[Psychotherapy with a boy with depression following the death of his 2 brothers]

The author describes the psychotherapy of about 2 1/2 years duration of a 14-year old boy. This psychodynamically oriented psychotherapy dealt with the aftermath of two disasters in his family: The accidental deaths of two older brothers five and four years ago. These events had a lasting effect on the family which negatively interfered with the achievement of developmental tasks in adolescence in the patient. He had erected massive defenses against his own wishes and became withdrawn and depressed. The main issues dealt with in therapy were: (a) The boys fear to step out of his position as the families "child" in consideration of his grieving mother. (b) The boy's difficulty to tolerate and integrate aggressive fantasies and feelings because of his guilt feelings and fear of another loss due to these fantasies and feelings. The working through of conflictual issues in psychotherapy enabled the boy to gain awareness regarding his own needs and wishes, and to find ways to fulfill them. Subsequently, he succeeded in making an adequate professional choice and to go into training for it.