Your client, Mary, has symptoms that would fit a diagnosis of dysthymia; however, as you take a careful history, you find that Mary has suffered an extraordinary series of traumatic losses over the...

Your client, Mary, has symptoms that would fit a diagnosis of dysthymia; however, as you take a careful history, you find that Mary has suffered an extraordinary series of traumatic losses over the past 3 years, including her son’s suicide and the subsequent deaths of her mother and her husband. Now she is being laid off from her job and losing her health insurance. She knows that having a psychiatric diagnosis might jeopardize her ability to find a new job and insurance coverage. You believe that Mary is experiencing reasonable responses to an extraordinary set of circumstances and can benefit from counseling. Mary is not suicidal, and she is functioning reasonably well. If you give her a DSM diagnosis, she may qualify for psychiatric services, including medications, at a community clinic. Otherwise, she can continue to work with you on a sliding-scale fee basis at your college counseling center. Mary trusts you, and wants to know what you think is best.

1. What would you do?

2. What factors would you need to consider?