Mr. M. was referred to the outpatient psychiatric clinic where I am employed as a social worker by the therapist who had been treating his former common-law wife at another psychiatric facility.
             Mr. M. is 49 years old, the second oldest in a family of 12 surviving siblings, having one older brother, seven younger brothers, three young sisters. Five additional brothers and sisters died in infancy. Mr. M. married at the age of eighteen, and by this marriage became the father of two sons, now 28 and 22 respectively, and a daughter now 27. About 1992, Mr. M. formed a relationship with Maura and for about six years they lived together and have two sons of their own; Mark, age 5, and John, age 2.
             2. Referral Source and Reason for Referral
             Mr. M. was referred to the outpatient psychiatric clinic of a Boston teaching hospital by the therapist who had been treating his former common-law wife at another psychiatric facility. He described himself as having felt somewhat depressed for about two years, a condition that had become more severe during the two months preceding the first appointment, reported some suicidal ideation, but was not considered a grave suicidal risk.
             Mr. M.'s expressed conflicting, unresolved feelings about Maura, a divorced woman with two children by her first marriage. For the past six years they lived together and had two sons of their own. They have been estranged for the past several months. The last two years of their relationship was characterized by many separations and reconciliations. Maura is ten years younger than Mr. M. Late in the spring of 1998; she refused to have any more to do with him. He had been very perplexed when Maura would not marry him when he became free to formalize their relationship in 1997 after his wife's death. While seeing the medical student in August, he discovered that Maura had another lover.
             Mr. M.'s feelings would vacillate between believing that he still loved her...