Part One

Age: 16
Sex: Female
Gender: Genderqueer
Sexuality: Pansexual
Ethnicity: African American
Relationship Status: Single
Counseling Setting: Private Practice
Type of Counseling: Individual
Presenting Problem: Recurrent depressive episodes
Diagnosis: Major Depressive Disorder

Presenting Problem: The client, who identifies as genderqueer and uses they/their/them pronouns, presents with significant mood disturbances that have persisted and intensified over the past year. They report experiencing frequent depressive episodes, characterized by a pervasive sense of deep sadness and a noticeable decline in their ability to find joy or fulfillment in activities they once enjoyed. The client describes a constant feeling of hopelessness and helplessness, alongside increasing difficulties with daily functioning and maintaining relationships. Their mood disturbances are accompanied by chronic fatigue, a profound lack of motivation, and persistent feelings of worthlessness and self-criticism. The client has been grappling with an overwhelming sense of emotional pain and despair, which they have been attempting to numb with alcohol. They acknowledge that this method is harmful and only provides temporary relief, yet they struggle to find alternative coping strategies.

Mental Status Exam: The client arrives appearing lethargic and disheveled. During the session, they exhibit a slouched posture and slow, deliberate movements. They often avoid making eye contact, particularly when discussing personal matters, and their affect is notably flat and subdued. The client’s speech is coherent but reflects a pessimistic and resigned attitude, with frequent expressions of self-doubt and hopelessness. They anxiously fidget with the many interesting rings that adorn their fingers. They comment that their favorite is a steampunk thumb-ring that they won at a RenFest. Their mood is consistently low, and they express difficulty in finding any positive aspects of their life or future, indicating a significant impairment in their overall sense of well-being and motivation.

Living Situation: The client resides with their mother and younger brother in a small, somewhat cluttered apartment. Their mother works long hours, which leads to extended periods of isolation and solitude for the client. This living arrangement has significantly contributed to their feelings of loneliness and exacerbates their depressive symptoms. The apartment environment is often chaotic, with frequent clutter, mostly empty pizza boxes, in shared areas, which the client finds overwhelming and distressing. They spend a substantial amount of time in their bedroom, where they feel both the most comfortable and most isolated. The state of their room often reflects their current emotional state, with a disorganized and messy environment, again, lots of pizza boxes, mirroring their struggle with maintaining a routine and managing their daily responsibilities. The lack of support and interaction at home has left them feeling increasingly disconnected and unsupported, contributing further to their depressive symptoms.

Academic History: The client’s academic performance is a significant concern, particularly during the winter months over the past few years. Historically, they have been a strong student, consistently achieving good grades and demonstrating high levels of responsibility. However, as winter approaches each year, their performance significantly declines. Teachers have observed a consistent pattern where their concentration and engagement drop markedly during these colder months. The client has reported increasing difficulty in keeping up with assignments, which has led to missed deadlines and a noticeable deterioration in the quality of their work. This seasonal decline in academic performance has caused them considerable stress and frustration. Their struggle with motivation and focus, coupled with a deepening sense of being overwhelmed by schoolwork, reflects a broader impact of their depressive symptoms on their educational achievements and overall well-being.

Family History: The client’s family background presents a complex mix of support and instability. Their mother, a single parent, works tirelessly to provide for the family but often finds herself overwhelmed by the challenges of balancing work and home life. This dynamic has placed additional emotional strain on the client, who has had to navigate the complexities of their family’s situation with minimal support from their father, who is absent from their life. There is a notable family history of mental health issues; the client’s maternal grandmother struggled with severe depression, which is believed to contribute to the client’s own susceptibility to depressive episodes. This familial backdrop of mental health challenges and limited paternal involvement has likely had a significant impact on the client’s current struggles and their ability to cope with stress and emotional distress.

Relationship History: The client has had a few romantic relationships, but these have been characterized by a lack of long-term stability and overall satisfaction. Their most recent relationship ended poorly, largely due to the strain of their depressive symptoms. Initially, the client’s partner, who also identifies as genderqueer, was understanding and supportive, but over time, they became increasingly frustrated with the client’s lack of motivation and frequent withdrawal. The client’s inability to fully engage in the relationship, coupled with their pervasive feelings of inadequacy and self-doubt, created a significant emotional gap between them. Misunderstandings, unmet expectations, and frequent arguments led to escalating tensions. Eventually, the partner felt overwhelmed by the client’s emotional needs and the lack of progress in their personal growth, resulting in a breakup. This ended relationship has left the client feeling particularly rejected and has deepened their sense of worthlessness.
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