Young woman Vera (18 years old) has been in therapy since July of the last year two

times a week. Since September she shifted to once a week because of the financial
difficulties of the family. The reason of application is that she didn’t hold on at the
second year of college, she interrupted the winter session not having passed all
examinations. She was in depression for two months when she didn’t get up from her
bed, she ate very little and lost 8 kg. Since March she has felt good and has gained
weight. Vera would like to feel more self-confident, not dependent on her parents
financially and emotionally.

The work with the parents caused me some difficulty since the very beginning.
Vera’s mother made the agreement for therapy, saying «May I phone you from time
to time and pay you by card?» Money wasn’t given to Vera’s hands. I agreed for the
card, but I didn’t allow her to call with the questions about what was going on in the
sessions. Still, mother had tried to write to me all the time in the beginning about how
Vera had overslept, whether she was taking drugs or not, whether she might have a
psychosis, she asked me whether Vera had attended sessions or not. At some moment
I couldn’t stand it anymore and asked her to come with Vera and father to meet me.

Mother seemed to me to be a well-socialized borderline woman. She either loved

Vera, her only daughter, very much, or she punished her cruelly. At the session they
were recalling how cruelly they had been offending each other, sometimes they
shouted and quarrelled during the meeting. Father was mostly taking the neutral
position, still he supported mother in her accusations more than tried to understand
his daughter. Father impressed me with his appearance, he was over 40 years old, but
he looked like a teenager with dishevelled hair and wearing blue jeans with holes, he
was very groomed. We made an agreement that I would not tell them if Vera had
attended or missed (if it ever happened) and that in general it was important that Vera
should have a safe space for psychotherapy. Mother had attended a psychotherapist
herself during that year and she took this idea of non-interruption. She said about me
that she had expected to see me dry and strict and not allowing anything, but I am
full-bodied and kind. Vera had had a psychotherapist before who had been in contact
with mother and it was one of the reasons why Vera had left the psychologist three
months after. Mother had taken her to see 3 psychiatrists by that moment thinking
that Vera had schizophrenia. All three of them told her that Vera was healthy and that
she didn’t need medication. At the sessions with Vera I found out that Vera had been
breastfed till she was 2 years old and Vera had been an obedient child, after Vera
turned 3 years old they started to have conflicts with mother and Vera didn’t obey,
and when Vera was 7, her parents had moved to another country and she had lived
with her grandmother for several years. It was the best time for her. Though she
recalls that when all her friends were playing alone in the yard, her grandmother
always accompanied her. Since Vera had turned 11 years old, she had moved to live
with her parents in Russia. The relationship was sadistic. Vera told me that her
parents had persecuted her with the police when she went to see her female friends at
their homes in her senior years at school. They threw her out of home in the cold
weather and didn’t let her into the house front door until she said that she was sorry
when she was younger, and once she had spent a night at the staircase of the house.
At the same time Vera was an «A» student. She entered one of the most prestigious
universities of Russia, but a paid department. Though she could have entered budget
departments of several good colleges with her good grades.

After the middle of October Vera started to miss sessions. She could discuss the
resistance in psychotherapy and that it was becoming difficult for her to come
anywhere. In November she started to miss the new college, not able to make all the
way there from home and was discussing her fear and the inexpediency of attending
the department she didn’t like. It was important for her to come to me and discuss
what was happening with her including her parents, but it seemed to me that she
didn’t trust me and the process till the end. I started talking again about the need of
increasing the number of sessions. At last, in December during the beginning of the
examination session she missed the exams and didn’t get the credits for the ones she
had passed in the previous college. She came to my sessions every other time and
didn’t write to me anything about herself. Then she showed up again but she asked
me to talk to her on Skype. At that moment I was already anxious for her and I
agreed. She seemed to me to be adequate but suffering from anxieties and the fear of
her mother. She also talked about the absence of sense and suicidal thoughts. At the
same time we were discussing her plans for the future and the variants of the
development after she fails the second college.

She had missed the following session. I understood that I wasn’t able to help her
anymore and I didn’t understand what was the way of working with her further. I was
thinking that I needed to talk to the parents and try to help Vera together. I was
thinking of the real suicide threat for Vera. On the other hand I was already
understanding my role in this family dynamics too poorly, completely captured by the
dynamics of the family. I was experiencing huge anxiety, my incompetence and
uselessness. But at the same time I was thinking that the work with the parents might
help Vera. I remembered that after our first meeting in July father had started to show
more care for Vera and sometimes he supported her, which Vera mentioned at the
sessions with gratitude. But at the same time, Vera was already 19 years old at that
moment, and I had never worked with the parents of such grown-up children before. I
was getting supervisions of my sessions with Vera, and the main idea was that Vera
was placing her anxiety in me and was projecting the criticizing mother upon me. I
talked to practicing psychiatrists and they didn’t increase my optimism, asking me to
talk to the family about the anti-depressant issue in the hard moments and about
seeing a normal psychiatrist. As the result I turned to the mother. First, she wrote an
angry text message to me about the fact that Vera had finally told her the truth about
her difficulties with the second college. Then I asked her to have a phone
conversation.

Mother: I’m calling you as you asked me.

Psychologist: I worry that when Vera feels bad and she encounters difficulties she
doesn’t turn for help. She has been missing sessions recently and I am afraid that I
can’t be helping her. Now it’s not an easy time for Vera and let’s think together what
we could do.

Mother: I can’t do anything. She runs away from us. I have 40 unanswered calls on
my phone and I can’t reach her on the phone, we went to her apartment without
warning and she told us that we had met her there accidentally. She doesn’t want to
talk to us, she runs away to her friends all the time. Only recently she came to see us
for half a day, and we had made an agreement 4 days before that, we were waiting for
her. And now she comes and informs us that she is choosing a different department
and we have to pay for it all and she won’t study. She has no calling. In my opinion,
she is degrading, her speech is becoming poor and she is becoming stupid.

Psychologist: I don’t find that anything has changed in her speech recently, she still
looks very intelligent and she builds her sentences exquisitely. It seems to me that
when you begin to worry about Vera, you speak degradingly about her.

Mother: Yes, you are right. But I can’t help it. What do you think is wrong with her?
She even threw her grandmother out of her home, she used to live with her. She tried
to make Vera go to the college. And she had blocked Grandma’s text messages, so
that she had to leave back for home all disappointed. She doesn’t let us come close at
all, she tells me that it’s all my fault. I don’t know what to do.

Psychologist: Let’s try to think what could be done so that Vera wouldn’t see you as
the parents dogging her footsteps, but so that she could turn to you when she feels
bad. Could you talk about it?

Mother: Oh, Elizaveta. I have come back to my psychologist, I haven’t seen her for 3
months as I had no money. And I talk only about her all the time. You wouldn’t
believe it. I understand that she needs to grow up, to separate from us. But she does
nothing on her own, neither study, nor work. Once she was making a salad, and I told
her that she was cutting the carrot that we had bought, for our money, and she made a
scandal, I understand that perhaps I didn’t hold back.

Psychologist: It may be hard for Vera when you talk to her about her studying for
your money, it might be additional load and then she doesn’t consider these colleges
to be her own, as if they were what is important for you, and not for her.

Mother: Yes, I understand it all, I do. She is not developing at all, she has no goals.
What do you think the forecast is?

Psy: I worry that I cannot help her when she disappears. She doesn’t come to the
sessions. In these moments I would like to. However, I don’t work with the parents of
such grown-up children. But it seems to me it would be difficult to do it in your case.
I would like to be in contact with you. Because it seems to me that Vera is falling into
depressive states which might be aggravating.

Mother: Yes, but the psychiatrists haven’t found anything. They were not just random
people in outpatient clinics, they were professors. But I will look for another one. Do
you think she has schizophrenia? Does she have depression 11 months a year? She
does feel good sometimes.

Psy: I don’t think she has schizophrenia or any other disorder. But I think that when
she is in a depressive state she can sleep for weeks and not go out of home.

Mother: Yes, once we came and she looked like she hadn’t washed for a week and I
decided that she was on drugs. I said then that we were beginning the renovation in
her apartment and I took her back home. At home she was sleeping too, but at least
she washed. And after a couple of days she left for her friends anyway. And do you
think she isn’t going to finish college anyway? And she will be like this all her life?

Psy: I am worried not about college now, but about Vera’s condition. Your girl is
smart and an «A»-student, she can have other educational options.

Mother: And what should we do? I don’t know where to look for her. And she won’t
agree to see a psychiatrist again. She is 18 years old. Maybe you could talk to her?

Psychologist: Yes, I will talk to her. But I will need to be in contact with the doctor
by all means. And I would like to increase the number of sessions with Vera to two
times.

Mother: Yes, certainly.

As the result of this conversation I calmed down considerably. First of all, I didn’t
have such huge responsibility for Vera’s life anymore. Then I saw the resistance
towards the parental influence more than during my sessions, where Vera was
showing more of her depressive part. And I clearly understood that my conversation
would stop mother from attacking and humiliating Vera after she finds out that Vera
has dropped out of college.

Really, Vera came after the New Year and told me that she had coped after the failure
at college easier than the first time, she has no desire to lay in bed for two months.
Mother is more or less adequate, but still she has taken her back to live with them,
again under the pretext of renovation. Above all that, we have shifted to two times a
week. I have retold the conversation with mother to Vera and our discussion of the
psychiatrist. I think that she wasn’t happy with that but she agreed to see a
psychiatrist in the future in case she feels bad again.

My request for the supervision: to share with what is going on and maybe construct
the further line of behaviour. I have been balancing between the saviour and the one
who is going to be thrown out of the door tomorrow, by either Vera or her mother.
(Father has been paying regularly for all Vera’s sessions – attended or missed). And
do I need to work with her parents? If I do, then how??