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Sallyanne is a 52-year-old woman who has three adult children. Her youngest child moved out of the family home after falling pregnant with her first child a year ago. She now lives alone after becoming separated from her husband six months ago. Sallyanne says that she has come for an assessment because she has been feeling incredibly stressed, nervous and tense over the last year. She describes recently feeling increasingly low as she struggles to sleep properly since her husband left, scoring 15 on the PHQ-9. She describes lying awake for hours at night not able to stop herself thinking and worrying about all sorts of things. She also describes herself as not being very good with change. She spent most of the first 15 minutes of the assessment talking about her daughter and new grandson. Sallyanne is very concerned that her daughter does not have the financial wherewithal to support her grandson, and she is concerned with the life he may have. She talks about political concerns, changes to the education system and the struggles local schools are having, the cost of university education and the difficulty young adults have with finding stable work, all of which make her worry for her grandson's future, her daughter's future and the future of generations to come. Sallyanne talks freely about her childhood, which she describes as an unhappy time and reports having been mistreated by her parents, fearing them, being unsure of what they would say or how they would treat her day to day. However, she does not have any unwanted or intrusive thoughts or nightmares about events that occurred.

Based on the case study, the probable diagnosis, treatment decision and justifications are shown in Table 3.1.

Table 3.1