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Mark has sought treatment at the urging of his primary care physician

Psychology

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Mark has sought treatment at the urging of his primary care physician. His recent episode of depression has lasted without remission for 3 years. Mark also has a history of alcohol abuse. His early alcohol abuse caused significant problems in Mark's first marriage, which ended in divorce when he was in his early 20s; however, problems with alcohol are 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 has joint custody of his twin adolescent daughters; he and his ex-wife alternate parenting every other week. He recently confessed to his ex-wife and daughters that he is gay, and this is what contributed to the divorce. His ex-wife did not seem shocked by the information but resents that it took him so long and "ruined" their life together. One of his daughters is being incredibly supportive and the other is distant since the revelation. Mark reports that he has 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. I knew I was gay in adolescence but felt my family could not handle it. I have made a huge mess of my life." 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 Mark had a social network that revolved primarily around his former marriage, but he has been withdrawn from that network since his separation and divorce. Currently, he spends most of his time alone, apart from caring for his daughters.

Refer to Social Work Disposition #6: Value: Competence; Ethical Principle: Social workers practice within their areas of competence and develop and enhance their professional expertise in your summary

1. Propose a treatment plan using a behavioral approach.
2. Propose a treatment plan using a cognitive approach.
3. Propose a treatment plan using a solution-focused approach.