Interpersonal Therapy
Slides adopted from Dr. Lisa Merlo
Framework
• A person’s behavior is viewed as influencing
the reactions of people around them
• The person’s typical “interpersonal style” may
influence negative feedback from others,
social isolation, relationship difficulties, etc.
• These situational factors may lead the
individual to become depressed
Coyne’s Interpersonal Model of
Depression
• People who are depressed can be
difficult to spend time with (e.g., they
complain, they express negativity, they
are less interested in participating in
pleasurable activities)
• Because of this, non-depressed people
tend to decrease the amount of time
spent with the depressed person
Coyne’s Interpersonal Model of
Depression
• The depressed person experiences a
lack of social support and a reduction in
social interaction
• This can lead the person to become
more depressed
• … which in turn makes them even less
desirable to be around
Clinical Application
• Interpersonal therapy helps the patient
to improve functioning, particularly in
current relationships, in order to break
the depressive cycle
• Sessions focus on interpersonal style
and interpersonal relationships
Interpersonal Therapy
• Interpersonal therapists focus on the
functional role of depression rather than on
its etiology or cause
• They look at the ways in which problematic
interactions develop when a person becomes
depressed
Goals of Interpersonal
Therapy
1) To diagnose depression explicitly
2) To educate the patient and family about
depression, its causes, and the various
treatments available for it
3) To identify the interpersonal context of
depression as it relates to symptom
development
4) To develop strategies for the patient to
follow in coping with the depression
Interpersonal Therapy
• In the first session, the psychiatric history
includes a review of the patient's current
social functioning and current close
relationships, their patterns and their mutual
expectations
• Changes in relationships prior to the onset of
symptoms are clarified, such as the death of
a loved one, a child leaving home, or
worsening marital conflict
The “Sick Role”
• The concept of the "sick role" is based on the notion
that illness is not merely a condition but a social role
that affects the attitudes and behaviors of the patient
and those around him or her
• Adolescent and parent(s) are informed that
depression will limit the teen’s abilities to perform as
well (to prevent excessive criticism)
• Teens are encouraged to maintain participation in
activities in order to help alleviate symptoms and
prevent additional problems from isolation, etc.
Areas of Focus
• IPT is typically focused on 1-2 of the
following problem areas:
•
•
•
•
•
Unresolved Grief
Role Disputes
Role Transitions
Interpersonal Deficits
Single Parent Families
Adolescent Concerns
• IPT attempts to meet unique
developmental needs of adolescents
•
•
•
•
•
Individuating from parents
Peer pressure
Romantic relationships
Experiences with death
Issues of control/authority with parents
1. Unresolved Grief
• In normal bereavement, a person experiences
symptoms such as sadness, disturbed sleep, and
difficulty functioning but these usually resolve in two
to four months
• Key factors to consider
•
•
•
•
Teen’s social support system
Teen’s place in family structure
Psychosocial development
Quality of the lost relationship
• GOALS =
• to facilitate the mourning process
• help the patient re-establish interests and relationships that
can begin to fill the void of what has been lost
2. Role Disputes
• Interpersonal role disputes occur when the patient and at least
one other significant person (usually parent) have differing
expectations of their relationship
• Keys factors to consider
•
•
•
•
Identify disputes
Negotiate options with parents
Examine and change relationship expectations
Clarify and alter communication styles
•
•
•
help the patient identify the nature of the dispute
decide on a plan of action
begin to modify unsatisfying patterns, reassess expectations of the
relationship, or both
• GOALS =
Do not direct the patient to one particular resolution or
attempt to preserve unworkable relationships
3. Role Transitions
• Depression associated with role transitions occurs
when a person has difficulty coping with life changes
that require new roles (e.g., initiation of romantic
relationship, transition to high school/college/work)
• Role Transitions in depressed people:
• Experienced as losses rather than opportunities
• GOALS =
• Help patient to give up the old role
• Encourage expression of the accompanying feelings of guilt,
anger, and loss
• Elicit support and encouragement from parents
• Facilitate acquisition of new skills
• Develop a new social network around the new role
4. Interpersonal Deficits
• Typically involves impairment in developmental tasks
(e.g., making friends, beginning romantic
relationships, forming social ties, making choices
about romantic commitment, vocation, sexuality)
• IPT helps teen identify specific role that deficits
played in current & past relationships, consider what
needs to be changed, and encourage those changes
• Key factors to consider
• Asking teens to practice new behaviors outside of therapy
sessions
• GOALS =
•
•
reduce the patient's social isolation
focus on the patient's past relationships, the present relationship
with the therapist, and ways to form new relationships.
5. Single Parent Families
• Severity typically depends on finality of the
parent’s departure, abruptness of change,
and whether the parent has left before
• IPT helps with:
•
•
•
•
Recognizing the impact of parent leaving
Processing feelings of bereavement/rejection
Processing hopes for continued relationship
Facilitating effective relationship w/ remaining
parent
• Establishing relationship with absent parent
• Understanding/accepting finality of the situation
Inclusion of Parents
• Parents are frequently included for part of
treatment
• Parents typically participate during initial
psychoeducation sessions in order to learn more
about depression and how it affects their child
• Parents participate during middle sessions when
the problem area involves the parent
• Parents participate in termination phase to
review: treatment progress, changes in family,
planning for the future (e.g., continued treatment)
Intervention Techniques
1) a focus on patients' emotions
2) an exploration of patients' resistance to treatment
3) discussion of patterns in patients' relationships
and experiences
4) taking a detailed past history
5) an emphasis on patients' current interpersonal
experiences
6) exploration of the therapist/patient relationship
Distinctions
Unlike other psychodynamic approaches, IPT:
• Is brief (16 sessions)
• Is focused (1-2 problem areas)
• Emphasizes the ways in which a person's current
relationships and social context cause or maintain
symptoms
• Does not explore the deep-seated sources of the
symptoms
• Views rapid symptom reduction and improved social
adjustment as its goals
• Frequently leads to more satisfying relationships in the
present