I CASE HISTORY
Bron is a 39-year-old woman, professionally qualified as a specialised nurse. She is married and has two children, 2 and 7 years of age. She has had several periods of depression dating back to her later teens.
Her present depression began about six months ago when she attempted to return to work after taking maternity leave for her second child. Additionally, her father-in-law had a serious illness and came to live with the family. Her symptoms included:
• depressed mood, crying, anxiety and worry,
• lack of feeling of pleasure,
• a pervasive sense of worthlessness,
• poor sleep,
• poor concentration.
Her BDI score was 33. She scored 2 on the hopelessness question (Q2) and 1 on the suicidal ideas question (Q9). She reported occasional suicidal thoughts but did not think she would carry them out and had no plan for doing so.
Previous treatment was by anti-depressant medication, with one abortive attempt at counselling. Her response to anti-depressives tended to be quite slow, although successful in the end. At this time, her response to medication had been minimal and her doctor switched medication and encouraged her to take up CBT via her occupational health scheme.
Bron did not have any health problems likely to influence her psychological problems.
Likely diagnosis: Major depressive episode, recurrent, severe.
II: CASE FORMULATION
A. Precipitants: Although Bron described her husband as a good man whom she loved she did not think that he offered her enough support, especially with the youngest child and with looking after his father. When she tried to return to work, she became preoccupied with the risk of making mistakes with patients and of being charged with malpractice. She felt that this played into an incipient lack of self-esteem. She was ‘struggling’ with looking after the children, trying to work and dealing with her worries. She...