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Interpersonal psychotherapy final
Interpersonal psychotherapy (IPT) is a time-limited, 12-20 session psychotherapy designed to treat depression. It focuses on interpersonal relationships and how disruptions in relationships may contribute to depression. IPT has three phases - initial, intermediate, and termination. In the initial phase, the therapist diagnoses depression, educates the patient, and identifies problematic relationship areas. Common problem areas addressed in IPT include grief, disputes, role transitions, and interpersonal deficits. In the intermediate phase, the therapist works with the patient to address the identified problems and improve interpersonal skills. The termination phase reviews progress and prepares the patient to end treatment. IPT has been shown to be an effective treatment for depression and other disorders by resolving inter
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Interpersonal psychotherapy final
- 1. INTERPERSONAL PSYCHOTHERAPY By: Teo QianHua Chen Xiu Wen Teo Meijun Gerald L. Klerman & Myrna M. Weissman
- 2. INTERPERSONAL PSYCHOTHERAPY ü Time-limited therapy(12-20 sessions) ü Especially designed for depression ü ‘here-and-now’ framework Focus on current interpersonal issues ü Medical model Depression as treatable
- 3. Gerald L. Klerman Myrna M. Weissman INTERPERSONAL PSYCHOTHERAPY
- 4. DUAL GOAL OFIPT Symptom remission Solve interpersonal problems related to depression IPT
- 5. THEORETICAL BASIS ü Interpersonal theory ü Adolf Meyer & Harry Stack Sullivan ü Focus on the importance of interpersonal relationships in determining behavior ü Psychological illness develops out of interpersonal disruptions ü Help patients to increase their understanding of the interpersonal events that triggered depression
- 6. THEORETICAL BASIS ü Attachment theory ü Peoplehave the fundamental need to form strong bonds with others. ü When these bonds are disrupted, the individual will experience emotional distress ü IPT targets interpersonal relationships that may affect patient’s attachment experiences
- 7. 3 PHASES OFIPT Initial phase Intermediate phase Termination Phase
- 8. Initial phase ü Diagnosis ü Psycho-education • Symptomsand behaviors of depression • Assign ‘sick role’ to patient ü Identify interpersonal issues most related to current depression • 4 problem areas
- 9. FOUR PROBLEM AREAS Grief • Death of a loved one • Prolonged grief Interpersonal disputes • Two parties or more have nonreciprocal expectations about the terms for behavior within relationship Role transitions • Adjustment to a life change that requires an alteration of behavior from old role to new role Interpersonal deficits • Patients who experience: • Feelings of loneliness • Paucity of relationships • Underdevelope d social and communication skills
- 10. ü Treatment contract ü Specify respectiveroles ü Focus of problem areas ü Practical details of treatment Initial phase
- 11. ü Work on indentifiedproblem areas ü Further clarification ü Implement strategies Intermediate phase
- 12. GRIEF DUE TODEATH ü Goal ü Facilitate resolution of grieving process
- 13. GRIEF DUE TODEATH ü Strategies ü Review +/- aspects of relationship with deceased ü Encourage expression of emotions ü Taught skills for communicating loss ü Apply skills to other significant relationships ü Establish new or furthering existing relationships
- 14. ROLE DISPUTES ü 3 stagesin a dispute ü Renegotiation ü Impasse ü Dissolution
- 15. ROLE DISPUTES ü Goals& Strategies ü In renegotiation and impasse stage ü Help to resolve conflict • Identification of communication patterns • Teaching new communication skills • Generating solutions to dispute ü Dissolution stage ü Focus on mourning of loss • Help patient understand situation • Feel at ease to form new relationships
- 16. ROLE TRANSITION ü Goal ü Help patientsrelinquish old roles ü Accept new roles ü Develop a sense of mastery in the new role ü Strategies ü Explore meanings, feelings and expectations regarding transition ü Learn new interpersonal skills ü Develop social support around transition
- 17. INTERPERSONAL DEFICITS ü Goal ü Improve interpersonalrelationships ü Strategies ü Explore repetitive interpersonal problems ü Teach skills for building and maintaining relationships ü Reinforce positive communication patterns
- 18. ü Reviews thepatient’s course of depressive symptoms and how they have changed ü Review changes in interpersonal functioning ü Link these changes to the improvement in the patient’s mood ü Highlight skills and strategies that were particularly useful ü Discuss end of treatment ü Address possibility that depression might recur ü Warn symptoms ü Teach strategies Termination phase
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- 20. ü Targeted at ü Providingpatients with the skills to change interpersonal relationship ü Improving their mood ü Different combinations of techniques used according to their problem area(s)
- 21. THERAPEUTIC ALLIANCE ü Essential inpredicting therapeutic change ü Provide information about the patient ü Provide a safe environment to bring about therapeutic change ü Without therapeutic alliance, other techniques may become ineffective
- 22. ENCOURAGEMENT OF AFFECT& CONNECTION WITH INTERPERSONAL EVENT ü Help patients become aware of, acknowledge and accept emotions about relationships ü Understand impact of affect on relationships ü Learn to negotiate interpersonal experiences more effectively ü Observe that –ve interpersonal events are associated with decline in mood and +ve changes are associated with improvement in mood Content and Process Affect ü Content Affect: Affect reported by patient ü Process Affect: Affect demonstrated by patient ü Observing for INCONGRUITY
- 23. COMMUNICATION ANALYSIS ü Understand patient’s patternsof interactions ü Recognize ineffective communication skills ü Acquire better communication skills
- 24. DECISION ANALYSIS ü Processes involved ü Identifya problematic interpersonal situation ü Formulate a goal ü Generate potential solution ü Evaluate and choose a strategy ü Consider the different actions one can take when faced with interpersonal difficulties
- 25. ROLE PLAYING ü Discuss, modeland practice the skills they have gained through therapy ü More comfortable and competent in transferring the skills to real life situations ü Allow therapist to observe and correct skills deficits that arises ü Not suitable for all patients
- 26. EFFICACY AND EFFECTIVENESS of IPT asa treatment to Major Depression & Other psychiatric illness
- 27. TREATMENT FOR MAJOR DEPRESSION Acute Treatment ü NIMH Treatment of Depression Collaborative Research Program (Elkin et al., 1989) ü Treatment groups • Imipramine, IPT, CBT, Placebo ü Reduction in depressive symptoms & improved functioning ü Severely depressed patients • IPT comparable to IMI and superior to placebo ü Follow-up • No significant differences in recovery (Shea et al., 1992)
- 28. Maintenance Treatment ü Maintenance Treatment • First tested with 150 acutely depressed female outpatients (Klerman et al. 1974) • IPT improved social functioning ü Meta-analysis (Mello et al., 2005) • 13 studies • IPT superior to placebo • similar to medication • more efficacious than CBT TREATMENT FOR MAJOR DEPRESSION
- 29. TREATMENT FOR MAJOR DEPRESSION Different population Adolescentpatients: Improvement in ü depressive symptoms ü functioning with friends ü problem-solving skills ü overall social functioning (Mufson et al., 1999) ü Effective in school- based clinic
- 30. TREATMENT FOR MAJOR DEPRESSION Different population Geriatricpatients ü combined treatment with nortriptyline & IPT was superior to IPT/medication alone (Reynolds et al., 1999) ü IPT alone less effective for older patients Adolescent patients: Improvement in ü depressive symptoms ü functioning with friends ü problem-solving skills ü overall social functioning (Mufson et al., 1999) ü Effective in school- based clinic
- 31. IPT AS A TREATMENT ForOther Psychiatric Illnesses ü Bipolar Disorder IPSRT was found superior to the comparison condition in delaying recurrence of depressive and manic episodes for acutely ill bipolar patients (Frank et al., 2005)
- 32. IPT AS A TREATMENT ForOther Psychiatric Illnesses ü Bulimia Nervosa 18 weeks of IPT, CBT or a behavior therapy control IPT has benefits comparable to those of CBT and superior to those of the control condition (Agras et al. 2000)
- 33. IPT AS A TREATMENT ForOther Psychiatric Illnesses ü Substance Dependence A study of 42 subjects with cocaine abuse who were attempting to achieve abstinence IPT was ineffective than a behavioral control therapy (Carroll et al. 1991)
- 34. AN APPLICATION OF INTERPERSONAL PSYCHOTHERAPY A Caseof an Adolescent Bully-Victim
- 35. AN APPLICATION OF INTERPERSONAL PSYCHOTHERAPY ü Adolescent Bully-victims ü Rising bullying cases in schools ü Increased risk of depression and suicidal ideation among bully victims (Chambless, 2010) ü IPT as an effective in treating adolescent patients and depression
- 36. AN APPLICATION OF INTERPERSONAL PSYCHOTHERAPY ACase of an Adolescent Bully-Victim Initial Intermediate Termination ü Assigning of “sick role” Inform adolescent of depression ü Restrictive Families Adolescent boys are more likely to become victims ü Bully-victims have less teacher and peer support ü Focus on present circumstances Free them of self-criticism
- 37. A Case ofan Adolescent Bully-Victim Initial Intermediate Termination AN APPLICATION OF INTERPERSONAL PSYCHOTHERAPY ü Disputes with parents • That leads to maladaptive communication patterns ü Goals: Self-assertion and communication • Expressions of feelings and problems ü Role-playing • Anticipate problems and rehearse expression of emotions in disputes Problem Area 1: Interpersonal Dispute
- 38. A Case ofan Adolescent Bully-Victim Initial Intermediate Termination AN APPLICATION OF INTERPERSONAL PSYCHOTHERAPY ü Past bully incidents • negative preconceptions of people ü Goal: reduce social isolation • Explore the distorted feelings toward people • New skills for building and maintaining relationships ü Role-playing • Practice the new skills Problem Area 2: Interpersonal Deficits
- 39. AN APPLICATION OF INTERPERSONAL PSYCHOTHERAPY ACase of an Adolescent Bully-Victim Initial Intermediate Termination ü Help adolescent recognize gains in self-assertion ü Calling into attention patient’s independent successes ü Discuss potential recurrent symptoms and how to handle them
- 40. THANK YOU VERY MUCH Good-bye andHave a nice day!