Overview Interpersonal Psychotherapy of Depression

Jonathan Lichtmacher, MD University of California, San Francisco February 2008

Goals and strategies Getting going Manualized treatments

CASE

IPT Overview
Brief treatment: 16 sessions Designed specifically for depression Focus is on interpersonal stressors that precipitate depression Goals:
Resolution of symptoms Mastery of an interpersonal problem Development of skills to prevent recurrence Support of patients autonomy

Etiology of Depression
Genetic Biological Developmental Psychosocial Stressor

IPT Overview
Brief treatment: 16 sessions (Termination) Designed specifically for depression Focus is on interpersonal stressors that precipitate depression Goals of IPT:
Resolve symptoms Master an interpersonal problem Develop skills to prevent recurrence Support patients autonomy

Early Interventions
History Diagnosis Educate Medicate if needed Review options for treatment Inject optimism

3 Phases of Treatment
I Preparing the patient for IPT
Evaluate Formulate (3-4 sessions)

II - The middle phase

Therapy unfolds (8 sessions)

III Termination
Acknowledge successes/losses (4 sessions)

IPT Exclusion Criteria

Psychotic Current Substance Abuse Acute Suicidality Bipolar Depression

Therapists Stance
Therapist is supportive/collaborative Therapist promotes positive transference Therapy is not anchored in transference, i.e. not interested in promoting regression Focus on current important relationships Generally relaxed, friendly, encouraging, permission giving.

Depression as framework
Enormously helpful for patients to see a cause and effect Behavior or communication can lead to depression Issues around assertiveness and the management of aggression are common

Preparing the Patient

Evaluate and diagnose Educate medical model to reduce shame Medicate if indicated Collaborate on getting well Formulate in a way that is self-evident to the patient

Phase I IPT specific strategies

Sick role Interpersonal inventory Set end date Choose one of 4 foci

IPT foci for formulation

Grief Role dispute Role transition Interpersonal deficits

Formulation
The formulation is a simplifying fiction, a plausible construct that organizes the patient to focus in treatment on an interpersonal life problem. JC Markowitz 2004

What if patient wants to talk about early traumas? Specific Techniques

Identifying feeling states Communication analysis Decision analysis Role play Emote and re-focus Use your intuition as a therapist

IPT Tools for Setting the Frame

How have things been going since we last met? Patient instructions for middle phase: Your job is to bring into the therapy things that come up between sessions that you have strong feelings about including me.

Manualized Treatments
All treatments are basically manualized. CBT is more specific IPT is goal directed, but once the frame is set, the process is organic to the two people in the room

The manual provides the framework

Follow-up
8 weeks Check in Reevaluate needs

Summary
IPT is researched treatment specifically for depression IPT uses dx of depression and the patients wish to not be depressed as the engine of the treatment Therapist uses positive transference The termination supports patient autonomy and speeds up the treatment

Website
www.interpersonalpsychotherapy. org