Termination, Including Maintenance Treatment and Follow-up
After Mike’s condition improved, the therapist introduced the termination of treatment. Mike spent the last two weekends and some weekdays at home to test his stressability. He also returned to his former office to collect his belongings. He became tearful describing his feelings associated with leaving the clinic. He described it as his first experience of being “seen and respected as the person I am” with vulnerabilities, emotions, and weaknesses. It deeply touched him to be supported by other patients in group therapy without having to perform. He had some anxiety about being self-employed, but was able to engage Jack’s former senior partner in leading the new branch. Mike summarized take-home messages: “Particularly in the group sessions, I learned to express myself and be open with other people even when I do not feel strong or perfect. And I discovered that the company does not equal my life. There is so much more to it that I’ve neglected so far. In the individual sessions I recognized that my feelings, including my anger, are valid and important. I always thought they would get in my way, but the opposite is the case—they are my motor.”
After six weeks of inpatient treatment, maintenance therapy was crucial to a smooth transition. For two weeks after discharge, the patient participated in the clinic’s day program to finish his group work and follow-up with his therapist. In addition, he started outpatient therapy with a clinical psychologist. In this less-than- ideal circumstance, the psychologist was not trained in IPT but read the manual after talking to Mike’s hospital therapist. Mike continued to take sertraline in the same dosage initially prescribed, and the focus of his outpatient psychotherapy remained role disputes and his new role.
Approximately one year after discharge Mike reported that he had remained euthymic with some ups and downs, despite some legal difficulties with starting his own business: “But I kept negotiating with my brothers because avoiding conflicts does not help. And with the help of a lawyer we found solutions.”
Use of Rating Scales Demonstrating Improvement in Symptoms, Functioning, and Other Domains
The patient had an initial score of 29 on the 17-item Ham-D, which indicates intense severity. His BDI score was 37. He met SCID (Spitzer et al., 1994) criteria for a single major depressive episode, dysthymic disorder, and substance (benzodiazepine) dependency. On the SCID-II interview he screened positive for anxious-avoidant and dependent personality traits. His GAF (APA, 1994) score of 42 indicated significantly impaired global functioning.
By the time of hospital discharge, the Ham-D score dropped to 10, the BDI to 12. The GAF score reached 70, indicating an acceptable level of functioning. Benzodiazepines were completely weaned. The anxious-avoidant and dependent traits decreased visibly when the depressive symptoms decreased and when the patient took greater action. He consciously decided not to avoid feelings and conflicts any longer after he recognized this behavior as maladaptive.