Shirley presents to counseling complaining of depression and lack of energy. Upon assessment she reveals that she only sleeps about 4 hours a night and she has lost about 20 pounds in the past few months. She has withdrawn from her friends but still maintains contact with the mother who lives in another state. She denies any suicidal ideation and does not have a history of suicide. She reports that her faith is important to her and that she has a personal relationship with Christ. Her church attendance, however, has been sporadic during the past few months because of her lack of energy to get to services on Sunday morning.