It was clear to the therapist that Sr. A was experiencing a role transition, with some evidence for a role dispute with his girlfriend. The therapist began psychoeducation about depression, his symptoms, and the course and effectiveness of treatment. During this exchange Sr. A seemed hesitant and unwilling to accept that his experience was a result of biomedical phenomena rather than something existential and spiritual. As he believed that this role transition was a test from God, the therapist decided to de-emphasize (but not fully abandon) the medical model and assignment of the sick role. The therapist presented this formulation to Sr. A:
therapist: These symptoms that you have been telling me about are a part of depression, which is a treatable illness. The depression is connected to the life transition you experienced after the accident you suffered at the workplace. You have explained to me that your transition was from once being a strong, virile, admired man in your country, to now an injured manual laborer in the U.S. who feels weak, frustrated, and victimized by the “cold, callous, and self-serving” people surrounding you here. Much in the way you have been telling me about some of the recent arguments with your girlfriend and how they make you feel, depression is affected by and affects relationships. Interpersonal therapy has been shown to be highly effective in treating depression. You have told me a little bit about how it has been difficult to get along with others, and in this therapy we will try to understand what current stresses and relationships in your life may be contributing to the depression, and how your depressed feelings affect how you interact in your relationships. This therapy is going to help you transition out of feeling depressed, inadequate, and frustrated into feeling healthier and happier.
Sr. A willingly accepted this formulation, adding that he felt this role transition was “similar to my experience when I first immigrated to this country" At the end of this session the therapist asked Sr. A about his role transition after immigration and how he was able to cope and adjust to his new life in the United States. He attributed his ease of adjustment and assimilation at the time to meeting with extended family members and finding a church, a pastor, and a social group who helped provide a community for him and helped him navigate employment and other opportunities.