Interpersonal Psychotherapy New

7/28/2019 Interpersonal Psychotherapy New

1/119

INTERPERSONAL

PSYCHOTHERAPYPRESENTER : DR. DAVIN

C/P : MS. NEETHI

11/02/2012


2/119

INTRODUCTION

Time-limited, interpersonally focused,psycho dynamically informed

psychotherapy

Goals : Symptom relief

Improving interpersonal functioning

Interpersonal Contexttherelational factors that predispose,

precipitate and perpetuate the

patients distress.


3/119

INTRODUCTION

Interpersonal relationships :- Focus oftherapeutic attention as the means to

bring about change.

Aims : Helping to improve pts interpersonal

relationships

Change their expectations about themAssist patients to improve their social

support network


4/119

INTRODUCTION

Multiple types :- Long-term, insight-oriented,

theoretically based, interpretive, and

open-ended IPTs More-modern, short-term, time-limited,

no interpretive approaches - avoidtheory & insight

Common beliefInterpersonalrelationships of a patient, have a rolein etiology of his/her psychopathology

& its treatment.


5/119

INTRODUCTION

Spectrum of approaches +

Open-ended : Emphasize participant

role of therapist and interpersonal

relationship of patient & therapist-longer, more interpretive.

Time-limited : Emphasis is on patient

and his /her current interpersonalrelationships in real life. - 1 or 2

current relationships targeted.


6/119

HISTORY

Roots in Psychodynamic Theory Primary instincts of sex and

aggression involve relating to others

Relationships with others contribute topersonality development

Psychological Problems due to deficitsin early relations

Transference and counter-transference are interpersonal


7/119

HISTORY

Object-Relations influence Object is human being Relations are internal, external,

fantasized or real interactions with others Early parent-child relations are

internalized as expectations for futurerelationships

Identity/personality derived from pattern

of early relationship experiences Expectations of others impacts quality of

current interpersonal relationships andmood


8/119

HISTORY

Biopsychosocial modelAttachment Theory (Bowlby)

Relationships are primary

Attachment is a biological drive

Attachment is a cybernetic system

Capacity to form flexible attachment

is principal feature of mental health Styles Secure , Anxious Ambivalent ,Anxious Avoidant


9/119

Patterns of attachment :-

develop early & tend to persist, but are

not fixed

persist within relationships persist across relationships

Less secure attachment - more

prone to psychiatric symptoms Disruption of attachment increases

vulnerability to psychiatric symptoms


10/119

Dysfunction results fromAn acute crisis, attachment disruption,

inadequate social support

IMPLICATIONS:

Focus on attachment i.e.interpersonal relationships

Resolution of here-and-now problems

should result in symptom relief Fundamental personality change is

unlikely in short-term treatment


11/119

HISTORY

American psychiatrist Harry StackSullivan (18921949) - Father ofInterpersonal Psychotherapy.

Alternative formulation to classicpsychoanalytical theory

2 basic drives:

(Physical) satisfaction (i.e., food, warmthshelter, sex)

(Interpersonal) security


12/119

HISTORY

Security : sense that one is anadequate human being

having a healthy self-esteem

feeling confident to handle stress being comfortable among others

being interpersonally competent

being relatively anxiety-free


13/119

HISTORY

We learn : How to separate fantasy from reality

develop a sense of self and self-esteem (or lack)

develop strategies for coping with anxiety Social stages of child development :-

Enduring patterns of thinking and behaving

Dont develop much because of inner

conflicts, as an attempt to deal with humanenvironment of one's family, school &community.

Ultimately maladaptive mental illness.


14/119

Therapist is not & cannot be apassive observer

Identify patterns of behavior & thinking

from the patient's history Support self-esteem of patient and

reinforce it appropriately

Address positive aspects of patient &his/her successes


15/119

The story of interpersonal therapy(IPT) began in 1969 at Yale University.

Dr. Gerald Klerman was joined by Dr.

Eugene Paykel(London) to design astudy to test the relative efficacy of a

tricyclic antidepressant(TCA) alone

and that with psychotherapy asmaintenance treatment of nonbipolar

depression.


16/119

Evidence for efficacy of TCAs forreducing the acute symptoms of

depression was strong, yet the main

treatment for depression at the timewas psychodynamic psychotherapy.

It was clear that many patients with

acute depression relapsed aftertermination of TCA treatment.


17/119

Unclear how long psychopharmacologictreatment should continue?

Whether psychotherapy had a role in theprevention of relapse?

Some psychotherapists thoughtmedication would make patients lessinterested in psychotherapy.

Some psychopharmacologists felt

psychotherapy would undo the positiveeffects of medication by having patientstalk about upsetting material.


18/119

Psychological FactorsAttachment StyleTemperament

Cognitive Style

Coping Mechanisms

Interpersonal Distress

Social FactorsIntimate Relationships

Social Support

Unique Individual

Interpersonal CrisesGrief and Loss

Interpersonal Disputes

Role Transitions

Interpersonal Sensitivity

Biological FactorsGeneticsSubstance Use

Medical Illnesses

Medical Treatments


19/119

OPEN ENDED IPT

Therapist : Is a participant

Cant be entirely objective

Cant avoid being target of patient'sstereotypical behaviour

Ability of therapist to:

Read his/her reactions to patientobjectively,

Reflect them therapeutically.


20/119

OPEN ENDED IPT

KieslerDyadic:-Therapist is a participant

observer

Impact messages: Feelings, thoughts &

behaviours of therapist in response to patient

Direct feelings

Action tendencies

Cognitive attributions Fantasies

Therapist's active monitoring of his/her

feelings & reactions- Strategy to understand


21/119

OPEN ENDED IPT

Categories of reply: Simply respond to the manifest content of

the statement

Ignore it and change the subject Interpret statement as an unconscious

message of patient to himself /patient to

therapist

Share either his personal reflection on or

his reaction to patient's statement.


22/119

OPEN ENDED IPT

4 phases :

(1) engaging :Attempt by therapist to

make himself a significant person in

the pt's life, both to get work doneefficiently & to prevent premature

termination

(2) uncovering (3) resolving

(4) terminating


23/119

TIME-LIMITED IPT

Our original intent was not to develop a newpsychotherapy,

but to describe what we believed was reasonable andcurrent

practice with depressed patients who might be considered

forinclusion under the rubric of short term supportive

psychotherapy.

Weissman & Klerman, (1993)


24/119

TIME-LIMITED IPT

Noninterpretive, time-limitedpsychotherapy

Gerald Klerman and colleagues

Treatment of nonbipolar, nonpsychotically depressed outpatients.

No assumptions about causes of

psychiatric illness Onset, response to treatment, and

outcomes are influenced by

interpersonal relations between the

patient and significant others.


25/119

TIME-LIMITED IPT

Set number of sessions Transference may be ignored/undermined

Workbook may be used

Focus is specifically on the pt'sinterpersonal relationships.

Advantage : IPT can be researched.

Goal :- Reduce and/or eliminatepsychiatric symptoms by improvingquality of pt's current interpersonalrelations & social functioning.


26/119

TIME-LIMITED IPT

Defined phases : Specific strategiesand tasks for therapist and patient.

Resolving problems within 4 social

domains: Grief, interpersonal roledisputes, role transitions, and

interpersonal deficits.

Efficacious for major depressionAdapted to treat other types of

mood and nonmood disorders.


27/119

TIME-LIMITED IPT

A persons behavior is viewed as

influencing the reactions of people

around them The persons typical interpersonal

style may influence negative

feedback from others, social isolation,

relationship difficulties, etc.

These situational factors may lead the

individual to become depressed


28/119

Coynes Interpersonal Model of

Depression

People who are depressed can bedifficult to spend time with (e.g., they

complain, they express negativity, they

are less interested in participating inpleasurable activities)

Because of this, non-depressed

people tend to decrease the amount oftime spent with the depressed person


29/119

Coynes Interpersonal Model of

Depression

The depressed person experiences alack of social support and a reduction

in social interaction

This can lead the person to becomemore depressed

which in turn makes them even less

desirable to be around


30/119

Interpersonal therapy helps patient to

improve functioning, particularly in

current relationships, in order to breakthe depressive cycle

Sessions focus on interpersonal style

and interpersonal relationships Interpersonal therapists focus on the

functional role of depression rather

than on its etiology or cause They look at the ways in which

problematic interactions develop when

a person becomes depressed


31/119

DIFFERENCES FROM OTHER

PSYCHOTHERAPIES Time-limited- outcome studies document

efficacy of short-term (12-16 weeks)

treatment

Not designed for personality change Focused on current interpersonal disputes,

anxieties, frustrations

Addresses 1-2 problem areas in

interpersonal functioning


32/119

DIFFERENCES FROM CBT

Goal is to change feelings, thoughts,actions in problematic relationships

Negative/irrational cognitions areaddressed only in interpersonalfunction

IPT attends to distorted thinking in

relation to significant others Goal is to change relationship pattern

rather than depressive cognitions


33/119

DIFFERENCES FROM CBT

Focus on affect & expression ofemotions

Explores avoidance & resistance

behavior Identification of patterns in clients

behavior, thinking, feeling andrelationships

Attention to past experiences

Focus on interpersonal experience

Emphasis on the therapeutic

relationship


34/119

IPT and Personality Change

IPT does not target alteration ofpersonality

Personality pathology may limit IPT

outcome IPT may help patient recognize

maladaptive personality features

IPT may improve social skills and thusameliorate maladaptive personality

traits


35/119

Role of IPT Therapist

Therapist is patient advocate, notneutral

Expresses unconditional positive

regard Intentionally cultivates positive

expectations of treatment

Optimistic, positive, reassuring Therapist is active in keeping

interpersonal problem areas to focus


36/119

4 SOCIAL DOMAINS

1. Grief: Problem area when onset ofthe patients symptoms is associated

with loss of a person or a

relationship, either recent or past.2. Interpersonal role disputes:

Conflicts with a significant other

(e.g., a partner, other family member,coworker/ close friend) that emerge

from differences in expectations

about the relationship.


37/119

4 SOCIAL DOMAINS

3. Role transitions : difficultiesassociated with a change in life

status (e.g., graduation, leaving a

job, moving, marriage/divorce,retirement, change in health status)

4. Interpersonal deficits : Apply to

those patients who are sociallyisolated or are in chronically

unfulfilling relationships.


38/119

TECHNIQUES

Essential IPT techniques include: discuss feelings (both positive &

negative) about interpersonal experience

take action to change interpersonalexperience

Other IPT techniques common to

other psychotherapies


39/119

TECHNIQUES

Explorative techniques Non-directive exploration Begin sessions with: How have things

been since we last met? Use open-ended questions Encourage clients sense of

responsibility

Direct questioning necessary to review depressive

symptoms necessary to review interpersonal

relationships


40/119

TECHNIQUES

Encourage the Affect Learning in psychotherapy is

emotional learning

Eliciting affect informs client re-meaningful goals

Facilitate acceptance of painful affect encourage clear expression of painful,

suppressed or unacknowledged feelings

inquire into sensitive areas


41/119

TECHNIQUES

Use emotions in relationshipsAssist client to negotiate painful affect

in significant relationships

Client may change relationshipbehavior (self or other) to eliminate

painful affect

Client may learn new ways to copewith anger or anxiety

Client may eliminate irrational thinking

and emotional sequelae


42/119

TECHNIQUES

Help clients with suppressedemotions

For clients who may be emotionallyconstricted or unassertive

Client may lack awareness or confidenceto express

Some clients distressed by strong

emotions (e.g. trauma history) may needhelp suppressing overwhelmingemotions may be counter-productive to encourage

emotional display


43/119

TECHNIQUES

Clarification Communication techniques to review

content, clarify feelings, promote

awareness repeating, rephrasing statements

calling attention to logical implications of

statements

raising contradictions or contrasts

Alert client to false, irrational or

pervasive beliefs regarding interpersonal

relationships


44/119

TECHNIQUES

Communication analysis Identify communication failures to

improve relationship satisfaction

Frequently review importantconversations or arguments

Illuminate common communication

difficulties


45/119

TECHNIQUES

Use of Therapeutic relationship Clients feelings toward therapist and

therapy are helpful focus

may reflect characteristic ways of feeling

and behaving in other relationships Therapist instructs client to express

complaints, fears, that arise about therapist

model genuine negotiation with suchfeeling

therapist can correct distortions andacknowledge genuine deficiencies


46/119

TECHNIQUES

Directive techniques Include educating, advising, modeling

Initially open to practical help: depressedclients may need case management

Provide suggestions if client unable tomake successful decisions independently

Modeling may involve informing client howtherapist might handle similar situation

Use directive techniques sparingly

use early, w/o undermining clientsautonomy


47/119

TECHNIQUES

Decision analysis : Help patient integrate communication

analysis, wishes & options & constraints

of situation Decide specific course of action

Role playing :

Help rehearse course of action before

implementing in real life


48/119

TIMELINE OF TREATMENT

Typical course lasts 12 to 20 sessions over a4- to 5-month period.

3 phases :

Initial phase : Dedicated to identifying theproblem area that will be the target fortreatment.

Intermediate phase : Devoted to working on

the target problem area(s) Termination phase : Focused on

consolidating gains made during treatment &preparing the patients for future work on theirown


49/119

Initial phase: Sessions 15 Give the syndrome a name; provide

information about the prevalence and

characteristics of the disorder

Describe the rationale and nature of the

therapy

Conduct the interpersonal inventory to identify

the current interpersonal problem area(s)associated with the onset or maintenance of

the psychiatric symptoms.


50/119

Review significant relationships, past and

present

Identify interpersonal precipitants of episodes

of psychiatric symptoms Select and reach consensus about the

interpersonal problem area(s) and treatment

plan with patient


51/119

Intermediate phase: Sessions 615

Implement strategies specific to the identified

problem area(s)

Encourage and review work on goals specificto the problem area

Illuminate connections between symptoms and

interpersonal events during the week Work with the patient to identify and manage

negative or painful affects associated with his

or her interpersonal problem area


52/119


53/119

INITIAL PHASE

Assessing the patient's currentpsychiatric symptoms and obtaining ahistory of these symptoms, thetherapist gives the patient a formaldiagnosis (DSM,ICD)

Discuss diagnosis, as well as whatmight be expected from treatment.

Assignment of the sick roleDualfunction Grant patient both permission &

responsibility to recover


54/119

Conducts an interpersonal inventorywith the patient and develops an

interpersonal formulationdetermine

precise focus of treatment

DIAGNOSIS AND


55/119

DIAGNOSIS ANDASSESSMENT OF A SICK

ROLE Thorough psychiatric interviewAssigning the sick role : Purposes are

both theoretical and practical.

Reinforces the idea that patient has aknown condition that can be treated

Explicitly identifies the patient as being in

need of help Temporarily exempt the individual from

other responsibilitiesdevote full attentionto recovery


56/119

Sick is undesirable and needs to beimproved

Person obliged to cooperate with

treatment Shifts blame from client to illness-

mitigate self blame

Symptom relief starts with helping the

patient to understand that his/her

psychiatric symptoms are part of a

known syndrome that responds to

several treatments.

REVIEWING DEPRESSIVE


57/119

REVIEWING DEPRESSIVE

SYMPTOMS

What interpersonal events related todepression?

Review current & past interpersonal

relationships Who does client interact with?

Frequency of contact, activities shared?

Assess quality and themes of relationships

Assess expectations of client (and other) inrelationships

Assess satisfying and unsatisfying aspects of

relationships

THE INTERPERSONAL


58/119

THE INTERPERSONAL

INVENTORY

Structure for elucidating social &interpersonal context of the onset andmaintenance of psychiatric symptoms &delineates the focus of treatment.

Concerns changes in relationships proximalto the onset of symptoms

Obtain chronological history of

significant life events fluctuations in mood and self-esteem

interpersonal relationships

psychiatric symptoms


59/119

Make connection between certain lifeexperiences and psychiatric

symptoms

Thorough interpersonal inventory : optimal treatment plan

key to success in therapy

ESTABLISH RELEVANT


60/119

ESTABLISH RELEVANT

PROBLEM AREAS Develop an individualized

interpersonal formulation

Link patient's symptoms to one of the4 interpersonal problem areas

Patient needs to concur with theproblem area proposed & agree towork on it in treatment.

Time-limited nature of treatmentnecessitates a focused approach.

Assign 1 or, at most, 2 problem

area(s).


61/119

Problem area that seems most likelyto be responsive to treatment is

addressed first

Patient's morale and overall sense ofcompetence enhances when progress

is made

COLLABORATIVELY DEVELOP


62/119

COLLABORATIVELY DEVELOP

TREATMENT GOALS

Formulate a treatment plan withspecified goals Guide the day-to-day work Identify specific steps the patient will

take to improve relationships andsocialization Summary should include reference to

specific individuals, events, &

interpersonal themes to help ensure thatthey are as personally meaningful to thepatient as possible.

Written summaryTreatment contract


63/119


64/119

IMPORTANT TASKS : Help client discuss topics pertinent to

problem area

Attend to clients affective stateAssist client in discussing therapeutic

relationship

Prevent client from sabotagingtreatment


65/119

GRIEF AREA FOCUS

Normal Grief involves: Symptoms including sadness, disturbed

sleep, agitation, impairment, etc.

Symptoms usually resolve in 24 weekswithout treatment

ABNORMAL GRIEF


66/119

ABNORMAL GRIEF

EVIDENCE Inadequate grief in bereavement

period

Multiple losses

Avoidance behavior (re funeral, grave,talk)

Symptoms around significantanniversary

Preserving environment of deceased

Fear of illness that caused death

Absence of social support during

bereavement


67/119

GRIEF - GOALS

Facilitate the mourning process Help client re-establish interests and

relationships to substitute for what has

been lost


68/119

GRIEF - STRATEGIES

Explore Events & Elicitation ofFeelings Discuss events prior to, during and after

the death

Reconstruction of Relationship Use photos and stories to discuss

relationship

Use belongings and memories to evokepainful feelings client has avoided

What were the ups and downs inrelationship? (normalize negative

features)-- Facilitate Expression of Affect


69/119

GRIEF - STRATEGIES

Behavior change: Plan and discuss development of new

social relationships (e.g. organizations,

church, work, dating)

Support client as they learn to fill empty

space


70/119

ROLE TRANSITIONS

Role transitions are varied in theirnature.

Examples according to Stuart and

Robertson (2003) include: situational role transitions,

e.g., job loss, promotion, graduation,

migration. relationship role transitions,

e.g., marriage, divorce, step-

parenthood.


71/119

illness related role transition,e.g., diagnosis of chronic illness,

adaptation to pain or physical

limitations.post-event role transition,

e.g., posttraumaticsymptoms,

refugee status.


72/119

ROLE TRANSITIONS

Diagnosis

Assess: How did life change? What

people in your life changed or left?

Goals :

mourning & accepting the loss of old role

recognizing the positive & negative aspects of

both old and new roles restoring the patient's self-esteem

ROLE TRANSITIONS -


73/119

ROLE TRANSITIONS -

STRATEGIES

Facilitate evaluation of lost role Tell me about the old ___. What were the

good, and bad, things? What haschanged?

Encourage expression of affect How did it feel to give up ___?

Identify positive aspects of new roleAre there potential benefits?

ROLE TRANSITIONS -


74/119

ROLE TRANSITIONS -

STRATEGIES Develop Social Skills needed for new role

What is required in new role?

Are assumptions of role demands

accurate?

Role play or rehearse difficult situations

Assist with managing performance anxiety

Establish new relationships and social

support

Facilitate discovery of new opportunities

for social support

INTERPERSONAL ROLE


75/119

INTERPERSONAL ROLE

DISPUTES

Diagnosis : Current Overt / Covert disputes with a

significant other Client and other have non-reciprocal

expectations Dispute related to onset or

perpetuation of depression Client demoralized about relationship

Poor patterns of communication Irreconcilable differences

IP ROLE DISPUTES -


76/119

IP ROLE DISPUTES

GOALS Identify the dispute Make choices about a plan of action

Modify communication patterns /

Reassess Expectations

Consider satisfying needs outside

relationship


77/119

ISSUES

Differences in expectations/valuesbetween client and other?

Clients wishes in relationship? Otherwishes?

What are the clients options?

How have they resolveddisagreements in past?

Strengths and weaknesses inrelationship?

What changes are realistically

possible?

IP ROLE DISPUTES-


78/119

IP ROLE DISPUTES

STRATEGIES

Assess stage of Role Dispute: Impasse- discussion stopped, low-level

resentment exists

treatment may initially increase

disharmony Renegotiation- aware of differences,

actively trying to change

Treatment may require calming parties to

facilitate resolution Dissolution- implies the relationship is

irretrievably disrupted

Treatment may resemble grief therapy

IP ROLE DISPUTES-


79/119

IP ROLE DISPUTES

STRATEGIES

Find Parallels in previous relationships What does client gain by the

behavior?

What are unspoken assumptions thatlie behind behavior?

Optimistic tone: lets figure out whatwent wrong here so we can decide

how to help you make it better Often communication problems are

revealed- Treatment involves

improving skills

IP ROLE DISPUTES-


80/119

IP ROLE DISPUTES

STRATEGIES

Help identify mixed feelings e.g. anger,fear, sadness

Devise strategies for managing feelings e.g.

direct communications, reducing irrational

suspicions

Role Play

Rehearse expressing feelings and wishes

Anticipate communication problems Consider Conjoint sessions with significant

other

INTERPERSONAL DEFICITS


81/119

INTERPERSONAL DEFICITS

DIAGNOSIS: History of social impoverishment,

chronic inadequate or unsustained

relationships Consider Dysthymia (or Double

Depression)

IPT adaptation for dysthymia Long standing or temporary deficits in

social skills yields low self-esteem,

withdrawal

IP DEFICITS GOALS


82/119

IP DEFICITS - GOALS

Reduce Clients social isolation Enable:

close relationships with intimates or family

members satisfying relationships with friends

adequate relationships in work role

IP DEFICITS STRATEGIES


83/119

IP DEFICITS - STRATEGIES

Review past significant relationships including childhood relationships with

family members

depressed patients minimize or forget

positive experiences explore repetitive or parallel problems in

past relationships

define interpersonal situations that lead to

difficulties



84/119


Use therapist-client relationship explore clients positive and negative

feelings toward therapist

discuss distorted or unrealistic thoughts orfeelings toward therapist

model resolution of relationship tension by

open and genuine communication



85/119


Encourage patient to increase socialinteractions

review attempts in treatment to identify

deficits identify deficits in communication skills

look for assumptions client makes about

others thoughts and feelings

IP DEFICITS


86/119

IP DEFICITS

COMMUNICATION ANALYSIS

Get detailed account of conversation orargument

Identify communication difficulties

ambiguous, indirect, & non-verbal as

substitute for open confrontation incorrect assumptions re communication

assuming that others know their feelings

accompanied by anger, frustration,silence

failing to make sure they are heard,understood

IP DEFICITS


87/119

IP DEFICITS

COMMUNICATION ANALYSIS

Incorrect interpretation of others statements perceive criticism where none intended

Indirect verbal communication

inhibited directly expressing expectations

or criticism instead use hints and ambiguous

messages

prone to build resentments toward otherswho are unaware of offense

silence - unaware of destructive impact


88/119

Use role playing rehearse difficult interactions with client

explore style of communicating with

others practice new skills -- e.g. expressing

anger or being assertive

rehearsal with therapist increases clients

interpersonal confidence

IP DEFICITS PROGNOSIS


89/119

IP DEFICITS - PROGNOSIS

Treatment of interpersonal deficitsoften difficult

Client often lacks relationships to

practice and develop skills Treatment goals limited to making

early gains interpersonally, not

resolving interpersonal deficits.

TERMINATION PHASE


90/119

TERMINATION PHASE

For time-limited treatment, important tokeep initial contract for 12-16 weeks

Termination Treatment issues

explicit discussion of termination during

last 3-4 sessions

acknowledge ending may involve loss and

grief

normalize fear, anger, sadness may need to distinguish sadness from

depression

TERMINATION ISSUES


91/119

TERMINATION ISSUES

Foster clients self-confidence incoping independently

Deflect clients attribution of success

to therapist Call attention to clients

accomplishments

Anticipate future difficulties with client help plan for future problems

rehearse explicit scenarios if helpful

discuss possibility of relapse of

TERMINATION


92/119

DIFFICULTIES

Failure for depression to resolve refer for other treatment, encourage hope

Client wants to continue

schedule 8 week waiting period

impart to client self-confidence in ability tocope

Maintenance IPT may be appropriate for:

chronic or recurring depression clients with personality problems or

interpersonal deficits

IPT IN GROUP FORMAT


93/119

IPT IN GROUP FORMAT

20 sessions over a 5-month period Therapeutic Stance

:warmth,support,empathy

Pre group meeting:

Assignment of the sick role,

Interpersonal inventory,

Development of the problem area(s)

Development of treatment goals Occur in a structured 2-hour pre-group

meeting

IPT IN GROUP FORMAT


94/119

IPT IN GROUP FORMAT

Important interpersonal skills arelearned while participating in a group

(e.g., interpersonal confrontation,

honest communication, expression offeelings)

IPT IN GROUP FORMAT


95/119

IPT IN GROUP FORMAT

Initial phase : 5 sessions Cultivate positive group norms and group

cohesion

Emphasizing the commonality of

symptoms among members and howthey will be addressed in the groupcontext.

Encouraged to review their goals withthe group

Make some initial changes in theirrespective interpersonal problem areas

IPT IN GROUP FORMAT


96/119

IPT IN GROUP FORMAT

Intermediate phase :6-15 Facilitate connections among

members as they share the work on

their goals with one another. Encourage group members to practice

newly acquired interpersonal skills in

& outside the group

IPT IN GROUP FORMAT


97/119

IPT IN GROUP FORMAT

Midtreatment meeting : Detailed review of each group

member's progress on his/her

individual problems and to refineinterpersonal goals

Termination phase :

Help members to consolidate theirwork & plan continued work

Assist in grieving loss of group.

IPT IN GROUP FORMAT


98/119

IPT IN GROUP FORMAT

Post treament meeting : 1 week after final group session

Develop an individualized plan for each

group member's continued work Maintaining IP focus :

Use of group summaries/self help

manuals

Group stage development theory

interventions - intensifies group

cohesiveness, prevents premature

dropouts

INDICATIONS


99/119

INDICATIONS

Major depressive disorder Bulimia nervosa

IPSRT(IP social rhythms therapy)

Bipolar disorderAnxiety disorders less evidence

Substance use,dysthymic disorders

no advantages


100/119

International society for IPTMay2000,Chicago

Manuals different age groups,subpopulations , different lengths,formats including telephoneadaptations

Basic principles followed:

No fault definition of illness Excusing pt from blame

Continued focus on relation b/w pts moodand life situations


101/119

Never indicated as monotherapy forpsychotic depression or bipolar disorder.

Complications : Straightforward therapy Treatment nonresponders should be evaluated

for possible prescription of an alternative,evidence-based treatment

Ethical issues : Require training andsupervision to develop proficiency

Specific IPT training guidelines(Weissmanet al)

Specific group training guidelines(Wilfley

et al)

Research & Evaluation


102/119

Research & Evaluation

Acute Treatment of major depression Boston-New Haven Study (1979)

4 Tx Groups (16 wks & 1yr follow-up):

IPT, amitriptyline, both combined, control IPT and amitriptyline equally effective

Combination IPT & Amitryptyline most

effective IPT grp. Sustained improved

psychosocial functioning 1 yr later (not in

AMI grp alone)

NIMH Treatment of DepressionCollaborative Research Program


103/119

Collaborative Research Program

(1989) 4 groups (16 wks, multi-site, N=250)

IPT, CBT, Imipramine & clinical

management (CM), placebo & CM

IPT comparable to Imipramine & CM

CBT showed somewhat less

improvement

IPT grp. had lowest attrition rate

Results for mod.-severe depression

Special population settings


104/119

Special population settings

Depressed primary care patients : 70% receiving IPT / nortriptyline

recovered in 8 mths

Depressed HIV + Patients Randomized study-101 pts

IPT+imipramine superior to CBT ,SPT

Peripartum depression :

CCTIPT > didactic education


105/119

Conjoint IPT for depressed patientswith marital disputes (IPT-CM)

Yale Univ. -18 pts -16 wks of IPT or IPT-

CM

Better marital adjustment,affection,sexual

relations

Depressed adolescents (IPT-A)

3 RCTsIPT > CBTself esteem and

social adaptaion


106/119

Maintainence treatment(Pittsburgh): 128 ptsIPT +imipramine for 4 mths

Remitted pts randomly assigned :

IMI+CM ,IMI+mthlyIPT,mthlyIPT ,mthlyIPT+placebo, pla+CM

Both IPT & Imipramine superior to

placebo

Bipolar disorder :IPSRT

HypothesisDisruption of social rhythms

destabilize & trigger relapse


107/119

Dysthymic disorder : Reconceptualize lifelong character

flaws ego-dystonic,chronic mood

dependent symptoms 3 RCTsimprovement in IPT +

sertraline combination significant


108/119

Non mood disorders : BulimiaFairburn modified IPTlong

term benefits,decreased binge eating

Anxiety disordersNot yet tested Substance useno efficacy in 3 CTs

Predictors of response


109/119

Predictors of response Social Dysfunction(higher function-

better)

Cognitive dysfunction

Expectation of improvement

Therapeutic alliance Endogeneity of depression-better

Double depressionpoorer outcome

Personality traitspoorer response Duration of current episode(longer-

worser)

Prior social judgement good

Case study


110/119

Case study

22y Brendan Depressed mood,poor

concentration,lethargy,reduced

appetite,sleep disturbance,suicidalideation since 3-4y,^since 3 mths

Sertraline 100 mgmod. Improvement

Carpenter by occupation ,haddifficulties with the way supervisor

talked to him .always quiet at

work,enjoyed work


111/119

1 good friend since primary school Felt uncertain around girls

Mother expired 2y backcancer

Not much contact with dad and elderbrother

O/Ecooperative,depressed mood

,restricted affect


112/119

IPT intervention Diagnosed MDD ,in partial remission

IP context + Supervisor diffIP dispute

Mothers death grief

Impoverished social networkIP sensitivity

IP inventoryattachment insecure

avoidant FormulationIPT focus created

Roles explained

Sessions 1-7-wkly,8-10-fortnightly,11-12

mthly


113/119

mthly

Middle sessions 3 problem areas

addressedpt was quite introverted

Dispute with supervisorpriority

Affect elicited and therapeutic

relationship established

Communication analysissupervisors

behaviour not personal

Brainstorming scenarios & role play

sessions-assertiveness

Next to grief

Seq of events related to moms death


114/119

Seq of events related to mom s death

recreate relationship

Process affect elicitedanger ,guilt

Next to utilise existing social supports to

develop new interests

Sought to develop stronger relationshipwith a maternal aunt & family friend

Socializing more with quieter men at

work Began to relax during events at tavern

secure base-looked for support &

uidance from thera ist


115/119

Termination phase discuss feelingsto prevent symptom intensification

Advised maintainence sessions if he

relapsed

FUTURE DIRECTIONS


116/119

FUTURE DIRECTIONS

1. Little is known about mechanisms bywhich interpersonal psychotherapyexerts its effects Greater understanding would assist in

further refinements and yield insightsabout nature of the psychiatric syndromeunder investigation.

2. Increased efforts to improve the

effectiveness of interpersonalpsychotherapy -altering the structure, identifying specific therapist

behaviors

FUTURE DIRECTIONS


117/119

FUTURE DIRECTIONS

3. Refining the definitions of the targetpopulations is advised

4. Need to translate interpersonal

psychotherapy efficacy data toeffectiveness studies and appropriate

clinical practice.

CONCLUSION


118/119

CONCLUSION

IPT stands, in contrast to other therapiesthrough an emphasis on the effects of apersons externalinterpersonalenvironment upon their mental health

Sufficient clinical trials conclude that IPTis an efficacious time limited treatmentfor a range of conditions,esp. depressionand bulimia

Manualised format makes it relativelyeasy to learn and apply.


119/119

Interpersonal Psychotherapy New

Documents

Transcript of Interpersonal Psychotherapy New