Lena internalized the interpersonal dynamics within her family as a model for relating to herself and others. Within this model, relationships are characterized by hostility, verbal and physical attacks, negativity, cynicism, and negation. “We all like, we verbally attack each other, like my parents fight often. Because of some problems that they’ve had for like many years. They’ve actually, like they’ve like, they’ve hit each other. And my mom’s scratched my father.” Being born into this environment meant that there was no one to help Lena metabolize painful experiences. Since her parents were occupied with their own seemingly insurmountable difficulties, there was no one to reflect back to Lena her experience as manageable—painful yet something that could eventually be overcome. She described a conflict that she had with her older brother to demonstrate the complete absence of effective parental support:

Times when I when I tried telling my parents that my that my older siblings were like dis- you know disrespecting me, and like there was this one time that my older brother he was like banging on my bedroom door, he just flipped out because I ate like I ate something that I- that he that he wanted for himself, he was freaking out about it and I just remember trying to like, just telling my parents about it like sometime later and, they said “Well you you guys should stop fighting you should get along I don’t understand why you guys are always like that. You know you’re family you should love each other.”

Based on this account, Lena’s parents did not actively intervene to protect her or to help resolve the conflict between her and her brother. They also communicated to her a breakdown in the capacity to make meaning of her experience, as well as a refusal to take responsibility for the development of their children in their statement, “I don’t understand why you guys are always like that.” In addition to this refusal of understanding, there was the added task of trying to reconcile all of the conflict within her family—including her parents’ constant fighting—with the opposite message that “family . . . should love each other.” Later, when Lena first began exhibiting signs of depression and started skipping school in order to sleep all day, her parents were equally passive in their attempts to intervene, help, or understand what was going on:

It got so bad that you know if like you know if some mornings when like one or more of my parents would be at my door telling me to get up and I would just tell them “No I just want to stay in bed.” And it was like that for a while and they just went with it, they just “Okay, we’ll leave you alone then.” I mean I had to go back eventually I mean my father told me, “You know Lena if we keep doing this you know your mom and I you know we will get in trouble, uhm you should you sh- you have to go back to school.”

Other familial relationships were equally strained. Lena said, “I have four siblings, ah two two brothers, one of them’s like my twin. And I have two sisters, uhm . . . I’m not close to any of them.” Lena reported feeling particularly distressed by her relationship with her eldest sister:

This is like hard to talk about but uh I I uhm, maybe it’s confusing but one of my sisters has like been trying to bond with me for some time and I just keep like . . . you know ignoring it, like distancing myself from her because of how she treats me, like all the time.

Lena was unable to trust her sister’s attempts to repair their relationship because of the deep wounds that Lena had incurred over many years of fighting. The damage had created a deep schism that felt irreparable, in part because any kindness that Lena’s sister showed her did not last long enough to create a stable sense of safety and trust. Lena described her eldest sister as someone who vacillated between making characterological attacks on Lena and attempting to make halfhearted overtures to repair and connect with her, which, when thwarted by Lena, resulted in another aggressive attack:

I mean I guess I still do have mixed feelings about it. She just she just never, she never treated me like really well when I was growing up. That’s why I haven’t really taken her up on her offer to go out and just do things, just I feel like deeply uncomfortable like I- (exhales) she she says like some really bad things to me. Just really bad and (exhale), and and I and sometimes and well this is pretty much all the time when I refuse to do something I just decline, she’ll like attack me, she’ll attack me again. Ask me, like “What’s wrong, what’s wrong with you Lena, like stop moping around. Here at home, like go out there, do something” and like she’ll I’ll overhear her talk- you know tell someone else in the family that I’m lazy and that I’m weird, and like all these like things. I don’t know if it’s just because, like because I said no all those times. It’s like it’s very hurtful.

I responded, “Sounds very hurtful. And so I guess that make it difficult to to trust, the gestures that she makes, I mean has she ever acknowledged any of these things that she’s done that have been hurtful?”

I tried talking to her about it more than once and, and it it never goes anywhere, like she’ll just tell me, Lena, you know you’re, you’re not- you know you do the same to me, and to everyone, like everyone does it. She she always like you know gives like a response like that and, she just ends it.

Lena never received the recognition from her sister that might have helped repair their relationship. Instead, her sister placed the blame on Lena for the problem and refused to take any ownership of her own role in the conflict. Lena’s sister did, however, attribute the origins of their difficulties back to their parents’ toxic relationship:

Another thing she does is like she’ll say is that like our parents have been having problems for decades. It’s because my parents’ like, marital marital problems that we’re all like this, I mean that’s how she puts it. She’ll blame like she’ll blame our parents for like other problems that we’ve had for years.

Although there is truth in the statement that Lena and her sister had inherited their parents’ conflicts and therefore had difficulty forming strong attachments, communicating about feelings, and resolving interpersonal problems, this response was also a refusal by Lena’s sister to validate or acknowledge the pain that she had inflicted on Lena. In these exchanges, Lena could neither be seen nor heard, and because of this Lena was erased in each familial interaction. I asked Lena directly: “Do you feel like anyone has ever heard you? Like really heard how you feel?” She responded,

Not really. Uhm I I know there are times when I’ve tried to argue with my eldest sister and, and I’ve noticed every time, I I try to talk to her about anything, confront her, she- the way she talks to me, it it doesn’t seem like she’s listening to me at all. Like I could be confronting her about something she did and she would attack like my character, like my traits, just like my flaws, just everything.

Lena was consistently met with invalidation, which made it difficult to justify her own feelings, even to herself. In addition, she strongly experienced underlying feelings of rage due to her continual misrecognition by others. This made it very difficult for Lena to develop secure, trusting attachments to anyone, let alone to people outside of her family. Bollas’s (1987) first human aesthetic is helpful in understanding Lena’s inner world. Based on her relationships with her primary caregivers during early development (the first human aesthetic), Lena had internalized a hypercritical self-object relationship. Based on these experiences, Lena treated herself as her own object the way she had been treated by others, and in turn she used this as a model for relating interpersonally.

I’ve always been like overly critical of of myself . . . and like I realize I’ve been doing the same with like with other people, you know when I when I was getting older. That’s one of the reasons why, like I have like trouble like maintaining relationships with like friends, you know just keeping just just uhm maintaining friendships.

The chaos and conflict of Lena’s family life manifested itself very early on in her childhood. Lena recalled a time in elementary school when she responded to her peers with a level of hostility that was reflective of all of the anger and pain she was battling internally:

When I was like in elementary school, like at recess, like right after lunch like I would sometimes be approached by some kids that I knew were in the same grade as me, they’d greet me, ask how I’m doing, maybe like invite me to join them, and and I pretty much just told, I, I told off pretty much everyone that that walked up to me, I would just say “Shut up. Like fuck off, fuck you. Leave me alone.”

This anger served to further alienate Lena from developing potential relationships with her classmates. However, she didn’t fully understand at the time why she was responding the way she was, and she felt a great sense of remorse later on when she was better able to grasp what had transpired:

I actually forgot all about that like it took I I remembered stuff like that only years later, like in like I wondered why, it seemed to me why so- a lot of kids my grade, you know from the rest of like elementary school and some in junior high, why it seemed like a lot of people were shunning me. And like I, I know why because I, I mistreated them, you know I was just a very, like I was just very mean spirited. And uhm, it’s it’s embarrassing, like to realize these things, like how I’ve behaved in the past.

Lena described this behavior as “impulsive,” and said that she sometimes had a tendency to “lash out” at others. Based on her description, it seems as if these instances were the result of pent-up anger that had been building over time:

I was like really angry. Uhm I, I still have that problem. I mean I haven’t done anything like that in a while, but . . . it’s just something like I’m always thinking about. What if I what if I just lash, lash out at someone again? . . . I don’t want to do that.

When Lena finally expressed her feelings, they came out in an aggressive way. This often had the unintentional effect of further exacerbating the situation or creating miscommunications between people who were not the intended recipients of her anger. Lena described one such incident between herself and her current neighbors:

I was telling you that you know I like I can be pretty impulsive, uh that apartment we live in now . . . there used to be like these this family that lived in this house right across the street from our apartment, there are like I mean one or two teenagers in that family and like I remember I caught them doing all kinds of things, and I mean I was a teenager at the time and I remember like being like very annoyed, like mad and like I flipped them the bird and like but I learned I learned from my mom that you know those people moved out a while ago and it was new people so like what was intended for you know like this boy that lived across the street, like you know like I ended up like offending the people that have been living in that house all these years.

This miscommunication contributed to the creation of an antagonistic relationship between Lena and her neighbors, who then seemed to intentionally go out of their way to be hostile toward Lena and her family members:

They harass me like any chance they get, any chance they can get, like they they try to like humiliate me, like they even have like some of their kids in on it like staring at me when I- if they happen to see me. It happens if they ever like notice me walking near somewhere in the neighborhood, they’ll look at me, they’ve yelled at me, like “Bitch.” Just all kinds of- just hateful things and I, I think I even once heard one of their children say that “Her, that’s just some like ugly woman who hates us.” Just just a lot of that.

This atmosphere of hostility, aggression, and humiliation deeply affected Lena, to the point where it had a significant impact on her decision of whether or not to leave her home. In this way, her fears about having negative social interactions in which she is humiliated or made to feel shameful about herself are not limited to her mind because there are actually people immediately outside her house who contribute to this persecutory environment of discomfort:

That’s actually one of the reasons why like I put off on doing some things because I you know they know where I live like they know what I look like and, it’s like it’s humiliating and just, like it’s really it’s messed me up even more actually. And I know that’s why, like you know once I’m finally able to, to you know get away from all that, like I would just I would be so relieved, I mean, it would be more that I would that I would be getting away from.

Based on some of these experiences, Lena often felt preoccupied by fears that she would behave in an impulsive, aggressive, or otherwise socially unacceptable manner in interpersonal relationships. Lena’s harsh selfcriticisms and what she described as “pessimism” interfered with her capacity to see herself in relation to others in a positive way, and as a result she often found herself withdrawing from social situations. This added a layer of guilt over having disappointed someone to the already present sense of inferiority, shame, and darkness. I asked Lena whether social relationships were difficult for her. She replied,

Yes. Like really, really difficult like it can be sometimes. Like I’ll- I’ve flaked out on people, like like sometimes when I’m like with them, like I don’t enjoy myself I don’t allow myself to relax enough and like I just like just even when I’m in the middle of doing like something, just going for a long walk I just you know like my problems just just things I worry about are always in in my mind.

Lena often felt consumed by worrisome thoughts, and her anxiety made it impossible to derive any joy from interactions that might otherwise be pleasurable. “I really like I hurt myself a lot by like just how I think. Just really negative, like pessimistic, you know?” When I asked Lena what she worried about, she said:

My family, like just how they treat me, my living situation, like money. Uhm, like how people in my neighborhood like some of our neighbors have treated me, uhm . . . just a lot to do with people, just problems I’ve- I’ve always had, just my like just just like how like how impulsive I can be.

Lena’s anxieties and overwhelming feelings of darkness made it very difficult for her to be motivated to change her circumstances. As a result, she often found herself backing out of things that she knew might actually help her feel better. She withdrew when she wanted to reach out, and she would sometimes be unable to follow through on plans that she would have liked to keep. Lena described this behavior as “self-sabotage,” and this further complicated her already negative self-appraisals. Lena stated that her depression had affected every part of her life and how she functioned. “And even like how I, how I talk to people sometimes, like how I like interact. It’s it’s it’s really harmed me, like . . . a lot of opportunities I had to to do better, and to do better in life, like I just I sabotaged them.” She explained,

Sometimes like if I know that I would be able to do something that I know would help me relax more, like maybe I’ll make plans with people and, and like when it’s getting close to that day when I when I am going to go out and do stuff with them, like I start like saying these things to them, “Oh maybe, maybe it’s not such a good idea maybe we can do it some other time,” and and I’ve- like one of those people he had once asked me, you know “Why are you talking like that?” After I would tell him “No I actually do want to do this I just I just feel discouraged” and he would ask me why and I told him, “I guess just just like just just a self-defeatist, like just like how I talk about it, even though I know I can do these things without a problem and, like sometimes at the last minute I might flake out, I might I don’t know I might have I might start to have like second thoughts, about about it.”

In her attempts to cope with all of these difficulties, Lena ended up developing other symptoms and behaviors that were reflective of her inner struggle with shame, worthlessness, and an impaired capacity to symbolize painful experiences.

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