History of Present Illness

Joy, a thirty-seven-year-old, bisexual-identified financial analyst, presented to our psychiatric evaluation clinic with the chief complaint of “being stuck.” Joy, who had chronic, severe hypertension and a long history of poor medication adherence, had suffered a small myocardial infarction eight months earlier. Afraid for her long-term health, Joy had decided to leave her high-stress job and look for a new one. A generally social and gregarious person, she now stayed superficially connected with a core group of five or six friends who were mothers at her daughter’s preschool. Joy reported a depressed mood, anhedonia, feelings of guilt and low self-worth, decreased energy, poor appetite, and impaired concentration for the past three months. Reporting that she did not want to get out of bed in the mornings, she described herself as “basically lazy and unmotivated.” She summarized, “I guess I’m just in a rut.” Notably, Joy reported that her job loss had led to increased conflicts over the sharing of child care with her ex-partner, whom she had left two years earlier. She spent most evenings and weekends at the apartment of her supportive boyfriend, Ben, but was increasingly feeling that she did not deserve his kind attention.

Joy came to the evaluation clinic seeking therapy that would target her depression and help her move out of the “rut” in which she found herself. She felt she no longer had control over her life. Though she wanted to go back to work, she lacked the motivation to search for a new career.

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