Interpersonal Psychotherapy for Depression Paula W. Stoessel, Ph.D. 2010.

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Overview • Time-limited psychotherapy • Diagnostically focused • Validated psychotherapy, APA guidelines – Manualized – Randomized – Comparison group

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Theoretical Underpinnings Draws on work of Harry Stack Sullivan – Ego in the present – ―As soon as you begin to arrange the furniture in something that cannot be directly experienced, you are engaged in a work that requires more than parlor magic…‖ (The fusion of psychiatry and social science, p. 204) Importance of attachment (Bowlby and others) 6

Basic Principles of Time-Limited Psychotherapy • Convey to patient the sense that s/he is understood • Establish an affective connection • Always convey optimism that patient’s problems are treatable • Utilize validated treatment ritual/framework • Create sense of mastery through success experiences 7

Brief Therapy Structure Specific time frame Directive, non-neutral, active therapist stance Goal-oriented Emphasis on ―moving along‖ rather than process IPT therapists take role of patient’s ally or advocate, fostering positive transference (not explored) 8

IPT Session Structure for Each Session Review of depressive symptoms Relationship of interpersonal events, relationships to depressive symptoms ―How have things been since we last met? ―Was there a time in the past week when you felt better or worse? -What was happening at that time?‖ 9

Connection between interpersonal context and mood Non-etiological framework Interpersonal relationships connected to mood Life events related to interpersonal context – Loss of loved one – Interpersonal conflict – Transition – Loss of interpersonal effectiveness 10

Overall structure of IPT Sessions scheduled once weekly Meeting time 50-60 minutes, although first session may be longer Beck Depression scale completed by the patient prior to each session and reviewed during the session IPT divided into early, middle, and late sections (which include termination) 11

Important IPT Techniques Encourage expression of affect Suggest increased activity and socialization Explore options Clarification Communication analysis Directive techniques (psychoeducation, advice, modeling) Role play BLAME THE ILLNESS OR THE INTERPERSONAL SITUATION, NOT THE PATIENT!!! 12

Early Sessions (weeks 1-4) Psychiatric interview; determine appropriateness of IPT Diagnose depression—medical model Evaluate need for medication Give patient permission to take care of him/herself (―sick role‖) Interpersonal inventory Treatment plan Interpersonal formulation, focus area Collaboration with patient to set focus area, plan 13

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Early Sessions, continued Establish therapeutic alliance/rapport Begin psychoeducation Depression as medical illness IPT as validated treatment Give patient a treatment manual IPT as ―here and now‖ therapy Explain structure, process of IPT

Instill hope 15

Early Sessions Interpersonal Inventory Review current and past relationships as they relate to depressive symptoms Nature of interaction with significant persons Expectations of patient, other—were these fulfilled? Satisfying/unsatisfying aspects Desired changes in relationships 16

Middle Sessions (weeks 5-12) Begin with collaborative treatment focus at week 3 or 4 of therapy Focus on one problem area: Begin with one and, at most, add one other Define structure of treatment Address focus area from roughly week 3 or 4 to week 12 17

GRIEF Goals: Facilitate the mourning process Help patient reestablish interests, new relationships Strategies: Relate symptoms onset or exacerbation to death of significant person Reconstruct patient’ relationship with deceased 18

GRIEF Strategies, continued Encourage patient to describe in detail events prior to, during, and after the death Explore associated feelings Increase support, activities Be aware of difficulties with separation and loss, particularly surrounding termination 19

ROLE DISPUTES Goals: Identify dispute Choose plan of action Address differences in expectations or faulty communication Strategies: Relate onset of depression to current dispute 20

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Role Disputes Strategies, continued Determine state of dispute Renegotiation (calm participants) Impasse (increase disharmony to reopen negotiation) Dissolution (assist in mourning Explore nonreciprocal role expectations Examine parallel disputes Look at factors perpetuating dispute Emphasize role of depression 22

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Role Transitions Goals: Mourning and acceptance of loss of old role Acceptance of new role Building self-esteem through sense of mastery

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Role Transitions Strategies Review positive and negative aspects of old and new roles Explore feelings about what is lost, the change itself Consider new opportunities in current role Realistically evaluate what is lost Encourage expression of affect Help establish social support, new skills 28

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Interpersonal Deficits Goals: Reduce patient’s social isolation Encourage formation of new relationships Strategies Review past significant relationships Explore repetitive patterns If appropriate, utilize relationship with therapist and seek patterns with others 30

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TERMINATION Remind the patient frequently what session you are on, and how many remain Throughout treatment, and particularly during the final sessions (weeks 13-16), emphasize the gains made during therapy Improvement of depressive symptoms Gains in interpersonal relationships Encourage expression of loss; validate the patient’s feelings Encourage independence Arrange for follow-up therapy and/or medication 35

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