Interpersonal Psychotherapy

Introduction and Overview

A need for conceptual framework Conceptual frameworks help recognize

relational patterns and cognitive schemas

Treatment plans will be developed from the conceptual frameworks

Historical context Interpersonal Domain (Sullivan)

Sullivan keep away from Freud’s drive theory (sexual and aggressive instincts)

Personality develops through repetitive interactions with parents and others

personality as the collection of interpersonal strategies to avoid anxiety and disapproval, and maintain self-esteem.

Historical context Cognitive Domain Internal working model (Object Relations and

Attachment theory) View of self and others Emotional responsiveness and availability Good parents vs. bad parents

Schemas (Cognitive Behavioral therapy) Can be called maladaptive cognitive schemas, core

beliefs, or faulty expectations Schemas: A cognitive structure for screening, coding, and

evaluating the stimuli.

Historical context The familial/contextual domain

Family system theory Internalize family roles (i.e., rescuer) as self-

schemas Re-create family roles/patterns with others Faulty communication patterns Family rules Family myths

Core Concepts 1. The Process Dimension

The relationship b/w therapist and client is the foundation of therapy

Understanding and intervening with what is going on b/w therapist and client in their interaction.

Content vs. Process comments

A powerful tool for genuine understanding and honest communication.

Core Concepts 2. Corrective Emotional experience

Identify maladaptive cognitive & interpersonal patterns

Use “process comments” to clarify interpersonal styles

Engage the client in work together to find a way to change

Transfer the learning in therapy to others in clients’ lives.

Core Concepts 3. Client Response Specificity

Definition: therapists need to tailor their response to fit the specific needs of each client.

Flexible to modify interventions and respond in new ways

Match the needs for diverse clients

Interpersonal process approach Establishing a Working Alliance (WA) Honoring the client’s resistance A internal focus for change Responding to painful feelings Familial and developmental factors Inflexible interpersonal coping strategies Interpersonal patterns and themes An interpersonal solution Resolution and change

Establishing a Working Alliance (WA)

The WA is a collaborative relationship WA: agree on goals, collaborate on tasks, and establish a

bond relationship based on trust and acceptance

Empathic understanding is the foundation for WA Genuine concern, respect, and non-judgmental attitude Demonstrate understanding and identify patterns

Immediacy—working in moment Using process comments to build WA

Honoring the client’s resistance Identify resistance

Help client identity when resistance is occurring with a non-judgmental manner

Address reluctance to resistance Validate the protection aspects Do not repeat maladaptive patterns in session

Formulate working hypotheses What is the threat?

Respond to resistance Educate Explore the danger/identify the threat

A internal focus for change Shifting to an internal focus

A prerequisite for change Focusing clients inward Reluctance to adopt an internal focus

Placing the locus of change with clients Fostering clients’ initiative Avoiding a hierarchical relationship Supporting clients’ own autonomy and initiative Shared control in the therapist-client relationship

A internal focus for change

Helping clients in solving their own problems Providing a corrective emotional experience

Tracking clients’ anxiety Identifying signs of clients’ anxiety Approach clients’ anxiety directly Focus clients inward to explore their anxiety

Responding to painful feelings Approach the clients’ feelings

Expand and elaborate clients’ affect

Identify the predominant affect

Hold client’s pain

Therapists’ factors for not responding to clients’ feelings

Familial and developmental factors Understand structural family relations-patterns The family’s ability to respond to the child’s need for

both relatedness & separateness Three styles of parenting: control and affection

Authoritative - high control/high affection Authoritarian - high control/low affection Disengaged – low control/low affection Permissive – low control/high affection

Love withdrawal Insecure attachment

Inflexible interpersonal coping strategies Horney’s interpersonal model

Unmet development needs

Turning against self to block core conflict

Core Conflict or Anxiety

Inflexible interpersonal coping style

Move Away from

Othersavoid

Move Toward Othersplease

MoveAgainstOthers

intimidate

Reject self

Rejectothers

Elicit Rejection

Fromothers

Interpersonal patterns and themes How clients bring their problems into the

therapeutic relationship moving toward, moving against, or moving

away Testing Behavior Transference Reactions

Interpersonal balance

An interpersonal solution Resolving problems through the interpersonal

process Bring client’s conflicts into the therapeutic

relationship Using the process dimension to facilitate

change Providing a corrective emotional experience Therapists’ initial reluctance to work with the

process dimension

Resolution and change The working –through process

Change relationship patterns with therapist acquaintancessupportive othershistorical figuresprimary others

Therapist actively help clients Realistically anticipate others responses Provide corrective emotional experience

Resolution and change Work through family-of origin work

Internal focus for change Grief work

Plan for future: Orienting clients to listen to themselves

what they want to do, what they want to be, and what they want to become

Resolution and change Clients are ready to terminate when

Clients report they consistently feel better & can respond in more adaptive ways

Client expand their old coping styles and don’t reenact maladaptive relational patterns

Others gives them feedback that they are different

Accepting that the relationship must end

Resolution and change Effective terminations: review-predict-practice

Review what has changed Predict and make realistic plans for coping with

the problems which could come up practice to respond differently

Ending the relationship Say good-bye