Interpersonal Short Term Psychotherapy for Depression
Treating depression with Interpersonal therapy:
Several years ago, I had the opportunity to participate in a scientific study of the treatment of depression through Interpersonal Short Term Psychotherapy, (IPT). The study was done through the New York Psychiatric Institute with funding by the NIMH. I was supervised for three years by Laura Mufson, PhD. who was the psychologist who developed the modality.
The treatment followed a manualized protocol of techniques that had to be uniformly followed by all the therapists selected to apply the IPT therapy. The following is a general outline of what the treatment consisted of.
These are the basic concepts:
Select one problem areas out of five possible ones.
Define the “limited sick role”.
Have one or two sessions with parents.
Role play new social behavior.
Review symptoms on every session.
Educate client on how to prevent a relapse of the depression.
The five problems areas:
Interpersonal disputes (role disputes)
Therapist will explore with the client the most important relationships in their lives, looking to find situations that are causing the client to have anger or other conflictive feelings towards another person. Client will be helped to own and express their feelings in a healthy way.
Role transitions.
The therapist will explore with the client, if there have been major changes in the social environment, such as school, moved from another city or country, changed jobs, ended a relationship, etc.. Therapist will assess how the he or she has been coping with the changes and if there are conditions that are causing the client to feel isolated, lonely, invalidated, etc.
Grief.
The therapist will ask the client if there have been any major loses in client’s life, such as the passing of a loved one, moving, chronic illness, etc. The emotions and reactions that the situation is triggering for the client will be explored and he or she will be assisted in identifying and expressing those emotions.
Interpersonal deficits.
Client will be assessed to see how he or she is functioning in the social environment and if there are enough connections or if the client is lacking in social skills to develop a supportive social network or friends. The therapist will then help the client learn skills to make new friends and link up with others for additional support.
Single parent family.
This problem area is used only for adolescents clients, it’s purpose is to mainly deal with family conflicts emanating from the dynamics where roles are under stress, due to the absence of one parent. Because of financial pressures, the one available parent, may not be as available to the children because needing to work extra in order to sustain the family. Conflictive emotions are explored, and strategies for improving relationship in the family are discussed.
Select one problem areas out of five possible ones:
People usually have several problems at once, which can be overwhelming for them and the therapist. So the first step is to keep things simple, help the client sort out the problems and triage them in order of importance. We focus first on the interpersonal dimension of the person’s life, rather than the inner workings of his mind. Following the guidelines outlined above, we choose only one problem area, even if the client also fits the description of other ones.
Define the “limited sick role”:
As part of educating the client about the disease of depression and the treatment ahead, the client is assigned a “limited sick role”. This means that the client is given permission to take it easy as with any other illness, where the person needs to rest. This also similar to the aspect of self care, where the client is urged identify and meet his needs.
Have one or two sessions with parents:
Parents are the foundation of the adolescent’s interpersonal relationships. Therefore will be educated about depression, the symptoms and its treatment. It the parents are part of the role conflicts, they will be invited again in order to be part of a mediation process in order to defuse the issues.
Role play new social behavior:
This is very much like the fourth pillar of therapy which describes the aspect of therapy based on practice. Through role playing with the therapist, the client is able to learn or sharpen the social skills needed to have positive interpersonal relationships.
Review symptoms at the start of every session:
After the client is given a thorough assessment of the symptoms of depression, each session will start with a “symptom review”. This will help client learn to talk about his emotions and become more aware of how their emotions influence their life. This is a good process for the client to develop emotional intelligence. This sharper awareness will teach client to see that their emotions are in a more constant flux than they realized. This awareness also facilitates the client gaining more control over their emotions and moods.
Educate client on how to prevent a relapse of the depression:
The client is taught how to identify different triggers that can bring about symptoms of depression and to prevent a relapse. They will be encouraged to seek help and support from others in order to not fall back into unproductive coping style such as isolation.
The outcome of the study showed that participants were able to overcome many of the symptoms of depression in an average of eight weeks. This treatment modality was used without the aid of anti depression medication because adolescents have a tendency to be resistant to comply with taking psychotropic medications.