The Influence of Intergenerational Family Dynamics on Psychosis and Suicidal Behavior

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Length: 24 minutes

Cathleen M. Morey, LICSW

This presentation demonstrates the value of conceptualizing suicidal behavior and psychosis from a psychodynamic theoretical perspective that includes a comprehensive understanding and formulation of intergenerational family dynamics in addition to the individual’s intrapsychic determinants.  Through an intergenerational transmission process involving complementary projective identification dynamics, an individual family member - i.e. the “identified patient” of the family - may become a repository for the family’s disavowed anxiety, conflict, aggression, trauma, and rage.  A case study is presented in which a young adult woman, the “identified patient”, became the projective container for her parents’ unconscious and unformulated experiences, and she in turn deposited these intolerable affects back into her family system through psychotic processes and ongoing, chronic suicidality.  The patient’s symptomatic behavior is conceptualized as an unconscious, encoded behavioral communication that requires translation by the family therapist into language and affect that is meaningful to the patient and family.  Once the split off and disavowed aspects of the intergenerational family history are translated and integrated into the current family context, the problematic projective identification dynamics can be disrupted.  Through the family therapy process, each member of the family examines the role he/she plays in the genesis and maintenance of the psychotic, suicidal family pattern.  As family members gain perspective about their previously unconscious behaviors, they develop the capacity to express their thoughts and feelings towards each other directly, which frees them up from communicating through behavioral symptoms.  In this way, they are able to interact with each other differently and experience new ways of communicating together.

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