A Case Study: A Discussion of Depression, Ambivalence, Attachment, and Culture Portrayed in the Therapeutic Environment

ABSTRACT

This paper uses object relations theory to conceptualize and manage the complexities of a home-based case that was followed for a period of six months. It discusses maternal depression in relation to the caregiver role, self-harm, and self-determination. The client's ambivalence issues are addressed, with particular emphasis on transference and countertransference issues in the relationship and the use of transitional space and objects. Also discussed is the effect of maternal depression and ambivalence on mother-infant attachment, with the introduction of interaction-guidance as a treatment modality. An examination of cultural differences and the concomitant ethical implications that arose in the treatment process is provided. Finally, therapeutic implications and reflexivity are addressed.

KEYWORDS:

• Ambivalence
• attachment
• culture
• depression

Victoria A. Fitton, PhD, LMSW, holds the Ruth Koehler Endowed Professorship in Children's Services, Michigan State University School of Social Work, East Lansing, Michigan. She is engaged in ongoing clinical practice and clinical supervisory work.