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Nana, a 19‐year‐old girl self‐referred for therapy, was accompanied to the first session by her mother, Jessica, a 52‐year‐old accountant. Nana was nearing the end of her sophomore year at a local university. Nana described bad grades, outbursts of crying and anger, problems with peers at her school, and conflict with her father, Emery, as her reasons for wanting to come to therapy. Nana had tried speaking with a counsellor at her school but told her mother that the counsellor showed no respect for her. Jessica disclosed in the first session that Nana had said in one of her tantrums that she wanted to kill herself but that she did not believe Nana really meant it.
Nana lived alone with her mother. Her parents had divorced, and she was 5 years old when they split up. She had a 25‐year‐old half‐brother (father’s son) who was married and living in another country. They had begun to form a bond as she got older, and she spoke with him regularly. Their father was currently married to another woman, and Nana had two younger half‐sisters, ages 9 and 11. Nana’s relationship with her father was characterized by starts and stops, hopes and disappointments.
She described her father as always pessimistic and that he had lots of health issues. She shared that her father blamed her for the problems in his life, telling her that she should call and check on his well‐being more often. She was very distraught about her father's lack of concern for her.
Jessica was a quiet woman who was very thoughtful in her speech. She took great care in knitting a family network for Nana that included numerous uncles, aunts, and cousins not related by blood. Jessica practiced Buddhism but shared multiple religious traditions with Nana. Nana liked all of them and felt like embracing all of them. Emery was very critical of Jessica ’s spirituality and blamed her for teaching Nana all the wrong things.
Nana reported feeling isolated at school. She was very critical of her classmates who were superficial and that she hated them. She tried befriending the “smart, good girls” but dismissed her once she started talking about metaphysics. One day she said, “I feel so out of place in school, where do I fit in?”
She had played competitive hockey where she excelled , but her teammates marginalised her because they are jealous. She loved to read and tried to participate in class discussions but reported that teachers completely ignored her when she raised her hand, responded to her questions as if she were challenging them, or shot down her ideas completely. Nana reported that it was really hard to study, that she would get distracted by thoughts about her father and things that had happened at school during the day, and that she replayed past negative events in her mind repeatedly.
Nana shared that she did not want to burden her mother with her problems because she knew how hard her mother worked and how much she was trying to be a good mom. She experienced significant guilt that she was causing her mother stress. However, Nana also reported that she felt her mother did not really understand how much pain she was in and would just tell her that she loved her. Nana felt that she should be able to handle her life better like her mother.
Here is a couple of reflection questions:
What internal and external strengths can you identify for Nana?
What role might Nana’s parents’ experiences be in their expectations of and responses to Nana’s distress?
What other questions can you think of?