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John, Sally, and their daughter Mary came into therapy wanting to help deal with current issues relating to Mary’s depression and self-harm. They had discovered that Mary had been occasionally cutting herself as well as isolating herself in her room for long hours. Sally had recently been diagnosed with breast cancer, which was successfully operated on, and was in remission. From an object relations perspective much of the family’s relationship and way of dealing, or in this case not dealing with Sally’s cancer, was facilitating Mary’s depression.Sally’s cancer had been minimized due to its highly operable nature. Both John and Sally explained to Mary that it was unnecessary to talk about the cancer as her mother had been “cured” already, ignoring the intense feelings of loss, sadness, and anger by all the family members before the positive news. Although this pattern and unconscious rule in their family where issues of intense emotional content were not to be discussed, this highly traumatic event appeared to be the breaking point for Mary. In a sense the holding environment of the family itself, i. . the capacity and environment of the family unit to hold these intense emotions was negligible, not only did the parents send the message that they were unable to deal with intense emotions, they also related that they were unwilling to do so. Mary’s depressive reaction to this was two fold. There is an aspect where her cutting and depression were ways to reign in the family’s attention, to inject some emotional caring into her family, which she did successfully as evidenced by the family’s urgency at entering therapy.However, through therapy more was revealed about her depressive feelings and behavior. Through understanding what was going on in the room, the push and pull of how her parents would be minimizing of the emotional content and Mary’s reactions, it was eventually interpreted that in many ways her depression was a way of getting back at her parents, a sublimation of her anger towards them. Because her anger at her parents was intoleraterable within their family system Mary’s anger was turned towards herself, instead of expressing her anger towards them she turned inwards.The cutting served as an unconscious way of projecting her feelings onto her parents, where they would subsequently become worried, angry, and depressed, many of the feelings Mary was feeling herself and wished to be able to consciously express to her parents. In this way Mary was only able to genuinely able to relate to her parents object within herself, not within the outside world of their family environment. Additionally, through a number of sessions working only with John and Sally it was revealed that both of their family’s of origin had very strong influences on the current functioning of their family.Both John’s parents and Sally’s parents suddenly became divorced, a huge shock on both their family systems. How this relates to their current family is that in a way they were both involved in a transference relationship with Mary, more specifically projective identification, where John and Sally’s fear of intense emotion and what is not being said is projected onto Mary, who in turn feels much like they did in childhood, angry, alone, and depressed. The focus of treatment may initially appear to be Mary, and symptom wise it should be, e. g. regarding medication, possible suicidal ideation, etc.But much of the focus of the family therapy in order to change the current functioning will be John and Sally. Helping the parents to realize their unconscious projection and subsequent recreation of their childhood within their current family will be the main focus and thus source of change within the therapy. Through helping to create an adequate holding environment in the therapy room, allowing the family’s resistance to be lowered and interpretations and insight to develop will help them be able to digest the emotional content that once seemed so frightening to them.My role as a therapist is to help facilitate this environment and process of insight development. This is mainly done through an open ended and very Rogerian stance within the room and in dealing with the family, while having a strong therapeutic frame that demonstrates well defined but somewhat flexible boundaries. This stance both helps to facilitate the holding environment and the therapeutic process as well as modeling a holding environment that will be developing over time within their family that can weather tough emotional content. Treatment outcome with this family is very positive.Although slow going treatment will help this family to find a new sense of freedom in their interactions with one another and a new way of functioning that is more encompassing of one another’s needs. However because this treatment can be slower and has a focus that is more broad than just the current issue of Mary’s symptoms, it is key to pay close attention to her symptoms, potentially involving her in other treatment outside of the family therapy as the cathartic process that is inevitably part of insight oriented therapy may be painful for her at times.

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