Interpersonal psychotherapy of depression

Abstract

Among a variety of short term psychotherapies created to treat depression IPT (Interpersonal Therapy) by Klerman et al. (1984) is meanwhile one of the most well known and widespread used approaches. A variety of studies have shown empiric evidence of its efficacy. IPT's most influential theoretical grounds are Bowlby´s attachment theory and the interpersonal school of psychiatry (Sullivan), assuming that all psychiatric illnesses incl. depression develop in an interpersonal context: problems areas in interpersonal relations may contribute to onset and potentially chronicity of current depression or/and depressive symptoms may interfere with interpersonal well being/psychosocial functioning.

Based on empirical studies on e.g. life events, social support, stress & depression the authors defined four problem areas:

1. 1) complicated grief

2. 2) interpersonal conflict

3. 3) interpersonal role conflict/role transition and

4. 4) interpersonal deficits/isolation

The therapy is divided in 3 phases: In the initial 3-4 sessions the patients current depression is individually attributed to one of the four problem areas on which will exclusively be focused on within the main therapy section. IPT works in a “here-and-now” framework and connects state and change of depressive symptoms with state and change of (realtime) interpersonal functioning and well being through therapeutic work. The dual goals of IPT are achieving symptom remission and solving attributed interpersonal problem by promoting the interpersonal skills of patients both within and outside the therapeutic setting.

Open and focused exploration, psychoeducation (patient as expert of his/her illness), the transportation of the sick role (Parsons 1954), assessment of the interpersonal inventory/interpersonal resources, instilling hope, the definition of patients and therapist role during therapy, the explanation of the IPT concept, the agreement on the problem area and a therapy contract are basic procedures within introductory sessions in IPT.

In the main period (3/4-14 sessions) patient and therapist work on explore the agreed-upon focus. The IPT manual describes goals and treatment strategies for each problem area. Clarification, self disclosure, communication analysis, option seeking etc. are main techniques in IPT.

During termination period the patient recognizes what was gained, what impairments, problems are left. The motivation for booster sessions (maintenance) is clarified and the patient is prepared about prophylaxis and how to manage crises in the future.

This CME course is meant to teach IPT basics enabling participants of the course to start practicising IPT under supervision. It will be focused explicitly on the following aspects:

• • time frame

• • medical model

• • dual goals of solving interpersonal problems and symptom remission

• • interpersonal focus on patients affective engagement solving current life problems contributing to current depression

• • specific and general psychotherapeutic techniques and

• • empirical support of IPT

Short role-playing will be used to train IPT techniques. A handout will be available.