Follow-Up, Relapse, and Recovery – Holding the Long View

Case 1, Episode 6 

“She’s better… but I’m scared. What if this comes back?”

— Sarah’s grandmother, three weeks into treatment

In the early days, the goal was stability. Now, Sarah is sleeping again. She’s taking low-dose risperidone with minimal side effects. She started texting a friend again. She even rejoined one of her virtual classes. 

It would be easy to think: Mission accomplished. But psychiatric recovery isn’t a light switch—it’s a process. And the most powerful part of that process often happens after the crisis passes.

What Does Recovery Look Like?
Recovery[1] doesn’t mean symptoms never return.
It means the person returns—with new awareness, new supports, and a plan.
With Sarah, your follow-up work includes:

• Monitoring her clinical course

• Navigating setbacks without judgment

• Supporting identity reformation

• Maintaining a therapeutic alliance through fear and doubt

1. The Follow-Up Structure: What, When, and How Often?

Frequency:

• Weekly for the first month

• Biweekly once stable

• Monthly with sustained remission

What to Assess[2] Each Visit:

• Sleep, appetite, stressors

• Symptom recurrence or progression

• Medication adherence and side effects

• Functioning: school, relationships, self-care

• Emotional tone: fear, shame, hope, motivation

Structure the Check-In:
Use the 5F Framework:

• Feelings – “How have you been emotionally?”

• Function – “How have you been managing your daily routines?”

• Focus – “What’s been on your mind the most?”

• Fears – “Anything worrying you about the future or your progress?”

• Forwards – “What’s one small step you want to take before we meet again?”

2. Red Flags[3]: What to Watch For
Early intervention prevents crisis escalation.
These subtle signs may precede relapse:

• Declining sleep or appetite

• Re-isolation or missed appointments

• Resurfacing of paranoia, even vaguely

• Resistance to medication or therapy

• Drop in insight or increased magical thinking

• Emotional numbing or shutdown

 If any of these arise:

→ Reassess safety, social supports, and consider med/treatment adjustment
→ Involve family, or clinical team early
→ Normalize the fear of “going backward”—without labeling the person as regressing

3. Navigating Setbacks: Grace + Structure
Setbacks are not failures. They are feedback.
If Sarah stops taking her meds, misses classes, or starts hearing whispers again, avoid panic. Instead:

• Rebuild trust: “You’re not in trouble. You’re not broken. Let’s figure out what’s changed.”

• Review the timeline: “When did things start to feel different again?”

• Reground in strengths: “You’ve gotten through this before. What helped last time?”

• Restart without shame: “This is part of the process. Let’s adjust the plan.” 

4. Moving from Symptom Control to Identity Formation
Sarah is 22. She is still becoming who she is.
And illness threatens that process.
Your job now is to help her go from I am a patient to I am a person who once needed help and now owns her story.

Ways to Support Identity[4] Work:

• Reflect strengths regularly: “You’ve shown so much insight and courage.”

• Encourage creative outlets: journaling, art, storytelling

• Discuss labels carefully: “Psychosis was part of your experience—not your identity.”

• Explore purpose: “What do you want to do with what you’ve learned about yourself?”

5. When to Consider Treatment Plan Revision

Over time, things may evolve:

• If symptoms stay in remission for 6+ months, consider dose tapering under close monitoring

• If therapy goals shift, move toward deeper trauma work, cognitive restructuring, or psychodynamic exploration

• If side effects interfere, switch, or adjust medications

• If Sarah is thriving, widen the conversation to long-term goals, education, and growth[5]

 Always remember:

• Treatment is a dialogue, not a prescription.

• And progress is nonlinear.

From Crisis to Continuity: A Message for Clinicians
Psychiatry is not about fixing people. It’s about walking with them, through fog, through relapse, through rediscovery.[6] Sarah will have good days and bad ones. She may one day need meds again. Or not. She may write a memoir, become a nurse, or simply live quietly with a few close friends.

Whatever her path, the point is: she has a path again. Because someone held her story long enough for her to hold it herself.

That someone is you.

Reflective Prompt for You

• What does recovery mean to you, not just clinically, but personally?

• When was the last time you helped someone move from surviving to growing?

• Reflect, journal, or share your story with a peer. These moments matter more than we know.

What’s Next?
This concludes Case 1: Sarah’s Story.
In our next series, we’ll dive into a different kind of complexity:
A 48-year-old man with chronic depression, medication fatigue, and a deep fear that he’s “too broken to be fixed.” 

We’ll explore:

• Treatment-resistant depression

• Psychodynamic themes of self-worth

• Medication strategies after multiple failures

• The power of patient narratives in chronic care

Until then, thank you for showing up, thinking deeply, and holding hope.

Let’s keep changing psychiatry—one case at a time.

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References:

[1] Drake, Robert E., and Rob Whitley. "Recovery and severe mental illness: description and analysis." The Canadian Journal of Psychiatry 59.5 (2014): 236-242.

[2] Van Weeghel, Jaap, et al. "Conceptualizations, assessments, and implications of personal recovery in mental illness: A scoping review of systematic reviews and meta-analyses." Psychiatric rehabilitation journal 42.2 (2019): 169.

[3] Lynette, S., D. N. P. Bragg-Underwood, and M. S. N. Cole. "Practice Matters: Red Flags in Adults with Mental Illnesses." International Journal of Faith Community Nursing 2.2 (2016): 39.

[4] Yanos, Philip T., David Roe, and Paul H. Lysaker. "The impact of illness identity on recovery from severe mental illness." American journal of psychiatric rehabilitation 13.2 (2010): 73-93.

[5] Treichler, Emily BH, Eric A. Evans, and William D. Spaulding. "Ideal and real treatment planning processes for people with serious mental illness in public mental health care." Psychological Services 18.1 (2021): 93.

[6] Crawford, Mike J., et al. "Providing continuity of care for people with severe mental illness: a narrative review." Social Psychiatry and Psychiatric Epidemiology 39 (2004): 265-272.