Session seven

This last session was carried out about six months after the previous session and a month after the supervision for session six.

Sera reported that Jade looked much calmer and more relaxed. Jade claimed that the conflict with her husband had lessened considerably. She felt she could express her needs and share her thoughts with her husband. Jade sounded cheerful and happy as she reported this. When Sera asked what had helped her change, Jade reported that music had helped her. Jade had been “listening to music all the time” and all of her family members ended up listening to the music together. She even began to explore more music and she had expanded her musical choices considerably. Jade reported that her husband was now helping her with housework and that her children were more relaxed.

For the supportive imagery, Jade chose the positive changes in her life. Jade proudly said of her changes, “I have grown”, she felt in charge of her life now, and thus she did not blame other people. Jade selected “Wachet auf” [Sleepers Awake!] (J.S. Bach,

2007). She drew a big tree in the middle with light around it while listening to the music (Figure 5.9).

Figure 5.9 Drawing from session seven. Title: A big stable tree, bright sunlight, very satisfying.

Jade expressed satisfaction with her drawing: “The big tree enjoys sunlight ... It is very pretty ... It is stable and bright ... very satisfying.” When Sera asked how Jade would use this image, Jade responded that whenever she felt a difficulty, this warm image would help her, as imagery from previous sessions had. Jade said that she was

optimistic about what future awaited her. The session ended as Sera congratulated Jade on her good work and Jade expressed her gratitude to Sera.

Sera reported that she was “impressed by the power of music”. She felt that Jade seemed more secure and comfortable with herself as reflected in the tree she had drawn. Sera was proud of Jade and the positive changes she had made meant Sera could close the case with a sense of satisfaction. I congratulated Sera for guiding Jade over the seven sessions with great results. At the time Sera handed in her report, she had also completed other SMI cases. I may have given a supervision of this case together with sessions of other cases, however I, unfortunately, did not provide a separate supervision on this session. I do remember that Sera had conducted other cases well and handed in regular reports. I think by this time I was more relaxed with Sera, trusting her as a very able SMI therapist.

a. Analysis

It was impressive to learn how Jade had changed for the better and how she continued to use music as her important supportive resource. It seems she internalized the positive experience from the SMI sessions (learning) and integrated the support from the music in her life (change), especially when she was in need (difficulty). As depicted in her drawing in the previous session, the music and support from Sera may have lifted her to fly (intervention, relationship). The drawing (expressive media) seemed to reflect the secure and confident Jade (affect, change): a big tree filling the whole circle in the middle. Regardless of the long gap after the previous session, there was harmonious energy between Jade and Sera throughout the session (relationship, affect). Sera led a focused and well balanced session and Jade seemed to be content and satisfied

(intervention, affect). Regardless of the previous difficulties, I was pleased with how Jade was able to use SMI to change her outlook of herself and others and how Sera handled this last session (intervention).

As I review this case now as a researcher, I feel very sorry for Sera for taking on such a difficult case as her first case and I wonder if I acknowledged that and provided enough support.

5.6 Summary

This case demonstrates how the therapist's countertransference affected the course of the therapy (relationship, affect). Because of her countertransference, Sera may have had difficulties following the SMI manual sensibly (intervention) and she struggled to manage Jade's anxiety (difficulty, affect).

There were parallel processes observed between Jade and Sera, and Sera and me

(relationship). Sera struggled to contain Jade’s anxiety and I struggled to contain Sera’s anxiety (affect, difficulty, intervention).

Sera seemed to enact both how Jade may have felt and how Jade made her feel at the time (affect, relationship). Regardless of her efforts (intervention), Jade was stuck and depressed, and in a helpless situation (affect, difficulty). Jade must have felt especially disappointed after the small but remarkable gains after session two (affect, difficulty).

No matter how hard Sera worked to save Jade in session after session (intervention), Jade kept giving in, unable to get out of her pit (difficulty). Sera must have felt helpless and desperate (affect), especially after Jade had made such progress and then given up on it (difficulty).

This conflict between the client and the therapist (difficulty) was also displayed in the course of the supervision (relationship). It was a struggle to contain Sera's anxiety (affect) solely with supervision (intervention) and Sera could not follow instructions or make use of support provided for her (difficulty, learning). I felt helpless (affect) about how Sera kept re-enacting her countertransference, even though we explored and worked on Sera’s countertransference at almost every supervision (difficulty, intervention, learning). I remember I also enjoyed working with her (affect,

relationship). Sera’s reflection and understanding of herself was brilliant (learning).

Each time she sent me apologetic emails, Sera was very frank and I could feel her fighting an internal dilemma (affect, difficulty, relationship). It was frustrating (affect) to see how her talent was tangled with her personal issues (difficulty). Sera must have felt the same with Jade, feeling joyful and frustrated working with Jade (affect, relationship). Jade was insightful and worked very hard trying to implement what she learned in the session (learning), but she was caught in many personal issues

(difficulty).

This case also illustrates how important it is to use supportive imagery/resource that is based on the client’s solid experience in life. Jade acted on the hopeful messages from the supportive imageries from session two, which were rather manufactured and premature. Jade’s short lived success after session two, enrolling in a new school and moving forward, accentuated her helpless situation more clearly in session three (difficulty) and she fell further into depression (affect) after realising her stark,

depressive reality (S.4) (difficulty). After all, what seemed to help Jade to change most were the music (expressive media) and perhaps the trust Jade had in Sera’s intention to support her (relationship). Jade listened, almost religiously, to music (expressive media) that supported her (resource/supportive imagery) when she felt down (affect, difficulty). Even though Sera’s interventions did not seem to be effective at times, Jade must have felt Sera’s support and her intention to help her (resource/ supportive imagery, relationship). Because of Jade’s trust in Sera (relationship), I believe Jade followed Sera’s advice diligently using the music (resource/supportive imagery) in her daily life.

Music and art (expressive media) reflected Jade’s inner battles (affect). Even though Jade heard supportive messages (resource/supportive imagery) from the music most of the time, music (expressive media) would provoke her inner struggle when she was in a

dilemma (affect, difficulty): “feeling complicated, like a swirl”, “confused” and “could not focus” (S.3, postlude). Drawing exhibited Jade’s internal (psychological) condition explicitly in all sessions. Drawing (expressive media) seemed to make her aware of her feelings (affect) and Jade gained some insight (learning). As Jade slowly progressed, her drawings reflected this: the bird flying in an endless dark grey sky (S.2), the water fountain disappearing in the flood (S.3), Jade in a rain coat walking towards the sun (S.4), a mother embracing her child while light was chasing away the darkness (S.5), supportive figures helping Jade to fly (S.6), “a big stable tree” (S.7).This case

exemplifies how music and art (expressive media), as well as trust in the therapist (relationship) can be the supportive resource (supportive imagery) when the client cannot find a resource in her life.

Sera learnt from the deep reflective understanding of herself and of her

countertransference during the supervision process (learning). At the end of session three, she also seemed to learn that she needed to listen to Jade before she proceeded to work with the supportive resource. From session four onwards, Sera changed and listened to Jade attentively (affect, change). Even though Sera was an experienced therapist, this was an extremely challenging first case (difficulty). I wish I had been more aware of her vulnerability (difficulty, affect) as a new SMI therapist (learning) and supported her more (intervention).

The severity of the problems (difficulty) presented in this case such as severe distress and conflicts and the strong countertransference of the therapist and her anxiety will be explored further in the next three chapters with more demanding cases.