not-yet-known not-yet-known not-yet-known unknown Presenting Problem & Client Description This case study has three main subjects: Jason (Supervisor), “Brian” (Therapist) and “Jerimiah” (Client) (Brian and Jerimiah’s names are not real and the details of their lives have been changed to protect their confidentiality). The client, Jerimiah, presents on the surface as a lovable, heavyset factory floorman, the kind of person who might be described as “a big teddy bear”. Just under the surface of his jovial nature, Jeremiah presents as someone who carries a heavy burden. He spends his therapy sessions mostly complaining about the amount of care co-workers and family members require. At his most depressed, Jerimiah can feel stuck in his life and long for a solution, even one that means not existing anymore. The client’s distress level and symptomatology was assessed at intake and at every session using the Outcome Questionnaire (OQ)-45.2 (Lambert et al., 2018). The OQ-45.2 is a well established and widely used tool for assessing psychotherapy outcomes. It consists of 45 items, each rated on a 5-point Likert scale, ranging from 0 (”never”) to 4 (”almost always”). It is designed to measure overall psychological distress and functioning across three main subscales (Symptom Distress, Interpersonal Relations, and Social Role performance). The client’s OQ score at intake was 73, which is considered “moderately high” and fits with Jerimiah’s sentiment that if other people were not such a bother to him, he would be “just fine”. Importantly, starting on the treatment’s third session, Jerimiah reported on the OQ-45.2 that he “sometimes” had suicidal ideation. This will be explored in more detail in the case description that follows.