News and Events
2000 Wyeth-Ayerst American Psychiatric Association Resident Reporter
JANICE C. VEENHUIZEN MD
Interpersonal psychotherapy or IPT is a brief and time limited manualized treatment for depression with demonstrated efficacy. Therapy is based on the relationship between depression and interpersonal problems in one of four areas: grief (complicated bereavement), role disputes, role transitions, or interpersonal deficits. Therapists take an active nonneutral role, working with the patient using specific strategies to solve the interpersonal problem area that has become the focus of treatment. Depression symptoms are monitored and improvement is noted as interpersonal problem areas are addressed.
The treatment lasts approximately 12 to 16 sessions with defined initial, middle, and termination periods. The initial sessions last for one to three sessions. The sessions begin with a standard psychiatric evaluation and diagnosis of depression. Tools such as Hamilton D rating scales are used in diagnosis and to track progress. Next an interpersonal inventory takes place to establish the problem area. This includes, for example, evaluation of who the patients’ significant others are, as well as the patients’ social supports and any difficult relationships they have. The patient is asked if anyone has died recently and if the death was antecedent to the depression as well as being asked about other recent life changes.
Once the diagnosis and interpersonal problem areas have been established the patient is given an interpersonal diagnostic formulation and a treatment plan is established. This is discussed with the patient who is given the “sick role”. By giving the patient the sick role they can displace their guilt feelings such as being weak or bad off of themselves and onto the illness. The therapist explains the nature of depression including DSM IV diagnosis and Hamilton D rating scales. The patient is told they have an illness that is treatable. This portion of the therapy includes a great deal of psychoeducation and instillation of hope. Once the patient agrees to the interpersonal formulation and the therapeutic alliance is established the therapist moves onto the middles session of treatment which last for about 3 to 12 sessions.
The treatment focus in the middle sessions is on the interpersonal problem areas designated most important in the interpersonal formulation. Specific IPT strategies are used to tackle each problem area. Each session begins with an open ended question and ends with a summary. If the problem area is grief a complicated bereavement issue would be explored. In role disputes relationships with spouses, family members, friends and coworkers are examined. In role transition problems issues such as divorce, birth of a child, loss of a job, or empty nest syndrome are worked on. If a patient does not have a problem in the above areas it is assumed that they have interpersonal deficits and are socially isolated. This is then actively addressed.
The last three sessions are the termination sessions. During this time gains are consolidated. There is discussion of patients progress and accomplishments are pointed out as well as a fostering of patients independence. Termination feelings of sadness are explicitly discussed and the patient is reminded that sadness does not equal depression. Prevention of relapse is addressed. In a patient with a history of several episodes of depression consideration of maintenance treatment is evaluated. Treatment is ended on the pre-specified 12th to 16th session.
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