INTERPERSONAL THERAPY
for
DEPRESSION
An Overview
Presented by:
Eric L. Strang, Psy.D.
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
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.
Goals of ITP
• Reduce Symptoms of Depression
– Improve
• Sleep
• Appetite
• Energy
• Outlook
• Enhance Patient’s ability to cope
with the people and situations
associated with the onset
Treatment Focus
• IPT focuses on:
– Current Problems
– Key figures in Patient’s present life
– Clarification of Patient’s perspective
of their life
– Patient’s affect
– Recognition of emotional response
– Development of new experience
IPT includes
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Identifying / exploring options
Problem solving
Psychoeducation
Resource development
IPT Does Not…
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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
COURSE OF TREATMENT
• Initial Sessions (Meetings 1-4)
– Diagnosis
– Explain treatment procedures
– Provide initial symptom relief
• Intermediate Sessions (Meetings 5-8)
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Implementation of Treatment Strategies
Monitoring symptoms
Enabling clarification
Maintain alliance
• Termination (Sessions 9-12)
– Process role transition
– Recognize Patient’s independent
competence
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
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
DIAGNOSIS
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Review depressive symptoms
Assess severity
Link to DSM
Use Scales to assess & track
Name the disorder
Evaluate need for medication
EXPLANATION
Explain:
• The “medical” nature of their
disorder (blame free illness)
• The treatable nature of
Depression
• The framework of treatment
• Positive prognosis
INTERPERSONAL
INVENTORY
• Review of key people in Patient’s
life to assess the relationship’s:
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Comfort and closeness
Open expression of feelings & needs
Level of Support
Pros and Cons
IDENTIFICATION OF
PROBLEM AREAS
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Grief (complicated bereavement)
Role Dispute
Role Transition
Interpersonal Deficits
GRIEF
• Focus of treatment when Pt’s
symptoms are associated with the
death of a significant other.
• Complicated bereavement
– Postponed, avoided, or interrupted
mourning
– Anniversary effects
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
ROLE TRANSITIONS
• Focus of treatment when Pt’s
symptoms are related to changes
in relationships.
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Divorce
Moves
Graduation
Birth of siblings
• Can be positive or negative
change
INTERPERSONAL DEFICITS
• Usually the focus when the other
problem areas don’t apply.
– Problems with loneliness, social isolation,
limited attachments.
• Problems establishing or sustaining
intimate relationships due to:
– Low self-esteem
– Dysthymia
– Social anxiety
FORMULATION
• Bridge to treatment phase
• Provides focus for treatment
• Must be:
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Plausible
Understandable
Based on interpersonal history
Organizing and empathic
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 can’t 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.
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
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.
IPT Techniques
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Nondirective Exploration
Direct Elicitation
Encouragement of Affect
Clarification
Communication Analysis
Decision Analysis
Role-Play
Nondirective Exploration
• Use of open-ended questions to
facilitate gathering of information
• Use of supportive
acknowledgement:
– Go on
– Tell me more
– I understand
Direct Elicitation
• Specific questioning used to
obtain information used for:
– Developing the interpersonal
inventory
– Symptom identification
– Clarification of key points
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:
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Become aware of their emotions
Better understand their feelings
Make informed decisions
Practice managing affect
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
Communication Analysis
• Identifies communication problems
• Therapist elicits a detailed account of
a critical conversation/argument in
order to:
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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
Decision Analysis
• Technique for assisting Pt in
considering the pros and cons of
alternatives.
• Identify desired goals
• List possible methods
• Generate likely outcomes
Role-Play
• Can provide opportunities for
identifying problematic skills
• Opportunity for evaluating Pt’s
emotional responses to
interaction
• Allows for practice of skills
• Pt can take the role of a person
they would like a relationship
with.
Therapeutic Relationship
• Transference not Interpreted
• Used to assess outside
functioning
• Here-and-now issues provide
teachable moments
Therapists Role
• Active Non-neutral Advocate
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Advice / suggestions
Psychoeducation
Modeling
Problem solving
Unconditional / Nonjudgmental
Present focused
Skills Trainer
Coach
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
Treating Grief
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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
Treating Interpersonal
Disputes
• Identify the disagreement and the
stage:
– Renegotiation
– Impasse
– Dissolution
• Chose plan of action
• Modification of communication
and/or expectations
Treating Role Transitions
• Communicate understanding of Pt’s
perspectives of:
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The demands of the new situation
What was gained
What was lost
The new expectations and responsibilities
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Giving up old role
Mourning old role
Acquiring new skills
Developing new supports and attachments
Recognizing the positive aspects of the change
• Assist in:
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 Pt’s feelings regarding
relationships
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
TERMINATION
(Continued)
• Acknowledge healthy sadness and role
transition
• Call Patient’s attention to their
independent competence
• Address Non-response
– Minimize Pt’s self-blame
– Emphasize alternative treatments
• Assess need for continued Treatment
or Maintenance
– Renegotiate contract
Differences Between IPT and
Psychodynamic Psychotherapy
• IPT focuses more on the Hereand-Now
• IPT focuses more on Pt’s life
outside the clinic
• No Transference Interpretation
• IPT focuses on changing current
interpersonal patterns
• IPT is more structured
Differences Between IPT and
Cognitive Behavioral Therapy
• IPT focuses on interpersonal
affect and behavior
• IPT Less Structured
• IPT does not assign homework