Transcript Interpersonal therapy (IPT)

Interpersonal therapy (IPT)
Furhan Iqbal
Cambridge
[email protected]
IPT
IPT is a psychological treatment specifically developed for
the needs of individuals with depression
It has since been modified for treatment of other disorders
It is a time limited, focused treatment emphasising the link
between mood and current interpersonal relationships
whilst acknowledging the role of genetic, biochemical,
developmental and personality factors in the causation
and vulnerability to depression
Weissman, Markowitz and Klerman (2000) ‘Comprehensive Guide to Interpersonal
Psychotherapy’
IPT
IPT does not offer a causal explanation but is a pragmatic
treatment for depression
The underpinning belief is that depression does not occur
in a vacuum and occurs in an interpersonal context
Tackling difficulties in the interpersonal context helps in the
recovery from depression
Background
Adolf Meyer at the Johns Hopkins University and Harry
Stack Sullivan were the founders of the Interpersonal
school
Meyer’s psychobiological approach emphasised current
psychosocial and interpersonal experiences
Sullivan linked clinical psychiatry to anthropology, sociology
and social psychology and viewed psychiatry as the
scientific study of people and the processes that go on
among them thus emphasising the interpersonal (as
opposed to the intrapsychic)
Target for change in IPT
In IPT clinical depression is regarded as having 3
components
1.
2.
3.
Symptom function
depressive affect, Neurovegetative symptoms
Social and Interpersonal relationships
Personality and character problems
IPT targets 1 and 2
It explicitly aims at symptom reduction as well as improving
social adjustment and interpersonal relationships
IPT other features
IPT works at the conscious and preconscious level
Unconscious processes are recognised though not
addressed
IPT focuses on the here and now and on change
Depression is recognised as a clinical disorder within the
biomedical paradigm
A diagnosis of depression is given and ‘sick role’ is
legitimised
Characteristics
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Time limited
Focused
Focused on current not past IP relationships
IP not intrapsychic
IP not cognitive/behavioural
IPT focuses directly on affects (as opposed to thoughts)
Personality recognised as important though not a focus
Therapist is active not passive and an advocate not
neutral
• Therapeutic relationship regarded neither as
transference nor as friendship
Interpersonal problems
In IPT there are 4 groups of IP problems
1.
2.
3.
4.
Grief
IP role disputes
Role transitions
IP deficits
IPT suggests specific strategies to tackle the IP problems
Phases of treatment
3 phases of treatment
1.
2.
3.
Initial sessions (1-3 sessions)
Intermediate sessions-The problem areas
Termination
Initial sessions
1.
Dealing with depression:
Review depressive symptoms
diagnose depression
explain depression in a biomedical paradigm and explain
treatment
give the patient the sick role
evaluate the need for medication
2. Relate depression to IP context
3. Identification of major problem areas
4. Explain IPT concepts and contract
Intermediate sessions
In the intermediate sessions the focus is on the problem
areas (IP problems) identified in the initial sessions
IPT broadly groups IP problems into 4 categories; Grief,
Interpersonal role disputes, Role transitions and IP
deficits
For each group of IP problems IPT suggests goals and
strategies to achieve the goals
Final phase and Termination
The final phase of treatment focuses on consolidation of
therapeutic gains and on termination of therapy
As regards to termination
• There is an explicit discussion regarding termination
• Acknowledgement that it is a time of grieving
• Move towards patient recognition of independent
competence
Issues of lack of response and maintenance of treatment
are discussed