INTERPERSONAL THERAPY for DEPRESSION

1
INTERPERSONAL THERAPY for DEPRESSION

• An Overview
• Presented by
• Eric L. Strang, Psy.D.

2
IPT Is

• Evidence based
• Brief / Time-Limited
• Manualized Treatment that
• Targets improvement of interpersonal functioning
• Promotes enhancement of communication within
  relationships
• Focuses on current interpersonal conflicts

3
CONCEPTUAL MODEL

• Recognizes the role of Attachment in the
  development of depression
• Focuses on conflicts, transitions, and grief in
  key relationships.
• Improvement comes from changing the affective
  experience of key relationships.

4
Goals of ITP

• Reduce Symptoms of Depression
• Improve
• Sleep
• Appetite
• Energy
• Outlook
• Enhance Patients ability to cope with the people
  and situations associated with the onset

5
Treatment Focus

• IPT focuses on
• Current Problems
• Key figures in Patients present life
• Clarification of Patients perspective of their
  life
• Patients affect
• Recognition of emotional response
• Development of new experience

6
IPT includes

• Identifying / exploring options
• Problem solving
• Psychoeducation
• Resource development

7
IPT Does Not

• Delve into early childhood
• Focus on cognitions
• Interpret defenses
• Seek the sources of guilt, shame, or resentment
  (viewed as symptoms)
• Encourage free association
• Allow indefinite treatment
• Encourage dependence

8
COURSE OF TREATMENT

• Initial Sessions (Meetings 1-4)
• Diagnosis
• Explain treatment procedures
• Provide initial symptom relief
• Intermediate Sessions (Meetings 5-8)
• Implementation of Treatment Strategies
• Monitoring symptoms
• Enabling clarification
• Maintain alliance
• Termination (Sessions 9-12)
• Process role transition
• Recognize Patients independent competence

9
PATIENT SELECTION

• The following are characteristics of Patients
  appropriate for IPT
• Ability to establish therapeutic relationship
• Willingness to work within a time limited
  framework
• Able to acknowledge contribution of interpersonal
  difficulties

10
INITIAL PHASE

• During the First Three Sessions
• Review of Symptoms and Diagnosis
• Explanation of Depression Treatment Options
• Medication Evaluation (if indicated)
• Interpersonal Inventory
• Case Formulation
• Treatment Contract
• Sick Role

11
DIAGNOSIS

• Review depressive symptoms
• Assess severity
• Link to DSM
• Use Scales to assess track
• Name the disorder
• Evaluate need for medication

12
EXPLANATION

• Explain
• The medical nature of their disorder (blame
  free illness)
• The treatable nature of Depression
• The framework of treatment
• Positive prognosis

13
INTERPERSONALINVENTORY

• Review of key people in Patients life to assess
  the relationships
• Comfort and closeness
• Open expression of feelings needs
• Level of Support
• Pros and Cons

14
IDENTIFICATION OF PROBLEM AREAS

• Grief (complicated bereavement)
• Role Dispute
• Role Transition
• Interpersonal Deficits

15
GRIEF

• Focus of treatment when Pts symptoms are
  associated with the death of a significant other.
• Complicated bereavement
• Postponed, avoided, or interrupted mourning
• Anniversary effects

16
INTERPERSONAL DISPUTES

• Focus of treatment when Pt is at odds with an
  important other regarding expectations of the
  relationship.
• Disagreements that are repetitive or at a
  stalemate.
• Most common

17
ROLE TRANSITIONS

• Focus of treatment when Pts symptoms are related
  to changes in relationships.
• Divorce
• Moves
• Graduation
• Birth of siblings
• Can be positive or negative change

18
INTERPERSONAL DEFICITS

• Usually the focus when the other problem areas
  dont apply.
• Problems with loneliness, social isolation,
  limited attachments.
• Problems establishing or sustaining intimate
  relationships due to
• Low self-esteem
• Dysthymia
• Social anxiety

19
FORMULATION

• Bridge to treatment phase
• Provides focus for treatment
• Must be
• Plausible
• Understandable
• Based on interpersonal history
• Organizing and empathic

20
Sample Formulation

• It seems that you have been having conflicts with
  your parents. It is possible that these problems
  may be related to your feelings of depression,
  since these feelings emerged at the same time.
  Sometimes depression can make a problem seem too
  large to handle. This is because you are
  depressed, not because you cant change the
  situation. Over the next few weeks, we will meet
  once a week to talk about these problematic
  situations, and we will try to generate
  alternative ways to cope with them. At this time
  medication does not seem to be necessary to
  relieve your symptoms but may be considered in
  the future if they continue.

21
TREATMENT CONTRACT

• Linked to the formulation and presented
  immediately following
• Must include the time frame and number of
  sessions (weekly sessions for 3-4 months)
• Must include the proposed focus based on the
  formulation
• Includes an explanation of the prognosis and
  supporting research

22
SICK ROLE

• Remove Blame
• Use Medical Analogies
• Provide relief from the pressure of performing at
  their normal (premorbid) level.
• Arrange for extra support for effort or
  quantity/quality.

23
IPT Techniques

• Nondirective Exploration
• Direct Elicitation
• Encouragement of Affect
• Clarification
• Communication Analysis
• Decision Analysis
• Role-Play

24
Nondirective Exploration

• Use of open-ended questions to facilitate
  gathering of information
• Use of supportive acknowledgement
• Go on
• Tell me more
• I understand

25
Direct Elicitation

• Specific questioning used to obtain information
  used for
• Developing the interpersonal inventory
• Symptom identification
• Clarification of key points

26
Encouragement of Affect

• Therapist is attuned to emotion laden statements
• Therapist encourages expansion of these topics by
  eliciting details.
• Therapist provides validation and normalization
  of emotional responses.
• Provides opportunities for Pt to
• Become aware of their emotions
• Better understand their feelings
• Make informed decisions
• Practice managing affect

27
Clarification

• Requests for Pt to rephrase or repeat a statement
  in order to
• Call attention to an important point
• Set up expansion by therapist
• Create awareness of contradictions

28
Communication Analysis

• Identifies communication problems
• Therapist elicits a detailed account of a
  critical conversation/argument in order to
• Understand the meaning of the interaction
• Assess the methods of communication
• Call attention to distortions
• Highlight possible assumptive errors
• Offer alternative interpretations
• Must be done within cultural context

29
Decision Analysis

• Technique for assisting Pt in considering the
  pros and cons of alternatives.
• Identify desired goals
• List possible methods
• Generate likely outcomes

30
Role-Play

• Can provide opportunities for identifying
  problematic skills
• Opportunity for evaluating Pts emotional
  responses to interaction
• Allows for practice of skills
• Pt can take the role of a person they would like
  a relationship with.

31
Therapeutic Relationship

• Transference not Interpreted
• Used to assess outside functioning
• Here-and-now issues provide teachable moments

32
Therapists Role

• Active Non-neutral Advocate
• Advice / suggestions
• Psychoeducation
• Modeling
• Problem solving
• Unconditional / Nonjudgmental
• Present focused
• Skills Trainer
• Coach

33
INTERMEDIATE PHASE

• Maintenance of supportive alliance active
  listening / empathy
• Avoid drift focus on identified problem area
• Normalize depressive symptoms
• Pull for affect
• Focus on interpersonal encounters
• Highlight positive effort as well as problems
• Role-play interpersonal options
• Summarize sessions
• Repeat depression measure every 3-4 weeks

34
Treating Grief

• Facilitate mourning (catharsis)
• Reestablish interests
• Establish substitute relationships
• Process the details of the loss
• Sequence of events
• Consequences of the loss
• Address feelings of guilt
• Develop tolerance for affect

35
Treating Interpersonal Disputes

• Identify the disagreement and the stage
• Renegotiation
• Impasse
• Dissolution
• Chose plan of action
• Modification of communication and/or expectations

36
Treating Role Transitions

• Communicate understanding of Pts perspectives
  of
• The demands of the new situation
• What was gained
• What was lost
• The new expectations and responsibilities
• Assist in
• Giving up old role
• Mourning old role
• Acquiring new skills
• Developing new supports and attachments
• Recognizing the positive aspects of the change

37
Treating Interpersonal Deficits

• Primary treatment goal is to increase social
  contacts
• Practice forming new relationships
• Review past relationships
• Clarify patterns of strengths and problems in
  relationships
• Clarify Pts feelings regarding relationships

38
TERMINATION

• Begins during final quarter of treatment
  (sessions 9-12)
• Must be explicitly discussed and planned for
• Review warning symptoms of depression
• Review identified problem area
• Review strategies for improving relationships
• Review changes in patient
• Address potential relapse

39
TERMINATION(Continued)

• Acknowledge healthy sadness and role transition
• Call Patients attention to their independent
  competence
• Address Non-response
• Minimize Pts self-blame
• Emphasize alternative treatments
• Assess need for continued Treatment or
  Maintenance
• Renegotiate contract

40
Differences Between IPT and Psychodynamic
Psychotherapy

• IPT focuses more on the Here-and-Now
• IPT focuses more on Pts life outside the clinic
• No Transference Interpretation
• IPT focuses on changing current interpersonal
  patterns
• IPT is more structured

41
Differences Between IPT and Cognitive Behavioral
Therapy

• IPT focuses on interpersonal affect and behavior
• IPT Less Structured
• IPT does not assign homework