Interpersonal Psychotherapy IPT

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Interpersonal Psychotherapy (IPT)

• Lena Verdeli, Ph.D.,
• Teachers College
• New York State Psychiatric Institute
• Columbia University

2
Applications of IPT for Mood Disorders

• Major depression, acute and maintenance treatment
  
• Geriatric depression acute and maintenance
• Depressed adolescents
• (individual and group)
• Depressed HIV positive adults
• Dysthymic adults
• Distressed primary care patients

• Bipolar Disorder
• Conjoint marital therapy
• Antepartum/postpartum depression
• Depressed adolescents and adults in Uganda
• Prevention of mood disorders

3
IPT for Other Disorders

• Bulimia
• Social Phobia
• Borderline Personality Disorder
• Insomnia
• Drug Abuse
• PTSD
• Chronic Somatization

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Principles

• Developed in the 70s by Klerman, Weissman and
  colleagues.
• Assumes that regardless of the causes of
  depressive episodes, their onset is triggered by
  interpersonal problems
• By understanding these interpersonal
  difficulties and helping the person manage them
  more effectively, we can help her recover from
  the episode

Weissman M, et al. Comprehensive guide to
interpersonal psychotherapy. New York Basic
Books, 2000.
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Four problem areas

• Grief
• Interpersonal disputes
• Role transitions
• Interpersonal deficits

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Therapists Role in IPT

• Empathic
• Active but not prescriptive
• asks questions
• helps patient consider options for managing the
  interpersonal problem
• makes suggestions if patient has difficulty
  generating options (but avoids telling the
  patient what to do)
• Stays focused on interpersonal problem areas

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Three Phases of IPT

• 16 WEEK TREATMENT
• Initial Phase Sessions 1 - 4
• Middle Phase Sessions 5 -13
• Termination Sessions 14 - 16

• 12 WEEK TREATMENT
• Initial Phase Sessions 1 - 3
• Middle Phase Sessions 4 - 10
• Termination Sessions 11 - 12

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Tasks of Initial Phase (Sessions 1 - 4)

• A. Dealing with the Depression
• 1. Review depressive symptoms
• 2. Characterize the syndrome as a clinical
  depression
• 3. Explain depression as a treatable medical
  condition/give hope
• 4. Give the patient the sick role
• 5. Problem-solve around practical issues (for
  those who due to depression are failing in a
  role what are your options who can help you
  right now?)
• 6. Evaluate the need for medication

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Tasks of Initial Phase (Sessions 1 - 4)

• B. Link depression to interpersonal problems
• Find out what was happening around the time when
  the patient became depressed
• Presence of grief, dispute, transition
• Are there underlying interpersonal deficits?
• Identify maintaining factors
• Conduct the Interpersonal Inventory

10
Interpersonal Inventory

• Identify the important people, alive or dead, in
  the persons life
• Who are the important people in your life?
• After identifying these people, ask questions
  such as the following about each person
• How often do you see this person?
• How does this relationship affect your mood?
• What do you like about the relationship?
• What dont you like about it? Are there
  difficulties in the relationship?
• What has changed in the relationship?
• Do you argue? How often? Can you describe an
  argument?
• How would you like the relationship to be
  different?
• What would you like to stay the same?

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Tasks of Initial Phase(Sessions 1-4)

• C. Identify Major Problem Area
• Based on the information gathered, determine the
  problem area(s) related to the current
  depression.
• - Grief
• - Interpersonal Disputes
• - Role Transitions
• - Interpersonal Deficits

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Tasks of Initial Phase(Sessions 1-4)

• D. Explain the IPT Principles and Rules to the
  patient
• Outline understanding of the patients
  interpersonal problem
• Agree with patient on treatment goals, and the
  problem area(s) that will be the focus of
  treatment
• Describe procedures of IPT and practical aspects
  of treatment (length, frequency, fees, policy for
  missed appointments)

13
Tasks of Middle Phase (Sessions 5 13 )

• Begin sessions with a check of patients
  depression symptoms
• Educate about depression and process of
  improvement throughout treatment
• Link interpersonal problem area to mood
  throughout the sessions

14
Treatment Techniques Used in Middle Phase of IPT

• Mood rating
• Link mood to interpersonal relationships/events
• Encouragement/management of affect
• Communication analysis
• Decision analysis (finding options)
• Role play
• Skills building
• Homework
• Remind frequently about termination We have 7
  more meetings until we end

15
Grief

• Goals
• 1. Facilitate the mourning process.
• 2. Help the patient reestablish interest and
  develop new relationships to help to manage the
  loss.

16
Interpersonal Disputes

• Goals
• Identify dispute
• Establish stage of dispute
• a. Renegotiation (clarify situation
  to facilitate resolution)
• b. Impasse (mutual desire to continue
  communication but both parties feel stuck)
• c. Dissolution (assist mourning)
• Understand nonreciprocal expectations and how
  these relate to dispute.
• Choose plan of action

17
Role Transitions

• Goals
• Mourn the loss of the old role.
• See the positive aspects or opportunities in the
  new role.
• Develop any new skills necessary to gain mastery
  of new role.

18
Interpersonal Deficits

• Goals
• Reduce patients social isolation.
• Encourage patient to form new relationships.

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Termination(Sessions 15 - 16)

• Termination is explicitly discussed throughout
  therapy.
• Changes in symptoms and interpersonal problem
  area are extensively reviewed.
• Explore patients feelings about termination.
• Discuss potential stressors in the future and
  problem-solve
• Discuss what constitutes a relapse (how would
  you know you that are getting depressed again?,
  when should you contact the team?)
• Deal with non-response or partial response.
  Discuss possibility of continuation or
  maintenance treatment.