Interpersonal psychotherapy final

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A school assignment on interpersonal psychotherapy

Interpersonal psychotherapy final

  1. 1. INTERPERSONAL PSYCHOTHERAPY By: Teo Qian Hua Chen Xiu Wen Teo Meijun Gerald L. Klerman & Myrna M. Weissman
  2. 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. 3. Gerald L. Klerman Myrna M. Weissman INTERPERSONAL PSYCHOTHERAPY
  4. 4. DUAL GOAL OF IPT Symptom remission Solve interpersonal problems related to depression IPT
  5. 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. 6. THEORETICAL BASIS ü Attachment theory ü People have 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. 7. 3 PHASES OF IPT Initial phase Intermediate phase Termination Phase
  8. 8. Initial phase ü Diagnosis ü Psycho-education •  Symptoms and behaviors of depression •  Assign ‘sick role’ to patient ü Identify interpersonal issues most related to current depression •  4 problem areas
  9. 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. 10. ü Treatment contract ü Specify respective roles ü Focus of problem areas ü Practical details of treatment Initial phase
  11. 11. ü Work on indentified problem areas ü Further clarification ü Implement strategies Intermediate phase
  12. 12. GRIEF DUE TO DEATH ü Goal ü Facilitate resolution of grieving process
  13. 13. GRIEF DUE TO DEATH 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. 14. ROLE DISPUTES ü 3 stages in a dispute ü Renegotiation ü Impasse ü Dissolution
  15. 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. 16. ROLE TRANSITION ü Goal ü Help patients relinquish 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. 17. INTERPERSONAL DEFICITS ü Goal ü Improve interpersonal relationships ü Strategies ü Explore repetitive interpersonal problems ü Teach skills for building and maintaining relationships ü Reinforce positive communication patterns
  18. 18. ü  Reviews the patient’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
  19. 19. TECHNIQUES
  20. 20. ü Targeted at ü Providing patients with the skills to change interpersonal relationship ü Improving their mood ü Different combinations of techniques used according to their problem area(s)
  21. 21. THERAPEUTIC ALLIANCE ü Essential in predicting 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. 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. 23. COMMUNICATION ANALYSIS ü Understand patient’s patterns of interactions ü Recognize ineffective communication skills ü Acquire better communication skills
  24. 24. DECISION ANALYSIS ü Processes involved ü Identify a 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. 25. ROLE PLAYING ü Discuss, model and 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. 26. EFFICACY AND EFFECTIVENESS of IPT as a treatment to Major Depression & Other psychiatric illness
  27. 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. 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. 29. TREATMENT FOR MAJOR DEPRESSION Different population 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
  30. 30. TREATMENT FOR MAJOR DEPRESSION Different population Geriatric patients 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. 31. IPT AS A TREATMENT For Other 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. 32. IPT AS A TREATMENT For Other 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. 33. IPT AS A TREATMENT For Other 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. 34. AN APPLICATION OF INTERPERSONAL PSYCHOTHERAPY A Case of an Adolescent Bully-Victim
  35. 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. 36. AN APPLICATION OF INTERPERSONAL PSYCHOTHERAPY A Case 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. 37. A Case of an 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. 38. A Case of an 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. 39. AN APPLICATION OF INTERPERSONAL PSYCHOTHERAPY A Case 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. 40. THANK YOU VERY MUCH Good-bye and Have a nice day!

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