Dear Reader,

I was inspired to share this case because this demographic rarely presents in therapy: a 65-year-old first-generation Chinese immigrant mother, deeply rooted in traditional values, who came with a willingness to self-reflect and change. Yet her story mirrors many of the relational struggles I encounter in both clinical work and everyday life within the Asian American community. I hope her journey sheds light on the psychological complexities of inner worlds shaped by history, culture, and family.

We began treatment over seven years ago, and much of her background emerged gradually—often the case in politically repressive societies where painful histories remain unspoken. Her emotional landscape was shaped by silence, modeled by parents who avoided discussing trauma and implicitly taught her to suppress her own feelings.

She initially presented with panic attacks and generalized anxiety. As we explored her history, it became clear that these symptoms were not isolated but rooted in years of emotional suppression, relational hypervigilance, and internalized fear. In her early life, anxiety had been adaptive—a necessary response to real and persistent danger. But as her environment stabilized, those same responses left her feeling isolated and mistrustful.

She was born in rural Hunan province, China in the 1960s, part of the Baby Boomer generation raised by parents from China’s Silent Generation. Each era imprints a particular style of parenting. Her parents—shaped by war, displacement, and chronic scarcity—relied on authoritarian methods: strict control, high demands, and minimal emotional expression. Think of it like being in the military, where obedience and loyalty are valued more than autonomy. In her home, decisions were made unilaterally. Even when advocating for something as personal as a job change, she was overruled. Her voice rarely mattered.

Her parents had lived through a century of upheaval. They survived the Japanese occupation (1931–1945), the Chinese Civil War (1937–1945), and the political chaos of the Great Leap Forward and Cultural Revolution. These events left psychological scars that were never openly acknowledged. In a climate of constant threat, emotional expression was seen as a liability. Control and survival took precedence over intimacy. It is likely that both parents suffered from unrecognized PTSD, which limited their emotional availability and left the next generation emotionally adrift.

The death of her brother—a boy treasured for his role as the future bearer of the family name—intensified the emotional void at home. Her mother became deeply depressed and emotionally absent. In response, my patient assumed adult responsibilities far too early. She cooked, worked, and supported the household before reaching adolescence. This early parentification denied her the psychological space to explore, play, and form a secure sense of self.

These experiences shaped the foundation of her adult attachment style. She developed an anxious-avoidant pattern—craving connection, yet fearing rejection. Mistrust, like a slow-growing vine, wrapped itself around every relationship. It whispered that others could not be counted on, that she was not truly cared for. It was a quiet, persistent doubt that no amount of reassurance could silence.

In adulthood, this internal narrative created distance across all her relationships. Her marriage became strained. Friendships withered under the weight of unspoken expectations. And her relationship with her daughter—the one she valued most—began to fracture.

Her daughter, a 1.5-generation immigrant, had quickly adapted to American norms—valuing boundaries, emotional openness, and autonomy. In contrast, the mother clung to traditional ideals of duty, sacrifice, and obedience. Their communication styles often clashed. The mother saw her daughter’s independence as rejection; the daughter experienced her mother’s involvement as intrusive.

These tensions were compounded by cultural expectations around filial piety and financial dependence. The mother expected support and deference. The daughter, navigating a Western framework, sought individual growth and emotional clarity. These cross-cultural differences are common in immigrant families, but in this case, they were layered over an already fragile emotional bond.

Despite these challenges, the mother’s relationship with her daughter remained her most treasured. Her fear of losing that connection became the catalyst for change. She recognized that if nothing changed, the emotional distance might become permanent. That fear was what motivated her to try something new.

Much of our early therapeutic work was psychodynamic focused and insight oriented. In that time period, we built a sense of safety and naming the emotional patterns that had long gone unspoken. Progress was gradual. But therapy often moves like that—incrementally, with breakthroughs arising only after a foundation of trust has been laid. But at some point, the work felt stuck because we could not heal trauma by purely understanding it from a cognitive level, the work needed to go into an experiential realm.

A turning point came when we engaged in trauma-informed inner child work using the Internal Family Systems (IFS) model. This approach allowed her to access the parts of herself that had long been exiled—burdened, vulnerable, and silenced. Through guided visualization, she met her younger self: the girl who had cooked meals instead of playing, who was dismissed rather than comforted.

At first, she approached that inner child with hesitation. But over time, she responded with compassion. In IFS, this shift reflects the emergence of the “Self”—the calm, curious, healing core within each of us. From that place, she began to understand herself not as broken, but as someone who had adapted to survive.

That internal shift created room for external change. She became less reactive, more emotionally flexible, and more capable of staying present during difficult interactions. For the first time, she could speak with her daughter without withdrawing or defending. Their conversations began to include moments of genuine connection.

Of course, not everything changed. Cultural dissonance remained. Misunderstandings still arose. But her emotional posture was different. She no longer approached conflict with fear, but with curiosity. Her ability to tolerate ambiguity and remain engaged had grown.

This case has stayed with me because it reminds me of what therapy can truly offer—not just relief from symptoms, but real transformation. We may be the first person to offer someone a new experience of relationship. Our job is not only to listen, but to hold hope—for as long as it takes. The therapeutic relationship itself can be the corrective emotional experience a patient never had.

To anyone reading this who sees echoes of their own story: know that the patterns we inherit are powerful, but not unchangeable. We are shaped by our histories, yes—but we are also capable of reauthoring them. Healing doesn’t always begin with answers. Often, it begins with a question, a pause, a moment of tenderness toward the parts of ourselves we’ve learned to neglect.

With care,

Dana Wang MD