The Social Work Podcast: Interpersonal Psychotherapy (IPT)
phase incorporates assessment, interpersonal inventory, formulation and treatment The literature of clinical practice of interpersonal therapy in. Portugal is . identifying the relationship as import but being unsatisfied with. IPT has been tested with general success in a series of clinical trials for mood an "interpersonal inventory", a review of the patient's patterns in relationships. Therapists testing IPT-B in randomized controlled trials conduct at least two .. of interpersonal relationships measured by the Significant Others Scale (Power.
To include comparison groups, outcomes, measures, notable limitations This study compared a group receiving Interpersonal Psychotherapy IPT for antepartum depression to a parenting education control program. Results indicate that the IPT group showed significant improvement compared to the parenting education control program on all three measures of mood at termination. Limitations include high attrition rate, generalizability due to gender and ethnicity and lack of follow-up.
Group Interpersonal Psychotherapy for depression in rural Uganda. Journal of the American Medical Association, 23 To include comparison groups, outcomes, measures, notable limitations This study examined the efficacy of group Interpersonal Psychotherapy IPT in relieving depressive symptoms and improving functioning and evaluated the feasibility of such studies in sub-Saharan Africa.
Randomization was done at the village level, with sample groups of men or women in each eligible village assigned to either the IPT intervention group or a no-treatment control group. Results indicate that the IPT group participants showed significantly greater improvements in depression scores than those in the control condition.
Female IPT group members also showed greater improvement in all but one measured task consoling the bereaved. Changes in task performance were not statistically significant for men. Limitations include no attempt was made to find out about any treatment control group participants might have sought for their symptoms during the study period, possible interviewer bias, and length of follow-up. Group interpersonal psychotherapy for depression in rural Uganda: British Journal of Psychiatry, To include comparison groups, outcomes, measures, notable limitations This study examines the long-term effectiveness of a community-based group Interpersonal Psychotherapy IPT trial conducted in rural Uganda.
The study aim was to determine whether the substantial treatment benefits found immediately following the formal intervention were maintained 6 months later. Randomization to the intervention or treatment as usual study arms was by village, so that all participants in each study village belonged to the same study arm. Measures utilized include Hopkins Symptom Checklist HSCL and a gender-specific questionnaire assessing functional impairment on important activities.
Improvements in depression symptoms were maintained between 2 weeks and 6 months after the intervention. Limitations include possible effect of other therapies not evaluated, lack of control group and length of follow-up.
The efficacy of interpersonal psychotherapy for depression among economically disadvantaged mothers. One of the most important advances in attachment theory was the identification of distinct organized attachment systems. Ainsworth and colleagues in published a paper that identified the first three distinct organized attachment systems and they were the secure, the anxious or resistant and the avoidant attachment styles.
A fourth attachment style called disorganized or disoriented was added in the mids by Main and Solomon to describe infants who displayed no organized attachment system.
Attachment theory provides not only a framework for understanding emotional reactions in infants but also a framework for understanding love, loneliness, and grief in adults. Another theoretical basis for IPT is interpersonal theory. One of the ideas in interpersonal theory is that people lie along dimensions of hostility or friendliness, and dominance and submission.
And so any one person can be more dominant and friendly or more dominant and hostile or more submissive and hostile or more submissive and friendly. The theory also holds that people can be either more flexible or more rigid in any of these quadrants, so somebody can be dominant in some situations, but submissive in others, friendly or hostile depending on the situation.
However, there are some people for whom hostility or submissiveness are the primary modes of interpersonal relations almost regardless of the situation. Those folks will be considered rigid. So you have attachment theory and interpersonal theory. Both suggesting that we have interpersonal relationship patterns that were developed early in our life and that continue throughout time. And this is really the psychodynamic basis for interpersonal therapy. The epidemiological and empirical data as well as the theoretical justifications led the developers of IPT to identify four interpersonal relationship patterns that are most important to treat when working with people who are depressed.
And this could be between partners, ot could be between an employee and a boss, it could be between a parent and a child.
It reflects long term interpersonal problems and is described as having the worst prognosis. In the brief version of IPT, interpersonal deficits are not addressed simply because it's not possible to satisfactorily resolve any long standing interpersonal problems in four to eight sessions. It's also considered the category that is picked when none of the other three actually fits what's going on with the client. Mood is seen as related to life events. Depression is seen as a medical illness with interpersonal triggers and consequences.
Symptom reduction is understood to occur by focusing on current interpersonal functioning. So, again, this is the contemporary nature of IPT that although there is an understanding of the importance of interpersonal patterns that developed in the past, the focus is on the present. And finally, IPT is a time-limited treatment and that being time-limited is valuable.
So as a time-limited treatment, goals different from long term therapy. The treatment targets specific symptoms. What it does not do is it does not address character change. Also, time can be used as a leverage.
Interpersonal Psychotherapy for Older Adults - Oxford Research Encyclopedia of Psychology
And by this, what I mean is that your client should hear the ticking of the clock which can be used as a motivator for the client to make changes in a short period of time. This is in contrast to a long term treatment where there might not be that external motivation to get things moving. Assessment So, assessment is really important in IPT. It's systematic and is directly related to the intervention. In IPT, you start out with understanding the timeline of events leading up to the depression.
You use an interpersonal inventory that helps to identify which interpersonal pattern would be most important to address over the 12 to 16 sessions. The Hamilton Depression Rating Scale although not used to diagnose depression is recommended for use in treatment in the initial phase of the assessment as well as standardized measures such as the Beck Depression Inventory. The therapist is an active participant in this process. This is different than Freudian psychoanalysis where the therapist really was a blank slate and was there to interpret and to be the expert, but not really to be actively involved in the relationship.
The therapist is not a neutral figure. Again, this is different than traditional Freudian psychoanalysis. The therapist is responsible for assessing the client and making the DSM diagnosis. And finally, the therapist defines the treatment and what I mean by this is that the therapist tells the client what type of interpersonal relationship issue they will focus on.
My job is to be here and to sort of understand the process of treatment, but not to understand what my client is going to do.
In IPT however, it is short term. There are specific things that can be worked on and so the therapist really has a responsibility to define that for the client and part of that definition is letting the client know what their role is in treatment.
Their role most importantly is as the sick role. Sometimes this is analogized as similar to a person with diabetes. That is, they're in need of professional support and intervention. The first is the initial phase and this is where you do your assessment and identify the problem area for treatment.
In the middle phase, you have the treatment focus based on different problem areas, so even though are four problem areas in traditional IPT the middle phase would be an in-depth focus on one of them. In the termination phase, you identify treatment gains and unaddressed problems.
You elicit thoughts and feelings about the end of treatment and you make referrals and follow ups. Goals of Treatment Now, the goals for treatment in general are symptom relief from depression and improved interpersonal functioning. Each problem area has its own set of specific treatment goals and objectives. Now, some of the treatment techniques that are most commonly utilized in interpersonal therapy regardless of the problem area include psychoeducation and this includes providing accurate information about depression, modeling of behaviors, problem solving, for example, helping the clients explore options and also limit setting and this is both in the session and also understanding — helping clients set limits in their own lives outside of the therapy session.
Two other techniques that I find really useful are communication analysis and role play. In communication analysis, what you do is you get the client to provide a detailed account of a conversation, an argument with the significant other and you really focus on the feelings and intentions. So, you're looking for what is said, felt, intended wished for or understood.
In role play, what you do is you ask your client to describe a problematic situation and then you ask your client to play him or herself and you play the significant other. In this role play, you want to make sure that your client is correcting you if your responses do not approximate the responses of the significant other.
One it makes the role play more realistic. So once you do that, the — you as the therapist work really hard to minimize anxiety associated with the role play.
You can switch the roles so that you as the therapist play your client and your client gets to play the significant other and at any time you as the therapist can what they call break character to comment on the process or to provide some guidance for your client. So, again, in the initial sessions, what you're doing is you're focusing on the mood by establishing rapport, providing a diagnosis of depression, you're providing psychoeducation and you're educating your client on the sick role.
You also address — you also do the interpersonal inventory. You establish what the problem area is. You develop the interpersonal formulation and ultimately you try to instill hope. One of the things that you can do to help distinguish the patient from the depression is to provide psychoeducation about depression as a medical illness.
This can remove blame from the patient. It can also convey hope because the problem is well understood and also treatable.
It can normalize the problem and by normalizing I mean that it makes the client not feel so different because what's true is that one out of five women will experience an episode of depression during her lifetime. It also identifies the problem as time-limited and finally psychoeducation clarifies the expectation that your client will actively work to change. So once you provide the psychoeducation, you do the case formulation and all the other components of the initial phase, you're ready to set the stage for the middle phase.