CASE STUDYBackground InformationThe following section presents the treatment of Mark, a 43-year-old man with a long history of depression, who sought treatment after the end of his second marriage. Mark sought treatment at the urging of his primary care physician. His recent episode of depression had lasted without remission for 3 years.Mark also had a history of alcohol abuse. His early alcohol abuse had caused significant problems in Mark’s first marriage, which ended in divorce when he was in his early 20s; however, problems with alcohol were not a cause of current concern. He had been in therapy previously, during his separation and divorce 4 years earlier. However, Mark described it as unstructured and unfocused, and reported that he stopped going after a few sessions.He lives alone, although he had joint custody of his twin adolescent daughters; he and his ex-wife alternated parenting every other week. Mark reported that he had had periods of depression for “as long as I can remember.” In particular, he recalled his first episode of depression at age 12, shortly after his father abruptly left and severed all contact with Mark and his family.Mark reported that he had believed that his parents were happily married and, at that time, blamed himself for his father’s departure. Mark reported that his mother and older siblings never discussed his father. In describing his mood during adolescence and adulthood, he reported, “I have periods when I’m able to function OK. I go to work and all that, but I’m never really happy.” Mark’s primary depressive symptoms included depressed mood, loss of pleasure in nearly all activities, excessive guilt, fatigue, difficulty concentrating, and occasional passive thoughts of death.Mark had had a social network that revolved primarily around his former marriage, but he had been withdrawn from that network since his separation and divorce. Currently, he spent most of his time alone, with the exception of caring for his daughters. Mark was college educated and worked as an accountant for a local manufacturing company. He also wrote children’s stories and, prior to his most recent episode of depression, was working on a number of stories as a member of a local writer’s group.
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