Wk 12 - Interpersonal therapy

Question 1

Why/how was IPT developed? (x4)

Answer 1

As a manualised depression treatment
For use as control against CBT in huge clinical trial
Comparing also with medication and placebo
Turned out to be great in itself

Question 2

What was hypothesised to drive the change seen by IPT clients in trial comparing it to meds/CBT? (x1)

Answer 2

Chang in social circumstances and relationships

Question 3

According to Weissman, Markowitz and Kerman, how does IPT work? (x2)

Answer 3

Medical model of depression

Link between depressed mood and interpersonal relationships

Question 4

According to Weissman, Markowitz and Kerman, what does IPT focus on? (x3)
And its goals? (x1)

Answer 4

Modifying disrupted interpersonal relationships or
Expectations about those relationships
Trying to fix up conflicts, separations - transition to improve mood
Symptom relief

Question 5

What are 6 characteristics of IPT?

Answer 5

Time limited (eg 12 – 16 weeks)
Focused rather than open-ended
Current interpersonal relationships
Interpersonal not intrapsychic (not transference)
Interpersonal not cognitive
Personality is recognised but not a focus

Question 6

Why do people (inaccurately) try to lump IPT with psychoanalysis? (x1)
What is one important diff?

Answer 6

Emphasis on attachment styles

Doesn’t go into specifics of personality

Question 7

What are the historical contributions to IPT of Meyer and Sullivan?

Answer 7

Interpersonal school founded by both
Meyer (1957) psychobiological theory emphasised current interpersonal experiences
Sullivan (1953) linked psychiatry with sociology, anthropology and social psychology

Question 8

How does Interpersonal theory view human nature? (x5)

Answer 8

Relationship is primary
Focus on how individuals form, maintain, form problems in, and end relationships
Instinctual drive to interpersonal relationships –
Attachment organises behaviour in them
Attachment behaviour most evident when individual is distressed

Question 9

What are three theoretical underpinnings of IPT?

Answer 9

Attachment theory: basis for relationship difficulties
Communication theory: how maladaptive patterns can lead to difficulties
Social theory: understanding social context and effects of networks

Question 10

Explain Bowlby’s Secure attachment style for kids and adults (x4, x3)

Answer 10

Separate from parents to explore;
Returns if anxious;
Return of parent met with positive response;
Clearly prefers parents to strangers.

Trusting lasting relationships;
Good self esteem;
Seek social support when stressed.

Question 11

Explain Bowlby’s Ambivalent attachment style for kids and adults (x3, x3)

Answer 11

Wary of strangers;
Greatly distressed by separation from parent;
May not be comforted by return

Reluctant to become close to others;
May worry partner doesn’t love them;
Distraught when a relationship ends.

Question 12

Explain Bowlby’s Avoidant attachment style for kids and adults (x3, x3)

Answer 12

Avoid parents;
Doesn’t seek comfort from parents;
Little preference parents/strangers

May have problems with intimacy;
Invests little emotion relationships;
Unable/willing to share thoughts/feelings with others.

Question 13

Insecure attachment styles are vulnerable to… (x1)

Answer 13

Depression

Question 14

How does communication theory relate to attachment in IPT? (x2)

Answer 14

Attachment = template on which specific communication occurs
Better/worse ways of communicating attachment needs - avoidant aren’t sharing/getting met

Question 15

What are two central tasks in IPT?

Answer 15

Communication analysis - finding the details of what’s going wrong
Skills building - social, interpersonal skills role played and then practiced in RL

Question 16

How does social theory relate to IPT/depression? (x4)

Answer 16

Isolation/ social dysfunction causal in psychological distress
And, depressed tend to decrease in social functioning
Spectrum of responses to interpersonal stressors
Intervening in interpersonal relationships will improve functioning

Question 17

What happens (in IPT model) if interpersonal crisis either reaches subthershold intensity, or suprathreshold but with sufficient social support? (x1)

Answer 17

Resolution

Question 18

What happens (in IPT model) if interpersonal crisis reaches suprathreashold intensity, and person has insufficient social support? (x3)

Answer 18

Attachment needs unmet
Maladaptive communication of needs
Interpersonal problems/symptoms

Question 19

What is therapist’s role in IPT? (x7)

Answer 19

Active
Client advocate, supportive, directive (unlike PCT)
Gathers information
Educative
Modelling secure attachment and good communication patterns
Safe background for change

No transference analysis

Question 20

What is the client’s rollin IPT? (x4)

Answer 20

Active/collaborative
Ultimate responsibility for topics to be discussed
To discuss relationships with others openly
Explore feelings about those relationships

Question 21

What are the goals of IPT? (x5)

Answer 21

Not insight but change, eg:
Improvement in interpersonal relationships or
Change in expectations
Symptom relief - reduced depression, increased relationship comfort
Improvement in social networks - esp in transitions

Question 22

What is involved in the initial, intermediate and termination sessions of IPT? (x2, x1, x3)

Answer 22

Diagnostic evaluation and framework for treatment
Treatment contract

Addressing key problem areas

Consolidation
Relapse prevention
Termination

Question 23

What is the purpose of having client adopt a ‘sick role’ during initial sessions of IPT? (x5)

Answer 23

From medical model...
Removes blame from client
Conveys hope
Normalises the problem
Identifies problem as time-limited

Question 24

What is included in an interpersonal inventory in IPT? (x5)

Answer 24

All significant relationships
History of problematic relationships
Social support
Communication problems
Problems with expectations in relationships - what are they? Getting met?

Question 25

What are four interpersonal problem areas addressed by IPT? | Are these mutually exclusive?

Answer 25

Grief (complicated bereavement) Role disputes Role transitions Interpersonal deficits No - but if too much overlap/no clear area use latter as focus

Question 26

What are 6 key techniques in IPT? | And what has been added, having been excluded in original trials? (x1)

Answer 26

``` Clarification and directives Encouragement of affect Communication analysis Problem solving Role playing Use of the therapeutic relationship ``` Homework - need RL practice

Question 27

What are the aims of 'clarification and directives' in IPT? (x2) Which may use techniques of... (x5)

Answer 27

Restructure and feedback client’s material Increase awareness of what actually communicated ``` Open/closed questions Clarification Paraphrasing and reflecting Receptive and empathic listening Receptive silence ```

Question 28

What are the aims of 'encouragement of affect' in IPT? (similar to experiencing in emotion focussed...) (x1) Which may use techniques of... (x4)

Answer 28

Facilitate recognition, acceptance, expression of painful affect Using affect to bring about change: Negotiate behaviour change with others Delay expression or acting on affect until calm Revise thinking about affect-laden topics

Question 29

What is involved in 'communication analysis' in IPT? (x4)

Answer 29

Clients encouraged to “put everything into words” Communication discussed in interpersonal context Reconstruction of interpersonal events Therapist as role model

Question 30

What are common communication difficulties? (x3)

Answer 30

Ambiguous, indirect non-verbal communication as substitute for open confrontation Incorrect assumption that one has communicated clearly and been understood Silence, closing off communication

Question 31

What is involved in 'problem solving' in IPT? (same as CBT) (x5)

Answer 31

``` ID problem Explore perceptions and expectations Brainstorming/analysis of consequences Implementation Monitoring of attempted solution ```

Question 32

What are the aims (x2) and tasks (x2) of 'role playing' in IPT?

Answer 32

Assist client to develop different points of view and Understanding communication patterns Practising and reinforcing communication Ask clients to play themself and also the other person

Question 33

What is grief/complicated bereavement in IPT terms?

Answer 33

“Normal” grief = full awareness of the reality of death; Symptoms usually resolve in 2 -4 months Complicated bereavement = delayed/failure to mourn; or “over-grieving” Many stages described in dealing with loss

Question 34

What are the symptoms of (x4) and goals (x2)of IPT when working with grief? (x2)

Answer 34

Sadness, Disturbed sleep, Agitation, Decreased day-to-day functioning Facilitate mourning Help find new activities and relationships

Question 35

What are the tasks in IPT when working with grief? (x5)

Answer 35

``` Relate timeline of symptoms to loss Exploration of circumstances of loss and Of actual relationship with deceased Generation of associated affect/promoting its acceptance Helping client make new attachments ```

Question 36

What are interpersonal disputes in terms of IPT? (x2) | Which may be at one of which three stages?

Answer 36

Conflict with significant others Differing expectations of roles Negotiation – active attempts to change things Impasse – stalled negotiations Dissolution – considering ending the relationship

Question 37

How does IPT go about addressing interpersonal disputes? (x4)

Answer 37

Identify stage of dispute Modify communication patterns Reassess expectations of relationship - realistic? Assist patient to communicate their needs

Question 38

What tasks might be involved in addressing addressing interpersonal disputes in IPT? (x3)

Answer 38

Parallels in other relationships -patterns, e.g. parental relationship Encourage and model direct communication Role playing

Question 39

What role transitions are associated with depression? (x4)

Answer 39

Couple become parents Adolescent leaving home Healthy person having serious illness or accident Older adult retiring from work

Question 40

What difficulties commonly arise during role transitions? (x4)

Answer 40

Loss of social support/network Management of emotions - fear, anger Need new repertoire of social skills Diminished self esteem

Question 41

What are the goals of IPT when dealing with role transitions? (x4)

Answer 41

Facilitate mourning of old role/acceptance of new Help client see new role as less negative Help gain mastery Developing new attachments and supports

Question 42

What are 5 IPT techniques for helping with role transition issues?

Answer 42

``` Relate symptoms to recent life change Explore affect - loss Review old and new role in positive and negative light Identify challenges of new role Problem solve and implement solutions ```

Question 43

What is covered by 'interpersonal deficits' in IPT terms? (x5) And when would you choose this area as your focus?

Answer 43

Can occur in social phobia Avoidance/anxiety in social relationships Lacking social skills Problems initiating/sustaining relationships Describes consistent style of attachment or personality (cf acute social stressor) Not common - if other problem areas present focus on those

Question 44

What are the goals of IPT when dealing with interpersonal deficits? (x3)

Answer 44

Reduce isolation Assess strengths realistically Begin extending social repertoire

Question 45

What are three strategies for dealing with interpersonal deficits in IPT?

Answer 45

Review past significant relationships Problem solving with positive reinforcement Communication analysis and role play

Question 46

What is involved in the termination process of IPT? (x4)

Answer 46

Reinforcement of gains Acknowledgement of sense of loss/grief/transition Normalising feelings about termination Managing post-therapy contacts

Question 47

What is the empirical support of IPT (from NIMH Treatment of Depression Study) (x3) And what is its use under the current APA guideline for depression?

Answer 47

= to medication for mild/moderate Better than placebo And better than CBT for severe Women especially may respond better to IPT followed by meds for non-responders

Question 48

What disorders other than depression has IPT been applied to? (x7)

Answer 48

``` Postpartum depression Dysthymia, and + alcohol HIV patients Bipolar disorders Bulimia nervosa Social phobia Comorbid anxiety and depression in adolescents ```

Question 49

What are the limitations of IPT? (x4)

Answer 49

Still don't know... Who is best suited for IPT vs other treatments? Manualised treatment vs clinical judgement Necessary elements of IPT? Level of training required for effective delivery?