March 13, 1991

The patient was seen for 40 minutes alone and for 15 minutes with his mother, for a total of 55 minutes. He again tended not to be very talkative during the session and spoke about things going better. His overall affect remains somewhat blunted but more cheerful then previously. Cynicism is still apparent. After his mother came in, she mentioned difficulties he and his father had in an argument over the mock trial tournament that the patient had attended in Portland where his father was the coach. The patient had made suggestions about cutting another team member who happened to be a friend the patient was having conflict with. The patient felt that he had figured out his reasons logically, but his father did not want to follow his advice and pointed out the reasons. In retrospect, the patient tended to deny the extent of the conflict while his mother tended to emphasize the problems that he and his father had in communication. Both agreed, however, that there has been continued improvement. At this point, I would like the patient to continue on 100 mg of nortriptyline at bedtime and see him again for an hour within two weeks.

The Cheese Man, M.D.