Disclosure
Presenter
Company
Wendy Carter
n/a
Product
n/a
Research
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Other:
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Wendy Carter, Ph.D., Sophie Grigoriadis, M.D., Ph.D.,
Lori Ross, Ph. D. & Paula Ravitz, M.D.
Objectives
1) Review existing literature on Postpartum Depression
(PPD), relationship distress and psychotherapy
interventions for PPD with couples
2) Describe a newly modified couples IPT approach
(Conjoint IPT- PPD) to treating PPD in the context of
relationship distress
3) Highlight and illustrate the applicability of this
approach in a case study
Postpartum Depression
 Approximately 13% of women meet criteria for a MDE
with postpartum onset (APA, 2000; Dietz, 2007;
O'Hara & Swain, 1996)
 Women who become depressed within the first year
following childbirth are more likely to:
become depressed following future pregnancies
(Cooper & Murray, 1995)
have difficulty developing secure attachment with
their children (Murray et al., 1999)
PPD and the Family System
PPD is linked to immediate and enduring delays in
the social, emotional and cognitive growth of
children
PPD negatively impacts the emotional well-being
of partners
E.g. greater rates of anxiety and depression;
increased stress in relationships with both
partners and children
Relationship Distress and PPD

Relationship distress:
 Identified as a moderate predictor of PPD (Beck, 2001)
 Related to more severe depressive symptoms of greater duration (Fisher et
al., 2002; Patel et al., 2002)
 Related to increased risk for developing chronic mental health problems
(Campbell et al., 1992; Viinamaki et al., 1997)
 Depressive symptoms predicted postpartum relationship adjustment
(Whisman, Davila, Goodman, 2011)
 Postpartum relationship difficulties informed by attachment styles ( e.g.
Feeney et al., 2003)
Sources of relationship distress
 Increased conflicts and disputes in the postpartum
period (Dennis & Ross, 2006; Johnstone et al., 2001)
 Less instrumental and emotional support from
partners (Dennis & Ross, 2006)
 Women’s perceptions of unequal division of childcare
and household responsibilities (e.g. Des-RivieresPigeon et al., 2002; Terr et al., 1991)
 Postpartum relationship difficulties informed by
attachment styles ( e.g. Feeney et al., 2003)
Couple Interventions for PPD
 Misri et al. 2000 Examined the impact of a partner-supported
intervention on mood and relationship perception among 29 women
diagnosed with PPD
 Randomly assigned to either:
 Control group (attended 7 psycho-educational sessions solo) OR
 Intervention group (attended 3 sessions solo and 4 sessions with
partner)
 Women accompanied by their partners reported:
Reduced psychological distress
Fewer depressive symptoms
More positive perceptions of their relationships with partners
Couples Therapy for Depression
 Barbat & D’Avanco (2008) –
meta-analysis comparing couple therapy to individual
psychotherapy for depression
 567 participants from 8 clinical trials
 Findings:
 Fewer Depressive Symptoms: Couples = Individual
 Reduced Relationship distress: Couple > Individual
 Only the couples form of IPT (IPT-CM) linked the
context of depression to relationship distress in
couples
Couples form of IPT: IPT-CM
 Foley et al. (1989)--individual IPT and IPT-CM among
18 participants with comorbid depression and Role
Disputes with their spouse
 Fewer Depressive Symptoms:
IPT-CM = Individual IPT
 Improved Relationship Adjustment:
 IPT-CM = Individual IPT
 Improved Relationship Functioning:
 IPT-CM > Individual IPT
Rationale for Conjoint IPT-PPD
 Relationship distress both a predictor and an outcome
of PPD
 IPT-CM demonstrated successful for treatment of
depression and improved relationship functioning
among couples whose primary issue is relationship
disputes
 IPT-PPD successfully adapted to for use with perinatal
and postpartum women in the treatment of depression
(O’Hara et al. 2000; Spinelli and Endicott 2003; Stuart
and O’Hara 1995; Zlotnick et al. 2006)
Theory
(Weissman et
al., 2000;
Stuart &
Robertson,
2003)
IPT
Couples
Format
(IPT-CM)
(Foley,
1989)
Conjoint
IPT-PPD
Integration of
Attachment
Theory
(Ravitz,
Maunder &
McBride, 2007)
Postpartum
context
(Stuart &
O’Hara ,
1995)
Conjoint IPT-PPD
 90 minute sessions for 12 weeks with trained IPT
therapist
 Adaptations specific to the postpartum period
Psycho-education about depression in the postpartum
period
 Review expectations of parenthood and changes in
dynamics since the birth of the child
 While the identified problem area is Role Disputes,
postpartum is a major
time of transition and
may
integrate work on Role Transitions
Indications for
Treatment
PPD, less than one year
postpartum and
experiencing relationship
distress
Couples in an established
relationship
Both interested and
willing to participate
Contraindications
for Treatment
Actively suicidal,
currently psychotic,
or have bipolar
disorder or chronic
depression
Interpersonal violence
Have already made a
decision to terminate
the relationship
Initial
Phase
Middle
Phase
Sessions 1-4
Sessions 5-10
Final Phase
Sessions 11-12
Case Study: Ellen & Daniel
 Both in their early thirties
 Together for 3 years
 Two children (2 years and 4 months)
 Ellen– diagnosed with a MDE with postpartum onset
symptoms perpetuated by the distress in their
relationship
Pre-treatment Edinburgh Postnatal Depression
Scale=16
Pre-test Scores
Dyadic
Adjustment
Scale (Spanier,
1976)
Overall Dyadic
Adjustment
ELLEN
93*
DANIEL
109*
Dyadic Consensus 55
50*
Dyadic
Satisfaction
Affectional
Expression
25*
37*
4*
8*
Dyadic Cohesion
11*
15
PHASE
OBJECTIVES
Initial Phase Provide psycho-education about PPD
Sessions 1-4 Link PPD to relationship distress
Clarify the therapeutic contract
 Assess the mental health functioning of both
the mother and her partner
Conduct individual interpersonal inventories
Explore relationship models
 Explore the history and current conflicts in
the relationship
 Assign homework to clarify each party’s
“dispute list”
Middle Phase
Sessions 5-10
Identify key disputes
Develop an action plan
Renegotiate key disputes
Final Phase
Sessions 11-12
Acknowledge and explore issues related to termination
Recognize growth and improvements
Navigate ongoing issues and future obstacles
PHASE
Initial Phase
Sessions 1-4
OBJECTIVES
Provide psycho-education about PPD
Link PPD to relationship distress
Clarify the therapeutic contract
 Assess the mental health functioning of both the mother and her
partner
Conduct individual interpersonal inventories
Explore relationship models
 Explore the history and current conflicts in the relationship
 Assign homework to clarify each party’s “dispute list”
Middle
Identify key disputes
Phase
Develop an action plan
Sessions 5-10 Renegotiate key disputes
Final Phase
Sessions 11-12
Acknowledge and explore issues related to termination
Recognize growth and improvements
Navigate ongoing issues and future obstacles
Impart a sense of hope
Evaluate the need for future treatment
Use of
Affect
Communication
Analysis
Change
between
sessions
IPT
TECHNIQUES
Psychoeducation
Role
playing
Decision
Analysis
PHASE
OBJECTIVES
Initial Phase
Sessions 1-4
Provide psycho-education about PPD
Link PPD to relationship distress
Clarify the therapeutic contract
 Assess the mental health functioning of both the mother and her
partner
Conduct individual interpersonal inventories
Explore relationship models
 Explore the history and current conflicts in the relationship
 Assign homework to clarify each party’s “dispute list”
Middle Phase
Sessions 5-10
Identify key disputes
Develop an action plan
Renegotiate key disputes
Final Phase Acknowledge and explore issues related to
Sessions 11-12
termination
Recognize growth and improvements
Navigate ongoing issues and future obstacles
Impart a sense of hope
Evaluate the need for future treatment
Dyadic
Adjustment
Scale
Ellen
Daniel
Pre-Test
Post-Test Pre-Test
Post-Test
Overall Dyadic
Adjustment
93*
126
109*
133
Dyadic
Consensus
55
58
50*
52
Dyadic
Satisfaction
25*
38
37*
45
Affectional
Expression
4*
9
8*
12
20
15
23
Dyadic Cohesion 11*
Conclusion and Next Steps
 To date, no other couples therapy approaches where at least
one member of the dyad was clinically depressed have
included modifications that overtly address depression
during the postpartum or at any other specific life stage
 Conjoint IPT-PPD may be a useful psychotherapeutic
intervention with couples struggling in the postpartum
period to negotiate conflicts
 A randomized controlled clinical trial is now required to
study the effectiveness of conjoint IPT-PPD in comparison
to usual practice