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She had stayed home crying. She said she called to cancel, but no message was left for the therapist. In this session she was more depressed than in any previous session and seemed to verge on quitting. Content revolved around how she was treated unfairly at the home for the elderly where she worked and so felt herself to be the lowest person there. The therapist pointed out that she provoked the criticism by behaving at work in a passiveaggressive manner. When she felt hurt by this, the therapist said she was angry and depressed by his remark, and she was able to acknowledge that this was so.

In- 45 STATES AND STATE CYCLES ideal state ACTIVE, COMPETENT, MUTUAL TRA-LA-LA HURT BUT WORKING CRYING r------, I ACUTE I SELF- : I DISGUST I I I L. ______ J HURT warded-off state AND NOT WORKING FIGURE 5. Model for the Cycle of States. stead, as shown in Figure 5, she attempted to avoid that state in one of two ways: She would either withdraw immediately and enter the hurt and not working state, or when someone else was available, enter the competitive state, and argue that this person was at fault.

Generol monlhs FIGURE 1. Levels of the Highest Symptom Subsets and General Symptom Level over Time According to Repeated Patient Reports on Symptom Checklist (SCL-90). 28 CHAPTER ONE rated at every encounter and the depression subscale again yielded one of the highest scores. The evaluator and therapist agreed with the patient in that they also rated her depressive mood as decreasing with treatment (see Figure 2). Overall symptoms, from eight other subscales, also declined in a similar manner (see Figure 3).