Disability, Identity & Invisible Grief
Maren, 34, graphic designer
Fictional teaching case
Compare the formulations ↓Presentation
Born with spina bifida (myelomeningocele, L4-L5). Uses a wheelchair full-time since age 14 after progressive loss of ambulation. Works remotely as a freelance designer but wants to transition into UX research: recently passed over for an in-house position she suspects was due to accessibility concerns. Divorced two years ago, now in a new relationship where her partner's family keeps calling her 'inspiring.' Says: 'I spent my whole life being the girl who didn't let it stop her. I'm tired of being a story about overcoming.'
Read the full case history and clinical context
Raised by a single father after mother left when Maren was 3 (mother cited inability to handle the medical demands). Father was devoted but anxious: managed every medical appointment, surgery, and accommodation with military precision, leaving no room for Maren to grieve or struggle. Spina bifida required 11 surgeries by age 16, including shunt revisions and orthopedic procedures. Father's refrain: 'We don't feel sorry for ourselves in this family.' No space for anger or sadness about disability. Older brother was the 'easy child': healthy, athletic, low-maintenance. Maren became hyper-competent and emotionally self-sufficient by necessity. No substance use. Previous therapy at 22 was CBT for depression, helpful for acute symptoms but never addressed disability identity or the medical trauma of childhood surgeries.
Compare how approaches understand this case
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Showing 2 of 7 formulations.
Schema Therapy
Early maladaptive schemas: Abandonment (mother left because of disability: 'I am too much'), Emotional Inhibition (father's 'we don't feel sorry for ourselves': grief and anger are forbidden), Self-Sacrifice (over-functioning in relationships so that nobody ever has to carry her, because needing to be carried is what her mother could not stay for). The compensatory strategy: Overcompensator mode, relentless self-sufficiency that masks the Vulnerable Child who was scared in hospitals and whose mother left.
Identify the Abandonment schema and its origin in the specific ableist context of her childhood: not 'people always leave' but 'my mother left because my body was too much, and I've been proving I'm not too much ever since.' Mode work: when the Overcompensator is running relationships, what happens to the Vulnerable Child who actually needs support? Limited reparenting: the therapist offers what neither parent could, attunement to Maren's actual emotional experience of disability, including the parts that aren't inspiring.
"When your partner's family calls you inspiring and something tightens in your chest: that's not ingratitude. There's a much younger part of you in there, the girl whose mother couldn't handle it. The girl who learned that being disabled means being too much. Can you feel her?"
Existential Psychotherapy
Maren is in a confrontation with thrownness: she was delivered into a particular body, in a world built for other bodies, without being consulted about either. Her childhood was spent in what Heidegger would call inauthenticity: performing a version of herself that denied the grief, fear, and rage that are natural responses to 11 surgeries and a mother who left. The emerging exhaustion with 'the overcoming story' is the beginning of authentic existence: facing what is rather than what she was told should be.
Take the disability seriously as a mode of being-in-the-world, not as an obstacle to be overcome or a lesson in resilience. Explore how spina bifida has shaped Maren's perception, her relationship to space and movement and access, her experience of others' gaze. The grief for the childhood spent in hospitals deserves space. The anger at being reduced to 'inspiring' is healthy: it's a refusal of bad faith. The question isn't how to overcome; it's what it's actually like to be Maren.
"You said you're tired of being a story about overcoming. I think that tiredness is important. What if 'overcoming' was never your job? What if the question is just: what is it actually like to be you (in your body, in your chair, in your life) without the performance?"
IFS
A powerful Manager part (the Hyper-Competent One, the Girl Who Doesn't Let It Stop Her) has organized Maren's entire life around proving that disability doesn't diminish her. This part built the career, maintained independence, and kept the grief at bay through relentless self-sufficiency. But it's exhausted and increasingly at odds with an emerging part that's tired of performing inspiration. An Exile carries the terror of the 3-year-old whose mother left because the disability was too much, and the lonely child who endured surgeries without being allowed to cry.
The Hyper-Competent part deserves deep respect: it has been essential. But it's also keeping Maren from grieving what was lost: the childhood spent in hospitals, the mother who left, the body that was always a project to be managed rather than a home to be lived in. The part that is tired of performing inspiration is not weakness or self-pity, it is a protector losing confidence in its own strategy. The move here is not to referee between the competent adult and the grieving child, because in this model neither of them is Maren. Maren is what is there when both can be turned toward with curiosity, and it is from that position that the Exile can unburden what she has been carrying since she was three.
"There's a part of you that has spent 34 years proving that your disability doesn't define you. That part is remarkable. But I think there's another part, maybe one that's been locked away since childhood, that's asking: what if I'm allowed to be angry about this? What if I'm allowed to grieve?"
Narrative Therapy
The dominant family narrative, 'we don't feel sorry for ourselves,' is a story of compulsory resilience. Maren's emotional reality was narrated out of existence by a father who loved her but couldn't tolerate her suffering. The result: she internalized a story in which grief about disability is self-pity, need is weakness, and the only acceptable disabled life is an 'inspiring' one. The new partner's family calling her 'inspiring' is the social version of the same erasure.
Externalize the Overcoming Story: who told Maren she had to be inspiring? What did that story require her to do? What did it forbid her from feeling? Map its influence: career choices, relationship patterns, the divorce, the job loss. Find unique outcomes: moments when Maren was angry, sad, or struggling and the world didn't collapse: moments when she was disabled and just herself, not a story. Re-author: a disability narrative that includes both competence and grief, both independence and need.
"The world has been telling you a story about yourself since you were born: 'She doesn't let it stop her.' That story has required you to perform inspiration every day for 34 years. What did it cost you? What were you not allowed to feel?"
Feminist Therapy
Maren's experience is shaped by intersecting systems of power: ableism (her body as deficient and 'inspiring'), gendered expectations (disabled women as either pitiable or superhuman), and economic marginalization (passed over for a position likely due to accessibility concerns). Her father's 'we don't feel sorry for ourselves' was not just individual coping; it reflected a culture that offers disabled people only two narratives: overcome or be pitied. Her mother's departure was enabled by a society that doesn't support caregiving.
Power analysis: who benefits from Maren being 'inspiring'? What does compulsory resilience cost her daily? Consciousness-raising about inspiration porn: being called 'inspiring' for existing in a wheelchair is a form of objectification, not respect. Connect Maren to disability community, disabled professional networks, and disability justice frameworks. The job she was passed over for: that's not a personal failure, it's structural discrimination. Name it.
"Your partner's family calls you inspiring. The company that didn't hire you probably thought they were being practical. But here's what's actually happening: the world is more comfortable with you as a symbol than as a person. What would it look like to refuse that role?"
NARM
Maren's developmental needs were systematically shaped around the disability in ways that created specific survival adaptations. Connection (mother's abandonment was explicitly linked to disability: 'I can't handle this'), Attunement (father managed the medical body but never the emotional one: surgeries were logistics, not experiences), Trust (mother's departure taught her that being disabled makes you too much for people), Autonomy (hyper-competence as the only acceptable mode: no room to need help or fall apart).
Work at the intersection of identity, embodiment, and relational patterns in present time. When Maren's partner's family calls her 'inspiring,' what happens in her body? When she was passed over for the job, what survival pattern activated? The developmental needs that were unmet (attunement to her emotional experience of disability, trust that she won't be abandoned for being too much, autonomy to define her own relationship to her body) can be addressed relationally.
"You just told me your father handled every surgery and every appointment, and you said it the way you'd read out a schedule. What happens in your body as you say it? And I'm curious about something else: when you imagine someone asking how you were doing, rather than how the procedure went, what happens then?"
Somatic Experiencing
The spina bifida itself is not the trauma. The surgeries are where SE finds its material: eleven times before sixteen, a child was held down, put under, and woke up altered, in situations that offered every defensive response nowhere to go. Fight and flight were mobilized against restraint and anesthesia and then interrupted, which on this model leaves the activation bound rather than discharged. Maren's hyper-competence sits on top of a nervous system that learned early to go still and wait it out, in the one setting where going still was the only option available.
Titrate: nothing about eleven surgeries gets approached whole. Take one detail, the corridor, the smell, the count backward from ten, and stay with it only until activation registers, then pendulate back to something settled. Resourcing has to use sensation she actually has, so the standard 'notice your feet on the floor' is the wrong cue here; her hands, her breath, the weight of her back against the chair. Track the defensive impulses that surface, the arm that wants to push the hand away, the head that wants to turn, and give them room to complete at the body's speed rather than the conversation's. Separately and more slowly: what does the chair feel like from the inside, as her way of being a body rather than the absence of another one?
"I want to try something different. Instead of talking about your spina bifida, I want to ask: what does your body feel like right now, from the inside? Not what it can't do, not what the doctors have said about it: what it actually feels like to be in your body, in this moment, in this room."
Where Approaches Genuinely Disagree
Grief that was forbidden does not disappear, it goes underground and turns against the self. The hyper-competence defends against mourning that was never permitted, and what is defended cannot be mourned.
Locating the problem inside the person pathologizes a social failure. The suffering is political, not intrapsychic.
Philosophical Lenses
These are not treatment plans. They are ways of seeing — philosophical perspectives that illuminate aspects of this case that clinical modalities may not address directly.
Maren's experience is what Ahmed calls a 'misfit': the friction between a body and a world not built for it. The wheelchair is not the disability. The stairs are. The inaccessible venue is. The interviewer's unconscious flinch is. Ahmed's phenomenology of orientation reveals that the world is arranged for certain bodies and not others, and that this arrangement is experienced by the well-fitted as neutral, natural, simply 'the way things are.' Maren wants to transition into UX research: a field that talks constantly about accessibility while conducting its own hiring processes in spaces that exclude her. The invisible grief is not about spina bifida. It is about the daily labor of navigating a world that was not designed with her in mind and then being expected to be grateful for the accommodations that partially correct this failure.
Maren has used a wheelchair full-time since age 14 after progressive loss of ambulation. Merleau-Ponty's concept of the habitual body is crucial here: the body retains the schema of its former capacities even as the actual body changes. The phantom limb is his most famous example: the amputee's body 'remembers' the arm. Maren's situation is more complex: she did walk, and her body schema still carries that history, layered beneath the current schema organized around the chair. She is not a person who cannot walk. She is a person whose body holds two histories, one ambulatory, one not, and whose daily experience is the negotiation between them. The grief is 'invisible' partly because it has no single origin. It is distributed across every encounter with a world built for the body she no longer has.
Deleuze and Guattari's concept of the Body without Organs challenges the medical model that organizes Maren's life. Medicine has mapped her body (L4-L5, myelomeningocele, progressive loss) through a schema of deficit: what is missing, what doesn't work, what deviates from the normative body. But Maren's body is not a broken version of a normal body. It is a body with its own capacities, its own ways of moving, sensing, and inhabiting space. The BwO is not about having no organs but about refusing the organization imposed from outside: the medical gaze that sees only pathology, the social gaze that sees only limitation. Maren's desire to move into UX research is itself a Deleuzian gesture: she wants to redesign the interfaces between bodies and worlds, which is precisely the work of someone who has lived the failure of existing interfaces.
Sources & Method
This is a composite fictional case — no real client is depicted. Formulations represent how each modality would typically conceptualize and approach a case with this presentation, based on published clinical literature and training materials. Each formulation draws on the modality's own theoretical framework, key texts, and clinical principles as documented on its modality page. Full source citations for every modality are available on the Sources page.