InterPersonal Therapy of Depression- Interpersonal Deficits

Transcription

1 InterPersonal Therapy of Depression- Interpersonal Deficits

2 Interpersonal Deficits are chosen as the focus of treatment when a patient presents with a history of social impoverishment that involves inadequate or unsustaining interpersonal relationships. Patients with such deficits may never have established lasting or intimate relationships as adults. In general, patients with a history of extreme social isolation tend to be more severely disturbed than those with other presenting problems.

3 In essence, anything from social phobia to Personality Disorder.

4 Optimal social functioning includes close relationships with intimates or family members, less intense but satisfying relationships with friends and acquaintances, and adequate performance and relationships in some sort of work role. For patients with interpersonal deficits it may be useful to focus on those who are socially isolated. The socially isolated group may lack relationships with either intimates or friends, or may not have a work role. They may have longstanding or temporary deficiencies on social skills. *Diagnosis of Interpersonal Deficit

5 Because there are no current meaningful relationships, the focus of the treatment is on past relationships, the relationship with the therapist, and beginning to form new relationships

6 Review of past significant relationships, including negative and positive aspects. Exploration of repetitive or parallel problems in these relationships. Discussion of the patients negative and positive feelings about the therapist and parallels in other relationships. *Goals for Treatment

7 Relationships are explored systematically starting with the most distant past and working towards the present in a chronological manner. This has the same momentum as seen in other problem areas with a movement of focus from the past to the present and then to the future.

8 *InterPersonal Psychotherapy of Depression- Termination

9 Since IPT is explicitly short term and not open ended, it is important to maintain the initial contract.

10 Termination should be explicitly discussed in the last 3 to 4 sessions. The patient is giving up a relationship, and should be establishing a sense of competence to deal with further problems without the psychotherapists help.

11 Over the last 3-4 sessions Explicitly discuss the ending of treatment. Acknowledge this as a time for potential grieving (their words, actually a role transition, but this stage is akin to the expression of emotion seen in the problem areas) There is a movement towards the patients recognition of their independent competence.

12 Some patients deny the importance of the end of the relationship. Recurrence of symptoms in this group is normal, but the patient may interpret this as a recurrence of their depression. This needs to be reframed for the normal feelings of sadness, fear and apprehension that is to be expected.

13 Throughout therapy the therapist needs to be drawing attention to the patients independent success and supports. This can then be come back to in the final sessions as a way of reinforcing the patients ability.

14 The final session may discuss work that the patient yet has to do (the therapy does not continue on just because all the work is not finished, it ends as per the contract), the patients ability to judge when to seek help, early warning signs and ways of coping.

15 The patient may bring new problems to work on right to the last session, but more frequently new problems are no longer brought in.

16 The therapy ends at the last contracted session. The only exception is the patient who remains severely symptomatic and who has had little or no benefit from therapy. This patient can remain in followup until another support is in place, they are the group who should be considered for medication treatment. Any thoughts of seeing the patient again, need a cooling off period of at least 4-8 weeks