Dynamic Consultations with Psychiatrists. Jason Maratos

her relationship with her daughter? The doctor replied that she was aware. JM then responded, so she was consciously prepared to sacrifice her relationship with her daughter for the sake of struggling to do things in the way that she thought was right.

      JM inquired how the doctor made sense that Ms. A sacrificed the most important thing in her life for the sake of doing things in the way that she thought (she felt) was right and what the point of conflict with her daughter about the bringing up of grandchildren was. And more, what was the nature of the conflict between her and her daughter? Ms. A's daughter felt that her mother was overprotective. Ms. A believed that her daughter should correct her children's errors, while her daughter believed that she should allow her children to experience the consequences of their mistakes. JM asked if there was a way of helping Ms. A to maintain the connection with her daughter by changing her behavior in relation to the grandchildren and if there was a way of helping her understand that her beliefs about the values of bringing up the grandchildren are connected with her own experience as a child. Ms. A feels strongly that the children's needs should be addressed in an immediate way, whereas her daughter was prepared to hold back. Can Ms. A's current behavior toward the grandchildren be linked to her own early childhood experiences? The doctor noted that when she was a child, Ms. A was aware that her needs were not addressed and only demands were placed on her.

      JM responded that her own privation as a child remained a powerful force for her current behavior toward her grandchildren. It was emotionally impossible for her to allow what she perceived to be some privation in her own grandchildren. The meaning she gave to the current situation was a replication of her own privation as a child. Analytically it is important to see how she had not overcome the trauma of her early privation and that it was these feelings that were driving her (even to her own cost) to rush to meet the grandchildren's needs immediately. In this way Ms. A was attempting to overcompensate for her own privation, and this feeling was so powerful that living with her daughter had become impossible.

In view of this understanding, if Ms. A were to be receptive to analytical therapy, what would you set as the objective of therapy? Therapy would be directed toward resolving the feelings arising from her early painful experiences. JM concurred; she needs to mourn and grieve the deprived childhood that she had. After the mourning is complete, she will be more likely to be able to separate her own childhood experiences from the present experiences of her grandchildren. For example, her relationship with her daughter will be a lot better if she allowed her daughter to bring up her children in a way that her daughter thought right, instead of seeing that as a repetition of her own privation. She will be in a better position to allow her daughter to be the authority over her own children. She will be able to see that her grandchildren, being brought up in her daughter's way, are not being deprived in the same way that she had been when she was a child.

      JM asked if there any chance that she may live with her daughter again. It was clear that her daughter will welcome her back. JM responded that there is a hope that if she resolves this mourning that she will be able to live with her daughter and have a life in which her need to be connected is more likely to be satisfied than it is presently. This change will address one of the main reasons for her depression. Once she has resolved that grief, she is more likely to see the separateness of her own experience from the experience of her grandchildren and she will be able to have a more contemporary life experience with her daughter. Ms. A is likely to feel that her grandchildren, being raised in the way that her daughter and her husband wish, is not a repetition of her own deprivation and that her grandchildren are having a pretty good life. Feeling like this, will make it easier for her to take a grandparenting role, which is secondary to that of her daughter. She will be a grandmother helping her daughter instead of going against her. This will enable her to adopt the new role of “the helpful grandmother” and will remove one source of frustration and conflict in the new extended family situation.

      JM noted that because her depression has a large element that is reactive to the situation, an improved life situation is likely to improve the feelings of depression. It is fortunate that the relationship with her daughter is not irrevocably broken down and it is conditional. “Mum, if you respect my way of bringing up my children, I will welcome you to live with my family.” So the line of therapy could be two‐pronged: one line is to help her accept, mourn, and complete the grief about her own childhood experience and the second to point to the direction that she can strengthen the connection with her daughter (instead of threatening it with antagonism) and in this way remove one of the main sources of her depression.

      JM noted that another aspect of her life is her need to develop other relationships not related to her eldest daughter and her family. She needs to have her own adult and separate connections and sources of support. If she remains with the only connection of that with her daughter and her family, this is likely to create serious difficulties. There is a high risk that she will become overbearing and overdemanding. There will need to be a separate focus on why her relationships with her own peers have not gone well. Relationships with her peers are a whole new chapter. My guess is that she breaks the relationships with her peers before they have any chance of becoming genuinely supportive. It seems that she does not have the patience to negotiate the relationships with her peers so that they become mutually supportive. Ms. A's approach is good in the beginning of a relationship, but she seems to break it at the initial stage without working at developing the relationship with her peers. She misses the opportunity of advancing the superficial relationship to make it a more substantial one. The doctor agreed to work with her in moving through her previous experience and on developing new relationships with her family and with her peers.

      JM then noted that it seems that her difficulty in proceeding in the mourning process is reflected in her reluctance to even contemplate her early life experience. She needs to be shown that it is possible with a professional's presence and sympathetic understanding to undertake this painful mourning process. Her chances of moving on will improve if she completes this mourning process and accepts that the past was past and is not being repeated in the present. This has been an interesting case; thanks for presenting it so well.

      Scientific Literature

This case is of particular interest because it highlights the long‐term impact of child selling. This is, of course, an abusive practice that was common in several countries during times of famine or other social privation. Children are also sold for sexual exploitation, prostitution, or for organ transplantation for a financial reward to, usually, the father. Most commonly the sold children are females. Surprisingly there is no scientific literature easily accessible on this issue. One can find the case of the sold child in the literature of Child Abuse and Neglect.

      The other focus for this case is one of the “loss of role” and loss of connections in the later stages of life. References to “retirement” in more general terms (not only from gainful employment) are cited in relation to other cases in this work.

Mrs. Z

      Introduction

      Mrs. Z is a 56‐year‐old unemployed woman, living alone in her elder brother's public housing unit.

      History of Present Illness

      Mrs. Z began to complain of low mood in the last 2 to 3 years. She also realized that she was never happy throughout her life. She had on‐and‐off crying spells. She slept poorly. She had intense anticipatory fear when she knew that her brother would be returning to the city. She had fleeting suicidal ideation from time to time, but there were never actual attempts or related preparation. She sought help from general practitioner and was later referred to psychiatric outpatient department.

      Personal History

      Mrs. Z was born in the city. She has two older brothers and one younger sister, with each sibling was born 2 years after the previous one. She reported that she was treated badly by her father and elder brothers since childhood. She was often blamed and scolded by them for being “stupid,” while her mother turned a blind eye toward such treatment. She had always been a submissive child to her young sister and to her father and elder brothers, hoping that she would