A school assignment on interpersonal psychotherapy

1. INTERPERSONAL
PSYCHOTHERAPY
By: Teo Qian Hua
Chen Xiu Wen
Teo Meijun
Gerald L. Klerman & Myrna M. Weissman

2. INTERPERSONAL PSYCHOTHERAPY
ü Time-limited therapy (12-20 sessions)
ü Especially designed for depression
ü ‘here-and-now’ framework
Focus on current interpersonal issues
ü Medical model
Depression as treatable

3. Gerald L. Klerman
Myrna M. Weissman
INTERPERSONAL PSYCHOTHERAPY

4. DUAL GOAL OF IPT
Symptom
remission
Solve
interpersonal
problems
related to
depression
IPT

5. THEORETICAL BASIS
ü Interpersonal theory
ü Adolf Meyer & Harry Stack Sullivan
ü Focus on the importance of interpersonal
relationships in determining behavior
ü Psychological illness develops out of interpersonal
disruptions
ü Help patients to increase their
understanding of the interpersonal events
that triggered depression

6. THEORETICAL BASIS
ü Attachment theory
ü People have the fundamental need to form strong
bonds with others.
ü When these bonds are disrupted, the individual will
experience emotional distress
ü IPT targets interpersonal relationships that may affect
patient’s attachment experiences

7. 3 PHASES OF IPT
Initial phase
Intermediate
phase
Termination
Phase

8. Initial phase
ü Diagnosis
ü Psycho-education
• Symptoms and behaviors
of depression
• Assign ‘sick role’ to patient
ü Identify interpersonal
issues most related to
current depression
• 4 problem areas

9. FOUR PROBLEM AREAS
Grief
• Death of a
loved one
• Prolonged
grief
Interpersonal
disputes
• Two parties or
more have
nonreciprocal
expectations
about the
terms for
behavior within
relationship
Role
transitions
• Adjustment to
a life change
that requires
an alteration of
behavior from
old role to new
role
Interpersonal
deficits
• Patients who
experience:
• Feelings of
loneliness
• Paucity of
relationships
• Underdevelope
d social and
communication
skills

10. ü Treatment contract
ü Specify respective roles
ü Focus of problem areas
ü Practical details of treatment
Initial phase

11. ü Work on indentified problem areas
ü Further clarification
ü Implement strategies
Intermediate
phase

12. GRIEF DUE TO DEATH
ü Goal
ü Facilitate resolution of grieving process

13. GRIEF DUE TO DEATH
ü Strategies
ü Review +/- aspects of relationship with deceased
ü Encourage expression of emotions
ü Taught skills for communicating loss
ü Apply skills to other significant relationships
ü Establish new or furthering existing relationships

14. ROLE DISPUTES
ü 3 stages in a dispute
ü Renegotiation
ü Impasse
ü Dissolution

15. ROLE DISPUTES
ü Goals & Strategies
ü In renegotiation and impasse stage
ü Help to resolve conflict
• Identification of communication patterns
• Teaching new communication skills
• Generating solutions to dispute
ü Dissolution stage
ü Focus on mourning of loss
• Help patient understand situation
• Feel at ease to form new
relationships

16. ROLE TRANSITION
ü Goal
ü Help patients relinquish old roles
ü Accept new roles
ü Develop a sense of mastery in the new role
ü Strategies
ü Explore meanings, feelings and expectations regarding
transition
ü Learn new interpersonal skills
ü Develop social support around transition

17. INTERPERSONAL DEFICITS
ü Goal
ü Improve interpersonal relationships
ü Strategies
ü Explore repetitive interpersonal
problems
ü Teach skills for building and
maintaining relationships
ü Reinforce positive communication
patterns

18. ü Reviews the patient’s course of
depressive symptoms and how they have
changed
ü Review changes in interpersonal
functioning
ü Link these changes to the improvement in
the patient’s mood
ü Highlight skills and strategies that were
particularly useful
ü Discuss end of treatment
ü Address possibility that depression might
recur
ü Warn symptoms
ü Teach strategies
Termination
phase

19. TECHNIQUES

20. ü Targeted at
ü Providing patients with the
skills to change interpersonal
relationship
ü Improving their mood
ü Different combinations of
techniques used according to
their problem area(s)

21. THERAPEUTIC ALLIANCE
ü Essential in predicting therapeutic
change
ü Provide information about the
patient
ü Provide a safe environment to bring
about therapeutic change
ü Without therapeutic alliance, other
techniques may become ineffective

22. ENCOURAGEMENT OF AFFECT &
CONNECTION WITH
INTERPERSONAL EVENT
ü Help patients become aware of,
acknowledge and accept emotions about
relationships
ü Understand impact of affect on
relationships
ü Learn to negotiate interpersonal
experiences more effectively
ü Observe that –ve interpersonal events
are associated with decline in mood and
+ve changes are associated with
improvement in mood
Content and Process Affect
ü Content Affect: Affect reported
by patient
ü Process Affect: Affect
demonstrated by patient
ü Observing for INCONGRUITY

23. COMMUNICATION ANALYSIS
ü Understand patient’s
patterns of interactions
ü Recognize ineffective
communication skills
ü Acquire better
communication skills

24. DECISION ANALYSIS
ü Processes involved
ü Identify a problematic
interpersonal situation
ü Formulate a goal
ü Generate potential solution
ü Evaluate and choose a
strategy
ü Consider the different
actions one can take when
faced with interpersonal
difficulties

25. ROLE PLAYING
ü Discuss, model and practice the
skills they have gained through
therapy
ü More comfortable and
competent in transferring the skills
to real life situations
ü Allow therapist to observe and
correct skills deficits that arises
ü Not suitable for all patients

26. EFFICACY
AND
EFFECTIVENESS
of IPT as a treatment to Major Depression & Other psychiatric illness

27. TREATMENT FOR
MAJOR DEPRESSION
Acute
Treatment
ü NIMH Treatment of Depression
Collaborative Research Program (Elkin et
al., 1989)
ü Treatment groups
• Imipramine, IPT, CBT, Placebo
ü Reduction in depressive symptoms &
improved functioning
ü Severely depressed patients
• IPT comparable to IMI and superior to
placebo
ü Follow-up
• No significant differences in recovery
(Shea et al., 1992)

28. Maintenance
Treatment
ü Maintenance Treatment
• First tested with 150 acutely
depressed female outpatients
(Klerman et al. 1974)
• IPT improved social functioning
ü Meta-analysis (Mello et al., 2005)
• 13 studies
• IPT superior to placebo
• similar to medication
• more efficacious than CBT
TREATMENT FOR
MAJOR DEPRESSION

29. TREATMENT FOR
MAJOR
DEPRESSION
Different population
Adolescent patients:
Improvement in
ü depressive symptoms
ü functioning with friends
ü problem-solving skills
ü overall social functioning
(Mufson et al., 1999)
ü Effective in school-
based clinic

30. TREATMENT FOR
MAJOR
DEPRESSION
Different population
Geriatric patients
ü combined treatment with
nortriptyline & IPT was
superior to IPT/medication
alone (Reynolds et al., 1999)
ü IPT alone less effective for
older patients
Adolescent patients:
Improvement in
ü depressive symptoms
ü functioning with friends
ü problem-solving skills
ü overall social functioning
(Mufson et al., 1999)
ü Effective in school-
based clinic

31. IPT AS A
TREATMENT
For Other Psychiatric Illnesses
ü Bipolar Disorder
IPSRT was found superior to
the comparison condition in
delaying recurrence of
depressive and manic episodes
for acutely ill bipolar patients
(Frank et al., 2005)

32. IPT AS A
TREATMENT
For Other Psychiatric Illnesses
ü Bulimia Nervosa
18 weeks of IPT, CBT or a
behavior therapy control
IPT has benefits comparable to
those of CBT and superior to those
of the control condition
(Agras et al. 2000)

33. IPT AS A
TREATMENT
For Other Psychiatric Illnesses
ü Substance Dependence
A study of 42 subjects with
cocaine abuse who were
attempting to achieve abstinence
IPT was ineffective than a
behavioral control therapy
(Carroll et al. 1991)

34. AN APPLICATION
OF
INTERPERSONAL
PSYCHOTHERAPY
A Case of an Adolescent Bully-Victim

35. AN APPLICATION OF
INTERPERSONAL
PSYCHOTHERAPY
ü Adolescent Bully-victims
ü Rising bullying cases in schools
ü Increased risk of depression and
suicidal ideation among bully
victims (Chambless, 2010)
ü IPT as an effective in treating
adolescent patients and depression

36. AN APPLICATION OF
INTERPERSONAL
PSYCHOTHERAPY
A Case of an Adolescent Bully-Victim
Initial Intermediate Termination
ü Assigning of “sick role”
Inform adolescent of depression
ü Restrictive Families
Adolescent boys are more likely to become
victims
ü Bully-victims have less teacher and peer
support
ü Focus on present circumstances
Free them of self-criticism

37. A Case of an Adolescent Bully-Victim
Initial Intermediate Termination
AN APPLICATION OF
INTERPERSONAL
PSYCHOTHERAPY
ü Disputes with parents
• That leads to maladaptive communication
patterns
ü Goals: Self-assertion and communication
• Expressions of feelings and problems
ü Role-playing
• Anticipate problems and rehearse
expression of emotions in disputes
Problem Area 1:
Interpersonal
Dispute

38. A Case of an Adolescent Bully-Victim
Initial Intermediate Termination
AN APPLICATION OF
INTERPERSONAL
PSYCHOTHERAPY
ü Past bully incidents
• negative preconceptions of people
ü Goal: reduce social isolation
• Explore the distorted feelings toward
people
• New skills for building and maintaining
relationships
ü Role-playing
• Practice the new skills
Problem Area 2:
Interpersonal
Deficits

39. AN APPLICATION OF
INTERPERSONAL
PSYCHOTHERAPY
A Case of an Adolescent Bully-Victim
Initial Intermediate Termination
ü Help adolescent recognize
gains in self-assertion
ü Calling into attention patient’s
independent successes
ü Discuss potential recurrent
symptoms and how to handle
them

40. THANK
YOU
VERY MUCH
Good-bye and Have a nice day!