CASE STUDY ON DEPRESSION & SELF-FORGIVENESS

By Jared R Fabac
N.C.C.A. Clinical Member --Certified Temperament Counselor

Background Information

Name: Greg
Sex: Male
Age: 65
Marital Status: Married
Children: 3 Stepchildren – Adults
Wife: Gloria
Date of Report: August 1, 2019

Reason For Seeking Counseling

1. Currently struggling with depression.

2. Has several incidents of unresolved guilt stemming from his past.

Overview
His APS Report indicated that he was:

1. Melancholy Compulsive in Inclusion

2. Choleric in Control
3. Melancholy Compulsive in Affection

Session Notes

Session One:
 
Greg was referred to me from another member in our church which whom he is also a
neighbor. Greg came into my office a bit hesitant and closed off. He didn't make much eye
contact and was quick to disqualify himself as "okay" immediately upon our introductions. Greg
is 65 years old and retired. He was raised catholic and has had a superficial relationship with God
most of his life. He has accepted Jesus as his savior; however, he has failed to indeed come into
an intimate relationship with him. Greg has been married for ten years to his wife, Gloria, and is
currently struggling with purpose in life, depression and unresolved guilt.
 

Temperament Case Studies ~ 1

 We started the counseling session with an overview of our expectations and the
temperament therapy model. I then administered the A.P.S. response form and allowed the client
to complete the examination privately. The client completed the exam in just over 9 minutes.
Before returning into the room, I was able to quickly review the results of the A.P.S. report and
identify that Greg was an Mc-C-Mc temperament type. This was immediately beneficial as it
defined how I would interact going forward. Upon returning to the room, Greg stated "that was
very interesting" and expressed that he enjoyed going through the assessment. We moved to
discuss some of my credentials and certifications and, once understood, I invited Greg to give
me a quick snapshot of his life and his reason for seeking counseling.
 
Greg has been in and out of therapy most of his life; however, he quickly stated that it
has been mostly unsuccessful. The client feels that most therapists who attempted to deal with
his needs spent most time comparing his situation to those of their own life. Client stated that
therapists "just wanted to talk about their own stories" and not focus on how I was feeling. Greg
explained that he was previously diagnosed with psychological disorders and currently is on the
medication Latuda (50MG decreased to 30MG after some dizzy spells and numbness in the
fingers).
 
Greg explained that he has struggled with thoughts of suicide previously. He stated that
sometimes he wished St. Peter would just let him enter heaven because he expects the afterlife to
be much easier than this life here. I affirmed his feelings and moved into an immediate ladder
risk assessment to determine if there was a crisis risk of suicide. Upon completing the ladder risk
assessment, the following was determined:
 
Ideation / Intent: Present
Plan: Not Present
Means: Not Present
Timeframe: Outside 24 hours.
 
I determined that the client was not an imminent risk for suicide. I made the call that
counseling could continue without a referral necessary.
 
The client is in his 1st marriage and states that it is a healthy marriage for the most part.
His wife was married once before. Greg lost his mother 19 years ago (2000) and his wife lost her
first husband during that same year. This grieving stage brought them together. During the
marriage, the client's stepchildren did not initially receive him well. Greg attributed that to the
loss of their natural father and has said that the relationships with all three children have
improved significantly over time.

The client made mention that his wife is "never wrong" and quickly told a story of how
he was in a recent argument after purchasing a new vehicle that ended up having several
problems. He stated his wife accused him of not reading the fine print and blaming him for the
situation they were in. He briefly opened up that he struggles with anger, and his wife considers
him "verbally abusive" at times.
 

Temperament Case Studies ~ 2

 Greg has struggled with spiritual doubt from the perspective of having a purpose here
on earth. He stated that not having a clear purpose on earth compounds with several other
emotional struggles and causes guilt, both real and false, to overwhelm his days. Greg has been
attending Bridge Church for the previous six weeks and has genuinely enjoyed it. He states his
wife isn't quite ready to participate in church again, and she was also raised Catholic, and this
was a bit too different for her. I opened the invitation to him to let her know I was freely
available to her, also.
 
The goal of session 1 was to begin to build trust and authority in the counseling
relationship. Both seemed to be successful. I asked the client to prepare to get into the details of
what he feels is the cause of his depression and guilt for next week. We then spent the final few
minutes praying together and asking God to open his heart to the wisdom he would share and to
give him continued courage and positive expectations of the future sessions.

Session Two:
 
Session 2 was dedicated to allowing Greg to explore his understanding of why he is in
the position he is in. The goal of the session was to uncover the root issues of unresolved guilt
and depression. My approach to this session was to allow the client to express his perspectives
with the understanding we would be able to bring clarity to these unresolved issues in the
following session by connecting them to his temperament characteristics.
 
We were able to identify four different causes of guilt that Greg was experiencing.
Before exploring these, we determined that alcoholism was prevalent in both of his parents
growing up. Greg stated that he also drinks socially throughout the week, but it does not impact
any relationships or areas of his life.
 
I moved to question Greg about when these feelings of guilt began in his opinion. He
stated that it started when he fell short in his relationship with his mother during her final years.
This was considered root cause #1. His father died 24 years ago and, at that time, he and his
mom had a substantial shift in their relationship in which he grew very close to her. For the next
five years, he had a great relationship with his mother and felt a sense of responsibility for not
doing more to prolong her life. He had his first experience with guilt at this point, 19 years ago,
when his mother died, and he felt he didn't do enough to take care of her longer. This sounds like
it was primarily because he didn't get to experience a more extended amount of joy with her in
his life, and he blamed himself for that. 

Greg's mother died on July 17th, and her Birthday is October 13th. Both of these times
bring up negative feelings and thoughts. This could likely be from not expressing his feelings to
his mother before she passed. As a Melancholy compulsive in affection, he probably never
indeed expressed his appreciation and love for his mother and is dealing with those things now.
It sounds like his father was also an Mc in which he never showed any affection to him growing
up. He has very few strong relationships, and this was one of them. He was also experiencing the
inability to control his mother's outcome, causing a conflict with his Choleric temperament in
control.
 

Temperament Case Studies ~ 3

 When discussing his grieving process over his mother, he moved into connecting his
wife's loss and grieving process here, as well. We began to explore his relationship with his wife,
and he referred to himself as a "narcissist" because of the way he treats and can sometimes
verbally lash out at his wife. Greg's wife accuses him of being verbally abusive and struggling
with his temper. This would be where the 2nd input of guilt is coming from. He is currently
struggling with his wife from the perspective of trying to deal with her "never wrong" attitude,
no matter how wrong she may be. I would assume that his wife may be a phlegmatic from the
stubbornness that he describes; however, I am going to attempt to profile her in the future to help
connect this.
 
As a melancholy compulsive in both affection and inclusion, it sounds like he tries to
show his affection through tasks and providing an economically stable home. However, when he
attempts to accomplish tasks, they're never done right, or they're never good enough. 
 
Over the past three years, the arguments between him and his wife have been getting
more and more intense and frequent. Likely because they are both operating within their
temperaments without any understanding of the other's needs. His wife has not been very
supportive of his previous therapy attempts, and she is equally as pessimistic of this process, as
well. She has no desire to come and experience our church at this time. I have continued to keep
the door open to bringing her in and allowing her to explore this process alongside Greg. The
client made multiple mentions of his brokerage and investment accounts and that he is
exceptionally financially responsible falling in line with his natural temperament.
 
Naturally, as a Melancholy Compulsive in affection, it appears that he is showing his
appreciation and love for his wife (who he indeed does love) through tasks and economic
stability, but it seems his wife is not receptive of that. This will likely be an intense revelation in
both of their lives. We began to speak more about if he experienced these types of issues from
his previous relationships, before his wife. It was at this time that we uncovered the root cause of
guilt #3 — past relationships.
 
Here is where we get a clear picture of the choleric control temperament and behavior
in full force. The client discussed that he previously had relationships in which he would seek
out married or weaker women that he felt he could control and manipulate. He sought more
vulnerable women who were not strong enough to stand up to him. Greg stated that no single
relationship was sufficient for him, and he continued to seek more and more control over the
women he formed these sexual relationships with.
 
He suffers true guilt not only from this sinful behavior but also from how he treated
these women. He said he would date three married women at once to try and fill a void he was
experiencing, and he was simultaneously filling a void they had, as well. He said the marital
status ensured he could control the relationship because they had "everything to lose," and he had
"nothing to lose." It was the perfect scenario to unbiblically meet his Melancholy Compulsive
temperament needs while simultaneously fulfilling his choleric control needs. It was the accurate
picture of someone meeting unbalanced temperament unbiblically.
 

Temperament Case Studies ~ 4

 Finally, we moved into a more in-depth exploration of other relationships in his life that
may be causing guilt in his life. He moved into his childhood and the way he treated his younger
sister when they were young. He said he was physically abusive to her, and this ended up being
labeled root cause of guilt #4. Greg hasn't spoken to his sister in 19 years after there was a heated
exchange at the time in which his mother passed. He said over the years, and he never realized
that when he would pick on her at a young age, he was truly physically abusing her pretty bad.
He had an opportunity to go to New York and attempt to reconcile this relationship. After some
more in-depth exploration of his anxious feelings about this, he decided he was ready to take that
opportunity.
 
At this time, we moved to explore scripture together that showed depression and guilt
and the freeing power of God's forgiveness. The following verses were used:
 
1. Genesis 4:6-7 - Cain's distress from his guilt.
2. Psalm 32 - Depression and finding a way out through confession and repentance of sin.
3. 2 Corinthians 4:16-18 - Tough situations are inevitable, but depression is avoidable.
 
 
I assigned study of Galatians 5:22-23 for homework and we prayed over his trip and
thanked God for giving him the courage to open up about these past issues so that we could have
the opportunity to deal with them biblically. It was a powerful session where we unrooted a lot of
deep emotional trauma and temperament needs being met unbiblically.
 
Due to the client traveling to New York over the next week, we will have one week off
before moving into session #3.
 
 
Session Three:
 
The client returned to session #3 after spending the previous weekend visiting his sister
in New York. Our goal for this session was to explain temperament and begin to connect his past
actions with clarity of unmet temperament needs.
 
His relationship with his sister was one of the critical areas of guilt in his life. We spent
the initial catching up on this visit and talking about the outcome of the visit. Due to the visit,
there was an extra week in between sessions. Client stated that the visit went very well and that
steps were taken in the direction of reconciliation. During the visit, he found out that his sister
had brain surgery. This has resulted in some deterioration of mental awareness for his sister.
Client stated that he wished she would have been fully aware so that he could reconcile with the
same person he knew 19 years ago.
 
He acknowledged that this path might have been more difficult, but as a choleric, he
wanted to control the outcome of the situation and have it play out the in way that he saw fit.
Also, as a melancholy compulsive in inclusion and affection, he is continuously looking for ways
to devalue himself and his worth. But we made sure to validate his efforts and acknowledge them
as a courageous step forward, and one that should be commended.

Temperament Case Studies ~ 5

  
During this visit, the client also found out that his sister-in-law is terminal with about
one-year to live. However, due to his need for very few deep relationships, he was handling this
without issue. He has decided to make it an effort to be in contact with his sister more frequently
and continue to improve the relationship and help her in ways that fit his natural temperament
and task-oriented affections.
 
His biggest fear of the trip was that he had to visit his mother's death with his sister.
This was because it was at that point where the bitterness and relationship strain began. That fear
was faced and handled with the help of prayer. This was a massive step in the right direction as
prayer requires someone to relinquish the mind to be in control and recognize the external
influence of God. Something difficult for a choleric in control to accomplish.
 
At this time, we began to move into the explanation of temperament. We discussed
temperament using the seed in the ground example. The client was very interested in
understanding more, so we went into an example of changing into specific clothes for specific
events after a shower. We discussed that in our naked form, we are exactly how God has
designed us, and it isn't until we make a choice to put on specific clothes that we cover that
design. This was used to show how personality can mask our temperament and also how
character is learned behavior. This resonated with the client very well, and he had a great
fundamental understanding of what temperament is and how God uses it to help us fall into his
aligned purpose for our lives so that we may experience the fruit of the spirit. 
 
Reading and understanding Galatians 5:22-23 was assigned as homework the previous
session, so we transitioned to exploring if the assignment was carried out. The client spent a lot
of time studying the assigned scripture and had some great questions about it. He wanted to get
more clarity on how there was no "law" against the fruit of the spirit, and so we spent a few
minutes discussing this while praising his effort of studying the scripture. 
 
We then moved into an explanation of his individualized temperament using the A.P.S.
clinical report to guide the conversation. Being a melancholy compulsive, we started with
inclusion and explaining that he had very high intellectual energy. This seemed to immediately
resonate with him as it was also how he viewed himself. Client immediately perked up and
began affirming the information being provided. We discussed that he was a "task-oriented"
person and that he values relationships greatly, but they are selective. He agreed that he builds
walls to avoid getting hurt. We also discussed how his mood follows his thinking, and he
affirmed these enthusiastically. He stated, "it's like you read a book of life." 
 
Session Four:
 
Next, we moved into discussing Control temperament behaviors. We once again began
this explanation, gently pointing out the client's strong leadership ability and quick decision-
making ability due to his choleric temperament. We then moved into a more sensitive
understanding of the need to control others, yet be entirely intolerable of others having control
over his own life and behavior. This progressed into an immediate connection with multiple
areas of guilt in his past being connected to this temperament needs. He began to see that it

Temperament Case Studies ~ 6

wasn't that he was evil, but that he was meeting these temperament needs unbiblically. He
immediately connected his abusive temper as a relative temperament trait without even needing
to bring it up. The light was beginning to shine through, and a significant breakthrough was
happening. 
 
We then moved into an exploration of his affection temperament as a melancholy
compulsive. We explored his deep feelings that he was unable to express to others. He admitted
the difficulty he showing affection, and he always thought it was learned from his father. The
truth was, it was his natural temperament. We explored how he showed affection in his deep
relationships through task-based ways, and he was able to understand an apparent disconnect in
his marriage and why it hurt so much when his wife didn't acknowledge these tasks (We still
have hope to have an entire session with his wife and profile her, as well). 
 
Finally, we worked through the four specific reasons that the client mentioned he felt
guilty and depressed. We were able to connect each one with his temperament and that they were
indeed his attempt at fulfilling his temperament needs unbiblically. 
 
1. His mother's death - His Choleric desire to control the outcome and his hurt from being a
melancholy compulsive in inclusion and this being one of those selective relationships
he valued and wanted. 
2. His abusive outbursts to his wife - His choleric temperament in control and her "never
wrong" position on most things showed he loved his wife based on the tasks he did for
her, but he was unable to control situations because of her stubbornness. This leads to the
anger and outbursts and ends up with him feeling rejected. 
3. His previous relationships with married women - He was filling his need to control
others with the safety of not needing to move into a deep relationship because they were
married. He was able to satisfy all three temperament needs unbiblically. 
4. His abusive relationship with his sister - He viewed his sister as a weaker person, and his
choleric control temperament took over, and he controlled her with physically abusive
behavior.
 
The client was blown away by this session. We discussed that the client was new in
Christ and focused on scripture that allowed him to understand God forgave him and what was
holding him most depressed was his need to forgive himself after understanding the "why"
behind his previous actions. He broke down in tears and apologized for his emotions pouring out.
We studied the following scriptures together and read them out loud: 
1. Romans 3:21-25 - We all fall short of God's expectation but are justified by grace. 
2. Romans 5:13 - Explore justification again.
3. Romans 8:1 - No condemnation for those in Christ. 
4. 1 Corinthians 13:5 - Focusing on no record of wrongs being kept.
 
Our session ended with the revelation that Greg was free to forgive himself under the
sacrifice of Jesus Christ. We spent the remainder of the session praying together. As a
Melancholy Compulsive, I felt it necessary for the client to express his forgiveness as accurately
as possible. To accomplish this, I assigned homework for the client to write himself a letter of

Temperament Case Studies ~ 7

forgiveness and include supporting scripture. Client stated this session was one of the most
powerful counseling sessions he's ever had in his life.
 
The client informed me he has a minor eye procedure being done, and he would need to
miss the following week session and pick back up in two weeks. He said he was anxiously
looking forward to our next session, and I briefly explained we discuss the decision to meet
temperament needs biblically and exploring how to accomplish that. The client showed great
enthusiasm to take that step, and we ended the session there.
 
Session Four:
 
Greg came back for his fourth counseling session, excited to get back and felt that he
was ready to dive into session 4 and transition into depending on himself to meet his
temperament. He had a week off of counseling due to his surgery, and he stated that he was able
to see things so much differently now that he had a new perspective of his temperament and
emotional construction.
 
We started the session by visiting the previous homework assignment of writing his
self-forgiveness letter. As promised, we kept it anonymous and allowed him to release his
previous guilt in this letter and to release it. He agreed to allow me to have it and let it go. We
took the letter, prayed over it put it away.
 
We then moved into discussing the current temperament needs and how each can be
met biblically. We quickly concluded that each temperament need was currently out of balance
and needed to be met. The good news was that his temperament also allowed him to make
adjustments quickly and follow instruction.
 
We started with evaluating his current intellectual and social inclusion needs. We
discussed that his rapid mood shifts were following his mindset. We agreed to make Galatians
5:22 a daily prayer and to focus his thoughts on positives each day and to affirm the positive
each night.
 
Next, our focus moved on the client, viewing himself through the lens of God and
realizing a higher purpose in his life. We focused on Psalm 139 and discussed understanding that
God knows his needs and that he is entirely created the way God wants him. This allowed him to
release the high expectations of himself. Client stated he felt "an entire building was lifted off my
shoulders when we discussed this."
 
The client then naturally moved into understanding more about how his wife would
play a role in this process. Because of this, we moved into discussing meeting the choleric
control needs. To show a more comprehensive understanding of meeting temperament needs
holistically, we discussed the client's need to begin to invite his wife into the decision-making
process to avoid burning out. To still meet his need for control, we discussed strategies for not
relinquishing control completely, but delegating responsibility to lessen the burnout risk.
 

Temperament Case Studies ~ 8

 The client shows excellent leadership potential with his strong Choleric control traits;
however, he still has the Melancholy Compulsive traits in inclusion, so we had to be strategic on
creating opportunities for him to express his leadership desires, while not becoming
overwhelmed socially. This lead to the introduction of the client to begin serving on the Sunday
traffic team and train to become a team leader. These duties would allow him to work
independently, yet still, grow in his ability to lead a small team while earning recognition for his
deeds.
 
Knowing anger has been something he has struggled with in the past, we moved into
discussing some conflict resolution strategies so that he can begin to control any abusive tempers
that may arise in conflict. We introduced a 10-step conflict management system that the client
and his wife can use to recognize the importance of his wife's feelings while allowing him to
control his abusive behavior that typically was exposed in arguments and conflict. I saw an
immediate look of relief when the 10-step conflict system was introduced.
 
Finally, we discussed the client's affection temperament needs. The main thing
discussed here was the compulsive fear of rejection that was keeping him from expression his
deep feeling and compassion for the deep relationships in his life. We discussed John 3:16 in a
way that showed that he was free to express more emotions because he could become secure in
God's love. The client discussed the need of sharing more of the "why" behind his task-oriented
displays of affection so that the people he cares about are interpreting his actions accurately, as
love.
 
We finished touching back on the main issue that initiated this counseling relationship
in the first place, forgiveness. We talked about the ongoing need to forgive and God's command
to offer forgiveness to those with a genuinely repentant heart. We discussed that the desire to get
even for those who do wrong would arise, but he must remember what God has already forgiven
him for, and how we must express the same grace to others.
 
The client shared some heartfelt thanks and tears. He stated that his life is in a new
place and that his walk with the Lord has become stronger than ever. He admitted the hurt he has
placed in the lives of others and his desire to be new in Christ. We ended the session by praying
together, and I finished the counseling relationship. It was a great day.
 
 
CONCLUSION
 
Greg was given the freeing power of self-forgiveness when he understood that his
problems were directly associated with unmet emotional needs in his life. These needs were
currently being met in unbiblical ways that were bringing acute stress into his emotional
wellbeing. Once he was able to connect these voids with biblically satisfactory ways to meet
them, the problems rapidly began to be resolved. I was able to quickly establish trust in this
counseling relationship, which in turn translated to a very engaged and teachable Melancholy
Compulsive counselee. At this stage, Greg began to see the limitless possibilities of exploring
ways to meet emotional and temperamental needs through service, relationships, and much more.
 

Temperament Case Studies ~ 9

 Greg realized the opportunities in front of him and wanted to grab them to experience
transformation. He began by agreeing to join a serve team at the church. The parking lot team
was a perfect fit in which he was able to avoid an overstimulating amount of social interaction
but was still able to satisfy his Melancholy Compulsive needs in affection through recognition of
his service and high approval in his work with a "hands-off" affection affirmation.
 
Greg also agreed to continue developing his spiritual disciplines by joining a small
group. This step would allow him to grow spiritually while also forming a very small group of
close relationships that would still give him unique opportunities to lead and manage his
Choleric control gifts.
 
Greg's immediate balancing of needs has made him a much more satisfactory spouse, as
well. By being able to more clearly articulate the “why” behind his actions, he is able to
effectively share with his wife more intimately both emotionally and affectionally.

Greg has experienced transformation and sanctification through the knowledge and
understanding of Jesus Christ in his life. I will continue a follow up with Greg but am completely
confident in releasing him from weekly counseling into a self-sufficient state of living.
 

Temperament Case Studies ~ 10