Interpersonal Therapy

Overview of Interpersonal Therapy Short term intervention directed at focusing on client’s interpersonal problems in order to treat mental health challenges NOT theoretically unique Utilizes principles of psychodynamic theory (client’s emotional and interpersonal life) as well as cognitive and behavioral theories (rationality of thoughts and behavior change)

Focus of Interpersonal Therapy Three issues addressed: Client’s use of defenses Underlying cognitive structures of self and others Working alliance as model for other relationships Goal of treatment: mastery of social roles and adoption to interpersonal situations Treatment typically ranges from 12-16 weeks in one hour sessions

History of Interpersonal Therapy Evolved from progressive psychiatrists who saw the impact of the environment on people's functioning Connection between psychiatric disorders and interpersonal relations for children and adults (Harry Stack Sullivan, 1930’s) Self as a changeable consciousness that arises out of interaction with significant others Relationship between engaging within social roles (family members, student, employee, friend, partner) and psychopathology ( and vice versa)

History of Interpersonal Therapy (cont.) Attachment theory (Bowlby): people are innately inclined to form attachments and this allows species to survive Family experiences, as a child, determines the way emotional bonds are made Mental illness arises from inability to make and keep those bonds Treatment focus is to examine patterns of current interpersonal relationships and understand their etiology from prior experiences with attachment figures

History of Interpersonal Therapy (cont.) IPT as a distinct therapy modality developed by Weissman and Klerman in 1970’s Unit of intervention may be face to face involvement of client with one or more significant others Clients learn about the relationship between their symptoms and what is going on within their interpersonal life

Major Concepts: Interpersonal Therapy Assumption that depression is a medical illness manifested by: Symptoms Quality of social functioning Personality style Life events affect mood Improving life situation promotes improving mood Psychopathology not caused exclusively by interpersonal relationships; but occurs within an interpersonal context Improving social functioning can reduce symptoms

Synthesis of IPT Concepts Time-limited, focus on current interpersonal relationships Client has social functioning problems originating in one or more of the following areas: Interpersonal disputes Role transitions Grief processes Interpersonal deficits IPT seeks to change how a client thinks, feels and acts in problematic interpersonal relationships Areas where therapist may assist: Increasing assertiveness Reducing guilt Poor social skills Over-emphasis on unpleasant events Manner of expressing negative emotions

Comparing IPT with Cognitive Behavioral and Psychodynamic Interventions Attention called to distorted thinking only within context of relationships with others (not in uncovering core cognitive schema) Not the depth of CBT into source of cognitions Utilizes reassurance, clarification of feelings, communication training, testing perceptions and performance through interpersonal contacts More emotional expression than with CBT IPT effective for client’s with a tendency to avoid addressing interpersonal problems

Examples of Change Within 4 Major IPT-focused Types of Problems Interpersonal disputes. Practitioner identifies faulty communication patterns plus invalid or unreasonable expectations Worker assists with adapting communication patterns or reassessing expectations Role transitions: May be result of maturational or situational crises Therapist seeks to modify or develop new sources of support; reappraising old and new roles Grief: Determine how client’s relationship capacity has been affected Establishing new relationships; clarify mourning cognitions, experience feelings Interpersonal deficits: Modify problematic relationship patterns such as excess dependency or hostility

IPT and Manualization To “manualize” means that specific activities are covered within each week of a 12-16 week session it is critical to have “fidelity” with the manual’s approach 1-4: Assessment and planning ( uses an interpersonal inventory) 5-8: Attention is directed to one or more of the four IPT focus areas (as goals) 9-12: Acknowledging feelings around grieving, recognizing gains, generalizing outcomes Assist client to acknowledge new areas of competence

Client/Worker Relationship in IPT Present-focused but with clarity of need to work within a time frame (hence goal orientation is ever present) Transference and countertransference assessed but not interpreted This assists the worker in understanding the dynamics of the client’s interpersonal patterns

IPT Assessment Presenting challenge assessed and its attendant symptoms Diagnosis of symptoms is shared with client Allows client to know their symptoms have a “name” for which there is a solution Interpersonal Inventory Client lists all significant past and current relationships Information is shred about each person with whom client has had significant relationship

Nature of interaction ( frequency of contact and activities shared) Interpersonal Inventory ( undertaken for all significant relationships) Nature of interaction ( frequency of contact and activities shared) Expectations of each person within the relationship and extent to which those were met Satisfactory and unsatisfactory aspects of relationship (examples) How client would like to change relationship

Use of Interpersonal Inventory Social worker analyzes patterns of interaction and behavior related to themes of: Dominance and submission Dependency and autonomy Intimacy and trust Cooperation or competition Separation and loss Based on inventory results, client and worker agree on a primary relational problem for intervention

IPT Intervention Techniques Nondirective exploration: Supportive listening to build trust and normalize problems Encouragement of affect: encouraging expression of unpleasant emotions previously defended against Clarification of beliefs and perceptions: uncovering cognitive distortions, calling attention to contradictions and promoting logical thinking Communication analysis: reflecting patterns that can be problematic such as silence, contradictory and indirect messages, plus “double bind” messages

IPT Intervention Techniques (cont.) Use of therapeutic relationship: encouraging client to share feelings about worker and the therapeutic process (not probing for “roots” as in psychodynamic theories) Behavior change strategies: modeling and role playing to facilitate experiments outside of session Also limit setting with impulsive clients

IPT Evidence of Effectiveness Clinical trials have found IPT equally effective or more effective than antidepressant therapy Used together there is an additive effect Used with adolescents, older adults, women with post-partum depression, bulimics Outcomes of IPT can be maintained over time

Critique of IPT Supports a “medical model” in sense of DSM diagnosis and possible use of antidepressants Requires formal training in order to subscribe to “manualized” approach

Summary of IPT Short term intervention, manualized, with 3 decades of effectiveness data on treatment of depression Combination of ego psychology/psychodynamic and cognitive behavioral approaches Problems of clients conceptualized as emanating from: Interpersonal disputes Role transitions Grief processes Interpersonal deficits Above demonstrated through problematic interpersonal relationships Goals focus on client changing thinking, feeling and behavior within problematic interpersonal relationships