What would a formal diagnosis be:

Watson is a 35-year-old cisgender heterosexual male who works as an oncology nurse. Watson is a veteran of the United States Marine Corps and was separated after a suicide attempt from the increasing demands of his job and a reported "awful command". Watson was discharged after 10 years of service under honorable circumstances. Watson lives alone and has around a 45-minute commute to and from his job. Watson often works day and night shifts which makes commitment to regularly scheduled therapy difficult. Watson came in for worsening feelings of self-reported "depressed and just lonely" feelings. Watson reports that his job has him in constant contact with dying and terminally ill patients of varying ages that ultimately led him to his worsening feelings of depression and brought him to seek help. Due to his non-uniform work schedule, Watson has not had a regular sleep schedule since he started nursing school and often will have to stay up all night for an oncoming night shift or operate on a lack of sleep before a day shift. Watson self-reports a tendency to "drink too much" and details how it helps him cope with the stressors of his job and his feelings. When asked about on average how much alcohol he consumes a night, Watson reported "between 12-18 beers a night". You also notice that Watson is extremely thin.

Watson has three siblings, two older brothers and one older sister. Watson is also divorced from his wife of 5 years and lives locally; while his ex-wife and 2 children live in another state. Watson reports that he now sees his children more regularly "about once every 2 months" but states previously there was a time he didn't see them for "about 2 years". Watson states that this was due to worsening tension between he and his ex-wife, which has now eased. Watson reports that while at work one day, he came home and his wife had left with their children. She stated she wanted a divorce and moved across the country. Watson reported that upon learning this, he "got drunk, and went to go get more beer, and didn't care if he made it back in one piece or not".

Watson's parents divorced when he was young and coparented amicably as far as he was concerned. Watson reports his father as being "a previous alcoholic but is now a sober struggling artist" and his mother as "a retired librarian". Watson reports "no issue" with his parents and that he "talks to them maybe once a year". Watson's father is in a relationship with another woman and reports his mother as being single since their divorce. Watson reports occasionally talking with his siblings, but reports feeling "indifferent if we keep up with one another".

Watson reports having multiple "two-week flings" with women but reports that none of them last much longer than that. Watson reports that he "admittedly falls fast" but "for some reason or another, they never work out". His last relationship with a woman was described as "being used for money" and that he would "pay for her car to be fixed, her food, to go shopping, but only ever hung out with her once". This continued for three months before Watson reportedly ended the "relationship" after feeling used. Watson reported not expecting anything from the woman in return but that it "became evident the only reason she talked to me was for money and every text would be asking for me to Venmo her for one thing or another". Watson has since been identified as single and reports he doesn't "care to find someone else to use me".

Watson has "two close friends", Jen, and Ben, with whom he met while in the Marine Corps. Watson also reportedly lived with Jen and Ben after his divorce, discharge from the military, and while in the process of selling his house, "till I got back on my feet" which he reports was about two years of living with Jen and Ben. Watson reports being "better friends" with Jen as he feels more comfortable to talk with her about his feelings but likes to "drink, watch football, and go hunting with Ben". It was on Jen's "constant nagging" that Watson approached therapy.

Jen accompanied Watson to the initial intake session with you. When you speak with her privately, Jen endorses that Watson has seemed exceptionally down during the past six months. She reports that he has a loss of interest in activities. This loss of interest ranges from activities of daily living such as keeping his living spaces clean all the way to him no longer seeming to enjoy activities that he once found enjoyable. She also reports to you that Watson endorses feelings of worthlessness and guilt that reach almost delusional proportions. She reports that he regularly expresses that he believes he is the cause for world hunger and the problems of his friends and family. She reports that Watson has also missed a lot of work due to his symptoms and that he has faced disciplinary action at work as a result of this. Jen also expresses that, seven months ago, Watson went through a period of time where his mood was exceptionally elevated. During this time, Watson was engaging in a lot of activities such as taking on extra shifts at work, starting new projects such as a "research project" which he believed would make him famous in his field. Watson had a very high sense of self-esteem during this time, and he believed that he was "better than everyone else." He would also speak rapidly during this time, and he was sometimes difficult to understand because he was talking so fast. He was also engaging in a lot of risky behaviors during this time such as buying things he couldn't afford (like a new truck) and splurging on expensive clothing items. Watson would also be very irritable during this time, often screaming at Jen and her partner. Jen described this mood as exceptionally elevated and endorsed that this was different from Watson's normal mood. She stated that the mood lasted for three weeks before shifting to the current depressed mood that he is presenting with.

When you meet with Watson again, he endorses that his symptoms of low mood have been causing him significant distress and impairment in his life. Watson also acknowledges that he has periods where his mood is exceptionally elevated, but doesn't view these as problematic and he even wishes that he could experience these moods again.