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John,” age 7, (who is the “identified patient”), was referred to you by his pediatrician. The “identified patient” presented with behavioral problems – specifically acting in an overly aggressive manner at school and “clinging” to his mother while at home. Mom (Jennifer, age 38) states that the only time he is not being a problem is “when he is sleeping.” Mother reports that she is a “stay at home mom,” not particularly happy in her marriage – since her “husband (Bob age 39) works all the time” as the general manager of a car dealership, owned by her father.
She reports unplanned weight gain, fatigue, disinterest, and a lack of sexual interest. She fears her husband may be having an affair with his secretary. What is your assessment and how might you proceed in helping John?