Connie, a, 33-year-old mother of a 4-year-old son, Robert, is referred by her general practitioner to a behavioral health outpatient program because of her complaint that she has been depressed and unable to concentrate ever since she separated from her husband 3 months previously.Connie left her husband, Donald, after a 5-year marriage. Violent arguments between them, during which Connie was beaten by her husband, had occurred for the last 4 years of their marriage, beginning when she became pregnant with Robert. There were daily arguments during which Donald hit her hard enough to leave bruises on her face and arms. During their final argument, about Connie's buying an expensive tricycle for Robert, her husband had held a loaded gun to Robert's head and threatened to shoot him if she didn't agree to return the tricycle to the store Connie obtained a court order of protection that prevented Donald from having any contact with her or their son. She took Robert to her parents' apartment, where they are still living. Connie is an only child, and a high-school and secretarial-school graduate. She worked as an executive secretary for 6 years before her marriage and for the first 2 years thereafter, until Robert's birth. Before her marriage Connie had her own apartment. She was close to her parents, visiting them weekly and speaking to them a couple of times a week. Connie had many friends whom she also saw regularly. She still had several friends from her high-school years. In high school she had been a popular cheerleader and a good student. In the office where she had worked as a secretary, she was in charge of organizing office holidayparties and money collections for employee gifts. She had no persona history of depression; and there was no family history of violence, mental illness, or substance abuse. Her parents had been happily married for 25 years. Connie met Donald at work, where he was an accountant. They married after a 3-month courtship, during which time Connie observed Donald using cocaine twice at parties. When she expressed concern, he reassured her that he was only "trying it to be sociable," and denied any regular use. Donald, a college graduate, is the oldest of three siblings. His father drank a pint of bourbon each night and often beat Donald's mother. Donald's two younger brothers have histories of substance abuse. During their first year of marriage, Donald became increasingly irritable and critical of Connie. He began requesting that Connie stop calling and seeing her friends after work, and refused to allow them or his in-laws to visit their apartment. Connie convinced Donald to attend couples counseling, but he refused to continue after the initial two sessions. Despite her misgiving about Donald's behavior toward her, Connie decided to become pregnant. During the seventh month of the pregnancy, she developed thrombophlebitis and had to stay home in bed. Donald began complaining that their apartment was not clean enough and that Connie was not able to shop for groceries. He never helped Connie with the housework. He refused to allow his mother-in-law to come to the apartment to help. One morning when he couldn't find a clean shirt, he became angry and yelled at Connie. When she suggested that he could pick-up the cloths from the laundry, he began beating her. She left him and went to live with her parents for a week. He expressed remorse for hitting her and agreed to resume couples counseling. At her parents' and Donald's urging, Connie returned to her apartment. No further violence occurred until after Robert's birth. At that time Donald began using cocaine every weekend and often became violent when he was high. In the 3 months since she left Donald, Connie has become increasingly depressed and hopeless. Her appetite has been poor and she has lost 15 pounds. She cries much of the time and often wakes up at 5:00 A.M., unable to get back to sleep. Ever since she left Donald, he has been calling her at her parent's home and begging her to return to him. One week before her counseling assessment evaluation, Connie's parents took her to their general practitioner. Her physical examination was normal, and he referred her for counseling. When seen by the counselor in the outpatient clinic, Connie is pale and thin, dressed in worn-out jeans and dark blue sweater. Her hair is unruly and she appears older than she is. She speaks and moves slowly as she describes her depressed mood and lack of energy. She says that her only pleasure is in being with her son. She is able to take care of him physically, but feels guilty because her preoccupation with her negative feelings about herself prevents her from being able to play with him and connect with him emotionally. She now has no social contacts other than with her parents and her son. She feels worthless and blames herself for her marital problems, saying that if she had been a better wife, maybe Donald would have been able to give up the cocaine. When asked why she stayed with him so long, she explains that her family disapproved of divorce and kept telling her that she should try harder to make her marriage a success. She also thought about what her life would be like trying to take care of her son while working full time and didn't think she could make it. She states that she is having difficulty adjusting to being a single parent and life without Donald and notes vague suicide ideation. She reports ongoing conflict with her parents who continue to disapprove of her leaving Donald