Termination Phase

During the final sessions (Sessions 10-12), we focused on consolidating Ellen’s gains. She felt increasingly confident as a mother and enjoyed being with her daughter more. At times she felt a little guilty about wanting time for herself or apart from her daughter, but was able to recognize that it is normal to want to have time separate from one’s children and to do things she used to enjoy before becoming a mother. Ellen continued to assert herself more effectively and was less hesitant to reach out for help. She felt more comfortable asking for help and realized that the experience was similar to her having to delegate tasks when she ran the recruiting department at her firm. She resumed exercising, which made her feel better about her body and enhanced her mood. She was able to better connect with her old friends and her brother and sister-in-law who had kids; until she had her baby, she had not fully appreciated what their lives had been like. Ellen acknowledged that she and Joe were communicating better than they had before having a baby.

I complimented her on the hard work she had done in treatment with me. I also provided psychoeducation about her risk of relapse and discussed relapse prevention. Given that this had been Ellen’s third episode of depression, she had a great than 90% chance of a recurrence without further treatment. I encouraged her to pay particular attention to her mood in the setting of any potentially stressful life events—transitions, conflicts, deaths—as she now appreciated the connection between her mood and what is going on in her life. I reminded her that she had found a treatment that worked for her and that she could continue treatment to maintain her progress or return for “booster” sessions if she needed to ward off or began experiencing a recurrence of depressive symptoms.

By Session 12, Ellen’s score on the Ham-D had fallen to 7, which is considered euthymic, and her EPDS to 4. To her surprise, Ellen wanted to consider going back to work part-time. She admitted to feeling increasingly uncomfortable not earning money and, while she enjoyed being with her daughter, she missed the stimulation and connection with adults that she enjoyed at work. She also reported feeling selfconscious at times about “just being a mother” and worried that she would not have anything interesting to talk about with other adults. In addition, Ellen and Joe had started to talk about having a second child. While she denied feeling depressed, she wanted to continue treatment with me to learn to better manage intermittent uncomfortable feelings and to explore going back to work and getting pregnant again. I agreed that it was a good idea to continue weekly sessions. IPT had helped her, and she was at great risk for relapse in the setting of two potential role transitions (returning to work and a second pregnancy). We agreed to continue meeting weekly for another twelve weeks to maintain her progress and planned to reassess the need for further treatment at that time.

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