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Interpersonal Psychotherapy IPT

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1. Facilitate the mourning process. ... c. Dissolution (assist mourning) ... Mourn the loss of the old role. See the positive aspects or opportunities in the new role. ... – PowerPoint PPT presentation

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Title: Interpersonal Psychotherapy IPT


1
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

4
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.
5
Four problem areas
  • Grief
  • Interpersonal disputes
  • Role transitions
  • Interpersonal deficits

6
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

7
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

8
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

9
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?

11
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

12
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.

19
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.
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