interpersonal psychotherapy for depression
DESCRIPTION
Interpersonal Psychotherapy for Depression. Bob Hill, Ph.D. Appalachian State University Boone, NC 28608 Email: [email protected]. Overview. Depression Theoretical Sources for IPT Prominent Features of IPT Outline of IPT Phases of IPT Treatment Clinical Examples Empirical Support. - PowerPoint PPT PresentationTRANSCRIPT
Interpersonal Psychotherapy for Depression
Bob Hill, Ph.D.Bob Hill, Ph.D.
Appalachian State UniversityAppalachian State University
Boone, NC 28608Boone, NC 28608
Email: [email protected]: [email protected]
Overview
DepressionDepression Theoretical Sources for IPTTheoretical Sources for IPT Prominent Features of IPTProminent Features of IPT Outline of IPTOutline of IPT Phases of IPT TreatmentPhases of IPT Treatment Clinical ExamplesClinical Examples Empirical SupportEmpirical Support
Depression IPT clearly effective for treating DepressionIPT clearly effective for treating Depression Diagnostic Criteria for Depression: Diagnostic Criteria for Depression:
A.Five (or more) of the following symptoms have been present during the same 2-week period; at least one of the symptoms is either
1.depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others. Note in children, can be irritable mood.
2. anhedonia: markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
Depression Criteria continued (2+ needed):
3.significant weight loss when not dieting or weight gain or decrease or increase in appetite..
4.insomnia or hypersomnia nearly every day 5.psychomotor agitation or retardation observable by others 6.fatigue or loss of energy nearly every day 7.feelings of worthlessness or excessive or inappropriate guilt 8.diminished ability to think or concentrate, or indecisiveness 9.recurrent thoughts of death, recurrent suicidal ideation with
or without a specific plan, or suicidal intent.
Reasons to consider Medication
Client too depressed to participate in treatmentClient too depressed to participate in treatment Client not psychological, resistant to talking txClient not psychological, resistant to talking tx Client who is at risk for suicideClient who is at risk for suicide Client with recurrent Depressive episodes, with Client with recurrent Depressive episodes, with
symptoms of symptoms of Melancholic FeaturesMelancholic Features May respond more quickly with medication and May respond more quickly with medication and
IPT combinedIPT combined
Depression with Melancholic Features
1) anhedonia1) anhedonia 2) lack of reactivity to usually pleasant stimuli2) lack of reactivity to usually pleasant stimuli 3) Three or more of: 3) Three or more of:
Distinct quality of depressed moodDistinct quality of depressed mood Depression is worse in a.m.Depression is worse in a.m. Early morning awakening (at least 2 hrs)Early morning awakening (at least 2 hrs) Marked psychomotor agitation or retardationMarked psychomotor agitation or retardation Significant anorexia or weight lossSignificant anorexia or weight loss Excessive or inappropriate guiltExcessive or inappropriate guilt Psychotic symptomsPsychotic symptoms Suicide riskSuicide risk
Prevalence of Depression
DysthymiaDysthymia
DepressionDepression
DisorderDisorder TotalTotalMalesMalesFemalesFemales
6.4 %6.4 % 4.8 %4.8 % 8.0 %8.0 %
17.1 %17.1 %12.7 %12.7 %21.3 %21.3 %
National Comorbidity Survey (1994)
Historical Influences of IPT
PsychoanalysisPsychoanalysis Harry Stack SullivanHarry Stack Sullivan Object Relations TherapyObject Relations Therapy Interpersonal Theory (Leary, Kiesler)Interpersonal Theory (Leary, Kiesler)
IPT: Roots in Psychodynamic Theory
Primary instincts of sex and aggression involve relating to others
Relationships with others contribute to personality development
Psychological Problems due to deficits in early relations
Transference and counter-transference are interpersonal
Object Relations Influence
““Object” is human beingObject” is human being ““Relations” are internal, external, fantasied or real Relations” are internal, external, fantasied or real
interactions with othersinteractions with others Early parent-child relations are internalized as Early parent-child relations are internalized as
expectations for future relationshipsexpectations for future relationships Identity/personality derived from pattern of early Identity/personality derived from pattern of early
relationship experiencesrelationship experiences Expectations of others impacts quality of current Expectations of others impacts quality of current
interpersonal relationships and moodinterpersonal relationships and mood
Manualized Interpersonal Therapy
Klerman, G. (1984). Klerman, G. (1984). Interpersonal Interpersonal Psychotherapy for Depression.Psychotherapy for Depression.
Weissman, M. (2002). Weissman, M. (2002). Comprehensive Comprehensive Guide to Interpersonal PsychotherapyGuide to Interpersonal Psychotherapy..
Prominent Features of IPT
IPT designed for symptom reduction and IPT designed for symptom reduction and improved interpersonal relationshipsimproved interpersonal relationships
Focus on current disputes, frustrations, Focus on current disputes, frustrations, anxieties in the interpersonal context which anxieties in the interpersonal context which impact mood and self esteemimpact mood and self esteem
IPT Compared to Other Therapies
Time-limited- outcome studies document efficacy Time-limited- outcome studies document efficacy of short-term (12-16 weeks) txof short-term (12-16 weeks) tx Not designed for personality changeNot designed for personality change
Focused on current interpersonal disputes, Focused on current interpersonal disputes, anxieties, frustrations anxieties, frustrations Addresses 1-2 problem areas in interpersonal Addresses 1-2 problem areas in interpersonal
functioningfunctioning
IPT Compared to Other Therapies
Interpersonal, not intrapsychicInterpersonal, not intrapsychic Interpersonal, not Cognitive BehavioralInterpersonal, not Cognitive Behavioral
Goal is to change feelings, thoughts, actions in Goal is to change feelings, thoughts, actions in problematic relationshipsproblematic relationships
Negative/irrational cognitions are addressed Negative/irrational cognitions are addressed only in interpersonal functiononly in interpersonal function
IPT attends to distorted thinking in relation to IPT attends to distorted thinking in relation to significant otherssignificant others
Goal is to change relationship pattern rather Goal is to change relationship pattern rather than depressive cognitionsthan depressive cognitions
IPT Compared to CBT Focus on affect and expression of emotionsFocus on affect and expression of emotions Explores avoidance and resistance behaviorExplores avoidance and resistance behavior Identification of patterns in client’s behavior, Identification of patterns in client’s behavior,
thinking, feeling and relationshipsthinking, feeling and relationships Attention to past experiences Attention to past experiences Focus on interpersonal experienceFocus on interpersonal experience Emphasis on the therapeutic relationshipEmphasis on the therapeutic relationship Exploration of client’s wishes, dreams, Exploration of client’s wishes, dreams,
fantasiesfantasies
Blagys & Hilsenroth, 2000
IPT and Personality Change
IPT does not target alteration of personalityIPT does not target alteration of personality Personality pathology may limit IPT Personality pathology may limit IPT
outcomeoutcome IPT may help patient recognize maladaptive IPT may help patient recognize maladaptive
personality featurespersonality features IPT may improve social skills and thus IPT may improve social skills and thus
ameliorate maladaptive personality traitsameliorate maladaptive personality traits
Role of IPT Therapist
Therapist is patient advocate, not neutralTherapist is patient advocate, not neutral Expresses unconditional positive regardExpresses unconditional positive regard Intentionally cultivates positive Intentionally cultivates positive
expectations of treatmentexpectations of treatment Optimistic, positive, reassuringOptimistic, positive, reassuring
Therapist is active in keeping interpersonal Therapist is active in keeping interpersonal problem areas to focusproblem areas to focus
Outline of IPT Intervention
Initial Sessions (Overview)Initial Sessions (Overview) Assess Depressive symptomsAssess Depressive symptoms Complete Interpersonal AssessmentComplete Interpersonal Assessment Identify Major Interpersonal Problem Identify Major Interpersonal Problem
AreaArea Explain IPT and make treatment contractExplain IPT and make treatment contract
Initial Sessions (“Sick Role”)
Review Sxs, Dx of depression to communicate Review Sxs, Dx of depression to communicate “sick role”“sick role”
Functions of “Sick Role”Functions of “Sick Role” Sick person exempt from responsibilitiesSick person exempt from responsibilities Sick person in need of helpSick person in need of help Sick is undesirable and needs to be improvedSick is undesirable and needs to be improved Sick person obliged to cooperate with TxSick person obliged to cooperate with Tx Sick role shifts blame from client to illnessSick role shifts blame from client to illness
Mitigates self blameMitigates self blame
Relate Depression to Interpersonal Context
What interpersonal events related to depression?What interpersonal events related to depression?Review current & past interpersonal relationshipsReview current & past interpersonal relationships• Who does client interact with?Who does client interact with?• Frequency of contact, activities shared?Frequency of contact, activities shared?• Assess quality and themes of relationshipsAssess quality and themes of relationships• Assess expectations of client (and other) in Assess expectations of client (and other) in
relationshipsrelationships• Assess satisfying and unsatisfying aspects of Assess satisfying and unsatisfying aspects of
relationshipsrelationships• Discuss changes client wants in relationshipsDiscuss changes client wants in relationships
Inventory of Interpersonal Problems 64 items assess diverse interpersonal problems: 64 items assess diverse interpersonal problems:
• • Being too controlling or manipulativeBeing too controlling or manipulative
• • Being self-centered and resentfulBeing self-centered and resentful
• • Having minimal feelings of affection for, and Having minimal feelings of affection for, and little connection with, other peoplelittle connection with, other people
• • Being socially avoidantBeing socially avoidant
• • Being nonassertiveBeing nonassertive
• • Being gullible and easily taken advantage of Being gullible and easily taken advantage of
• • Being excessively selfless, generous, trusting, Being excessively selfless, generous, trusting,
• • Being too intrusiveBeing too intrusive
Interpersonal Problems Circumplex
IIP Circumplex Evan
IIP Scale Profile
Identification of Major Problem Area
Assess interpersonal experience and depression to Assess interpersonal experience and depression to identify of one of identify of one of FourFour Problem Areas: Problem Areas:
Interpersonal Role DisputeInterpersonal Role Dispute: with spouse, lover, : with spouse, lover, family member, friends, co-workerfamily member, friends, co-worker
Role TransitionRole Transition: e.g. new job, relocation, divorce: e.g. new job, relocation, divorce Interpersonal DeficitsInterpersonal Deficits: evidenced by social : evidenced by social
impoverishment, loneliness, isolationimpoverishment, loneliness, isolation GriefGrief: following death if abnormally severe, : following death if abnormally severe,
protracted or impairingprotracted or impairing
Problem Area Focus Four problems areas are:Four problems areas are:
Not exhaustive, nor mutually exclusiveNot exhaustive, nor mutually exclusive Not “deep” conceptual theoryNot “deep” conceptual theory
Communicate to client Problem area focusCommunicate to client Problem area focus Problem area ensures focus on Problem area ensures focus on
recognized problem rather than personal recognized problem rather than personal weaknessweakness
E.g. E.g. ‘try to discover what you want and need ‘try to discover what you want and need from others and help you learn how to get from others and help you learn how to get it’it’
Explain Interpersonal Focus Tx focus will be interpersonal satisfaction, not Tx focus will be interpersonal satisfaction, not
intrapsychic explorationintrapsychic exploration Educate about link between depressed mood Educate about link between depressed mood
and difficulty getting what we want/need from and difficulty getting what we want/need from othersothers
Therapist describes nature of clients Therapist describes nature of clients interpersonal difficultyinterpersonal difficulty
Agree on goal of improved interpersonal Agree on goal of improved interpersonal relationsrelations
Set expectation: make changes btwn sessionsSet expectation: make changes btwn sessions
Setting Treatment Contract
Set 2 –3 treatment goals with client related Set 2 –3 treatment goals with client related to problem area focusto problem area focus
Ask client what would be the: Ask client what would be the: Best possible outcomeBest possible outcome Most expectable outcomeMost expectable outcome Worst possible outcomeWorst possible outcome
Describe expected Duration and Frequency Describe expected Duration and Frequency of treatment (12-16 weeks)of treatment (12-16 weeks)
Teaching Client Their Role in IPT ““Talk about things that affect you Talk about things that affect you
emotionallyemotionally ““Your responsibility to select topics that are Your responsibility to select topics that are
most important to you”most important to you” ““No right or wrong thing to talk about”No right or wrong thing to talk about” ““When important feelings emerge, raise When important feelings emerge, raise
them”them” ““including feeling about me or the including feeling about me or the
therapy”therapy”
Starting Intermediate Sessions Initial Assessment and Development of Initial Assessment and Development of
Treatment Contract Typically 2-3 SessionsTreatment Contract Typically 2-3 Sessions Important tasks of Important tasks of Intermediate SessionsIntermediate Sessions: :
Help client discuss topics pertinent to Help client discuss topics pertinent to problem areaproblem area
Attend to clients affective stateAttend to clients affective state Assist client in discussing therapeutic Assist client in discussing therapeutic
relationshiprelationship Prevent client from sabotaging treatmentPrevent client from sabotaging treatment
Interpersonal Disputes: Diagnosis Current Overt or Covert disputes with a Current Overt or Covert disputes with a
significant othersignificant other Client and other have non-reciprocal Client and other have non-reciprocal
expectations expectations Dispute related to onset or perpetuation of Dispute related to onset or perpetuation of
depressiondepression Client demoralized about relationshipClient demoralized about relationship
Poor patterns of communicationPoor patterns of communication or irreconcilable differencesor irreconcilable differences
Interpersonal Disputes: Goals
Identify the disputeIdentify the dispute Make choices about a plan of actionMake choices about a plan of action Modify communication patterns or Modify communication patterns or Reassess ExpectationsReassess Expectations Consider satisfying needs outside Consider satisfying needs outside
relationshiprelationship
Interpersonal Disputes: Strategies Assess stage of Role Dispute:Assess stage of Role Dispute: ImpasseImpasse- discussion stopped, low-level resentment - discussion stopped, low-level resentment
existsexists Tx may initially increase disharmonyTx may initially increase disharmony
RenegotiationRenegotiation- aware of differences, actively - aware of differences, actively trying to changetrying to change Tx may require calming parties to facilitate Tx may require calming parties to facilitate
resolutionresolution DissolutionDissolution- implies the relationship is - implies the relationship is
irretrievably disruptedirretrievably disrupted Treatment may resemble grief therapyTreatment may resemble grief therapy
Interpersonal Disputes: Issues
Differences in expectations/values between Differences in expectations/values between client and other?client and other?
Clients wishes in relationship? Other wishes?Clients wishes in relationship? Other wishes? What are the client’s options?What are the client’s options? How have they resolved disagreements in past?How have they resolved disagreements in past? Strengths and weaknesses in relationship?Strengths and weaknesses in relationship? What changes are realistically possible?What changes are realistically possible?
Interpersonal Disputes: Strategies
Find Parallels in previous relationshipsFind Parallels in previous relationships What does client gain by the behavior?What does client gain by the behavior? What are unspoken assumptions that lie What are unspoken assumptions that lie
behind behavior?behind behavior? Optimistic tone: “lets figure out what went Optimistic tone: “lets figure out what went
wrong here so we can decide how to help wrong here so we can decide how to help you make it better”you make it better”
Often communication problems are Often communication problems are revealed- Tx involves improving skillsrevealed- Tx involves improving skills
Interpersonal Disputes: Strategies Help identify “mixed feelings” e.g. anger, fear, Help identify “mixed feelings” e.g. anger, fear,
sadnesssadness Devise strategies for managing feelings e.g. direct Devise strategies for managing feelings e.g. direct
communications, reducing irrational suspicionscommunications, reducing irrational suspicions Role PlayRole Play
Rehearse expressing feelings and wishesRehearse expressing feelings and wishes Anticipate communication problemsAnticipate communication problems
Consider Conjoint sessions with significant otherConsider Conjoint sessions with significant other
Problem Area: Role Transitions
Diagnosis: Depression and interpersonal Diagnosis: Depression and interpersonal problems related to problems related to role changesrole changes e. g. separation/divorce, children left e. g. separation/divorce, children left
home, start/end job or school, retired, home, start/end job or school, retired, promoted, financial or health problemspromoted, financial or health problems
Assess: How did life change? What people Assess: How did life change? What people in you life changed or left? in you life changed or left?
Role Transition: Tx Strategies
Facilitate evaluation of lost roleFacilitate evaluation of lost role ““Tell me about the old ___. What were Tell me about the old ___. What were
the good, and bad, things? What has the good, and bad, things? What has changed?changed?
Encourage expression of affectEncourage expression of affect How did it feel to give up ___? How did it feel to give up ___?
Identify positive aspects of new roleIdentify positive aspects of new role Are there potential benefits?Are there potential benefits?
Role Transition: Tx Strategies Develop Social Skills needed for new roleDevelop Social Skills needed for new role
What is required in new role?What is required in new role? Are assumptions of role demands accurate?Are assumptions of role demands accurate?
Role play or rehearse difficult situationsRole play or rehearse difficult situations Assist with managing performance anxietyAssist with managing performance anxiety
Establish new relationships and social supportEstablish new relationships and social support Facilitate discovery of new opportunities for Facilitate discovery of new opportunities for
social support social support
Interpersonal Deficits: Diagnosis
History of social impoverishment, chronic History of social impoverishment, chronic inadequate or unsustained relationshipsinadequate or unsustained relationships
Consider Dysthymia (or Double Depression)Consider Dysthymia (or Double Depression) IPT adaptation for dysthymia IPT adaptation for dysthymia
Long standing or temporary deficits in social Long standing or temporary deficits in social skills yields low self-esteem, withdrawalskills yields low self-esteem, withdrawal
Interpersonal Deficits: Goals
Reduce Client’s social isolationReduce Client’s social isolation Enable: Enable:
close relationships with intimates or close relationships with intimates or family membersfamily members
satisfying relationships with friendssatisfying relationships with friends adequate relationships in work roleadequate relationships in work role
Interpersonal Deficits: Strategies
Review past significant relationshipsReview past significant relationships including childhood relationships with family including childhood relationships with family
membersmembers depressed patients minimize or forget positive depressed patients minimize or forget positive
experiencesexperiences explore repetitive or parallel problems in past explore repetitive or parallel problems in past
relationshipsrelationships define interpersonal situations that lead to define interpersonal situations that lead to
difficultiesdifficulties
Interpersonal Deficits: Strategies
Use therapist-client relationshipUse therapist-client relationship explore client’s positive and negative explore client’s positive and negative
feelings toward therapistfeelings toward therapist discuss distorted or unrealistic thoughts discuss distorted or unrealistic thoughts
or feelings toward therapistor feelings toward therapist model resolution of relationship tension model resolution of relationship tension
by open and genuine communicationby open and genuine communication
Interpersonal Deficits: Strategies
Encourage patient to increase social Encourage patient to increase social interactionsinteractions review attempts in treatment to identify review attempts in treatment to identify
deficitsdeficits identify deficits in communication skillsidentify deficits in communication skills look for assumptions client makes about look for assumptions client makes about
others thoughts and feelingsothers thoughts and feelings
Use Communication Analysis Get detailed account of conversation or argumentGet detailed account of conversation or argument identify communication difficultiesidentify communication difficulties
ambiguous, indirect, & non-verbal as substitute for ambiguous, indirect, & non-verbal as substitute for open confrontationopen confrontation
incorrect assumptions re communicationincorrect assumptions re communicationassuming that others know their feelingsassuming that others know their feelingsaccompanied by anger, frustration, silenceaccompanied by anger, frustration, silencefailing to make sure they are heard, understoodfailing to make sure they are heard, understood
Use Communication Analysis Incorrect interpretation of others statementsIncorrect interpretation of others statements
perceive criticism where none intendedperceive criticism where none intended indirect verbal communicationindirect verbal communication
inhibited directly expressing expectations or inhibited directly expressing expectations or criticismcriticism
instead use hints and ambiguous messagesinstead use hints and ambiguous messages prone to build resentments toward others who prone to build resentments toward others who
are unaware of offenseare unaware of offense silence - unaware of destructive impactsilence - unaware of destructive impact
Use Communication Analysis Use role playingUse role playing
rehearse difficult interactions with clientrehearse difficult interactions with client explore style of communicating with explore style of communicating with
othersothers practice new skills practice new skills
e.g. expressing anger or being assertivee.g. expressing anger or being assertive rehearsal with therapist increases client’s rehearsal with therapist increases client’s
interpersonal confidenceinterpersonal confidence
Interpersonal Deficits: Prognosis
Treatment of interpersonal deficits difficultTreatment of interpersonal deficits difficult client often lacks relationships to practice client often lacks relationships to practice
and develop skillsand develop skills treatment goals limited to making early treatment goals limited to making early
gains interpersonally, not resolving gains interpersonally, not resolving interpersonal deficits interpersonal deficits
Grief Problem Area Focus
Normal Grief involves: Normal Grief involves: Symptoms including sadness, disturbed Symptoms including sadness, disturbed
sleep, agitation, impairment, etc. sleep, agitation, impairment, etc. Symptoms usually resolve in 2 –4 weeks Symptoms usually resolve in 2 –4 weeks
without treatmentwithout treatment
Abnormal Grief Evidence
Inadequate grief in bereavement periodInadequate grief in bereavement period Multiple lossesMultiple losses Avoidance behavior (re funeral, grave, talk)Avoidance behavior (re funeral, grave, talk) Symptoms around significant anniversarySymptoms around significant anniversary Preserving environment of deceasedPreserving environment of deceased Fear of illness that caused deathFear of illness that caused death Absence of social support during Absence of social support during
bereavementbereavement
Abnormal Grief Treatment Goals
Facilitate the mourning processFacilitate the mourning process Help client reestablish interests and Help client reestablish interests and
relationships to substitute for what has been relationships to substitute for what has been lost lost
Grief Treatment Strategies Explore Events and Elicitation of FeelingsExplore Events and Elicitation of Feelings
Discuss events prior to, during and after Discuss events prior to, during and after the deaththe death
Reconstruction of RelationshipReconstruction of Relationship Use photos and stories to discuss Use photos and stories to discuss
relationshiprelationship Use belongings and memories to evoke Use belongings and memories to evoke
painful feelings client has avoidedpainful feelings client has avoided What were the ups and downs in What were the ups and downs in
relationship? (normalize negative relationship? (normalize negative features) Facilitate Expression of Affectfeatures) Facilitate Expression of Affect
Grief Treatment Strategies (cont.)
Behavior change: Behavior change: Plan and discuss development of new Plan and discuss development of new
social relationships (e.g. organizations, social relationships (e.g. organizations, church, work, dating)church, work, dating)
Support client as they learn to fill “empty Support client as they learn to fill “empty space” space”
Termination of Treatment For time-limited treatment, important to keep For time-limited treatment, important to keep
initial contract for 12-16 weeksinitial contract for 12-16 weeks Termination Treatment issuesTermination Treatment issues
explicit discussion of termination during last 3-explicit discussion of termination during last 3-4 sessions4 sessions
acknowledge ending may involve loss and griefacknowledge ending may involve loss and griefnormalize fear, anger, sadnessnormalize fear, anger, sadnessmay need to distinguish sadness from may need to distinguish sadness from
depressiondepression
Termination Issues
Foster client’s self-confidence in coping Foster client’s self-confidence in coping independentlyindependently
deflect client’s attribution of success to therapistdeflect client’s attribution of success to therapist call attention to client’s accomplishmentscall attention to client’s accomplishments anticipate future difficulties with clientanticipate future difficulties with client
help plan for future problemshelp plan for future problems rehearse explicit scenarios if helpfulrehearse explicit scenarios if helpful discuss possibility of relapse of depressiondiscuss possibility of relapse of depression
Termination Difficulties Failure depression to resolveFailure depression to resolve
refer for other treatment, encourage hoperefer for other treatment, encourage hope client wants to continueclient wants to continue
schedule 8 week waiting period schedule 8 week waiting period impart to client self-confidence in ability to impart to client self-confidence in ability to
copecope maintenance IPT may be appropriate for:maintenance IPT may be appropriate for:
chronic or recurring depressionchronic or recurring depression clients with personality problems or clients with personality problems or
interpersonal deficitsinterpersonal deficits
Specific IPT Techniques
Essential IPT techniques include: Essential IPT techniques include: discuss feelings (both positive & discuss feelings (both positive &
negative) about interpersonal experiencenegative) about interpersonal experience take action to change interpersonal take action to change interpersonal
experienceexperience
Other IPT techniques common to other Other IPT techniques common to other psychotherapiespsychotherapies
Exploratory Techniques Non-directive explorationNon-directive exploration Begin sessions with: “How have things Begin sessions with: “How have things
been since we last met?”been since we last met?” use open-ended questionsuse open-ended questions encourage clients sense of responsibilityencourage clients sense of responsibility Direct questioningDirect questioning
necessary to review depressive symptomsnecessary to review depressive symptoms necessary to review interpersonal necessary to review interpersonal
relationshipsrelationships
Encourage Affect
Learning in psychotherapy is emotional Learning in psychotherapy is emotional learninglearning
eliciting affect informs client re meaningful eliciting affect informs client re meaningful goalsgoals
facilitate acceptance of painful affectfacilitate acceptance of painful affect encourage clear expression of painful, encourage clear expression of painful,
suppressed or unacknowledged feelingssuppressed or unacknowledged feelings inquire into sensitive areasinquire into sensitive areas
Use emotions in relationships Assist client to negotiate painful affect in Assist client to negotiate painful affect in
significant relationshipssignificant relationships client may change relationship behavior client may change relationship behavior
(self or other) to eliminate painful affect(self or other) to eliminate painful affect client may learn new ways to cope with client may learn new ways to cope with
anger or anxietyanger or anxiety client may eliminate irrational thinking and client may eliminate irrational thinking and
emotional sequelaeemotional sequelae
Help Client with suppressed emotions
For Clients who may be emotionally For Clients who may be emotionally constricted or unassertiveconstricted or unassertive
client may lack awareness or confidence to client may lack awareness or confidence to expressexpress
some clients distressed by strong emotions some clients distressed by strong emotions (e.g. trauma history) may need help (e.g. trauma history) may need help suppressing overwhelming emotionssuppressing overwhelming emotions may be counter-productive to encourage may be counter-productive to encourage
emotional displayemotional display
Clarification
Communication techniques to review Communication techniques to review content, clarify feelings, promote awarenesscontent, clarify feelings, promote awareness repeating, rephrasing statementsrepeating, rephrasing statements calling attention to logical implications of calling attention to logical implications of
statementsstatements raising contradictions or contrastsraising contradictions or contrasts
Alert client to false, irrational or pervasive Alert client to false, irrational or pervasive beliefs regarding interpersonal relationshipsbeliefs regarding interpersonal relationships
Communication Analysis
Identify communication failures to improve Identify communication failures to improve relationship satisfactionrelationship satisfaction
Frequently review important conversations Frequently review important conversations or arguments or arguments
Illuminate common communication Illuminate common communication difficultiesdifficulties
Use of Therapeutic Relationship
Client’s feelings toward therapist and therapy are Client’s feelings toward therapist and therapy are helpful focushelpful focus may reflect characteristic ways of feeling and may reflect characteristic ways of feeling and
behaving in other relationshipsbehaving in other relationships Therapist instructs client to express complaints, Therapist instructs client to express complaints,
fears, that arise about therapistfears, that arise about therapist model genuine negotiation with such feelingmodel genuine negotiation with such feeling therapist can correct distortions and therapist can correct distortions and
acknowledge genuine deficienciesacknowledge genuine deficiencies
Directive Techniques Include educating, advising, modelingInclude educating, advising, modeling initially open to practical help: depressed clients initially open to practical help: depressed clients
may need “case management”may need “case management” provide suggestions if client unable to make provide suggestions if client unable to make
successful decisions independentlysuccessful decisions independently modeling may involve informing client how modeling may involve informing client how
therapist might handle similar situationtherapist might handle similar situation use directive techniques sparinglyuse directive techniques sparingly
use early, w/o undermining clients autonomyuse early, w/o undermining clients autonomy
Decision Analysis
Depressed clients often have history of self-Depressed clients often have history of self-defeating decisionsdefeating decisions because they fail to consider consequencesbecause they fail to consider consequences and fail to see alternativesand fail to see alternatives
Therapist helps with decision analysis to help Therapist helps with decision analysis to help client recognize range of optionsclient recognize range of options insist on delaying action until each option is insist on delaying action until each option is
exploredexplored for interpersonal situationsfor interpersonal situations
Decision Analysis Involves
Set goal for interpersonal situation: “What Set goal for interpersonal situation: “What do you want to happen?”do you want to happen?”
Consider all useful alternativesConsider all useful alternatives observe alternatives that client omitsobserve alternatives that client omits
direct client to explore probable direct client to explore probable consequences of each line of behaviorconsequences of each line of behavior clients often restrict range of alternatives clients often restrict range of alternatives
or unrealistically assess consequencesor unrealistically assess consequences beware of premature decision analysisbeware of premature decision analysis
Role Playing
Useful to explore client’s feelings and style Useful to explore client’s feelings and style of communicating with othersof communicating with others
Rehearse new ways for client to Rehearse new ways for client to communicate in safe settingcommunicate in safe setting e.g. practice more assertiveness or e.g. practice more assertiveness or
expressing affectionexpressing affection Bolsters client’s self-confidence in Bolsters client’s self-confidence in
communicating genuinelycommunicating genuinely
Evidence for IPT Efficacy
Boston-New Haven Study (1979)Boston-New Haven Study (1979) 4 Tx Groups 4 Tx Groups (16 wks & 1yr follow-up):(16 wks & 1yr follow-up): IPT, amitriptyline, both combined, controlIPT, amitriptyline, both combined, control IPT and amitriptyline equally effectiveIPT and amitriptyline equally effective Combination IPT & amitrip. most effectiveCombination IPT & amitrip. most effective IPT grp. Sustained improved psychosocial IPT grp. Sustained improved psychosocial
functioning 1 yr later (not amitrip. Grp)functioning 1 yr later (not amitrip. Grp)
NIMH Tx Depression Research (1989)
4 Tx grps (16 wks, multi-site, N=250)4 Tx grps (16 wks, multi-site, N=250) IPT, CBT, Imipramine & clinical IPT, CBT, Imipramine & clinical
management (CM), placebo & CMmanagement (CM), placebo & CM IPT comparable to Imipramine & CMIPT comparable to Imipramine & CM CBT showed somewhat less improvementCBT showed somewhat less improvement IPT grp. had lowest attrition rateIPT grp. had lowest attrition rate Results for mod.-severe depression Results for mod.-severe depression
Brain Activity Changes with either IPT or Antidepressant Tx Pet scans showed higher prefrontal and less Pet scans showed higher prefrontal and less
temporal activity in depressed vs controlstemporal activity in depressed vs controls Both IPT and Paxil resulted in normalized Both IPT and Paxil resulted in normalized
Pet scan activity and improved Dep. SxsPet scan activity and improved Dep. Sxs Brody (2001); Martin (2001)Brody (2001); Martin (2001)
IPT Also Useful for Treating:
Dysthymia (see chapter in Weissman (2000) Dysthymia (see chapter in Weissman (2000) Comprehensive Guide to IPT)Comprehensive Guide to IPT)
Social Phobia (Lipsitz et al., 1999)Social Phobia (Lipsitz et al., 1999) Adolescent Depression (Muffson et al., 1999)Adolescent Depression (Muffson et al., 1999) Postpartum Depression (Postpartum Depression (O’Hara et al., 2000) Bulimia (Wilson et al., 2002)Bulimia (Wilson et al., 2002) Late-Life Depression (Late-Life Depression (Miller et al., 2001)
Bob Hill’s IPT Website:
Click on link at: Click on link at:
http://www.appstate.edu/~hillrw/http://www.appstate.edu/~hillrw/