Mariah C. is a 26 year old Caucasian woman who lives in a suburban western town. She has come to therapy because of difficulty with interpersonal relationships, both in her personal and work life. Mariah has been married for 6 years to Cliff. They have two children – Melissa who is 4 years old and Mackenzie who is 18 months old. Mariah has never been in therapy before. She works full time, as does her husband. Her children are in daycare full time. She is presenting with symptoms of irritability, difficulty sleeping, new onset hypervigilance and anxiety.
             Mariah's first problems started in her relationship with Cliff, about three months after the birth of her last child. She reports a change in her mood, and states she is more irritable with Cliff and the children, generally for things that would not have bothered her before. Around this same time she noted some difficulty with concentration, attention to detail and a diminished energy. Other symptoms include decreased libido. Mariah denies any thoughts of self-harm. Mariah reports that she had a similar episode while she was in training to be a medical assistant. It lasted approximately 3 months and resolved relatively spontaneously without intervention with a therapist. She has sought therapy this time because she is feeling like the symptoms are more severe than before and have also stated affecting her relationships.
             Mariah's past medical history is unremarkable. She has been hospitalized twice for childbirth. She had an appendectomy when she was 12. She has recently discontinued breastfeeding her youngest child. She was recently started on Paxil 20 mg every morning by her family practice physician. It was at the urging of her physician that she had presented for counseling.
             She has been employed as a medical assistant at a local family practice clinic. She has held the same job for the last 4 years. She expresses satisfaction with ...