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Figure 11–1. Completed depression time line.

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Figure 11–1. Completed depression time line.Based on the time line, the therapist suggests that although the patient is anxious about the possibility of another postpartum depression, she is not unhappy about the pregnancy per se. Rather, it seems that her mood worsened in May in the context of her husband's emotional withdrawal and increased absences from the house. In fact, the patient was initially quite happy about the pregnancy. But as her husband's absences (physical and emotional) continued, her mood worsened. These feelings were magnified when her husband was not home for their son's second birthday. Although the patient attributes low mood to worries about pregnancy, it seems that she is experiencing a covert role dispute with her husband around his job travel and emotional withdrawal. Rather than focusing on role transition (from parent of one child to pregnant with twins), the therapist suggests they focus on a role dispute with the husband. This decision is based on temporal sequence of mood changes and concurrent life events.

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