Family Therapy

Greater Surrey Children's Services

Gemma D. Walker, Ph.D., Psy.D. Psychologist UK License PSY17946

Progress Note: January 28, 1990

Session#16 Present: Ind

Treatment Goals: Reduce individual's [ind's] depressive symptoms [sxs] by teaching ind to recognize sxs, use appropriate coping skills to reduce negative feelings. Teach ind to appropriately express negative feelings at least 1x/wk w/[with] th[erapist].

Session Goals: Review coping strategies used at home prev[ious] w[ee]ks w/ ind. Teach other coping skills as appro[priate]. Monitor ind's home situation. Begin termination process.

Symptoms: Low mood, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou[sin].

Interventions & Response: Ind presented again in more age-appro clothes, glasses. Good eye contact; ind made "windshield wipers" sign to th upon entering office. Th returned gesture. Ind asked th, "Are you okay? You're skin's gone funny--all pasty." Th reassured ind that th was okay, just getting over flu. Ind fed Cat piece of salmon, retreated from windowsill w/ appro patience to allow for Cat's shyness. Th lowered blinds on window. Loud banging on window from outside. Ind curious; th explained that cat distracting th today. Ind accepted w/ some confusion evident. Ind, th disc'd [discussed] ind's latest assignment--thinking of people more than one way at the same time. Ind reports that he was able to see LGs as "responsible [for taking him in], but not generous" and cou as "pathetic" but powerful as bully. Th, ind enlarged topic, w/ th prompting ind to discuss good aspects of other fam members in relationship w/ each other and not w/ him. Ind able to call Uncle/LG "caring" towards Aunt/LG and cou, but "slacker" in monitoring cou's bxs [behaviors]. Ind able to discuss other positive aspects of fam, w/ some difficulty describing cou. Discussion interrupted by loud, muffled, repeated bangings on window. At ind's request, th agreed to open blinds. Cat not visible when blinds opened. Th, ind discussed idea of terminating therapy. Banging sounds on window again. Th modeled ignoring. Ind visibly distressed, although also tried to hide feelings. Th normalized ind's feelings, describing how she would miss ind, how therapy is meant to teach ind to do w/o therapist and praising ind's successes in therapy thus far. Th asked ind to think of good way to celebrate ind's "graduation" from therapy. Ind silent, unable to accept reframe of ending sessions as "graduation." Banging extremely loud; ind blinking hard, asked to end session. Th agreed, asked ind to try v. hard to think of how he and th can discuss his feelings about ending therapy next session.

Plan: Continue teaching ind coping skills for life w/ LGs' fam. Work on goals, including helping ind perceive ind's own strengths, use at home. Help ind adjust to idea of terminating therapy.

Personal process note, Jan. 28, 1990

Cat, Fere, Great Aunt Minerva, Whoever You Are, knock that noise off! You hear me? Or no more salmon! You think I WANT to end therapy with this kid? You think I LIKE sending him back alone to that hellhole?

The second Harry is gone, I am screaming this out my window at the Cat who sits, glaring sternly at me, from Schiller's window-ledge. Unfortunately, the Cat disappears, as the window is pushed open and Schiller's beaky face emerges.

Damn the Public Health Systems of my own country and his, that callously cut off therapy after some artificially-imposed limit. But I would use stronger language against caregivers who reduce a child to needing me the way Harry does, so I shut the window before I can say anything aloud to my petulant supervisor.

Personal process note, February 3, 1990

For some reason, the Cat is hanging around these days even when Harry is not here. When I try to speak to her or offer her food, I get spat at or at least hissed.

What do you want from me, Monster Cat?

Progress Note: February 4, 1990

Session#17 Present: Ind

Treatment Goals: Reduce individual's [ind's] depressive symptoms [sxs] by teaching ind to recognize sxs, use appropriate coping skills to reduce negative feelings. Teach ind to appropriately express negative feelings at least 1x/wk w/[with] th[erapist].

Session Goals: Review coping strategies used at home prev[ious] w[ee]ks w/ ind. Teach other coping skills as appro[priate]. Monitor ind's home situation. Begin termination process.

Symptoms: Low mood, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou[sin].

Interventions & Response: Ind presented again in more age-appro clothes, glasses. Good eye contact; ind made "windshield wipers" sign to th upon entering office. Th returned gesture. Th expressed concern that ind had left prev[ious] session unhappy over idea of terminating therapy. Ind denied. Th gently confronted ind, reminding him that therapy is a place where people speak openly and honestly, if they can. Ind got up, opened window roughly, threw salmon towards Cat roughly, slammed window shut, hurled down blinds to shut out Cat. Th gently asked why Cat deserves ind's anger. Ind said, "She's as bad as you--neither of you really care. She gets fish, you get paid, and it never meant anything!" Ind sat on floor, facing door and demanded, "How much longer until I leave?" Th sat on floor near ind, not touching, expressed relief that ind feels able to be openly angry at th. Ind slammed fists on floor, remained silent. Th softly expressed her own feelings on being forced to stop therapy because of Health System regulations, mandating no more than 20 sessions unless th diagnoses ind w/some "permanent mental illness." In choking voice, ind asked th to do this for him. Th explained that ind would have bad diagnosis in permanent school records, could be followed by it, punished for it for the rest of his life, especially by LGs. Th explained that th not willing to ruin ind's entire life so th can go on enjoying weekly time w/ ind. Ind asked if he can still see th "if nobody else knows." Th reality-tested w/ ind, asking how he would get to meetings w/ th, what LGs would do when they found out he was still seeing th. Th reminded ind that th is only on "exchange visit," will return to US in a few more months. Sniffing sounds from ind, who wiped nose on hand. Th offered tissues to ind's left hand; ind swiped roughly at tissues. Th dropped tissues near ind. Ind declared, "You can't make me cry, you know." Th agreed gently, expressed own sadness that ind angry because of th's actions, encouraged ind to think of better way to spend last few sessions together than arguing. Ind rose, not looking at th, said, "Don't use your tricks on me! I know about meeting anger w/ no fighting back!" and left room. Th followed at discreet distance to see that ind met Aunt in parking lot. Sprinklers went off in building.

Plan: Continue teaching ind coping skills for life w/ LGs' fam. Work on goals, including helping ind perceive ind's own strengths, use at home. Help ind adjust to idea of terminating therapy.

Collateral contact: February 4, 1990

Th returned to locked office after sprinklers turned off to find door open and Cousin Hagrid sitting on th's loveseat. Th's office completely dry. Cou wearing somewhat mismatched everyday clothes, good hygiene, looked v. uncomfortable, shifting in chair, eyes darting around room, etc. Th asked how cou got door open. Cou asked awkwardly, "Oh, erm was that door locked then?" Th asked cou to get to point of visit quickly, as th has other patients to see. Cou rose clumsily, twisted end of large, unattractive orange tie in hands, said w/ many pauses, that ind's "lost" relatives wish ind to continue therapy w/ th. Th explained briefly that this would not be possible under current system. Th escorted cou to door immediately; cou repeating phrases such as, "Now yer really wanter think about this, Doctor," etc. all the way out of building. Th escorted from building.

Personal process note, February 4, 1990

What good are all these "long losts", if they won't actively help the poor kid? Apparently they are all waterproof and they all walk through doors or something, but, hey, ask them to help out with one little boy and what do they do?

I can't believe I just wrote that. Th will have good drink as soon as th gets home this evening.

Progress Note: February 11, 1990

Session#18 Present: Ind

Treatment Goals: Reduce individual's [ind's] depressive symptoms [sxs] by teaching ind to recognize sxs, use appropriate coping skills to reduce negative feelings. Teach ind to appropriately express negative feelings at least 1x/wk w/[with] th[erapist].

Session Goals: Review coping strategies used at home prev[ious] w[ee]ks w/ ind. Teach other coping skills as appro[priate]. Monitor ind's home situation. Begin termination process. Help ind w/ anger over termination.

Symptoms: Low mood, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou[sin]. Anger at th.

Interventions & Response: Ind presented again in more age-appro clothes, glasses. No eye contact; ind stomped into office, eyes on floor. Th made "windshield wipers" sign to ind. Ind ignored. Th cleared throat, made gesture again. Ind ignored. Th went to window, offered salmon to Cat, who was sitting on neighboring windowsill. Th spoke to Cat, telling Cat how th feels v. unhappy because of Cat's constant rejecting behavior towards th. Th explained to Cat that th was "miserable" after prev session bec th wants to make peace w/ Cat, have proof that Cat cares about th, even if th can no longer see Cat every week on office's windowsill. Th explained to Cat that th still cares about Cat and would feed cat salmon forever, except th will be forced to leave England eventually. Th expressed sadness that some things cannot be changed, but promised Cat that th will always care about Cat, even if Cat cannot show caring back to th. Th wondered aloud what Cat would say back to th, if Cat could speak. Ind snarled at th's back, "I hate you, stupid, mean Person." Th answered that th has tried to give all she could to Cat, even figured out w/ ind's help what Cat wants most. Ind said as Cat, "I want to be fed all the time! I want to come indoors and stay with you forever! Why don't you care enough about me?" Th explained that th not allowed to keep Cat; rules at th's flat forbid pets. Th explained that she has given cat best she could within the rules th must obey. Ind as Cat replied, "You should stop obeying those stupid rules." Th replied that then th would lose job, home, ability to see cat at all. Th abruptly sat on floor, back still to ind, modeling her idea of ind's feelings, let shoulders, body sag, said, "I feel so sad. I feel so alone." After long pause, ind pushed tissue box roughly at th's hand. Th said, "I feel too bad to even cry." Ind carefully placed hand on th's shoulder, said, "I'm sorry. I'm just sorry." Th twisted around to make eye contact, which ind allowed, said, "Me too. But friends can get angry at each other sometimes when things get bad. Friends get over anger and fights." Ind blinked hard, asked for game of Trouble, was gradually able to laugh softly over game. At end of session, ind said, "Oh I forgot" and made windshield wiper gesture at th. Th returned gesture. Th, ind held hands walking out to Aunt's car.

Plan: Continue teaching ind coping skills for life w/ LGs' fam. Work on goals, including helping ind perceive ind's own strengths, use at home. Help ind adjust to idea of terminating therapy.

Collateral contact: February 11, 1990

Th returned to office to find ind's Great Aunt Minerva sitting in th's chair. Gt Aunt wearing somewhat mismatched everyday clothes, good hygiene, looked v. uncomfortable, shifting in chair, eyes darting around room, etc. Gt Aunt rose, made windshield wipers gesture on her glasses, said immediately, "I won't beat about the bush, Doctor. You are to continue therapy. We admit that we have made a few mistakes where you are concerned, but that changes nothing. You are to continue therapy with my great-nephew." Th explained patiently that Public Health System mandates only 20 sessions of therapy per year, etc., etc. Gt Aun declared impatiently, "We can fix that. There are appropriate channels--" Th interrupted, asked Great Aunt how she will "fix that" w/LGs, who have been hostile to therapy from start. Th quietly remarked that, releases or not, th unable to accept that "long lost fam members" acting completely w/in knowledge of ind's LGs, based on conflicting bxs between 2 sets of relatives regarding therapy, lack of other interventions by "long losts" in ind's life, ind's lack of knowledge of existence of "long losts", LGs never mentioning "long losts" to th. Gt Aunt flared nostrils, tightened lips, announced that she would return and that this issue was not closed. Th rubbed eyes w/ hands, heard explosive noise, looked up to find Gt Aunt gone from office, was unable to find in building.

Incident Report: included in chart February 11, 1990

Made report this date to security re: ind's Gt Aunt carrying explosives into building. Gave details of recent encounters. Security agreed to monitor visitors to building, watch for Gt Aunt.

Progress Note: February 18, 1990

Session#19 Present: Ind

Treatment Goals: Reduce individual's [ind's] depressive symptoms [sxs] by teaching ind to recognize sxs, use appropriate coping skills to reduce negative feelings. Teach ind to appropriately express negative feelings at least 1x/wk w/[with] th[erapist].

Session Goals: Review coping strategies used at home prev[ious] w[ee]ks w/ ind. Monitor ind's home situation. Help ind adapt to life w/o therapy.

Symptoms: Low mood, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou[sin]. Anger at th.

Interventions & Response: Ind presented again in more age-appro clothes, glasses. Good eye contact; ind made "windshield wipers" sign to th upon entering office. Th returned gesture. Ind fed Cat piece of salmon, retreated from windowsill w/ appro patience to allow for Cat's shyness. When cat came to sill, ind apologized in formal voice to Cat, told cat he will always care about her. Ind stiffened, turned to th, repeated speech. Th grinned at ind, who slowly smiled back. Th said, "More!" and grinned harder at ind. Ind expanded smile into bigger smile. Th bared teeth at ind in mock grin, trying to grin as hard as possible, demanded, "More!" Ind suddenly grinned, showing teeth, broke into laugh, said, "You're mental! I told you way back--you're just weird!" Th laughed, said, "Made yer laff" in best imitation of rural English accent. Ind laughed, said, "And you talk funny! And that's not what we sound like!" Th giggled, admitted she is bad imitator, told ind that she had still achieved a major goal for herself by getting ind to give her big smile "to remember him by." Ind said to floor, "I won't forget you." Th agreed, waved digital camera at ind, asked for photos together. Th, ind printed photos in greeting card format ind selected from th's computer. Th gave ind new copy of th's business card, wrote American office address on back, encouraged ind to "check in" from time to time if possible. Ind asked for help completing Snakes and Ladders game to keep at home. Th found ind's previous drawing, helped ind modify "gameboard" w/ sayings from therapy, drawings. Ind decided he will use painted pebbles and th's dice to play game. Ind asked th to show him "card games for one person". Th showed ind various versions of solitaire, w/ ind practicing 2 versions he likes. Th reminded ind that next session would be final session. Ind abruptly grabbed th around waist in strong squeeze, then walked out of office in front of th. Th, ind held hands walking out to Aunt's car.

Plan: Review ind's knowledge of coping skills for life w/ LGs' fam. Help ind adjust to idea of terminating therapy.

Progress Note: February 25, 1990

Session#20 Present: Ind

Treatment Goals: Reduce individual's [ind's] depressive symptoms [sxs] by teaching ind to recognize sxs, use appropriate coping skills to reduce negative feelings. Teach ind to appropriately express negative feelings at least 1x/wk w/[with] th[erapist].

Session Goals: Review coping strategies used at home prev[ious] w[ee]ks w/ ind. Monitor ind's home situation. Help ind adapt to life w/o therapy.

Symptoms: Low mood, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou[sin].

Interventions & Response: Final session. Ind presented again in more age-appro clothes, glasses. Good eye contact; ind made "windshield wipers" sign to th upon entering office. Th returned gesture. Ind refused th's salmon, fed Cat piece of gooey food he produced from plastic bag, retreated from windowsill w/ appro patience to allow for Cat's shyness. When cat came to sill, ind said, "There's a bit of kidney pie for you. That's special from me to you. I couldn't filch anything better. Sorry." Cat ate kidney pie rapidly, left sill for shrubbery under window. Th, ind wondered why Cat had left. Th reviewed w/ ind all the ways he had learned to cope w/ "difficult family." Ind began reciting list, grinning and rolling eyes, interrupted by gagging sounds outside, from below window. As th, ind rose to check, Cat returned to sill. Ind muttered that it was "all right then" and returned to describing his skills. Th, ind reviewed events of therapy, w/ th dwelling on places where th had seen ind making progress, due to his own good work. Th attempted to empower ind w/ some success, by describing how he had made therapy a success by working well w/ th. Th produced 2 cupcakes w/ candles, lit candles, said this was ind's party, asked ind to make speech. Ind smiled, shook head. Th presented ind w/ present--book of solitaire games for regular deck of playing cards. Ind showed th that he is still carrying list of his good qualities th had made for him. List battered; th offered to rewrite; ind refused, saying he likes it "exactly that way." Ind gave th folded paper, said he had made same type of list for her of th's good qualities, asked th not to open until ind gone from session. Th asked for "big goodbye hug to last a long, long time" and ind grabbed th around waist in strong squeeze, eyes tightly closed. Th, ind held hands walking out to Aunt's car. Th attempted to give Aunt instructions as to return to therapy if necessary; Aunt rolled up window and drove off as th spoke.

Plan: Complete termination summary for ind.

Correspondence contact: included in chart, dated February 25, 1990

Dr. Walker's Good Qualities

By Harry Potter

Your kids are lucky to have you for a mum.

Love, Harry Potter

Personal process note, February 25, 1990

If I had kids, Harry, I'd want one of them to be like you. And if I could adopt a British kid, you'd be first on the list.

Collateral contact: February 26, 1990

Th returned to locked office after lunch, found ind's Uncle Albus, Gt Aunt Minerva, Cou Hagrid all sitting in various chairs. Uncle Albus in th's chair, rose and offered chair to th, perched himself on arm of other chair. Some confusion as Gt Aunt, Cou all attempted to offer Uncle their seats. Th discussed fam's idea of ind's therapy w/ them, thanked them for attending final meeting to "wrap up."

Personal Journal entry [excerpt]: February 25, 1990

Sure, I knew at least one of them would show up, sooner or later. When Great Aunt Minerva tells you a topic is not yet closed, you believe her, even when you have locked your office door. But I was a little stunned to find them all there. Perhaps it was an attempt to prove what they were about to say by sheer force of numbers; who knows?

All of them were in their weird clothes again. Under all that hair, Hagrid looks like some sort of hunter or gamekeeper to me, right out of a Thomas Hardy novel. Except WAY more hair, of course, not to mention the fact that he has to be at least 10 feet tall. Minerva and Albus looked, frankly, like SCA dropouts or cast rejects from Disney's Sword in the Stone.

But they were all unfailingly polite to me, with the 2 men actually being downright warm. Albus kicked things off with something I never would have expected. "Have you ever heard of the Salem Academy?" he asked brightly. After a brief mental trip in the Wayback Machine, I realized that I had--in my teens my family had received a letter from a school with that name. "Ah, yes, there we are," replied Albus, apparently well pleased. "and they told you that you are a born witch, did they not?"

"And my parents promptly tossed the letter into the trash, since I was en route to an Ivy League school, and they did not want me hanging around with whatever crackpots wrote that letter."

"Ah, yes, well, yes, I admit that I had not expected that. I simply thought that you'd gone undercover as a Muggle to help their children. Until Professor McGonagall here realized... Ah, a Muggle...a non-magical person. You are aware that you have some latent powers, are you not?"

"She is not, Albus, I told you. I tested her myself," Aunt Minerva interjected, but with far less haughtiness than I would have expected.

"Indeed, indeed," Albus replied. "But surely, Doctor, you have been wondering about all the alarms and sprinklers going off? Surely you can tell, from even your own notes, that the sprinklers turn on whenever you become sad? And the fire alarms, naturally..."

When I am angry, I realized with a shock. And Minerva looks like the Cat because they both have the same shape of glasses around their eyes. And she knows the windshield wiper gesture because....

When the room swam back into view, I felt like steam was pouring out of my ears, my throat was burning, my stomach was warm, and Hagrid was anxiously fanning me with a handkerchief that could easily double as a picnic blanket. Up close that way, he's even hairier than I had expected, but somehow you can still see the innate kindness. And now he had a small, empty, glass vial sticking out of one exterior pocket.

"Perhaps it is a little late to start you on magical studies," murmured Albus, as if I had not just recovered, let alone lost, my senses. "But neither are you a squib--"

"'E means ye do have powers, mebbe not the strongest--" put in Hagrid helpfully.

"Thank you, Hagrid," intoned Minerva McGonagall squelchingly. Hagrid settled into stillness once more, as my tortured loveseat groaned beneath him.

Albus continued, "I have an offer to make to you, Doctor. You do seem to use magic, in a rather unique way, at least by our world's standards. Contact with young Harry seems to have triggered your abilities. But you must be tired of evacuating from buildings during your working day. We could teach you to control your magical, emotional outbursts. You have no children of your own, moreover, but you plainly want them. We have dozens of them. Perhaps you would be willing to consider a negotiation?"