Interpersonal Psychotherapy

1
Interpersonal Psychotherapy

• Major Depression

2
Dealing with the Depression

• Review Depressive symptoms
• Give the syndrome a name
• Explain depression as medical illness, give it a
  name
• Give patient the sick role
• Evaluate need for medication

3
Relate Depression to Interpersonal Context

• Review past and current relationshipsas they
  relate to current depressive symptoms
• Nature of interactions with significant others
• Expectations of and from sig others were they
  fulfilled?
• Satisfying , unsatisfying aspects of the
  relationships
• Changes person wants in relationships

4
Identification of major problem areas

• Determine problem area related to depression and
  set goals
• Determine which relationship or aspect of
  relationship is related to depression and what
  might change it

5
Explain IPT and Contract

• Outline your understanding of problem
• Agree on treatment goals
• Describe procedures here and now focus, need to
  discuss important issues, review current
  relationships, discuss practical aspects of
  treatment

6
Intermediate Sessions the problem areas

• Grief
• Goals
• Facilitate mourning process
• Help patient reestablish interest and
  relationships to substitute for what has been
  lost
• Strategies
• review symptoms
• Relate symptoms to death of sig other
• Reconstruct relationship with deceased
• Sequence of events prior, during , after death
• Explore feelings
• Consider ways to get involved with others

7
Interpersonal Role Disputes

• Goals
• Identify dispute
• Choose plan of action
• Modify expectations or faulty communication to
  bring about a satisfactory resolution
• Strategies
• review symptoms
• relate symptoms to overt or covert dispute with
  sig other that person is currently involved with

8
Interpersonal Role Disputes

• Determine stage of dispute
• Renegotiation (calm down participants to resolve
  dispute)
• Impasse (increase disharmony in order to reopen
  negotiation)
• Dissolution (assist mourning)

9
Interpersonal Role Disputes

• Understand nonreciprocal role expectations
• What are the issues?
• Differences in expectations and values?
• Options?
• Likelihood of finding alternatives?
• Resources?

10
Interpersonal Role Disputes

• Are there parallels in other relationships?
• What is the person gaining?
• What unspoken assumptions lie behind the persons
  behavior?
• How is the dispute perpetuated?

11
Role Transitions

• Goals
• Mourning and acceptance of loss of old role
• Help patient to regard new role in more positive
  frame
• Restore self esteem sense of mastery regarding
  demands of new role

12
Role Transitions

• Strategies
• Review symptoms
• Relate symptoms to difficulty in handling life
  change
• Review and aspects of new and old role
• Explore feelings what is lost
• Feelings about change
• Opportunities in new role
• Realistically evaluate what is lost

13
Role Transitions

• Strategies
• Encourage appropriate release of affect
• Encourage development of social support system
  and new skills called for in new role

14
Interpersonal Deficits

• Goals
• Reduce patients social isolation
• Encourage formation of new relationships
• Strategies
• Review symptoms
• Relate symptoms to problems of social isolation
  or unfulfillment
• Review past significant relationships ( and -)

15
Interpersonal Deficits

• Strategies
• Explore repetitive patterns in relationships
• Discuss patients and feelings about
  therapist and seek parallels in other
  relationships

16
Termination

• Explicit discussion of termination
• Acknowledge termination as time for grieving
• Move toward patient recognition of independent
  competence
• Dealing with nonresponse
• Continuation/maintenance treatment

17
Therapist Role

• Patient advocate, not neutral
• Active, not passive
• Relationship not interpreted as transference
• Therapeutic relationship is not a friendship