturn.) Eight  intervention.  The t h e r a p i s t s a i d , " I see t h a t  120 the t r a i n runs o f f the t r a c k s again and  again.  I wonder  i f the t r a i n c o u l d use t r a c k s i n the shape of a c i r c l e , then i t c o u l d keep on g o i n g . "  The  c l i e n t started to  connects the t r a c k s i n t o a l a r g e c i r c l e w h i l e t h e r a p i s t continued t o l d me f o r t and  the  w i t h the i n t e r v e n t i o n , "Today,  about your f r i e n d and about the movie."  you  the type w r i t e r , about your  At t h a t p o i n t , the  client  completed the c i r c l e of t r a c k s , but then q u i c k l y opened i t up  i n t o t o a U-shape.  He ran the t r a i n s l o w l y on  t r a c k s then suddenly, he two  l e t i t d e r a i l and  "flew"  i t about  f e e t away and through the window of a d o l l house where  the t r a i n smashed i n t o f u r n i t u r e and said,  "Oops" and  dolls inside.  smiled but d i d not s e t the  d o l l s s t r a i g h t . The  c l i e n t then spent  comment, l i k e , sinks".  The  "Oh,  a toilet,  He  overturned  s e v e r a l minutes  l o o k i n g a t d e t a i l s of the d o l l house w i t h an  and  the  occasional  but no d r a i n , " or  c l i e n t then g i v e s a b a b y - d o l l  "Two  a milk b o t t l e  p l a c e s the mother f a c i n g away from the baby,  looking  out the window. Ninth  intervention.  The  t h e r a p i s t intervened,  t h a t the mother i s l o o k i n g out the window and the baby."  The  "everything got up and He  cannot  c l i e n t responded immediately, "The  a s l e e p " then got up and  d e c l a r e d t h a t he had  i n the house".  "I  see  see  baby i s  see  He put away the t r a i n t r a c k s ,  t o the sand t r a y , "I want t o p l a y i n the  then took out h i s toy, the s o l d i e r he had  sand."  found i n the  121 park, and p l a c e d i t f a c e down i n t h e sand, s a y i n g , i s the desert".  He then b u i l t a h i g h c i r c u l a r  around t h e s o l d i e r .  "This  fence  Then, he smiled when he found t r e e s  and put many i n s i d e t h e fence. Tenth i n t e r v e n t i o n .  The t h e r a p i s t s a i d , " I cannot  see t h e s o l d i e r , he i s hidden by t h e t r e e s . " commented, " I t ' s a sanctuary."  The c l i e n t  The t h e r a p i s t c o n t i n u e s ,  " I t i s a s a f e p l a c e f o r t h e s o l d i e r , nobody can come i n and harm t h e s o l d i e r . " emphatically  The c l i e n t responded  (as i f c o r r e c t i n g t h e t h e r a p i s t ) , "And,  nobody can c u t down t h e t r e e s ! " " I t i s a sanctuary The  very  The t h e r a p i s t continued,  f o r t h e s o l d i e r and f o r t h e t r e e s " .  c l i e n t continued,  "The s o l d i e r wears camouflage, t h e  people cannot see him". The  t h e r a p i s t continued,  " J u s t l i k e you" (the c l i e n t  wore a m i l i t a r y type f a t i g u e t o p ) .  He responded i n an  eager v o i c e and l o o k i n g s t r a i g h t a t t h e t h e r a p i s t , "Top i s O.K., but they can see my pants.  I have o t h e r pants w i t h  b l o t c h e s and when I wear them people cannot see me i n t h e bushes.  I t ' s camouflage.  Eleventh "You  I can h i d e ! "  intervention.  The t h e r a p i s t i n t e r v e n e d ,  can be s a f e 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 p l a c e d then e n c i r c l i n g t h e sanctuary. elephants"  The he p l a c e d a " f a m i l y o f  i n t h e sand which were pursued by more l i o n s  and a r h i n o c e r o s .  He moved t h e l i o n s ' l e g s and e x p l a i n e d  122 t h a t "they a r e going t o a t t a c k t h e e l e p h a n t s " .  He p l a c e d  a p o l a r bear i n t h e water, "two b l a c k panthers were a t t a c k i n g a sheep", and two snakes were "hidden" i n t h e sand. Twelfth i n t e r v e n t i o n .  The t h e r a p i s t s a i d , "The  j u n g l e animals a r e ready t o a t t a c k t h e e l e p h a n t s . soldier i s safe."  The c l i e n t ' s f a c e became v e r y tense and  he moved t h e t o y s w i t h more speed. c l o s e r t o t h e elephants,  t o "eat t h e t r e e s " .  He moved t h e l i o n s  then he took t h e elephants and  p l a c e d them i n t h e sanctuary  and moved t h e b l a c k panthers  The t h e r a p i s t continued,  l i o n s w i l l not a t t a c k t h e elephants The  The  "Perhaps t h e  and t h e sheep now".  c l i e n t stopped t o l i s t e n , then put a g i r a f f e next t o  the sanctuary  fence,  "The g i r a f f e i s e a t i n g a t r e e  (growing i n s i d e t h e s a n c t u a r y ) " . At t h i s p o i n t , t h e s e s s i o n ended on time and t h e client  left.  Data A n a l y s i s The  c l i e n t s t a r t s t o communicate w i t h t h e t h e r a p i s t  b e f o r e they e n t e r t h e c o n s u l t a t i o n room about f i n d i n g a r e c o r d i n g d e v i c e i n one p l a c e and then going t o another p l a c e t o a v o i d being watched.  T h i s communication can be  e x p l a i n e d as an unconscious communication o f many l a y e r e d meaning.  As a r e p r e s e n t a t i o n of a t r i g g e r i s a c l o s e  d e r i v a t i v e o f t h e move from one p l a c e where people watched ( i . e . the family interview i n the previous  session) t o a  123 more p r i v a t e p l a c e The  (a p l a y room alone w i t h the  therapist).  same communication a l s o serves as a  r e p r e s e n t a t i o n of another t r i g g e r r e l a t e d t o c o n f i d e n t i a l i t y i s s u e , namely the presence of r e c o r d i n g of personal  information  (at the f a m i l y meeting,  the  i n t e r v i e w i n g nurse asked about s c h o o l r e c o r d s t o be to  her by the c l i e n t ' s parents w h i l e h o l d i n g the  file  i n p l a i n view).  On the way  sent  client's  t o the f a m i l y i n t e r v i e w ,  the c l i e n t passes the s t a f f s e c r e t a r y 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 t o  the theme of changes and  i s considered h e a v i l y disguised.  Next, the c l i e n t communicates the n e g a t i v e theme of stealing  ( " i t was  j u s t l y i n g t h e r e and  so I took i t " ) of a  t o y i n the park which i s a remote d e r i v a t i v e of what the t h e r a p i s t was the Centre,  doing,  by i m p l i c a t i o n of her c o n n e c t i o n  with  namely, s t e a l i n g and making use of the p r i v a t e  i n f o r m a t i o n which belonged t o the c l i e n t as w e l l as f o r her use as a student. negative  T h i s f i r s t communication i s a c l e a r  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 d e s t r u c t i v e n e s s of the a c t i o n by therapist.  According  the  t o Langs' theory the t h e r a p i s t i s  h e l d r e s p o n s i b l e f o r the t o t a l i t y of the treatment by c l i e n t which i n c l u d e a l l a c t i o n s by the Centre as r e l a t e t o the treatment. The  d e s t r u c t i v e n e s s of  the  they  the  t r i g g e r i s emphasized by the n e g a t i v e theme of b u i l d i n g a  124 bomb t h a t can explode and blow up t h e s c h o o l . F i r s t and second i n t e r v e n t i o n s .  These two  i n t e r v e n t i o n a r e not i n t e r p r e t i v e , however they seem t o f o l l o w t h e c l i e n t ' s l i n e o f thought.  The c l i e n t ' s  response o f being a b l e t o p l a y a f t e r s c h o o l up  has been blown  i s c o n s i d e r e d a model o f r e c t i f i c a t i o n by t h e c l i e n t ,  w i t h t h e meaning o f g e t t i n g r i d o f h i s s c h o o l  records  ("blow up t h e school") i n t h e p o s s e s s i o n o f t h e Centre as a p r e r e q u i s i t e f o r h i s p l a y therapy T h i r d and f o u r t h i n t e r v e n t i o n s .  ("play"). The i n t e r v e n t i o n s  were again not i n t e r p r e t i v e and t h e t h e r a p i s t d i d not f o l l o w t h e c l i e n t ' s model o f r e c t i f i c a t i o n o f g e t t i n g r i d of h i s p e r s o n a l r e c o r d s .  I t was p r e d i c t e d  that the c l i e n t  may t r y harder t o a l e r t t h e t h e r a p i s t t o t h i s i s s u e as w e l l as show s i g n s o f g i v i n g up on t h e t h e r a p i s t o r e l s e t r y t o harm t h e t h e r a p i s t . made a more e l a b o r a t e  Data show, t h a t t h e c l i e n t  e f f o r t a t communicating t o t h e  t h e r a p i s t w i t h h i s model o f 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 o f b u i l d i n g a good f o r t - h o u s e w i t h s o f t m a t t r e s s f o r two  people, which was r u i n e d  before i t d r i e s .  by r a i n and cannot be used  T h i s model i s a c l e a r d e r i v a t i v e appeal  t o t h e t h e r a p i s t t o make h i s therapy p r i v a t e and c o n f i d e n t i a l without t h e presence o f t h i r d ("mattress f o r two p e o p l e " ) .  parties  I t i s a l s o shows t h e  t h e r a p i s t t h a t t h e r e 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 b e f o r e i t d r i e s " ) .  125 F i f t h intervention.  T h i s i s y e t another non-  i n t e r p r e t i v e i n t e r v e n t i o n by t h e t h e r a p i s t and t h e c l i e n t responds t o i t by changing t h e t o p i c .  H i s n e g a t i v e theme  i s c l e a r l y a d e s t r u c t i v e and v i o l e n t one ("blew up t h e c a r w i t h a bomb") and an i l l e g a l one ("robbed a bank").  The  t o p i c shares t h e same theme w i t h t h e t r i g g e r , namely t h e theme o f t a k i n g p e r s o n a l  records  i n t e r f e r e n c e from t h e law  illegally  without  ( i . e . , o f robbers g e t t i n g away  w i t h t h e i r plunder and g e t t i n g r i d o f the law). no more e f f o r t s a t r e c t i f i c a t i o n by t h e c l i e n t ,  There i s and t h e  p r e v a i l i n g o f crime over law shows t h a t t h e c l i e n t i s c u r r e n t l y g i v i n g up on t h e t h e r a p i s t ' s a b i l i t y t o r e c t i f y the break i n the frame, as p r e d i c t e d by t h e t h e o r y . T h i s same n e g a t i v e image of s t e a l i n g and g e t t i n g away w i t h i t a l s o serves a t t h e r e p r e s e n t a t i o n of i n s u r a n c e coverage.  of the t r i g g e r  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 c e n t r a l fund o f t h e government i n s u r a n c e ("the  plan  bank") and g e t t i n g away w i t h i t (the p o l i c e c a r  chasing  t h e robbers i s d e s t r o y e d ) .  S i x t h and seventh i n t e r v e n t i o n s .  Both a r e non-  i n t e r p r e t i v e i n t e r v e n t i o n s which w i l l d i s c o u r a g e t h e c l i e n t i n h i s e f f o r t s t o communicate m e a n i n g f u l l y w i t h t h e therapist.  As p r e d i c t e d by t h e t h e o r y , t h e c l i e n t i s  l i k e l y t o g i v e up h i s e f f o r t s and t o shown s i g n s o f communicative r e s i s t a n c e . no  longer  Data show, t h a t t h e c l i e n t i s  communicating spontaneously and r i c h l y , but i s  126 t r y i n g t o answer i r r e l e v a n t q u e s t i o n s .  In h i s p l a y ,  c l i e n t c o n t i n u o u s l y shows s i g n s of f r u s t r a t i o n w i t h t h e r a p i s t , by not succeeding  the the  t o connect the t r a i n t r a c k s  and by r e p e a t e d l y running the t r a i n o f f the t r a c k s . i s a non-verbal  ( t h e r e f o r e non-conclusive)  This  evidence  for  the c l i e n t ' s i n t r o j e c t i o n of the t h e r a p i s t i n a b i l i t y "connect" the c l i e n t ' s themes t o the Eight intervention.  to  triggers.  Another n o n - i n t e r p r e t a t i v e  i n t e r v e n t i o n leads the c l i e n t t o f o l l o w the t h e r a p i s t ' s instruction  (connect  the t r a c k s i n t o a c i r c l e ) but t o  end  d e r a i l i n g the t r a i n again, and c r a s h i n g i t i n t o a house f u l l of d o l l s . evidence. intrusion  There are no  models of r e c t i f i c a t i o n i n  There are themes of d e s t r u c t i v e n e s s and (crash through the window).  r e s i s t a n c e i s i n evidence  The  violent  communicative  as the c l i e n t no l o n g e r 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  t e n t a t i v e 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. T h i s i s e x p l a i n e d by t h e o r y w i t h the f a c t t h a t the t h e r a p i s t was c l i e n t on some l e v e l by conducting and by not  the  h e l p f u l t o the  the s e s s i o n i n p r i v a c y  i n t r o d u c i n g f u r t h e r breaks i n the frame.  t h e r a p i s t i s however seen as someone who  The  turned away from  the c l i e n t , which i s a n e g a t i v e  image r e p r e s e n t i n g a v a l i d  p e r c e p t i o n of the t h e r a p i s t who  d i d not understand  and  make use of the c l i e n t ' s unconscious communications. There i s some r e f e r e n c e t o the window, f o r the second  127 time i n t h i s  s e s s i o n ( e i g h t i n t e r v e n t i o n ) , which may  be a  r e p r e s e n t a t i o n of the t r i g g e r of the o b s e r v a t i o n m i r r o r . The themes r e l a t e d t o the window are n e g a t i v e i n both cases. P l a y i n g i n the sand box,  the c l i e n t communicates a  n e g a t i v e image of a s o l d i e r l y i n g on h i s f a c e i n the desert.  I t i s an image t h a t r e p r e s e n t s the c l i e n t ' s  valid  p e r c e p t i o n of h i s c u r r e n t r e l a t i o n s h i p w i t h h i s t h e r a p i s t , namely t h a t the t h e r a p i s t i s non-communicative  (lying  down) as she does not t a l k about what the c l i e n t t o convey and t h a t h i s therapy Tenth  intervention.  i s barren  i s trying  (desert).  The t h e r a p i s t makes y e t  non-interpretative intervention.  The  face  another  f u n c t i o n of the  communication i s not d e s t r u c t i v e f o r the c l i e n t and  the  c l i e n t changes t o p i c and communicates a g a i n i n r i c h d e r i v a t i v e s a model of r e c t i f i c a t i o n .  The  client  presents  the t h e r a p i s t w i t h a c o m p e l l i n g theme of a sanctuary, where no harm can be done (nobody can c u t down the t r e e s ) and where one  i s s a f e from being watched  cannot see him).  (the people  The c l i e n t e a g e r l y a c c e p t s  the  t h e r a p i s t ' s c o n n e c t i o n of the p l a y image t o the h i m s e l f w i t h another model of r e c t i f i c a t i o n  client  with  the  image of h i m s e l f being capable of h i d i n g from being seen by the  people.  The model i s y e t another  appeal by the c l i e n t t o the  t h e r a p i s t t o p r o v i d e a sanctuary f o r him where t h i r d  128 p a r t i e s would be prevented from i n t e r f e r i n g therapy.  I t seems t h a t the c l i e n t has  therapist's efforts  with h i s  p i c k e d up  the  t o understand h i s unconscious  communications because the c l i e n t i s now  communicating  again w i t h r i c h images and h i s communicative r e s i s t a n c e has  diminished. Eleventh  and  twelfth interventions.  The  therapist's  i n t e r v e n t i o n i s a weak attempt a t i n t e r p r e t a t i o n .  It is  c o r r e c t i n the sense t h a t i t addresses the c l i e n t ' s f o r p r i v a c y and and  confidentiality,  but  i t remains  need  general  promises no a c t u a l r e c t i f i c a t i o n by the t h e r a p i s t .  Theory would p r e d i c t 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 more e f f o r t s  by the c l i e n t t o reach the t h e r a p i s t  communicatively. presents  The  c l i e n t again changes t o p i c  s t r o n g l y negative  themes  of powerful  ready t o a t t a c k weaker beings ( l i o n s and ready t o a t t a c k a f a m i l y of elephants; a sheep; and  and  lions  themes are c l e a r l y  encircling persecutory  predators  rhinoceros  panthers a t t a c k i n g  the s a n c t u a r y ) .  These  as they express imminent  t h r e a t of v i o l e n c e f o r those exposed f o r those i n a sanctuary  a  and  (elephants  (sheep) as w e l l and  the  as  soldier).  There i s a model of r e c t i f i c a t i o n i n the theme of b l a c k panther t u r n i n g away from t h r e a t e n i n g e a t i n g the t r e e s i n s t e a d . should  (sheep).  and  I t suggests t h a t the t h e r a p i s t  be s a t i s f i e d w i t h such g r a t i f i c a t i o n s  harm the c l i e n t  the sheep  the  Another model of  t h a t do  not  rectification  129 i s p r e s e n t e d w i t h t h e image o f t h e e l e p h a n t s b e i n g i n t o the sanctuary  placed  (where one i s not seen) s u g g e s t i n g t h a t  the t h e r a p i s t should put a stop t o t h e i n t e r f e r e n c e s o f t h i r d p a r t i e s and p r o v i d e a p r i v a t e and c o n f i d e n t i a l treatment The  (a sanctuary)  instead.  therapist's last intervention  (Perhaps t h e l i o n s  w i l l not a t t a c k t h e elephants and t h e sheep now) i s not only n o n - i n t e r p r e t a t i v e ,  i t i s a l s o has t h e f u n c t i o n o f 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  t h r e a t t o h i s therapy. The c l i e n t ' s response i s , as p r e d i c t e d by t h e theory, n o n - v a l i d a t i n g ,  i t does not  extend h i s deeper understanding o f t h e i s s u e , and i t i s i n the form o f a n e g a t i v e image o f something t h a t i s used f o r protection  ( i . e . , t r e e s i n s i d e t h e s a n c t u a r y can h i d e t h e  s o l d i e r from being seen from o u t s i d e ) b e i n g d e s t r o y e d from outside The  ( g i r a f f e e a t i n g from o u t s i d e  of the fence).  same image o f watching over t h e fence can a l s o  serve as a d i s t a n t r e p r e s e n t a t i o n of t h e o b s e r v a t i o n  mirror.  of the t r i g g e r , that i s  The n e g a t i v e theme o f  d e s t r u c t i o n of the s h e l t e r i n g trees  ( g i r a f f e e a t i n g away  t r e e s i n s i d e t h e sanctuary) i s t h e c l i e n t ' s response t o t h i s t r i g g e r : the observation of h i s treatment.  mirror destroys the privacy  The d i s t a n t r e p r e s e n t a t i o n  of the  t r i g g e r i s a s i g n o f some communicative r e s i s t a n c e . Discussion The  o v e r a l l p r e d i c t i o n s regarding  t h e presence o f  130 s e v e r a l major breaks i n the frame was d i d communicate d e s t r u c t i v e images and The  c o r r e c t : the  client  themes of danger.  p r e d i c t i o n s made on the b a s i s of the knowledge of  t r i g g e r s t h a t had correct.  The  e x i s t e d b e f o r e the s e s s i o n were a l l  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 t o treatment, were w e l l r e p r e s e n t e d i n the c l i e n t ' s material. triggers,  The  c l i e n t ' s r e a c t i o n s t o these  i n terms of themes and  theoretical predictions. meaning was triggers.  images, a l s o  followed  Themes were n e g a t i v e and  their  shared w i t h the u n i v e r s a l meaning of such The  s p e c i f i c p r e d i c t i o n regarding  the  unconscious i m p l i c a t i o n s of insurance payments f o r h i s treatment and  of the c l i e n t ' s r e c o r d s  c l i e n t ' s symptom of s t e a l i n g was was  i n r e l a t i o n to  a l s o c o r r e c t ; the  s t r o n g l y s e n s i t i v e t o t h i s i s s u e and  representation  of the o b s e r v a t i o n  of the t h i r d t r i g g e r , the  mirror  moderately d i s g u i s e d ,  client  communicated a  v i v i d s t o r y of bank robbers g e t t i n g away w i t h the The  the  loot. presence  i n the c o n s u l t a t i o n room, i s  y e t the  i m p l i c a t i o n s of the  of being watched were v i v i d l y p o r t r a y e d .  As  dangers  predicted,  t h e r e are s e v e r a l c o m p e l l i n g models of  rectification  p r e s e n t i n the c l i e n t ' s m a t e r i a l .  v i c i s s i t u d e s of  The  c l i e n t ' s communicative r e s i s t a n c e s f o l l o w e d moment i n t e r a c t i o n between the c l i e n t and diminishing  the  the moment-to-  the t h e r a p i s t  by  when the t h e r a p i s t understood h i s unconscious  communication and  increased  when she d i d not  understand.  Case Three,  Session  Two  O b s e r v a t i o n M i r r o r , Touching  Toys  and Background T r i g g e r s S t a t e of the Frame Observation mirror.  The c l i e n t i s s t i l l  being  seen  by the t h e r a p i s t i n the c o n s u l t a t i o n room w i t h the l a r g e observation mirror.  A c c o r d i n g t o theory, the  client's  p r i v a c y and c o n f i d e n t i a l i t y are m o d i f i e d which c o n s t i t u t e s a s e r i o u s break i n the frame. Touching  toys.  The  i d e a l frame a l l o w s no p h y s i c a l  c o n t a c t w i t h e i t h e r the c l i e n t or the possessions.  client's  Both are c o n s i d e r e d a v i o l a t i o n of the  i m p l i c i t ground r u l e s and boundaries they v i o l a t e the c l i e n t ' s p r i v a t e  of therapy because  space.  Contact w i t h t h i r d p a r t i e s and i n s u r a n c e payments. The background t r i g g e r s which had o c c u r r e d b e f o r e the f i r s t s e s s i o n ( c o n t a c t w i t h t h i r d p a r t i e s and treatment)  free  have not been c o r r e c t e d although t h e r e were no  f u r t h e r m o d i f i c a t i o n s of the frame i n these a r e a s . Hypotheses The o b s e r v a t i o n m i r r o r without covers r e p r e s e n t s a c o n s t a n t t h r e a t t h a t the c l i e n t w i l l be seen by unseen p a r t i e s which i s a powerful t r i g g e r w i t h  unconscious  i m p l i c a t i o n s of danger of being exposed, and of b e t r a y a l by the t h e r a p i s t .  To be seen but not t o see the  i s c o n s i d e r e d a s i t u a t i o n which can t r i g g e r  observer  iatrogenic  132 paranoia  i n the c l i e n t  The  (Langs>  t h e r a p i s t ' s touching  i s considered  unconsciously  own  theory  will  communicate t o the t h e r a p i s t t h a t such  i s wrong and  t h a t i t i s harmful t o the  client.  not n o t i c e d t h a t the c l i e n t  toy i n the c o n s u l t a t i o n room at the end  previous  possessions  t o the  I t i s p r e d i c t e d t h a t the c l i e n t  Since the t h e r a p i s t had his  of the c l i e n t ' s  a powerful t r i g g e r a c c o r d i n g  (Langs, 1976).  touching  1976).  of  forgot the  s e s s i o n , the t h e r a p i s t has kept the t o y f o r a  week ( u n t i l the s e s s i o n under d i s c u s s i o n ) her t o u c h i n g  h i s toy.  i n addition to  I t i s p r e d i c t e d t h a t such keeping  of h i s toy w i l l have an adverse impact on the c l i e n t that this  and  impact w i l l be communicated s y m b o l i c a l l y t o  the  therapist. According  t o theory,  i n f l u e n c e on the c l i e n t ' s  these t r i g g e r s w i l l e x e r t  unconscious communications,  however, the c u r r e n t l y p r e s e n t mirror)  i s considered  (observation I t i s therefore  unconscious m a t e r i a l w i l l  around the o b s e r v a t i o n  t h e r a p i s t has mirror  trigger  the most p o w e r f u l .  p r e d i c t e d t h a t the c l i e n t ' s organised  their  mirror.  Since  the  not r e c t i f i e d t h i s break i n the frame  i s s t i l l not covered),  (the  the c l i e n t i s l i k e l y t o show  communicative r e s i s t a n c e and m i s t r u s t towards the therapist. Data The  be  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 , t h a t he "almost f o r g o t about the  s e s s i o n " because he was w r i t i n g something on the computer. In the c o n s u l t a t i o n room, the c l i e n t goes t o the o b s e r v a t i o n m i r r o r , puts h i s f a c e r i g h t next t o the g l a s s and says' "I can see c u r t a i n s on the o t h e r s i d e ! "  Then,  he t a k e s o f f h i s w r i s t watch and puts i t i n h i s pocket. F i r s t intervention.  The t h e r a p i s t g i v e s back t o the  c l i e n t the t o y s o l d i e r he had f o r g o t t e n l a s t time.  The  c l i e n t t a k e s the s o l d i e r and drops i t ,  f a c e down, i n the  sand t r a y .  My  knapsack  The c l i e n t says, "Thanks.  friend left his  on the ground a t s c h o o l and h i s t e a c h e r stumbled  over i t and took i t away from my he can walk home without i t .  f r i e n d and she s a i d  So, he walked  that  15 minutes t o  X S t r e e t , then he t u r n e d around and had t o walk a l l the way  back t o s c h o o l . " Second  intervention.  The t h e r a p i s t s a i d ,  "I wonder  i f what happened t o your f r i e n d i s l i k e what happened t o you when I took your s o l d i e r and kept i t and-brought i t back t o 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 t o p l a y w i t h d o l l s r e p r e s e n t i n g d o c t o r s , nurses and p a t i e n t s .  H i s p l a y shows no c l e a r theme.  He t a k e s  d o l l s out of a box,  one by one, and r i g h t away throws them  back i n t o the box.  He then abandons the d o l l s and t u r n s  t o LEGO b l o c k s . something. therapist.  He takes out a p l a n and s t a r t s t o b u i l d  He l o o k s d e f i a n t and does not look a t the  134 Third intervention. t h e r a p i s t says, me  today.  20 minutes i n t o the s e s s i o n ,  the  " I t seems t h a t you have t r o u b l e t a l k i n g t o  I wonder i f something happened i n here t h a t  makes i t d i f f i c u l t  f o r you  to t a l k . "  The  c l i e n t answers  immediately, "I don't know. Nothing t h a t I know o f . " Fourth  intervention.  f i r s t t h i n g you d i d was and you side. you  t o l d me Then, you  had  t h e r a p i s t s a i d , "Today,  t o go t o the o b s e r v a t i o n can see c u r t a i n s on the  t r o u b l e t a l k i n g t o me.  s i d e of the m i r r o r . "  smiles.  The  the  mirror other  I wonder i f  are a f r a i d t h a t someone might be watching you  other  very  t h a t you  The  from  the  c l i e n t lowers h i s head  and  He then s t a r t s t o b u i l d something out of LEGO  quickly. I t t u r n s out t o be a house w i t h a door and  two  s p e c i a l windows: the g l a s s panes have s h u t t e r s on both s i d e s : the i n s i d e and  the o u t s i d e .  c l o s e s the s h u t t e r s s e v e r a l times.  The  c l i e n t opens  As he  and  i s completing  the r o o f of the house, the s e s s i o n s ends. The  c l i e n t puts  on h i s w r i s t watch, takes h i s toy s o l d i e r , and  leaves.  Data A n a l y s i s The  c l i e n t ' s l a t e n e s s and  the f a c t t h a t he  f o r g o t about the s e s s i o n i s a s i g n of r e s i s t a n c e which i s c o n s i d e r e d and  behavioral  i n t e r a c t i o n a l by the  occurs when t h e r e are major breaks i n the  (Langs, 1976). manifestly  The  observation  almost  mirror  is  theory  frame  represented  (I can see the c u r t a i n s on the other s i d e ) .  135 S i n c e the t h e r a p i s t makes her  first  intervention  right  a f t e r the c l i e n t ' s f i r s t communication i n the s e s s i o n , d e r i v a t i v e r e a c t i o n w i l l apply t o the f i r s t F i r s t intervention.  The  toy s o l d i e r .  the s c h o o l punished confusion for  The  f r i e n d and  (by the teacher) f o r a mistake and t h a t such punishment b r i n g s  The  of  the  ( h i s f r i e n d walked  then turned around  theme i s not  fully  and  developed  are s i g n s of communicative r e s i s t a n c e as  c l i e n t stops t a l k i n g and Second i n t e r v e n t i o n .  has  The  no admission t h a t her  c l i e n t t o f e e l confused.  The  play.  therapist's intervention i s i s no  admission by the t h e r a p i s t t h a t her a c t i o n was and  the  no c l e a r theme i n h i s  an attempt a t i n t e r p r e t a t i o n , however, t h e r e  appropriate  of  h i s knapsack i s t h a t of b e i n g  15 minutes t o a s t r e e t and  there  returning  n e g a t i v e theme of h i s s t o r y about  walked back t o s c h o o l ) . and  intervention.  c l i e n t comments, i n symbolic  form, on the t h e r a p i s t ' s t a k i n g , keeping and his  his  clear  not  a c t i o n caused  client's  the  indicator>(his  l a t e n e s s because he almost f o r g o t about h i s s e s s i o n )  is  not e x p l a i n e d  and  the  i n the  i n t e r v e n t i o n was  l i g h t of the t h e r a p i s t ' s a c t i o n not v a l i d a t e d by the c l i e n t .  Only a very vague n e g a t i v e theme can be the non-verbal p l a y t h a t f o l l o w s the client  (the d o l l - p a t i e n t ) f i n d s the  helping professionals nurses) u s e l e s s  intervention.  The  i n t e r a c t i o n with  (dolls representing  ( f o r h i s play) and  identified in  doctors  the  and  abandons h i s e f f o r t  at  136 communicating a s t o r y  (drops the d o l l s back i n t o the  H i s unorganised p l a y w i t h the d o l l s r e p r e s e n t i n g professionals confusion,  help  i s a l s o a r e f l e c t i o n of the c l i e n t ' s  which i s a consequence of h i s i n t r o j e c t i o n of  the c o n f u s i n g and  box).  f u n c t i o n of the t h e r a p i s t a c t i o n of  keeping h i s toy and  vague v a l i d p e r c e p t i o n  i s therefore  a non-verbal  of the t h e r a p i s t .  c o n t i n u e s t o show r e s i s t a n c e  and  The  taking and  client  the change of t o y s  (LEGO)  s t i l l does not b r i n g a v e r b a l s t o r y w i t h a c l e a r theme. Third intervention.  This  i s an attempt a t c o n n e c t i n g  the c l i e n t ' s r e s i s t a n c e w i t h the therapy, but s u f f i c i e n t explanation  ( i n t e r p r e t a t i o n ) t o the c l i e n t  what the t h e r a p i s t d i d . v e r b a l l y and  The  a  of  c l i e n t does, however, r e a c t  i t seems t h a t h i s main message i s t h a t i t i s  the t h e r a p i s t who going on  i t i s not  in his  has  the r e s p o n s i b i l i t y t o know what i s  sessions.  Fourth i n t e r v e n t i o n .  This i s a s u f f i c i e n t l y  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 m i r r o r ) w i t h the c l i e n t ' s i n d i c a t o r w i t h the t h e r a p i s t )  and  explains  of the t r i g g e r t o the c l i e n t  correct  (observation  (trouble  communicating  the unconscious meaning  ( h i s f e a r of being watched).  A c c o r d i n g t o theory, t h i s i n t e r v e n t i o n would r e c e i v e v a l i d a t i o n from the c l i e n t i f i t i s f o l l o w e d 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 t h e r a p i s t  by  diminished.  a  (Langs, 1982).  S i n c e the t h e r a p i s t d i d not r i g h t away cover the the c l i e n t ' s f e a r cannot be  a  mirror  137 The  c l i e n t d i d s m i l e which shows some  degree of  i n t e r p e r s o n a l v a l i d a t i o n ( i n t r o j e c t i o n of w e l l  functioning  t h e r a p i s t ) , however h i s r e s i s t a n c e continued.  H i s non-  v e r b a l communication  ( b u i l d i n g the windows w i t h  shutters  on both s i d e s of the panes) i s q u i t e eloquent, however, and  i t does show t h a t the c l i e n t  i s indeed working over  the unconscious meaning of the o b s e r v a t i o n p l a y theme i s a c l e a r non-verbal model of The  mirror.  rectification.  c l i e n t i s t e l l i n g the t h e r a p i s t t o cover  observation  m i r r o r a l s o from the i n s i d e of  the  the  c o n s u l t a t i o n room so t h a t nobody can watch him. played  His  Since  i n s i l e n c e , h i s i m p l i c i t message i s t h a t he  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 t h a t the c l i e n t d i d not f o r g e t t o take back  h i s toy and  t h a t he put h i s w r i s t watch back on i s another  non-verbal form of i n t e r p e r s o n a l v a l i d a t i o n of therapist's last intervention. is,  The  the  c l i e n t shows t h a t  he  a t the moment, f u n c t i o n i n g w e l l as a consequence of  i n t r o j e c t i n g a t h e r a p i s t who interpretation. i s explained  There was  gave a p a r t i a l l y  correct  no c o g n i t i v e v a l i d a t i o n which  by the f a c t t h a t the t h e r a p i s t d i d  r e c t i f y the break i n the  not  frame.  Discussion As p r e d i c t e d , the c l i e n t ' s symbolic m a t e r i a l d i d c e n t r e around the presence of the o b s e r v a t i o n the major t r i g g e r f o r t h i s s e s s i o n .  mirror  as  I t s i m p l i c a t i o n s were  138 negative  and were mainly r e f l e c t e d i n the  client's  r e s i s t a n c e , both communicative and b e h a v i o r a l . c l i e n t ' s negative h i s t o y was The  The  r e a c t i o n t o the t h e r a p i s t ' s t a k i n g of  a l s o as p r e d i c t e d .  impact of the background t r i g g e r s was  in t h i s session.  The  not c l e a r  c l i e n t mentioned t h e s e t r i g g e r s  n e i t h e r m a n i f e s t l y nor i n d e r i v a t i v e form.  The  i m p l i c a t i o n s 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 r e s i s t a n c e t o therapy.  I t can be t e n t a t i v e l y  proposed t h a t h i s model of r e c t i f i c a t i o n f o r the windows) may  (double s h u t t e r s  a l s o apply t o keeping a l l t h i r d  p a r t i e s out of h i s therapy. Case Three, S e s s i o n  Three:  Change of C o n s u l t a t i o n Room, E l i m i n a t i o n of Observation  M i r r o r , and Occupied  the  Sign  S t a t e of the Frame A f t e r the l a s t s e s s i o n , i n which the c l i e n t gave the t h e r a p i s t a c l e a r model of r e c t i f i c a t i o n t o .cover the o b s e r v a t i o n m i r r o r , the t h e r a p i s t was  a b l e t o arrange f o r  another c o n s u l t a t i o n room without an o b s e r v a t i o n The  change i n the rooms i s c o n s i d e r e d  mirror.  a break i n the  frame  w h i l e the e l i m i n a t i o n of the o b s e r v a t i o n m i r r o r i s an of s e c u r i n g the frame.  The  s i g n on the door of the new client.  t h e r a p i s t p l a c e d an  act  "occupied"  room i n the presence of  the  T h i s i s an a c t of s e c u r i n g the frame ( p r i v a c y ) ,  however, the i m p l i c a t i o n of the need f o r such a s i g n i s  139 the acknowledgement t h a t t h e r e i s danger from the  outside  of the room. Hypotheses The  change of rooms.  Any  change i n the p h y s i c a l  environment i s c o n s i d e r e d by the t h e o r y an impingement the frame (Langs, 1982).  The  on  change of rooms i s a break  i n the frame and some adverse r e a c t i o n i s p r e d i c t e d . Since t h i s change was  c a r r i e d out with the purpose t o  c o r r e c t another d e v i a t i o n (to e l i m i n a t e the mirror)  observation  and t h e r e f o r e t o secure the frame, i t i s p r e d i c t e d  t h a t 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 l e s s powerful  than t h a t of the s e c u r i n g of the  E l i m i n a t i o n of the o b s e r v a t i o n m i r r o r . e l i m i n a t i o n of the o b s e r v a t i o n m i r r o r was c l i e n t h i m s e l f i n h i s unconscious model of i n the p r e v i o u s  session.  frame.  The  proposed by  therapy.  Since the t h e r a p i s t a c t e d i n  i n e f f e c t secured  the  the frame of the  I t i s t h e r e f o r e p r e d i c t e d t h a t the  client's  new  c o n s u l t a t i o n room w i l l have a b e n e f i c i a l e f f e c t on c l i e n t and  the  rectification  accordance with the c l i e n t ' s unconscious p l e a , t h e r a p i s t has  be  the  i t i s expected t h a t the c l i e n t w i l l r e a c t w i t h  p o s i t i v e images and themes which w i l l express a sense of safety.  the c o m p l i c a t i n g f a c t o r i d the f a c t t h a t  the  t h e r a p i s t d i d not e x p l a i n t o 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 , t h a t he was  observation  mirror.  harmed by  the  140 Occupied s i g n . the c l i e n t  .  T h i s s i g n g i v e s a double message t o  I t a l e r t s him t o t h e presence of danger fr,om  the o u t s i d e  and i t o f f e r s p r o t e c t i o n of t h e p r i v a c y of h i s  treatment.  I t i s predicted that the c l i e n t w i l l react t o  t h i s s i g n w i t h both p o s i t i v e and n e g a t i v e images r e l a t e d to  safety.  Data On t h e way t o t h e s e s s i o n , t h e t h e r a p i s t s t o p s i n f r o n t of t h e c o n s u l t a t i o n room door and says, "We w i l l be in  another room today, without t h e m i r r o r . "  "occupied" s i g n on t h e door.  Upon e n t e r i n g ,  walks around t h e room p i c k i n g up v a r i o u s and  p l a c i n g them back i n p l a c e .  She puts an the c l i e n t  toys,  one by one,  He says, " H o l l y ! " and  "Wow!" s e v e r a l times and looks p l e a s e d .  The c l i e n t  places  s e v e r a l t o y s i n water and seems t o enjoys watching them swim.  The c l i e n t rubs h i s t h i g h and says, "My l e g h u r t s a  little.  T h i s g i r l a t s c h o o l h i t me l i k e t h i s  and  i t s t i l l hurts  toy  shelves. First  a little."  intervention.  new room today.  (shows how)  He then goes back t o t h e  The t h e r a p i s t says, "We  You looked pleased,  moving here a l s o h u r t s you a l i t t l e . "  are i n a  but perhaps our The c l i e n t  shrugs,  then goes q u i c k l y t o a t o y box and s t a r t s s e l e c t i n g animal figures.  He then p l a c e s  them i n t h e sand t r a y .  As he  p l a y s , t h e t h e r a p i s t asks about t h e s t o r y i n h i s p l a y and the c l i e n t e x p l a i n s  as he goes a l o n g .  He p l a c e s  "the b i g  141 elephant and t h e s m a l l elephant i n s i d e " a round a gate.  There i s "another  fence w i t h  s m a l l elephant w i t h one ear  m i s s i n g " j u s t o u t s i d e t h e fence.  The c l i e n t then p l a c e s  s e v e r a l winged c r e a t u r e s on t h e o u t s i d e around t h e fence as w e l l as s e v e r a l " a d u l t l i o n s p l a y i n g w i t h c h i l d  lions"  i n s i d e t h e i r own fenced p l a c e . Second i n t e r v e n t i o n .  The t h e r a p i s t says, " I see t h a t  i n your p l a y today you a r e u s i n g some o f t h e same t h a t you have used  i n your p r e v i o u s s e s s i o n .  your p l a y i s v e r y d i f f e r e n t , though.  animals  The s t o r y i n  Today, t h e e l e p h a n t s  are not out i n t h e open any more and a r e not i n danger o f being attacked.  They a r e i n s i d e t h e i r own fenced p l a c e  and so a r e t h e l i o n s .  The l i o n s a r e no l o n g e r dangerous,  they a r e p l a y i n g w i t h t h e i r c h i l d r e n . more about your s t o r y . "  Can you t e l l  me  While t h e t h e r a p i s t speaks, t h e  c l i e n t i s nodding. The c l i e n t says, " These (the winged c r e a t u r e s ) a r e guardians."  He then p l a c e s one guardian i n s i d e t h e  elephant p l a c e and says, " T h i s guardian i s guarding t h e door so t h a t t h e mother elephant does not open t h e gate w i t h her long trunk so t h a t t h e baby elephant doesn't go out o f t h e f e n c e . " Third intervention.  About f i v e minutes b e f o r e t h e  end o f t h e s e s s i o n , t h e t h e r a p i s t says, "Today, we a r e i n t h i s new room, and I put a s i g n on t h e door t o keep people from coming i n here.  I t seems t o me t h a t your s t o r y  tells  142 me  t h a t you  f e e l w e l l guarded i n here and t h a t you  s a f e being here j u s t l i k e the baby elephant w i t h h i s mother.  I t seems t h a t you  feels  feel safe  f e e l t h a t t h e r e i s no  more danger from o u t s i d e , i n your p l a y , even the l i o n s now  p l a y i n g behind  t h e i r own  fence.  Perhaps you  a l s o because t h e r e i s no m i r r o r i n t h i s room."  feel The  are safe  client  looks a t the t h e r a p i s t f o r a long time, then he puts i n t o the sand t r a y t h r e e l a r g e f i g u r e s , s a y i n g , the l e a d e r s of the guardians. The  "And  So the elephants  t h e r a p i s t announces the end  these  are  are s a f e . "  of the s e s s i o n  and  t h e r a p i s t i n t e r v e n e d b e f o r e the c l i e n t and  she  the c l i e n t leaves on time. Data A n a l y s i s The  en te re d the c o n s u l t a t i o n room by announcing the change i n rooms.  The  c l i e n t ' s response i s t h e r e f o r e c o n s i d e r e d  to  be a response t o her i n t e r v e n t i o n and t o the f a c t t h a t the c l i e n t found h i m s e l f i n a new  room.  The  c l i e n t e x p l o r e d the room, l o o k i n g and  fact that  the  sounding p l e a s e d  g i v e s t e n t a t i v e proof t o the h y p o t h e s i s  t h a t the absence  of the o b s e r v a t i o n m i r r o r w i l l have a b e n e f i c i a l e f f e c t the c l i e n t  .  The  on  c l i e n t ' s f i r s t v e r b a l response i s about  being h u r t "a l i t t l e " by someone.  T h i s message can  be  e x p l a i n e d 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  i n t e r v e n t i o n i s mostly  c o r r e c t as i t does r e l a t e the t r i g g e r  (change of rooms) t o  143 the h u r t of the c l i e n t  .  I t i s however not complete as i t  does not p l a c e the r e s p o n s i b i l i t y f o r the change on therapist a shrug  .  The  c l i e n t responds t o t h i s i n t e r v e n t i o n w i t h  (undecided  something m i s s i n g missing").  opinion) and with a n e g a t i v e image of ("the  s m a l l elephant w i t h one  V e r b a l l y , the c l i e n t responds  theme of a couple own  ear  w i t h a mixed  ( b i g and s m a l l elephant)  protected place  inside  their  (fenced p l a c e ) , r e p r e s e n t i n g the  p o s i t i v e image, of an o u t s i d e danger kept a t bay t h e i r own  fenced p l a c e ) , and  (lions i n  w i t h a p o s i t i v e image of  something made innocuous ("adult l i o n s p l a y i n g w i t h lions").  the  T h i s l a s t , p o s i t i v e image i s a  child  powerful  e x p r e s s i o n of the c l i e n t ' s f e e l i n g s of b e i n g f r e e  (lions  p l a y i n g ) and of being p r o t e c t e d  their  own  (elephants i n s i d e  fence, a p a r t from the e l e p h a n t s ) . Second i n t e r v e n t i o n .  The  intervention i s  i n t e r p r e t a t i v e and does not f u r t h e r the understanding.  non-  client's  However, i t does seem t o f u r t h e r the  client's story t e l l i n g .  There i s a r e p r e s e n t a t i o n of the  t r i g g e r of the s i g n 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  h i s s t o r y i s t h a t of the n e c e s s i t y f o r p r o t e c t i o n (guardian i n s i d e ) of the c h i l d own  caretaker's  (baby elephant)  (mother elephant)  careless inclination  ("to open the gate with her long trunk") c h i l d t o o u t s i d e danger ("so  from h i s  t o expose the  the baby elephant  does not  go  144 out"). The theme can be i n t e r p r e t e d as t h e c a r r i e r o f messages on two l e v e l s . unconscious p e r c e p t i o n  One i s t h a t o f t h e c l i e n t ' s  o f t h e f u n c t i o n o f t h e "occupied"  s i g n on t h e door as a g u a r d i a n p r o t e c t i n g t h e baby ( c l i e n t ) a g a i n s t t h e o u t s i d e danger (people p a s s i n g by, perhaps wanting t o watch t h e c l i e n t through t h e observation  m i r r o r ) as much as from h i s own mother  ( t h e r a p i s t ) , who had exposed t h e c l i e n t t o danger b e f o r e (observation  mirror  i n t h e f i r s t two s e s s i o n s ) .  The o t h e r l e v e l of meaning  i s t h a t o f a model o f  r e c t i f i c a t i o n o f f e r e d by t h e c l i e n t t o t h e t h e r a p i s t w i t h the p l e a t o p r o v i d e f o r a s a f e p l a c e  f o r him where t h e  entrance t o t h e c o n s u l t a t i o n room would be secured and danger from t h e o u t s i d e  eliminated.  Both l e v e l s o f  communications i n v o l v e images o f t h e need f o r p r o t e c t i o n and s a f e t y . Third intervention. correct.  This intervention i s p a r t l y  I t does connect t h e c l i e n t ' s s t o r y t o t h e  immediate r e a l i t y o f h i s therapy the e l i m i n a t i o n o f o b s e r v a t i o n not  (the s i g n on t h e door and  m i r r o r ) , however, i t does  e x p l a i n t h e c l i e n t ' s unconscious p e r c e p t i o n  t h e r a p i s t as dangerous  (the dangerous mother  of the  elephant).  The t h e r a p i s t does not accept and i n t e r p r e t t o t h e c l i e n t her r e s p o n s i b i l i t y t o make h i s therapy s a f e f o r him. A l s o , t h e i n t e r v e n t i o n does not touch upon t h e secure  145 frame i s s u e s r e l a t e d t o the c l i e n t ' s a n x i e t y c u r r e n t l y secure t h e r a p e u t i c  frame.  i n the  This intervention did  r e c e i v e unconscious i n t e r p e r s o n a l v a l i d a t i o n from client  ("elephants are s a f e " and  the presence of  the "the  l e a d e r s " ) , but not unconscious c o g n i t i v e v a l i d a t i o n . response by the c l i e n t i s i n accordance w i t h he  Such  theory.  Discussion The  i d e n t i f i e d t r i g g e r s f o r the s e s s i o n were the  breaks i n the frame and  one  s e c u r i n g of the frame.  two  All  t h r e e 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 r e p r e s e n t a t i o n  of one  t r i g g e r , by  themes r e l a t e d t o s a f e t y v e r s u s danger and r e c t i f i c a t i o n present According  the  by the model of  i n the c l i e n t ' s m a t e r i a l .  t o theory,  the c u r r e n t l y p r e s e n t  trigger,  which i s witnessed by both p a r t i e s t o treatment needs not be r e p r e s e n t e d  i n the c l i e n t ' s m a t e r i a l t o c o n s i d e r  the a c t i v e t r i g g e r f o r the c l i e n t ' s m a t e r i a l 1985).  (Langs,  I n t e r p r e t a t i o n s r e l a t e d t o such t r i g g e r s have  c o n s i s t e n t l y r e s u l t e d i n v a l i d a t e d responses by clients. material  Such v a l i d a t i o n i s a l s o e v i d e n t  i n the  adult current  i n the from of the i n t e r p e r s o n a l v a l i d a t i o n by  the c l i e n t i n t h i s s e s s i o n . correct.  i t as  O v e r a l l , the hypotheses were  146 Case Three, S e s s i o n  Fourteen  Audio r e c o r d i n g , Family Meeting, and Change i n t h e C o n s u l t a t i o n Room S t a t e o f The Frame Audio r e c o r d i n g .  The t h e r a p i s t recorded  the session  w i t h a tape r e c o r d e r w i t h t h e purpose t o use t h e r e c o r d i n g f o r s e l f l e a r n i n g . Such r e c o r d i n g i s c o n s i d e r e d  a major  break i n t h e frame i n v o l v i n g c o n f i d e n t i a l i t y and p r i v a c y of treatment as w e l l as s e l f - r e v e l a t i o n by t h e t h e r a p i s t who needs t o l e a r n and t h e r e f o r e f e e l s Family meeting.  inadequate.  The s t a f f nurse arranged t o meet  w i t h t h e c l i e n t ' s f a m i l y t o inform them about how t h e c l i e n t was doing  i n therapy and t o i n q u i r e about t h e  c l i e n t ' s c u r r e n t l e v e l o f f u n c t i o n i n g a t home and a t school. illness.  The t h e r a p i s t was absent from t h e meeting due t o Such meeting r e p r e s e n t s  t o treatment.  contact with t h i r d  I t i s another major break i n t h e frame  i n v o l v i n g c o n f i d e n t i a l i t y and p r i v a c y . was  not p r e s e n t  Even though she  a t t h e meeting, t h e t h e r a p i s t works a t t h e  c e n t r e and i s by i m p l i c a t i o n a l s o i n v o l v e d . i s wholly  party  The t h e r a p i s t  r e s p o n s i b l e f o r t h e c l i e n t ' s treatment and  t h e r e f o r e a l s o f o r t h i s break i n t h e frame. Change i n t h e c o n s u l t a t i o n room.  The w a l l s o f t h e  c o n s u l t a t i o n room had been p a i n t e d a f t e r t h e l a s t and t h e s m e l l o f p a i n t was s t i l l  strong.  the p h y s i c a l environment i s c o n s i d e r e d  session  Any change i n  a break i n t h e  147 frame and t h e r e f o r e has an adverse e f f e c t on t h e c l i e n t . However, such changes have been found t o e x e r t a l e s s p o w e r f u l i n f l u e n c e on t h e c l i e n t than breaks i n t h e frame r e l a t e d t o c o n f i d e n t i a l i t y and p r i v a c y o f treatment (Langs,  1982).  Hypotheses Audio r e c o r d i n g .  S i n c e t h i s break i n t h e frame  i n v o l v e s c o n f i d e n t i a l i t y and p r i v a c y o f treatment and because  i t i s a currently active trigger i t i s predicted  t h a t t h i s w i l l be the major o r g a n i s e r material  (Langs, 1985a).  of the c l i e n t ' s  I t i s hypothesized, according t o  the t h e o r y , t h a t a l l such breaks by t h e t h e r a p i s t s t i r up themes o f d e s t r u c t i v e n e s s , dangerous  therapist.  of unsafe environment,  I t i s also predicted  and o f  that  r e s i s t a n c e s w i l l be p r e s e n t because treatment has become dangerous  f o r the c l i e n t  Family meeting.  (Langs,  1982).  Although t h e t h e r a p i s t was not  p r e s e n t a t t h e meeting, t h e p r e d i c t e d e f f e c t on t h e c l i e n t i s t h e same as f o r a l l v i o l a t i o n s o f c o n f i d e n t i a l i t y and p r i v a c y o f treatment.  I t i s p r e d i c t e d , however, t h a t  this  meeting w i l l have a l e s s powerful e f f e c t on t h e c l i e n t than t h e a u d i o - r e c o r d i n g o f s e s s i o n because  i t i s not a  c u r r e n t t r i g g e r and because t h e t h e r a p i s t was not d i r e c t l y involved.  S i n c e t h e f a m i l y meeting was r e q u e s t e d by t h e  s t a f f o f t h e Centre, i t i s i m p l i c i t l y seen as s e l f s e r v i n g , and such t r i g g e r s u s u a l l y t r i g g e r s t r o n g  defences  148 and  resistances i n the c l i e n t s  (Langs, 1967).  Chancre i n t h e c o n s u l t i n g room.  Such t r i g g e r s , t h a t  do n o t i n v o l v e t h e f i x e d frame i s s u e s , a r e second organizers  order  o f t h e c l i e n t ' s m a t e r i a l as they a r e l e s s  damaging t o t h e therapy  (Langs, 1982).  I t i s hypothesized  t h a t t h e above two t r i g g e r s w i l l e x e r t a much g r e a t e r i n f l u e n c e on t h e c l i e n t than p a i n t i n g o f t h e w a l l s . Data As soon as t h e c l i e n t e n t e r s t h e rooms, he s n i f f s , grimaces and looks around, then a t t h e t h e r a p i s t . F i r s t intervention.  The t h e r a p i s t says,  i s from t h e newly p a i n t e d w a l l s . "  "The s m e l l  The c l i e n t answers, " I  know. I saw a l l t h e t o y s p i l e d up out i n t h e h a l l when I was here l a s t  Friday."  Second i n t e r v e n t i o n .  The t h e r a p i s t says,  l i k e t o ask you something. recorder. session.  " I would  I have brought a tape  Would i t be a l l r i g h t w i t h you i f I taped your I would l i k e t o understand you b e t t e r .  take t h e tape home and hear t h e s e s s i o n a g a i n . the o n l y person t o l i s t e n t o t h e tape." answers "What s h a l l I say?". "Anything you l i k e .  I would I would be  The c l i e n t  The t h e r a p i s t responds,  I c o u l d understand you b e t t e r and I  c o u l d h e l p you w i t h your problems b e t t e r i f you c o u l d me about what you a r e p l a y i n g . " Third intervention. you t h e r e c o r d e r " ,  The c l i e n t says,  The t h e r a p i s t says,  she p l u g s t h e tape r e c o r d e r  tell  "O.K."  " I w i l l show i n t o the  149 w a l l , and she p l a c e s i t about two meters away from both o f them.  The c l i e n t says, "I have a r e c o r d e r j u s t l i k e  o n l y b i g g e r , i t has a l i t t l e t h i n g on the r i g h t . "  this,  The  c l i e n t then d e s c r i b e s h i s r e c o r d i n g d e v i c e and l o o k s nervous.  He then u n f o l d s a mat w i t h a p i c t u r e of roads  and f i e l d s and s t a r t s b u i l d i n g a town and d r i v i n g c a r s on the  road. The c l i e n t coughs,  "I have a c o l d " .  l o o k s a t the t h e r a p i s t and says,  As he c o n t i n u e s t o p l a y , he says, " T h i s  i s a farm w i t h 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 i n t o the r i v e r . " c l i e n t then p l a c e s a "junky c a r " i n f r o n t of a  The "rich  mans's enormous house" and a " t r a i l e r p u l l e d by a t r u c k " i n f r o n t of another house. i n t o the w a l l . answers, the  Then he makes a t r u c k c r a s h  The t h e r a p i s t asks what happened and  he  "A drunk d r i v e r crashed i n t o the w a l l and then  p o l i c e c a r took the d r i v e r away".  The c l i e n t  then  crashes the same c a r again, and "the p o l i c e p u t s the c a r away " i n t o the junk y a r d " .  The c l i e n t then t a k e s away the  house and the t r a i l e r .  The t h e r a p i s t asks about h i s p l a y  and the c l i e n t answers,  "The p o l i c e have taken h i s  p r o p e r t y away because he d i d something wrong, you know, so t h a t he w i l l not do i t a g a i n " . Fourth i n t e r v e n t i o n .  The t h e r a p i s t asks, "To p r e v e n t  him from doing more damage?"  The c l i e n t i n s p e c t s  licence  p l a t e s on the c a r s : " T h i s one cannot d r i v e because he does  150 not have t h e l i c e n c e p l a t e . building) i s the j a i l ,  This  (the c l i e n t p o i n t s t o a  i t ' s next t o t h e fence so t h a t  cannot go out, but t h e c a r s can go i n t o p a r k i n g the gate".  Then he p l a c e s a c l o c k on t h e road  they  through " j u s t so  t h a t they can see t h e time from here and here and here" (the c l i e n t p o i n t s t o t h r e e The  directions).  c l i e n t s t a r t s t o b u i l d b r i d g e s and r u n c a r s under  them, but abandons the p l a y and takes t h e b r i d g e s away. F i f t h intervention.  The t h e r a p i s t says,  tape r e c o r d e r here today.  " I brought a  In your p l a y you t a l k e d about a  drunk d r i v e r c r a s h i n g i n t o a w a l l and p o l i c e t a k i n g him and h i s p r o p e r t y t o t h e junk y a r d . I t i s l i k e t h i s f o r you here.  I am l i k e a drunk d r i v e r , i r r e s p o n s i b l e and c a u s i n g  a c r a s h f o r both of us.  And i t i s dangerous f o r you here,  l i k e t h e c a t t l e t h a t needs t o be guarded not t o go i n t o the  road". The  "Weird".  c l i e n t looks down, p i c k s up a b l o c k and says, He then s t a r t s t o b u i l d t a l l  towers w i t h b l o c k s .  and p r e c a r i o u s  When he b u i l d s t h e f i r s t one, he  looks a t t h e t h e r a p i s t , h e s i t a t e s , then pushes i t t o t o p p l e over i n t h e d i r e c t i o n o f t h e t h e r a p i s t . c l i e n t says, and here,  "I l e t i t f a l l  i tfell  o n l y here"  where t h e c a r crashed.  The  so t h a t i t d i d n ' t damage here and he p o i n t s t o t h e road  Then, he b u i l d s another,  taller  tower, measures i t s h e i g h t and t h e d i s t a n c e o f f a l l i n g , then l e t s i t f a l l .  A few b l o c k s land on t h e t h e r a p i s t ' s  151 feet.  The  c l i e n t says, "I measured the d i s t a n c e  the tower w i l l f a l l He  exactly  occurred. dense and  here".  i n the same spot on the road where the  strong  i n the middle, l e t s i n f a l l ,  e x a c t l y on the t r a f f i c jam"  b l o c k s land on the t h e r a p i s t ' s f e e t . t h e r a p i s t says, "You  inspects  not have the  and  Sixth  feet".  The  and  licence plate".  has  pensive. Data  The  three  c l i e n t takes t h r e e  The  cars,  " T h i s one  does  c l i e n t shows the "and  The  this  one  t h e r a p i s t says, "Some c a r s  l i c e n c e p l a t e s so, they are not  c l i e n t doesn't say anything but  The  few  a licence plate."  Seventh i n t e r v e n t i o n . don't have any  "the  intervention.  i t d i d , and  t h e r a p i s t the blank l i c e n s e p l a t e , s a y i n g ,  drive".  again a  t h e i r l i c e n c e p l a t e s , saying,  a l s o , only t h i s one  saying,  measured t h a t the tower would  e x a c t l y on the t r a f f i c jam,  b l o c k s landed on my and  crash  He makes another, y e t t a l l e r tower, makes i t  middle f e l l  fall  that  then takes f o u r c a r s , makes them "stuck i n a  t r a f f i c jam"  The  so  t h e r a p i s t announces the end  allowed t o  looks  of the  session.  Analysis F i r s t intervention.  the t h e r a p i s t i n t e r v e n e s  the c l i e n t i s allowed the o p p o r t u n i t y t o say which makes the  before  anything  intervention a non-interpretive  one,  u n i l a t e r a l i n t r o d u c t i o n of a t o p i c by the t h e r a p i s t . i n t e r v e n t i o n c o n t a i n s unconscious i m p l i c a t i o n s functioning  t h e r a p i s t who  has  trouble with  of a  tension  a The poorly  152 c o n t r o l , who  needs h e l p and who  i n t o the c l i e n t  projectively identifies  (Langs, 1985a).  The  s h i f t i n g the emphasis, i n t r o d u c e d  c l i e n t responds w i t h  by the t h e r a p i s t , from  "the p a i n t e d w a l l s " t o " l a s t F r i d a y " and hall".  "toys i n the  In l i g h t of the one major t r i g g e r which e x i s t e d  b e f o r e the s e s s i o n , the c l i e n t ' s message t e l l s  the  t h e r a p i s t t h a t the c l i e n t i s working over something t h a t happened l a s t F r i d a y and was  t h a t something about l a s t  Friday  wrong (toys from the c o n s u l t a t i o n room must not be i n  the h a l l ) . The  client's  response c o n t a i n s  an a l l u s i o n t o  m a n i f e s t t r i g g e r ( f a m i l y meeting l a s t F r i d a y ) , a emotion of d i s g u s t i s outside  negative  (the c l i e n t grimaces) of something t h a t  (toys p i l e d up outside)  of where i t belongs  (toys belong i n the c o n s u l t a t i o n room).  In l i g h t of  the  t r i g g e r of the f a m i l y meeting, the c l i e n t ' s message i s a v a l i d perception  of the meeting as w e l l as a h e a v i l y  d i s g u i s e d model of r e c t i f i c a t i o n e x p r e s s i n g  the  opinion  t h a t h i s therapy does not belong i n another room ( i n the h a l l ) and w i t h other people (toys p i l e d Second i n t e r v e n t i o n . by the t h e r a p i s t and to enlarge regarding  The  up).  c l i e n t i s interrupted  t h e r e f o r e not allowed the  again  opportunity  on h i s r e a c t i o n w i t h unconscious communication the t r i g g e r of the f a m i l y meeting.  i n t e r v e n t i o n by the t h e r a p i s t i s a request t o tape the s e s s i o n .  The  for  The  second  permission  c l i e n t answers w i t h another  153 question  ("What s h a l l I say?") which shows h i s c o n f u s i o n  r e g a r d i n g the request as w e l l as a l a c k of a c l e a r a p p r o v a l . A f t e r the t h e r a p i s t ' s e x p l a n a t i o n of her (manifest) reasons manifest  f o r t a p i n g , the c l i e n t agrees ( on a  l e v e l ) t o co-operate  Third intervention.  ("O.K.").  A f t e r the t h e r a p i s t shows the  c l i e n t the r e c o r d i n g d e v i c e , he responds w i t h a trigger  (mentions h i s tape r e c o r d i n g device)  symptomatically  with anxiety.  manifest  and  H i s mention of "a c o l d " i s  a l s o a d e r i v a t i v e n e g a t i v e image of s i c k n e s s t h e r e f o r e t e l l i n g the t h e r a p i s t t h a t the immediate t r i g g e r ( r e c o r d i n g of h i s s e s s i o n ) i s making him  crazy.  Next, the  c l i e n t g i v e s the model of r e c t i f i c a t i o n i n the image of a safeguard guarding  from wandering i n t o dangerous p l a c e s the c a t t l e ) .  (the  dog  The t h e r a p i s t does not respond t o  these s h o r t but compelling unconscious  messages:  she  n e i t h e r i n t e r p r e t s nor does she r e c t i f y the break i n the frame by s t o p p i n g the r e c o r d i n g . In l i g h t of the t r i g g e r of the f a m i l y meeting, the " c a t t l e wandering" can r e p r e s e n t a v a l i d p e r c e p t i o n of the f a m i l y meeting as a p l a c e where f a m i l y and behaving as mindless forceful  safeguard)  cattle  staff  was  i n need of a "guard dog"  t o keep them i n cheque t o  (a  prevent  i n j u r y 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 . cattle  i s a negative  The  image of the  mindless  image as i s the image of the  154 dangerous road and the i m p l i e d image of drowning i n the river. The c l i e n t responds w i t h an e l a b o r a t e n e g a t i v e theme i n v o l v i n g n e g a t i v e images of junk and junk-yard, d r i v e r and a c a r c r a s h . The c l i e n t ' s  a drunk  v a l i d p e r c e p t i o n of  the t h e r a p i s t i s of someone c r a z y , s e l f d e s t r u c t i v e , and out of c o n t r o l h i s therapy  (drunk d r i v e r ) who  (crashed the c a r ) .  d e s t r o y e d something 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 i s i n h i s message: the t h e r a p i s t  (police)  must "take away" the tape r e c o r d e r (the drunk d r i v e r ' s p r o p e r t y ) t o prevent the c o n t i n u a t i o n of the r e c o r d i n g of recording  ("so t h a t he w i l l not do i t a g a i n " ) , which i s  t u r n i n g h i s therapy  into a worthless process  ("junk").  I t i s i n t e r e s t i n g t h a t another v a l i d p e r c e p t i o n of the t h e r a p i s t as a " r i c h man"  so w e l l r e p r e s e n t s the c u r r e n t  misuse of the i n e q u a l i t y of s o c i a l p o s i t i o n s of the v e r s u s the t h e r a p i s t  (the c l i e n t never c l e a r l y  the use of the tape r e c o r d e r on a m a n i f e s t  client  agrees  to  l e v e l , y e t the  t h e r a p i s t pays no a t t e n t i o n ) as w e l l as i m p l y i n g the t h e r a p i s t ' s p o s s e s s i o n of m a t e r i a l goods (tape r e c o r d e r ) r a t h e r than i n t e l l e c t u a l a b i l i t y (proper therapy  through  p s y c h o l o g i c a l means). Fourth i n t e r v e n t i o n .  F o l l o w i n g the  client's  c o m p e l l i n g model of r e c t i f i c a t i o n , the t h e r a p i s t does not stop r e c o r d i n g and the c l i e n t does not answer.  still  i n s t e a d asks a q u e s t i o n which Instead, the  client's  155 communication becomes more d i s g u i s e d  (the messages become  l e s s c l e a r ) which i s a s i g n of communicative r e s i s t a n c e i n the presence of danger (Langs, 1982) . p o s s i b l e t o d i s c e r n two  However, i t i s  h e a v i l y d i s g u i s e d models of  r e c t i f i c a t i o n i n v o l v i n g the p r o h i b i t i o n of an  illegal  act  ("cannot d r i v e " without a l i c e n c e ) and  the presence of  safeguards (the presence of a j a i l and  a fence so  cannot go o u t " ) .  The  "they  c l i e n t i s t e l l i n g the t h e r a p i s t t h a t  recording  i s i l l e g a l and  should be e l i m i n a t e d  s i n c e she  i s not s t o p p i n g  i t voluntarily.  by  The  force  mention of  the c l o c k i s even more obscure. F i f t h intervention. c o r r e c t l y , although the  The  therapist  intervenes  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 t h a t the t h e r a p i s t does  not  f o l l o w the c l i e n t ' s p l e a s  not  stop r e c o r d i n g  f o r r e c t i f i c a t i o n and  of the s e s s i o n .  seen by c l i e n t s as a c r a z y a c t and e x p e r i e n c e d as s p l i t and S i n c e the t h e r a p i s t has recording  and  y e t i s not  the t h e r a p i s t ' s c u r r e n t tape r e c o r d e r  Such i n t e r v e n i n g  is  the t h e r a p i s t i s  not t o be t r u s t e d  (Langs, 1985a).  t o t a l c o n t r o l over the use stopping  does  of  the  to act d e s t r u c t i v e l y ,  d e s t r u c t i v e a c t i n g out  (using  the  i n p l a c e of p s y c h o l o g i c a l means of  treatment) w i l l be  i n t r o j e c t e d by the c l i e n t , who  g i v e n up h e l p i n g the t h e r a p i s t and harm the t h e r a p i s t  has  the c l i e n t might t r y t o  (Langs, 1985a).  In response, the c l i e n t stops communicating  clearly  156 and uses a c t i n g out (pushing the tower t o f a l l of t h e crash) and s u r f a c e c a r r y d e r i v a t i v e meaning  on t h e s i t e  communication t h a t does not (themes and images) i n p l a c e of  the r i c h d e r i v a t i v e , communication which he used up t o t h i s point  i n the session.  H i s 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 t h e r a p i s t as c r a z y  and of the c l i e n t ' s r e a c t i o n  crazy) t o the t h e r a p i s t i n t h i s s i t u a t i o n . destructive  of the (feeling  Both a r e  images.  The c l i e n t pushes more towers t o f a l l towards t h e t h e r a p i s t and on the t h e r a p i s t ' s f o o t which a r e more s i g n s of a c t i n g out and e f f o r t s t o harm the t h e r a p i s t .  Taken as  a d e r i v a t i v e , the c l i e n t ' s comment t h a t he "measured the distance  so t h a t the tower w i l l f a l l  (meaning on the t h e r a p i s t ) perception  exactly  here"  i s the c l i e n t ' s v a l i d  o f the t h e r a p i s t as someone who  continues t o  harm t h e c l i e n t on purpose which i s a d e s t r u c t i v e  image.  The n e g a t i v e 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 i n t e r p r e t e d other t h a t as being a  perception  of something n e g a t i v e . Sixth intervention.  The t h e r a p i s t p o i n t s  out t o t h e  c l i e n t i n d i r e c t l y t h a t he i s t r y i n g t o harm t h e t h e r a p i s t . This intervention  i s incomplete, i t does not p o i n t t o t h e  r e s p o n s i b i l i t y of the t h e r a p i s t f o r her and again i s not f o l l o w e d recording).  destructiveness,  by r e c t i f i c a t i o n  (stoping the  The c l i e n t responds w i t h t h i n d e r i v a t i v e s  157 c a l l i n g a t t e n t i o n again t o the  i l l e g a l i t y of r e c o r d i n g  (no  l i c e n c e p l a t e s ) , which i s a n e g a t i v e image. Seventh i n t e r v e n t i o n . i n t e r p r e t i v e and understanding. be e x p l a i n e d ,  intervention i s  b r i n g s n o t h i n g new The  t o the  non-  client's  c l i e n t responds w i t h s i l e n c e which  among other t h i n g s ,  the t h e r a p i s t who and  The  as an  can  i n t r o j e c t i o n of  i s " s i l e n t " about the t r a u m a t i c t r i g g e r  does n o t h i n g t o stop harming the  client.  On the whole, the hypotheses f o r t h i s s e s s i o n were a l l correct. m a t e r i a l was The  The  p r i n c i p l e organizer  indeed the a u d i o - r e c o r d i n g  themes and  of the  client's  of the  images were a l l n e g a t i v e and  session.  corresponded  t o u n i v e r s a l i m p l i c a t i o n s of such breaks i n the The  c l i e n t ' s perceptions  the  l i g h t of the  of the t h e r a p i s t were v a l i d i n  i m p l i c a t i o n s of the t r i g g e r .  There were  s e v e r a l c o m p e l l i n g models of r e c t i f i c a t i o n and s i g n s of r e s i s t a n c e by the The  c l i e n t reacted  frame.  increasing  client.  t o the t r i g g e r of the  family  meeting o n l y b r i e f l y and w i t h c o n s i d e r a b l e  disguise.  d i s g u i s e d r e a c t i o n was  and  correctly predicted  The  the  s p a r s i t y of d e r i v a t i v e m a t e r i a l c o n c e r n i n g t h i s t r i g g e r , as opposed t o the p r e d i c t e d more powerful r e a c t i o n by c l i e n t , can be e x p l a i n e d  by the f a c t t h a t the  therapist  not only  i n t e r r u p t e d the c l i e n t ' s v e r b a l i z a t i o n s w i t h  question  regarding  the p e r m i s s i o n t o r e c o r d ,  s t a r t e d to a c t u a l l y audio-record  the s e s s i o n  the  but thus  she  her also  i n t r o d u c i n g another powerful t r i g g e r .  The  powerful  d e s t r u c t i v e images i n t h i s s e s s i o n were c o r r e c t l y p r e d i c t e d and i n accordance w i t h the u n i v e r s a l i m p l i c a t i o n s 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 s e s s i o n s y i e l d e d t h e  o v e r a l l and g e n e r a l c o n c l u s i o n t h a t t h e i n d i v i d u a l hypotheses, as formulated  f o r each s e s s i o n on t h e b a s i s o f  the s t a t e of t h e frame and f o l l o w i n g Langs' communicative t h e o r i e s , were c o r r e c t .  There a r e some examples of  p a r t i a l d i s c r e p a n c i e s between a formulated the r e s u l t  (data) which were d i s c u s s e d  each s e s s i o n .  hypothesis  and  specifically for  These examples are c o n s i d e r e d  the  consequence of the incomplete q u a l i t y of the a v a i l a b l e v e r b a l m a t e r i a l and are not departures I n s u f f i c i e n t volume some i n s t a n c e s very  from the t h e o r i e s .  of the v e r b a l m a t e r i a l was i n  l i k e l y a consequence o f the  t h e r a p i s t ' s premature i n t e r v e n t i o n s w i t h which she c u t o f f the c l i e n t ' s flow of m a t e r i a l . manifested  Discrepancies  were a l s o  i n examples where too many t r i g g e r s had t h e  e f f e c t of r e s u l t i n g i n m a t e r i a l of which t h e meaning confusing:  was  such m a t e r i a l d i d not c o a l e s c e c l e a r l y and  was  d i f f i c u l t t o make i n t e l l i g i b l e , which i s i n accordance w i t h Langs' t h e o r i e s .  C o a l e s c i n g meaning makes p o s s i b l e ,  and i s i n d i s p e n s a b l e f o r , a c l e a r a n a l y s i s of t h e t r i g g e r under i n v e s t i g a t i o n (e.g., Langs, 1982).  In other  160 examples the d i s c r e p a n c i e s hypotheses and  between the  the data were due  formulated  t o a l a c k of unconscious  meaning ( l a c k of d e r i v a t i v e s ) as the c l i e n t himself  expressed  or h e r s e l f i n terms of f l a t m a t e r i a l  t r i v i a l questions).  In such cases,  predominant i n the c l i e n t and  (e.g.,  r e s i s t a n c e s were  the p a r a l l e l hypotheses t h a t  p r e d i c t e d i n t e r a c t i o n a l r e s i s t a n c e s were indeed found correct. Testing a c r i t i c a l r i v a l hypothesis. m a t e r i a l of a l l s e s s i o n s were t h e r e  Nowhere i n the  i n d i c a t i o n s of  f i n d i n g s c o n t r a d i c t o r y t o Langs' t h e o r i e s r e g a r d i n g ground r u l e s and  boundaries of the  r e l a t i o n s h i p - the frame.  the  psychotherapeutic  In t h i s study, an  important  r i v a l h y p o t h e s i s i s proposed by the i n t r o d u c t i o n of  the  f o l l o w i n g h y p o t h e t i c a l s i t u a t i o n : the emergence, i n the c l i e n t ' s m a t e r i a l , of meaning t h a t would be d i a m e t r i c a l l y opposite Langsian, One  t o what i s p r e d i c t e d by the a f f i r m a t i v e , t h a t i s hypothesis. example of such a r i v a l h y p o t h e s i s would be  the  h y p o t h e t i c a l s i t u a t i o n i n which s t r o n g 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 h o l d i n g would  emerge i n a s e s s i o n s where a break i n the frame active.  There was  no such f i n d i n g i n t h i s  was  study.  Another example of a b a s i c c o n t r a d i c t i o n w i t h Langs' t h e o r i e s would be the h y p o t h e t i c a l s i t u a t i o n i n which an a c t of s e c u r i n g of the frame by the t h e r a p i s t , which  161 complied with a corresponding  model o f r e c t i f i c a t i o n by  the c l i e n t , would be f o l l o w e d by m a t e r i a l o f t h e c l i e n t containing e x c l u s i v e l y strong negative  and d e s t r u c t i v e  images and themes i n d i c a t i v e o f m i s t r u s t and poor h o l d i n g . There was no such f i n d i n g i n t h i s study. Yet another example o f a c r i t i c a l r i v a l  hypothesis  would be t h e h y p o t h e t i c a l s i t u a t i o n i n which t h e c l i e n t ' s m a t e r i a l that follows a breaking  o f t h e frame would  c o n t a i n a commentary t h a t would c a l l f o r t h e c o n t i n u a t i o n of t h e break i n t h e frame.  There was no evidence o f such  a f i n d i n g from t h e data. To s i m p l i f y t h e l o g i c behind t h e above arguments r e g a r d i n g t h e most important r i v a l h y p o t h e s i s , represent  let B  a break i n t h e frame, l e t R r e p r e s e n t t h e  r e a c t i o n o f t h e c h i l d t o B as p r e d i c t e d by Langs' t h e o r i e s , and l e t -R r e p r e s e n t l i g h t o f B, having opposite  o f R.  (as r e p r e s e n t e d led  the r i v a l hypothesis i n  the c h a r a c t e r i s t i c s t o p r e d i c t the  T h i s study showed t h a t a l l v a r i a b l e s o f B i n t h e data) l e d t o R and t h a t none o f B  t o -R. F o l l o w i n g t h e same n o t a t i o n : any o t h e r  hypothesis  rival  (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  o r i e n t a t i o n , would need t o show a p a r a l l e l r e s u l t : a l l v a r i a b l e s o f B would need t o l e a d t o 0 and no v a r i a b l e s o f B must l e a d t o -0. conducting  T h i s would be one adequate way o f  a study t h a t would i n t e n d t o show t h a t  there  162 e x i s t s another theory  comprising  a s e t of r i v a l hypotheses  which can s a t i s f y the evidence found i n these, other,  clinical  or  any  data.  In the predominant number of s e s s i o n s , 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 p r e d i c t e d .  In the few  cases  where no such models emerged i n the c l i e n t ' s m a t e r i a l ,  the  complementary a s p e c t s of the hypotheses, t h a t i s , the p r e d i c t i o n s of s i g n s of r e s i s t a n c e s and  of the  g i v i n g up h i s or her e f f o r t s t o communicate t o  client's the  t h e r a p i s t models of r e c t i f i c a t i o n , were found c o r r e c t . T h i s phenomenon i s most c l e a r l y observed by l o o k i n g a t sessions  i n sequence:  with negative  the f i r s t s e s s i o n s were r e p l e t e  images and  themes and  contained  of r e c t i f i c a t i o n : the m a t e r i a l c o n t a i n e d  c l e a r models  predicted  components of a c l i e n t ' s r e a c t i o n t o a frame break r e s i s t a n c e s were minimal. is,  the  and  In l a t e r s e s s i o n s however, t h a t  i n the presence of p e r s i s t e n t ( u n r e c t i f i e d ) breaks i n  the frame, t h e r e was g r a d u a l l y and  evidence t h a t the c l i e n t  was,  i n c r e a s i n g l y , g i v i n g up h i s or her e f f o r t s  t o a l e r t the t h e r a p i s t t o the meaning of the break, which was  c o r r e c t l y p r e d i c t e d by Langs' t h e o r i e s . According  t o Langs' theory,  a c u r r e n t break i n the  frame w i l l always be the c e n t r a l o r g a n i s e r material which was sessions.  (the m a t e r i a l w i l l c o a l e s c e  of the  client's  around t h i s t r i g g e r )  indeed the f i n d i n g i n t h i s study f o r a l l Evidence f o r t h i s was  sought, and  found, i n the  163 c l i e n t ' s m a t e r i a l i n (a) the presence of the m a n i f e s t or represented images and  t r i g g e r , i n (b) the presence of  themes, i n (c) the emergence of models of  rectification, represent  and  i n (d) the presence of themes t h a t  v a l i d perceptions  s p e c i f i c break i n the As d i s c u s s e d One,  negative  of the t h e r a p i s t ' s a c t  frame).  i n " L i m i t a t i o n s of the Study" i n Chapter  the complete understanding of the e f f e c t s of frame  d e v i a t i o n s can o n l y be achieved material  i f available c l i n i c a l  i n c l u d e s frame-securing i n t e r v e n t i o n s by  therapist.  the  As noted, t h i s study i n v o l v e d therapy under  c o n d i t i o n s of p e r s i s t e n t breaks i n the frame and t h e r a p i s t secured the frame o n l y i n t h r e e one,  (the  s e s s i o n t h r e e ; case two,  the  instances  s e s s i o n t h r e e ; and  (case  case  four, session three). O v e r a l l , t h i s study was  thus a b l e t o y i e l d o n l y  the  r e s u l t s of the f i r s t p a r t of a complete a n a l y s i s , t h a t i s , the a n a l y s i s of the c l i e n t ' s r e a c t i o n i n the l i g h t of s p e c i f i c break i n the frame.  The  second p a r t , t h a t i s ,  the a n a l y s i s of the c l i e n t ' s r e a c t i o n which f o l l o w s  the  a c t of s e c u r i n g of the frame by the t h e r a p i s t i n the t h a t was  the  way  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  p o s s i b l e o n l y i n the t h r e e  s e c u r i n g of the frame. represents  Each of the t h r e e  instances  of  instances  c o n c l u s i v e evidence of the p r e d i c t i v e v a l u e  Langs' t h e o r i e s w i t h r e s p e c t t o c h i l d r e n and  therefore  of  164 c o n c l u s i v e evidence of t h r e e a s p e c t s of the b a s i c t h e s i s of t h i s  study.  The  f i n a l proof  of the c o r r e c t n e s s  of the c h i l d t h e r a p e u t i c  and u n i v e r s a l i t y  frame, as proposed by Langs'  t h e o r i e s , would be found i n i d e n t i f y i n g a l a r g e 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 , would be f o l l o w e d by s e c u r i n g of the frame and  which  which  would, i n t u r n , be f o l l o w e d by unconscious v a l i d a t i o n by the c l i e n t s .  Interpersonal  p o s i t i v e images and  v a l i d a t i o n (the emergence of  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 s e c u r i n g of frame: images of r e s t o r e d t r u s t - a r e v e r s a l from p r e v i o u s l y expressed m i s t r u s t ,  the the  as w e l l as of c l e a r  i n t e r p e r s o n a l boundaries - a r e v e r s a l from v i o l a t e d  and  b l u r r e d boundaries, would emerge. C o g n i t i v e v a l i d a t i o n would r e f l e c t not o n l y t h e r a p e u t i c q u a l i t y of the p r o c e s s f o r the  the  child  (symptomatic improvement), but would a l s o show f u r t h e r evidence t h a t the c h i l d had  indeed been r e a c t i n g t o  i d e n t i f i e d break i n the frame and c h i l d r e n i s the same as the one  the  t h a t i t s meaning f o r  p r e d i c t e d by Langs'  theories. As noted, the study c o n t a i n s complete a n a l y s i s . c o n c l u s i v e proof  They p r o v i d e  t h r e e examples of such three  f o r the c o r r e c t n e s s  instances  of the  of  basic  p r o p o s i t i o n of t h i s t h e s i s , namely, t h a t the frame f o r  165 c h i l d r e n i n psychotherapy i s t h e same as t h e frame d e f i n e d by Langs f o r a d u l t and a d o l e s c e n t c l i e n t s .  An e m p i r i c a l l y  d e r i v e d , complete s e t o f r u l e s o f t h e c h i l d frame can o n l y be determined on t h e b a s i s o f complete a n a l y s i s o f d a t a o b t a i n e d from secure frame psychotherapy and t h i s  study  y i e l d e d r i g o r o u s p r o o f f o r t h r e e types o f breaks i n t h e frame: c o n t a c t w i t h t h i r d p a r t i e s , o b s e r v a t i o n m i r r o r , and changing t h e time f o r s e s s i o n s a d v e r s e l y i n f l u e n c e t h e p r o c e s s o f c h i l d psychotherapy by p r o v i d i n g evidence o f the  c o n s t r u c t i v e 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. F u r t h e r s t u d i e s o f secure frame psychotherapy a r e needed t o complete t h e s e t of ground r u l e s and boundaries of c h i l d psychotherapy by e m p i r i c a l means.  166  REFERENCES  Alexander, F. (1954). Some q u a n t i t a t i v e a s p e c t s o f psychoanalytic technique.  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(1960).  u n i v e r s e i n the t r a n s f e r e n c e  The p r e - o b j e c t situation.  A b s t r a c t e d i n R. Langs, The t h e r a p e u t i c i n t e r a c t i o n . V o l . 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  the communicative approach.  J . Raney (Ed.),  and  174 L i s t e n i n g and i n t e r p r e t i n g .  New York: Jason  Aronson. Raney, J . (1987). supervisor.  Discussion: the w e l l  The Yearbook o f P s y c h o a n a l y s i s and  Psychotherapy, 2, Rangell,  tempered  pp.85-93.  L. (1969). The i n t r a p s y c h i c p r o c e s s and  i t s a n a l y s i s : a r e c e n t l i n e of thought and i t s current implications.  A b s t r a c t e d i n R.  Langs, The t h e r a p e u t i c i n t e r a c t i o n . V o l . 1, pp. 412-413. Reich,  New York: Jason Aronson.  A. (1958).  of t e c h n i q u e .  Symposium: a s p e c i a l  variation  A b s t r a c t e d i n R. 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The nature of t h e t h e r a p e u t i c  a c t i o n of p s y c h o a n a l y s i s .  Abstracted  i n R.  Langs, The t h e r a p e u t i c i n t e r a c t i o n . V o l . 1, pp. 53-56. Szasz, T.  New  York: Jason Aronson.  (1962).  The problem o f p r i v a c y i n  t r a i n i n g a n a l y s i s : s e l e c t i o n s from a questionnaire  study of p s y c h o a n a l y t i c  and o p i n i o n s .  Abstracted  i n R. Langs,  practices The  t h e r a p e u t i c i n t e r a c t i o n . V o l . 1, pp. 257-258. New  York: Jason Aronson.  Szasz, T. New  (1980). Sex by p r e s c r i p t i o n . Garden C i t y ,  York: Anchor Press/Doubleday.  Tarachow, S.  (1962).  psychotherapy.  I n t e r p r e t a t i o n and r e a l i t y i n  J o u r n a l of P s y c h o a n a l y s i s ,  43.  pp. 377-387. Tarnower,  W.  (1966).  Extra-analytic contacts  between the a n a l y s t and the p a t i e n t .  Abstracted  i n R. Langs, The t h e r a p e u t i c i n t e r a c t i o n . V o l . 1, p. 323. Vlosky,  M.  New  York: Jason Aronson.  (1984).  Community mental h e a l t h ,  c l i e n t s ' r i g h t s , and the t h e r a p e u t i c frame. Raney (Ed.), L i s t e n i n g and i n t e r p r e t i n g .  New  J. York:  Jason Aronson. Winnicott,  D. W.  (1954).  Metapsychological  and  176 c l i n i c a l aspects  of r e g r e s s i o n w i t h i n  p s y c h o - a n a l y t i c set-up.  Abstracted  the  i n R.  Langs,  The  t h e r a p e u t i c i n t e r a c t i o n . V o l . 1, p. 127-128.  New  York: Jason Aronson.  Yin,  R. K.  Hills:  (1984). Sage.  Case study r e s e a r c h .  Beverly  177  APPENDIX I  THE  UNIVERSITY OF BRITISH COLUMBIA  Department o f C o u n s e l l i n g Psychology F a c u l t y o f Education 5780 Toronto Road Vancouver, B.C. Canada V6T 1L2 Dear Parent o r Guardian, I am a candidate U.B.C. doing  f o r M.A. i n C o u n s e l l i n g Psychology a t  a study under t h e p r o f e s s i o n a l s u p e r v i s i o n o f  Dr. L a r r y Cochran, o f C o u n s e l l i n g Psychology a t U.B.C. I had been working with your c h i l d a t t h e Mental H e a l t h Centre under t h e p r o f e s s i o n a l s u p e r v i s i o n o f Dr. John A l l a n of U.B.C. Department o f C o u n s e l l i n g Psychology. P a r t o f my work would a l s o be p a r t o f my m a g i s t r a l r e s e a r c h the symbolic study  is  expressions entitled:  C h i l d r e n i n Playtherapy  o f c h i l d r e n i n p l a y therapy.  "Extra-Conscious -  express  Communication  The of  Analysis of Variables Pertaining  t o t h e Ground Rules o f t h e T h e r a p e u t i c The  study on  Relationship".  study i s t h e r e s u l t o f my i n t e r e s t i n how c h i l d r e n meaning  i n symbolic  form  i n their  c h i l d r e n can p o r t r a y and r e f l e c t i n t h e i r p l a y  play  and how  t h e moment-  to-moment r e l a t i o n s h i p with t h e t h e r a p i s t . T h i s study w i l l be based on t h e a n a l y s i s o f t r a n s c r i p t s of t h e s e s s i o n s  o f your c h i l d r e n which w i l l  describe the  179  APPENDIX I I  THE UNIVERSITY OF BRITISH COLUMBIA Department of C o u n s e l l i n g Psychology F a c u l t y of E d u c a t i o n 5780 Toronto Road Vancouver,  B.C.  Canada, V6T  F a c u l t y A d v i s o r : Dr. L a r r y Cochran,  1L2  T e l . : 822-6139  PARENTAL CONSENT FORM April  1991  I do / do not consent f o r my c h i l d to  have t r a n s c r i p t s  available  of h i s or her  p l a y therapy s e s s i o n s  f o r a n a l y s i s by Vesna Bonac, master's  candidate  i n C o u n s e l l i n g Psychology, U.B.C., i n the r e s e a r c h study on symbolic  e x p r e s s i o n s of  children  acknowledge the r e c e i p t of t h i s I  understand  that  my  i n play-therapy,  and  I  form.  child's  confidentiality  and  anonymity are i n s u r e d i n a l l phases of the study and i n the resulting  report.  information  will  be  I  understand  removed  from  that  ALL  transcripts  personal BEFORE  the  study b e g i n s . I  understand  descriptions  of  that  the  children's  i d e n t i f y i n g the c h i l d .  study  play  will and  yield  play  talk  thematic without  

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