Object Relations Family Therapy Conceptulaization

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.e. 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