Matt was in many ways the stereotypical “all-American” teenager: a multisport athlete,
class president, and valedictorian of his high school. It seemed preordained that
he would attend his dream college and continue this extraordinary trajectory. But
something went wrong. In his first year of college, he struggled academically and
became increasing withdrawn. He sought treatment through the university’s health services.
He was diagnosed with depression but engaged ambivalently with the clinic, with intermittent
adherence with his medications and therapy appointments. His therapist worked hard
to understand Matt’s resistance to treatment and to establish a therapeutic alliance.
Matt ultimately disclosed—with a deep sense of shame—what he considered both his darkest
secret and fear. When he was 6 years old, his father began behaving erratically, went
missing for long periods of time; his father was committed against his will to a state
psychiatric hospital, where he eventually died. Tearfully, Matt turns to you and asks,
“What if the same thing is happening to me?”
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References
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Article info
Publication history
Accepted:
April 17,
2018
Received in revised form:
April 16,
2018
Received:
April 11,
2018
Identification
Copyright
© 2018 Society of Biological Psychiatry.
