Case Study: Holly There wasn't much information on the intake sheet. Just a name, Holly Roberts, the fact that she was a senior in college, and her presenting complaint: trouble making decisions.

The first thing Holly said when she sat down was, "I'm not sure I need to be here. You probably have a lot of people who need help more than I do." Then she started to cry.

It was springtime. The tulips were up, the trees were turning leafy green and purple clumps of lilacs perfumed the air. Life and all its possibilities stretched out before her, but Holly was naggingly, unaccountably depressed.

The decision Holly was having trouble making was what to do after graduation. The more she tried to figure it out, the less able she was to concentrate. She started sleeping late, missing classes. Finally, her roommate talked her into going to the Counseling Center. "I wouldn't have come," Holly said. "I can handle my own problems."

I was into cathartic therapy back then. Most people have stories to tell and tears to shed. Some of the stories, I suspected, were dramatized to elicit sympathy. Most people give themselves permission to cry only with some very acceptable excuse. Of all the emotions we're ashamed of, feeling sorry for yourself tops the list.

I didn't know what was behind Holly's depression, but I was sure I could help. I was comfortable with depression. Ever since my senior year in high school when my friend Alex died, I'd been a little depressed myself.

After Alex died, the rest of the summer was a dark blur. I cried a lot. And I got mad whenever anyone suggested that life goes on. Alex's minister said that his death wasn't really a tragedy because now "Alex was with God in heaven." I wanted to scream, but I numbed myself instead. In the fall I went off to college, and even though it seemed disloyal to Alex, life did go on. I still cried from time to time, but with the tears came a painful discovery. Not all of my grief was for Alex. Yes, I loved him. Yes, I missed him. But his death provided me with the justification to cry about the everyday sorrows of my own life. Maybe grief is always like that. At the time, though, it struck me as a betrayal. I was using Alex's death to feel sorry for myself.

What, I wondered, was making Holly so sad? She didn't have a dramatic story. Her feelings weren't focused. After those first few minutes in my office, she rarely cried. When she did, it was more of an involuntary tearing up than a sobbing release. She talked about not knowing what she wanted to do with her life. She talked about not having a boyfriend, but she didn't say much about her family. If the truth be told, I wasn't much interested. Back then I thought home was a place you left in order to grow up.

Holly was hurting and needed someone to lean on, but something made her hold back, as though she didn't quite trust me. It was frustrating. I wanted to help.

A month went by and Holly's depression got worse. I started seeing her three times a week, but we weren't getting anywhere. One Friday afternoon, Holly was feeling so despondent that I didn't think she should go back to her dorm alone. I asked her instead to lie down on the couch in my office and, with her permission, I called her parents.

1. Why did treating Holly with individual therapy alone reach an impasse?

2. What are the limits of evaluating individuals' behavior as a function of themselves and their personalities?

3. Why did Freud and Rogers exclude the family from treatment?

4. What are the respective strengths of individual and family therapy?

5. What are the primary vehicles of change in family therapy?