[insert something witty]

-co-creating a non-stigmatizing, anti-carceral plan for how to manage suicidal ideation. this could be as simple as regularly asking “hey, any suicidal thoughts lately?”, asking what kinds of lethal means he has access to, and checking in to see what his experiences with those thoughts have been lately. I’d also establish, again day one or the first day he’s feeling pretty stable, a plan for what to do when/if those thoughts become active. Would he like help reaching out to a higher level of care? A loved one? Does he consent in advance to hospitalization if there’s a crisis where his judgment is impaired? (I don’t believe in or practice involuntary hospitalization and would also explain this, no I don’t care that it’s the law, forced hospitalization makes people worse and makes it dramatically harder for them to access actual support, don’t call my licensing board on me pls)

-a focus on strengths and resources and how to shore those up. Important in general, deserved by all human beings, necessary for depressed patients. Ilya has been through a lot. He also has a lot going for him, internally and externally. He is intelligent, especially emotionally. He is incredibly empathetic and loyal. He is the best (okay tied for first) in the whole world at something he loves to do—by definition he is hardworking and dedicated. He is a good leader and a good friend to his teammates. In terms of resources: yes, he’s short on interpersonal supports, but a partner who loves him, even a long distance partner, is a big support. He had friends in Boston he could perhaps stay connected to, and a relationship with Svetlana that he could learn to lean on. He has effectively unlimited financial resources. He’s in good physical health. These all point towards a positive outlook! like literally just making a list of these things might help.

-referral to medical. neuro workup to make sure there isn’t a physiological brain issue, since depression is a common symptom of all kinds of neurological illness and he works at the Get Hit On The Head Factory. Discussion with a good psychiatrist who I collaborate closely with. i would assume that SSRIs/SNRIs would be trialed and fail (because I don’t think he would want to be on a medication with sexual side effects, and also it’s a bad fit for this kind of depression usually, i will spare y'all my SRI haterade soapbox), it’s possible that something like Wellbutrin or Lamotrigine would be helpful or it’s possible medication wouldn’t be part of the plan.

-making a diagnosis (probably major depressive disorder, recurring, moderate). Explaining, in detail, what that diagnosis means, what the prognosis is, and what it means to have a diagnosis. i’d also want to know a lot about what that means to him especially in re his mother

-a lot of listening to him share about daily life stressors. He’d probably have a lot to say bc he’s an outgoing guy and he’s lonely. initially not much of it would have a lot of emotional content, which is fine. this is also where hopefully he starts to feel comfortable talking. I would also continue to focus on strengths—what are the good things, what is he enjoying, etc. i'd ask a lot of questions about shane because he'd need a space to talk about this person in his life that's so important that he has to keep secret. not to tell him what to do in the relationship or anything. just to give him space to talk.

-then some gentle prodding to encourage him to share his feelings about these things. identifying what those feelings are like. Discussing how he’s coping with them and if there’s other methods he can think of trying. And then, crucially, starting to engage with where those feelings come from,. And listen, it doesn’t take the world’s most gifted analyst to draw the line from “I am not good enough for my boyfriend” to “I was never good enough for my father, which I know because he told me that repeatedly, usually while hitting me,” or from “Shane doesn’t really want me around” to “my mother didn’t care enough about me to stay alive.” And now we’re in it!!

-you probably don’t come right out and say those things, but you start to encourage him to draw those connections, to see where those ideas about himself may have come from, and to recognize what he learned about relationships when he was young. Two crucial things I’d keep an eye on here. First, very very important to avoid implying that “you learned about relationships from your parents” = “you are like your father (or like your mother, but especially not like your father)”. Secondly, again, strengths focused. I would be genuinely impressed with anyone who came from such a traumatic background who had developed such loving relationships and strong interpersonal values in adulthood, and I would say as much.