Case Illustration Referral Route and Presenting Problems

Mary, a 45-year-old, unemployed European American woman, was referred to an outpatient service by her psychiatrist for CT for depression. At the time of the initial assessment, Mary tended to make vague statements that lacked emotional details, although she appeared visibly upset and tearful. She reported feeling depressed and hopeless for the last 3 years. She requested therapy for her depression. Based on the results from a SCID-I interview, Mary met MDD criteria (depressed mood, lack of motivation, appetite disturbance, difficulty concentrating, and feelings of worthlessness). She denied having suicidal ideation. She also met the criteria for PTSD (e.g., recurrent thoughts, avoidance of thoughts and people, diminished range of affect, irritability, and sleep disturbance) in response to a hostage taking that had taken place 3 years earlier. Her score on the PTSD Checklist (PCL; Weathers, Litz, Huska, & Keane, 1991) indicated that she met the criteria for PTSD. A score of 33 on the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) suggested that she was experiencing severe depressive symptoms. Mary was taking Effexor at the time of the initial interview.

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