>> Object relations family therapy is a psychoanalytic model that incorporates both the original theory and practices of Sigmund Freud and the further development of his model that occurred through the work of object relations theorists such as Melanie Klein, W. Arty Ferrer [phonetic], D.W. Winicott, Margaret Moller and Steven Mitchell to name a few. It is the object relations theorists who focus on the early attachment of the infant to the parent. They introduce such concepts as the good enough mother, union and fusion versus separation and individuation and the creation of a facilitating and nurturing environment. With a growing interest in John Bowlby's attachment theories and Alan Schore's neuroscience, object relations family therapy is gaining in popularity even though the length of treatment is generally longer than we might associate with other family therapy models. The foremost family petitioners of objects relations family therapy are Doctors David and Jill Scharff whose family therapy institute in Chevy Chase, Maryland just outside of Washington, D.C. Object relations family therapist track the emotional experiences of a family member's and attempt to create a safe and secure holding environment in which these members can explore the issues that bring them to therapy. This holding environment is designed to be nurturing. It is founded on acceptance and an often intuitive sensing of the emotions underlying family interactions. Indeed this therapeutic holding environment seeks to replicate the kind of holding experience that leads to positive attachments between infants and their primary caregivers. In this video Dr. Bitter uses an object relations model to work with a family whose youngest child has recently been discharged from a residential treatment center after she tried to commit suicide. Claire is a junior in high school and her attempt involved an overdose of diovan that was discovered by school officials when she fell asleep in her class. Claire was in a residential treatment center for ten days before being released to her parents and allowed to go home. She has an older brother, John, who is away at college, but who came home briefly to see her when she was in the treatment center. The session begins with Dr. Bitter wanting to meet the members of the family. >> So I'd like to get to know your family. Maybe we could start with everyone introducing themselves and if it happens to be some other people in the family who aren't here, I'd like to know about them too. >> Well, this is Claire. She's the one that we called you about. Her father and I, we're worried about her. We're worried about all of us, really. >> Okay. So, just so I can keep names straight, you're Wendy. >> Mm-hmm. >> May I call you that? >> Sure. This is Logan. >> Okay, Logan. Nice to meet you. Are there other family members or just the three of you? >> I have a brother, John, but he's been in college for about a year so he's not really ever home except for vacations. And then there's my grandma and grandpa and we see them sometimes. >> Okay. So there's John and your grandparents. Would that be your parents Logan? >> No, they're my in-laws. They're Wendy's parents. >> Okay. So they're your parents. >> We don't see them very much. >> So it's mostly just the three of you at home these days, no other significant people coming in or out, or perhaps just John. Okay, so John's away at college. Claire, and I'm not sure what you make of that. Is that a difficult thing for you? Do you miss him or perhaps you're enjoying being an only child? >> I'm not sure what-- that we came to talk about John. Claire tried to commit suicide a few weeks ago. She took some pills. That's really what we're here to talk about. That's-- that's the reason that we're here. >> Okay. So can you tell me about that? >> Mom. >> Well, she just went to school one day, seemed normal enough. She was grouchy so. >> All teenagers are grouchy. >> Well, like always she was a little grumpy in the morning. But, I mean, otherwise she seemed fine. Then we get this call and she's at the nurse's office. Apparently she told a friend that she took some pills. Then the friend told the nurse and then they called us. >> I don't work due to my disability and so I got the call and then I called Wendy and we rushed over to the school and Claire really took all of this out of our hands because when we got there a bunch of emergency personnel, police were there and she wanted to come home but they were just adamant that she had to go to the hospital. And we couldn't even go with her, but we could meet her there. >> Okay. So what is this like for your Claire? What's going on for you? What are you feeling? >> Everything kind of got out of hand. >> So did you feel like this event became more than you wanted it to be? >> I don't know. I mean, I told them when they asked, I told them that I wanted to end my life. But I don't know. I don't know if I really did. But I know I didn't like the hospital and there was nothing mom or dad could do. >> Okay. So once you got to the hospital things just happened and you and your parents pretty much just stuck with it? >> Yeah, they took my blood and I hate needles. >> They decided not to pump her stomach because she had taken the pills, I don't know. I think it was diovan or something like that. But she had taken them before she went to school. So it was too late to pump her stomach. We were there 12 hours before they decided what to do with her. >> Wow. So it sounds like you were just kind of swept up into the mental health system. Did you wind up in residential care? For how long? >> For ten days. >> So this must have been quite an ordeal. You must have been scared, maybe worried? >> I was upset. I was worried. I felt helpless. I was scared. >> What kind of upset were you? >> Well, I was mad at Claire. She kind of took this out of our hands because we didn't have a say in anything. Once they took her there, I mean, we didn't even get to talk to her. We had-- well, we had two short family meetings that were basically worthless. >> It's just hard when the state takes over. >> Yeah, it is. And I hear you saying that and I almost hear you having some sadness about what that was like to go through with the state taking over. >> Well, yeah. I just wanted to bring her home. >> But your wife felt more angry than sad. Do you think she was angry at Claire? >> Yes, I was. I was angry at Claire. I mean, we're a nice family. I mean, why would she feel the need to do this? I don't understand. I mean, we've asked her and she won't tell us. She says she doesn't know. >> Okay. Well, Claire, maybe you don't fully know. So, I mean, like, sometimes the most painful events are really hard to know about. Sometimes they're very complicated. So your mom and dad were with you at the hospital before you left for the treatment center. Did your brother John come in? >> Not right away. >> He came about two days later. She was already in the center. >> I see. Well, what was that like for you? Did you get a chance to see him? >> Well, he came over but we didn't talk to much and he said he loved me and I said thanks. >> Okay. So you said, thanks. >> Yeah, well, I didn't really know what to say. I know he loves me but there wasn't anything he could do. >> Okay. And do you love him? >> Yeah, he's my brother. >> And how about your parents, do you love your parents? >> Yeah, they're my parents. >> Yeah, they are your parents. Would you say that they're easy parents, or difficult parents, or somewhere in between? >> Yes, I would kind of like to know this. >> Well, it's been better since I came home. >> Yeah, in what way? >> I don't know. They seem to want-- I- I don't know. >> Let's think about it. They want what? >> Me maybe. I- I don't know. >> I think that she thinks we're difficult parents. But she's been pretty difficult herself. I mean, even since she was young, an infant. Well, for example, when she was about a year old she just stopped eating. We took her to the doctor and she had lost 10 percent of her body weight in a month. Logan had-- they had him force feed her. I couldn't even stay in the room. >> She was pretty stubborn. I remember one time we went on vacation to this island. She was three and John, I guess, was eight or nine. And it was so cold there that she would just wear diapers, couldn't even keep her clothes on. >> Wow. So Claire's been a bit of a handful, even when she was just an infant. >> I guess I'm still a handful. >> Well, you're smiling when you say that but I sense that there might be something more behind that statement, something about what it's like to be a handful. Maybe it's too hard to talk about this, this feeling of being a handful. I notice that when you came in you chose to sit between your parents. >> Right. >> What do you like about being in the middle? >> Well, I just like sitting in the middle. It's my favorite thing. >> Okay, and does that happen at home? >> Yup, especially when we're at the dinner table. Dad's always over here on my left and I'm just right here and mom's right over there. >> Does that make you feel secure, like you have a nice place in the family? Now when you smile like that, it looks to me as though it does really make you happy. >> Yeah. >> Even when they're mad? >> Even when they're mad. >> Hmm. Could it be that it's not just even when they're mad, but it's because they're mad? Now, I realize that may be-- it doesn't make quite sense. But when they are both mad and you're in the middle, I have to ask myself, what is the reason? There must be some reason that you feel better off in the middle than you would be off on your own somewhere where you don't have to hear them being mad at you. You're kind of thinking about it. >> Yeah. >> So if you are in the middle, between mom and dad, where is John? >> He's gone. >> So he's always gone? Does he sometimes come home? >> He doesn't come home as much as I'd like. >> But he comes home sometimes. What happens when he comes home? >> Well, you know, we just catch up and, you know, he calls from time-to-time. >> If he needs money or he gets an award. >> We all just sit around the table and catch up. >> All of you? >> Yeah. >> Not all the time. >> Well, sometimes Claire doesn't seem interested. She'll take her food and go in the TV room and eat and watch TV. >> Okay. So when she goes off like that, do you miss her? >> Yeah, do you miss me when I'm gone? >> You're not gone. You're just in the other room eating. What does this have to do with Claire committing suicide? I mean, what does it matter who sits where, what happens when John comes home? He doesn't come home often enough, I'll tell you that. >> He's a man now. He wants to be on his own. He likes being on his own. >> Well, what do you think of Wendy's desire to understand why Claire tried to commit suicide, Logan? >> Well, I think we'd all like to know that. >> So you join your wife in wanting to know what was going on with Claire? You'd be interested in her and want to know what'd been bothering her? >> Yeah, but I don't think she'd tell us. >> Have you actually asked her? Like, have you asked her why she felt so sad, or hurt, or perhaps discouraged that she wanted to just end it all? >> Well, not quite like that. >>But in some way? >> Yeah, well, I told her that I didn't want her to ever do it again. >> So you do want her to know that you want her to live and you want her to be part of the family and that she's your child and that she is important to you? >> Yeah. >> Because I have an idea about what might have led to Claire's suicide attempt. >> You do? What is it? >> I think maybe she was trying to find out if she is loved as much as her brother, John. Would you two be as sad if she were gone as you seem to be when John is away at college? I don't know, but maybe she even feels that John is favored or more loved, something like that. >> Well, if she's unclear on whether we love her or not, she wasn't paying attention to those family meetings. I mean, I told her I loved her. I cried so hard I couldn't even stop crying, I felt like I couldn't. Wendy was crying. We both were crying and she wouldn't even-- Claire wouldn't even talk to us. >> Okay. So you were there and crying and Claire came into the session. But am I right, I hear she didn't talk? >> I didn't even like that psychologist. He was an ass. >> Uh-huh. So you didn't talk? >> No. >> What was it like to see your parents cry? >> Well, it was really like I had almost actually like really died. I didn't say anything and they just cried. I don't know. It was hard on all of us. >> Okay. So what was it like going home? >> Well, it's better-- different. I don't know. I mean, I guess I talked more when I came home. >> Maybe a little like coming back to life? >> Yeah, maybe. >> Okay. So I don't know, have the two of your cried since Claire has come home? >> Well, there's nothing really much to cry about now. >> Well, I kind of worry everyday and at night. A lot of times when they're not around I cry. I cry just about everyday. >> But you work at protecting Claire from your tears? >> I do. >> And yet it's your tears that seems to make her feel loved, maybe even wanted. >> Do you really think so? >> I do. But you don't have to take my word for it. You could ask Claire.