February 20th, 1991

The patient was seen for 30 minutes by himself and then together with his mother for 25 minutes. Initially he was somewhat terse in describing how he was doing, but nonetheless fairly outgoing and his affect shows continued improvement. He is feeling better about his work in school and his jobs and said that his social life was going adequately although he had less time to do things because of trying to get caught up in school. The one area that I picked up the most difficulty at this time was his relationship with his grandmother, who has had a stroke and is still recovering and clearly is an a very concrete mode of thinking most of the time. It is apparently from the patient's comment that the family was not really acknowledging this and when he was together with his mother I raised this issue particularly in relationship to the other things going on in the family at the time and her relationship with her husband. She and her husband are continuing to pursue counseling, although at a somewhat slow rate. It is still not determined if the counselor they are seeing is being covered by insurance and she is waiting to hear. I will continue to encourage them to be involved in counseling. I would like to see the patient again in three weeks. He will continue on nortriptyline 100 mg HS until then.

The Cheese Man, M.D.