DISCUSSION

Barbara’s depression had remitted with no further changes in pharmacotherapy. In focusing on her role transition, with its losses, challenges, and opportunities, she developed a sense of pride and joy in her role as a mother. She no longer idealized her old role, and she recognized that she was currently using positive aspects of her managerial capacity as a highly effective advocate for her daughter. At the same time, she had shifted her interpersonal patterns of relating to a more assertive and affilia- tive style, expressing her emotions, needs, and expectations. This involved interpersonal learning through a process of trials and discoveries with more direct communication—expressing her expectations of more from some, and revising her understanding with an existential acceptance that although others, like her mother, had limits, they were worth testing.

With respect to resolving the central focus on role transition, she was able to talk about her distress over losing positive aspects of her old role as a working mother of one, coupled with her wish to regain the sense of agency she possessed in the workplace. Some of the middle sessions included discussions of return to work, during which she clarified that it wasn’t really the return to her former specific job and workplace that she sought as much as the feeling of mastery. During the latter middle phase of our work, she spontaneously brought in ideas about potential opportunities in her newly configured role, and she began to explore alternative part-time work. We had been able to discuss both positive and negative aspects of the old and new roles, helping her to regain a sense of mastery in her new role as a powerful advocate for her disabled child and loving, devoted mother of two children. Unlike her experience growing up as the older, neglected sibling in a similarly configured family, she was able to derive satisfaction from the very different choices she had made in contrast to her parents—attending to the emotional and instrumental needs of both her children in partnership with her husband. At the same time, she was able to find ways to communicate more directly with both her husband and be more assertive with her mother, improving these relationships.

Barbara had tried one other empirically supported antidepressant psychotherapy and numerous medications that had not fully relieved her symptoms. Addressing the interpersonal aspects of her experience of her altered social role appeared central to her recovery. Over a relatively brief interval, without medication changes, the depression lifted as we focused on her relationships with her children, her husband, her mother, and herself. She found ways to derive self-esteem and improved relatedness in her new role. The simple focus and structured approach of IPT facilitated growth, change, and recovery.

In the final two sessions, Barbara’s discomfort with negative affect revealed itself when, feeling anger, sadness, and worry emerging because she felt that her care was contingent, she opted for the avoidant strategy of canceling the last two sessions. Her flexibility in reconsidering that strategy and re-examining those old expectations allowed us to reach a new understanding of the interpersonal forces that had contributed to her depression. I was reminded of lines from T.S. Eliot’s Little Gidding: “We shall not cease from exploration/And the end of all our exploring/Will be to arrive where we started/And know the place for the first time” (Eliot, 1943).

ACKNOWLEDGMENTS

I wish to gratefully acknowledge Dr. Clare Pain and Dr. Alan Ravitz for their help with reviewing this case report.

 
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