Questions: What is a theory for Mary? Mary, single, age 36 came to see you because she has struggled for many years with a sense of worthlessness. She has had many men in her life, and she has felt used most of the time. She said that her "boundaries are all screwed up". She lets in men who take advantage of her, but for some reason she isn't attracted to men who treat her well. As you begin to explore her background, she talks about her father sexually abusing her until about age 14. She said she knows her mother knew it was going on but she turned a blind eye. "From the outside, our family looked normal, and everyone at church thought we had a model family. My parents were involved in church activities, and my dad served on the elder board. Mary has struggled with relationships, largely out of a fear of getting close to anyone. She often stays home alone with her cats. When it is too much she seeks connections with people, which is often disappointing. She occasionally struggles with thoughts about life not being worth all of the pain. She said she drinks every day, but not usually to the point of intoxication. "It just takes the edge off", she says.

Based on the information provided about Mary, several psychological theories and concepts can be applied to understand her situation. Here are some key theories and perspectives that may help explain her experiences and behaviors:

1. Attachment Theory: This theory, developed by John Bowlby and Mary Ainsworth, suggests that early relationships with caregivers shape an individual's expectations and interactions in later relationships. Mary's history of sexual abuse by her father and her mother's neglect could have led to an insecure attachment style. This might manifest in her adult relationships as difficulty trusting others, fear of intimacy, and attraction to unhealthy partners who reinforce her negative self-worth.

2. Trauma Theory: Mary's experiences of sexual abuse are traumatic events that can have long-lasting psychological effects. Trauma theory posits that such experiences can lead to a range of symptoms, including feelings of worthlessness, difficulty in forming healthy relationships, and self-destructive behaviors. Her drinking and attraction to men who treat her poorly could be coping mechanisms to deal with unresolved trauma.

3. Cognitive-Behavioral Theory: This theory focuses on the interplay between thoughts, feelings, and behaviors. Mary's sense of worthlessness and her belief that she is only attracted to men who treat her poorly could be rooted in cognitive distortions formed during her childhood. Cognitive-behavioral therapy (CBT) could help her identify and challenge these negative thought patterns and develop healthier relationship dynamics.

4. Self-Medication Hypothesis: This concept suggests that individuals may use substances, like alcohol, to cope with emotional pain or psychological distress. Mary's daily drinking, even if not to the point of intoxication, might be a way to manage her emotional pain and feelings of worthlessness.

5. Family Systems Theory: This theory examines the family as an emotional unit and suggests that individual behaviors are influenced by family dynamics. Mary's description of her family as appearing normal to outsiders, despite the abuse, indicates a dysfunctional family system. Her mother's denial and her father's abuse could have created a family environment where unhealthy patterns were normalized.

In addressing Mary's struggles, a comprehensive therapeutic approach that considers these theories could be beneficial. This might include trauma-focused therapy, cognitive-behavioral therapy, and possibly family therapy to address the underlying issues stemming from her family dynamics. Additionally, support groups or individual therapy focused on building self-esteem and establishing healthy boundaries could be helpful in her journey toward healing and forming healthier relationships.