Case Illustration Presenting Problem Client Description

The following case illustration was adapted from Jarrett and Kraft (1997). Mr. Turner, a 50-year-old European American, widowed father of two daughters and Protestant choir director, met DSM-IV criteria for moderately severe, recurrent MDE, with good recovery between episodes. At the beginning of treatment, he had been depressed for 5 months following the terminal illness of a family member. He could not complete basic requirements of his job and had difficulty caring for his daughters. Mr. Turner described his relationships with congregation members as severely discordant, and he resented many interactions. He reported that he frequently thought about death and suicide, but said he would not commit suicide because it would be too painful to his family. His stated his main complaint as "self-doubt about my job, my family."

Mr. Turner described his nondepressed self as confident, successful, and competent; he thought of himself as a loving father, loyal son, kind and generous friend with concern for others and, most importantly, respected choir director. He experienced his first episode of depression at age 21; the current episode was his fifth, and each had lasted approximately 6 months to 1 year. His self-view had become increasingly negative with each successive episode. Mr. Turner considered his depression to indicate personal weakness, so he experienced recurring episodes as threatening to his sense of self, his vocation, and his life itself. He began to feel like an imposter to his friends and congregants, his family, and even to God.

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