Depression is a complex disabling condition that is common in primary care. Mr. X was previously diagnosed with depression but had defaulted treatment. It was through an extended consultation that we could unmask the diagnosis and initiate the therapeutic process. Objectives To use the model of an extended consultation to both diagnose depression and to formulate the psycho-social factors that predispose, precipitate and perpetuate the depression as well as the positive factors that ameliorate it (4 Ps). Methods An example of an extended consultation with Mr. X. was videotaped with his permission. Excerpts from the video transcript are reproduced to demonstrate the 4 Ps formulation and how the pattern approach of narrative therapy was employed to help Mr. X. Results Mr. X. gained insight into his condition. He was hence agreeable to initiate anti-depressant medication and continued to follow-up for his depression. Conclusion The extended consultation can be used to uncover therapeutic opportunities when engaging patients with depression, and to formulate the 4 Ps in order to complement pharmacotherapy for holistic management.