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When working in a session, or, as in this case, when reading the clinical report of a session, I pay special attention to the first verbal or non-verbal communication. It is usually a signpost to the underlying unconscious meaning or affect of the later themes. As in dream work, one listens to the manifest content while one searches for the unconscious meaning, especially relating to the transference. In this session there are two initial communications:
The first: ‘She looked smartly dressed and had blue streaks in her hair’. Any unusual change in appearance alerts me to the possibility of the patient's wish to draw attention to an attractive sexual body as a defence against feelings of sexual abnormality or conflict. I am influenced by the knowledge that this is a 16-year-old girl at the height of her adolescent changing body and her relation to it. There must also be a transference message and we are told that Leyla missed the previous five sessions.
The second: Staring at the new blue couch which she sits on, Leyla says, ‘Something has changed in the last 2 weeks’, and ‘It's not as big as the other one’. I hypothesize that she has come to her session full of ambivalence towards her therapist, with thoughts of ending and not needing the therapist any more. She has been attacking the therapist in