Interpersonal psychotherapy

Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery. It is an empirically supported treatment (EST) that follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks. IPT is based on the principle that relationships and life events impact mood and that the reverse is also true.[1][2] It was developed by Gerald Klerman and Myrna Weissman for major depression in the 1970s and has since been adapted for other mental disorders.[3] IPT is an empirically validated intervention for depressive disorders, and is more effective when used in combination with psychiatric medications. Along with cognitive behavioral therapy (CBT), IPT is recommended in treatment guidelines as a psychosocial treatment of choice,[4][5] and IPT and CBT are the only psychosocial interventions that psychiatry residents in the United States are mandated to be trained for professional practice.[6]

History

Originally named "high contact" therapy, IPT was first developed in 1969 at Yale University as part of a study designed by Gerald Klerman, Myrna Weissman and colleagues to test the efficacy of an antidepressant with and without psychotherapy as maintenance treatment of depression.[7][8] IPT has been studied in many research protocols since its development.[9][10] NIMH-TDCRP demonstrated the efficacy of IPT as a maintenance treatment and delineated some contributing factors.[11]

Foundations

IPT was influenced by CBT as well as psychodynamic approaches. It takes its structure from CBT in that it is time-limited, employs homework, and structured interviews and assessment tools.[12]

The content of IPT's therapy was inspired by Attachment theory and Harry Stack Sullivan's Interpersonal theory. Social theory is also influenced in a lesser role to emphasis on qualitative impact of social support networks for recovery.[13] Unlike psychodynamic approaches, IPT does not include a personality theory or attempt to conceptualize or treat personality but focuses on humanistic applications of interpersonal sensitivity.[14][15]

The aim of IPT is to help the patient to improve interpersonal and intrapersonal communication skills within relationships and to develop social support network with realistic expectations to deal with the crises precipitated in distress' and to weather 'interpersonal storms'.

Clinical applications

It has been demonstrated to be an effective treatment for depression and has been modified to treat other psychiatric disorders such as substance use disorders and eating disorders. It is incumbent upon the therapist in the treatment to quickly establish a therapeutic alliance with positive countertransference of warmth, empathy, affective attunement and positive regard for encouraging a positive transferential relationship, from which the patient is able to seek help from the therapist despite resistance. It is primarily used as a short-term therapy completed in 12–16 weeks, but it has also been used as a maintenance therapy for patients with recurrent depression.[19]

Interpersonal psychotherapy has been proven as an effective treatment for the following:[20]

Adolescents

Although originally developed as an individual therapy for adults, IPT has been modified for use with adolescents and older adults.[20]

IPT for children is based on the premise that depression occurs in the context of an individual's relationships regardless of its origins in biology or genetics. More specifically, depression affects people's relationships and these relationships further affect our mood. The IPT model identifies four general areas in which a person may be having relationship difficulties:

  1. grief after the loss of a loved one;
  2. conflict in significant relationships, including a client's relationship with his or her own self;[23]
  3. difficulties adapting to changes in relationships or life circumstances; and
  4. difficulties stemming from social isolation.[20]

The IPT therapist helps identify areas in need of skill-building to improve the client's relationships and decrease the depressive symptoms. Over time, the client learns to link changes in mood to events occurring in his/her relationships, communicate feelings and expectations for the relationships, and problem-solve solutions to difficulties in the relationships.[24]

IPT has been adapted for the treatment of depressed adolescents (IPT-A) to address developmental issues most common to teenagers such as separation from parents, development of romantic relationships, and initial experience with death of a relative or friend[24] IPT-A helps the adolescent identify and develop more adaptive methods for dealing with the interpersonal issues associated with the onset or maintenance of their depression. IPT-A is typically a 12-16 week treatment. Although the treatment involves primarily individual sessions with the teenager, parents are asked to participate in a few sessions to receive education about depression, to address any relationship difficulties that may be occurring between the adolescent and his/her parents, and to help support the adolescent's treatment.[25]

Elderly

IPT has been used as a psychotherapy for depressed elderly, with its emphasis on addressing interpersonally relevant problems. IPT appears especially well suited to the life changes that many people experience in their later years.[26]

Strengths and limitations

IPT is particularly accessible to patients who find dynamic approaches mystifying, or the 'homework' demands of Cognitive Behavioral Therapy (CBT) daunting. IPT has been specially modified for adolescents[27] who may find CBT too much like school work, whereas IPT addresses relationships—a primary concern. IPT is abstemious in its use of technical jargon—a bonus for those who distrust 'psychobabble'. C.G. Fairburn, in a 1997 study, reported that both patients and therapists in his bulimia studies expressed a preference for IPT over CBT.[28] This may have implications for compliance and therapist morale.

For general psychiatrists, a perceived limitation of IPT is it has not yet been modified for the management of psychoses ( although this limitation is true of many prominent psychotherapies). The CBT model requires such expertise for its use with this population that it would be considered risky for a trainee to attempt its use without expert training and support.[29]

As with any face-to-face therapy, it is demanding of the individual in that effort must be made to attend pre-arranged dates for the therapy sessions. Whereas substantive effort may not be needed for 'homework' tasks, the therapy involves the reenactment of past negative feelings which, as well as creating a danger of emotional harm, often requires more effort than that required in CBT sessions.

Studies, such as the one conducted by Paley et al. (2008), have found little difference in the efficacy of CBT and IPT. IPT showed a bigger treatment effect than placebo therapy, but did not differ in its effect size from other active psychotherapy modalities in a meta-analysis of 38 published studies.[4] Another 1996 study concluded after his experiment that both IPT and CBT showed a tendency for symptoms to recur, thus limiting the long term-effectiveness of these psychological therapies.[30]

Any study showing the success of such therapies often fail to take into account poor attrition rates, which are very common among psychological therapies, as many patients drop out because they feel the therapy isn't working. Thus when an average is taken of the success of the therapy which includes the patients that dropped out, the therapy appears to be less effective than it actually is. If patients remain to complete the therapy, they are more likely to benefit from it.[31]

References

  1. ↑ Markowitz, JC; Svartberg, M; Swartz, HA (1998). "Is IPT time-limited psychodynamic psychotherapy?". The Journal of Psychotherapy Practice and Research. 7 (3): 185–95. PMC 3330506Freely accessible. PMID 9631340.
  2. ↑ "Interpersonal Therapy (IPT)". Nightingale Hospital. Retrieved 26 April 2015.
  3. ↑ Cuijpers, Pim; Donker, Tara; Weissman, Myrna M.; Ravitz, Paula; Cristea, Ioana A. (2016). "Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis". American Journal of Psychiatry. 173 (7): 680–7. doi:10.1176/appi.ajp.2015.15091141. PMID 27032627.
  4. 1 2 Cuijpers, Pim; Geraedts, Anna S.; van Oppen, Patricia; Andersson, Gerhard; Markowitz, John C.; van Straten, Annemieke (2011). "Interpersonal Psychotherapy for Depression: A Meta-Analysis". American Journal of Psychiatry. 168 (6): 581–92. doi:10.1176/appi.ajp.2010.10101411. PMC 3646065Freely accessible. PMID 21362740.
  5. ↑ Tsai, Alexander C.; Barth, Jürgen; Munder, Thomas; Gerger, Heike; Nüesch, Eveline; Trelle, Sven; Znoj, Hansjörg; Jüni, Peter; Cuijpers, Pim (2013). "Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis". PLoS Medicine. 10 (5): e1001454. doi:10.1371/journal.pmed.1001454. PMC 3665892Freely accessible. PMID 23723742.
  6. ↑ Hollon, Steven D.; Beck, Aaron T. (2013). "Cognitive and Cognitive-Behavioral Therapies". In Lambert, Michael J. Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (6th ed.). Hoboken, NJ: John Wiley & Sons. pp. 393–442. ISBN 978-1-118-41868-0.
  7. ↑ Weissman, Myrna M. (August 2006). "A Brief History of Interpersonal Psychotherapy". Psychiatric Annals. 36 (8).
  8. ↑ Markowitz, John C.; Weissman, Myrna M. (2012). "Interpersonal Psychotherapy: Past, Present and Future". Clinical Psychology & Psychotherapy. 19 (2): 99–105. doi:10.1002/cpp.1774. PMC 3427027Freely accessible. PMID 22331561.
  9. ↑ Klerman, Gerald L.; Dimascio, Alberto; Weissman, Myrna; Prusoff, Brigitte; Paykel, Eugene S. (1974). "Treatment of Depression by Drugs and Psychotherapy". American Journal of Psychiatry. 131 (2): 186–91. doi:10.1176/ajp.131.2.186. PMID 4587807.
  10. ↑ Weissman, MM; Prusoff, BA; Dimascio, A; Neu, C; Goklaney, M; Klerman, GL (1979). "The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes". The American Journal of Psychiatry. 136 (4B): 555–8. PMID 371421.
  11. ↑ Elkin, Irene (1989). "National Institute of Mental Health Treatment of Depression Collaborative Research Program". Archives of General Psychiatry. 46 (11): 971–83. doi:10.1001/archpsyc.1989.01810110013002.
  12. ↑ Weissman, MM; Markowitz, JC; Klerman, GL (2007). Clinician's quick guide to interpersonal psychotherapy. New York: Oxford University Press.
  13. ↑ https://books.google.ca/books?id=emXzjtZmULEC[][]
  14. ↑ Hall, Judith A.; Andrzejewski, Susan A. (2009). "Encyclopedia of Human Relationships". doi:10.4135/9781412958479.n291. ISBN 9781412958462. |chapter= ignored (help)
  15. ↑ Prochaska (1984). Systems of Psychotherapy: A Transtheoretical Analysis.
  16. ↑ Bartholomew, Kim; Horowitz, Leonard M. (1991). "Attachment styles among young adults: A test of a four-category model". Journal of Personality and Social Psychology. 61 (2): 226–44. doi:10.1037/0022-3514.61.2.226. PMID 1920064.
  17. ↑ Kiesler, Donald J.; Watkins, Lucy M. (1989). "Interpersonal complementarity and the therapeutic alliance: A study of relationship in psychotherapy.". Psychotherapy. 26 (2): 183–94. doi:10.1037/h0085418.
  18. ↑ Kiesler, DJ (1979). "An interpersonal communication analysis of relationship in psychotherapy". Psychiatry. 42 (4): 299–311. PMID 504511.
  19. ↑ Cornes, CL; Frank, E (1994). "Interpersonal psychotherapy for depression". The Clinical Psychologist. 47 (3): 9–10.
  20. 1 2 3 Weissman, Myrna M.; Markowitz, John C. (1998). "An Overview of Interpersonal Psychotherapy". In Markowitz, John C. Interpersonal Psychotherapy. American Psychiatric Press. pp. 1–33. ISBN 978-0-88048-836-5.
  21. ↑ Joiner; et al. (2006). The interpersonal, cognitive, and social nature of depression. Mahwah, NJ: Lawrence Erlbaum Associates.
  22. ↑ Zhou, Xinyu; Hetrick, Sarah E.; Cuijpers, Pim; Qin, Bin; Barth, Jürgen; Whittington, Craig J.; Cohen, David; Del Giovane, Cinzia; Liu, Yiyun; Michael, Kurt D.; Zhang, Yuqing; Weisz, John R.; Xie, Peng (2015). "Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis". World Psychiatry. 14 (2): 207–22. doi:10.1002/wps.20217. PMC 4471978Freely accessible. PMID 26043339.
  23. ↑ "The Trauma Response". StillPoint Counseling. Retrieved 13 December 2015.
  24. 1 2 Swartz, Holly A. (1999). "Interpersonal Psychotherapy". In Hersen, Michel; Bellack, Alan S. Handbook of Comparative Interventions for Adult Disorders. Wiley. pp. 139–55. ISBN 978-0-471-16342-8.
  25. ↑ Mufson, L. (1999). "Efficacy of Interpersonal Psychotherapy for Depressed Adolescents". Archives of General Psychiatry. 56 (6): 573–9. doi:10.1001/archpsyc.56.6.573. PMID 10359475.
  26. ↑ Hinrichsen, Gregory A. (1999). "Treating older adults with interpersonal psychotherapy for depression". Journal of Clinical Psychology. 55 (8): 949–60. doi:10.1002/(SICI)1097-4679(199908)55:8<949::AID-JCLP4>3.0.CO;2-S.
  27. ↑ Mufson; et al. (1993). Interpersonal Psychotherapy for Depressed Adolescents. New York: Guilford Press.
  28. ↑ Fairburn, Christopher G. (1998). "Interpersonal Psychotherapy for Bulimia Nervosa". In Markowitz, John C. Interpersonal Psychotherapy. American Psychiatric Press. pp. 99–102. ISBN 978-0-88048-836-5.
  29. ↑ Morris, J. (2002). "Interpersonal psychotherapy — a trainee's ABC?". Psychiatric Bulletin. 26 (1): 26–8. doi:10.1192/pb.26.1.26.
  30. ↑ Barkham, Michael; Rees, Anne; Stiles, William B.; Shapiro, David A.; Hardy, Gillian E.; Reynolds, Shirley (1996). "Dose–effect relations in time-limited psychotherapy for depression". Journal of Consulting and Clinical Psychology. 64 (5): 927–35. doi:10.1037/0022-006X.64.5.927. PMID 8916621.
  31. ↑ "Strengths and Weaknesses of Interpersonal Psychotherapy". Vanda Counseling & Psychological Services. 21 January 2015. Retrieved 26 April 2015.

General references

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