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Ms. M is a 59-year-old woman who previously worked as a licensed mental health clinician but was unable to work at the time of our initial appointment due to the severity of her depressed mood and daily alcohol use. She was referred to me by a colleague who works on a local inpatient psychiatric unit and was concerned about her following a series of inpatient admissions for suicidality.
I discussed the purpose of this case writeup with Ms. M and obtained written informed consent to use her history and treatment details for this publication. To protect her confidentiality, I have altered specific details about her history that could make her identity known.
Ms. M does not remember much of her childhood, a consequence of many dissociated memories and a lifelong tendency to avoid painful memories of which she has conscious access. Her father was severely mentally ill—likely schizophrenic—and her earliest memories involve men in suits coming to the house to take her father to the hospital under court order. This was a frequent experience in her childhood. She describes her father as a physically imposing, “strange and scary” man. Despite his illness, however, Ms. M was fond of him, and her ability to separate her father as a person from his illness allowed her to salvage a few good memories with him. He was a devout Catholic and spent