I: Theorectical Basis.

Transcription

1 Interpersonal Psychotherapy. I: Theorectical Basis. Chris Gale Otago Registrar Training Group. 19 May 2011

2 Development

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5 ITP is: Is Brief. Focused. Current. Manualised. Psychodynamically based. Useful for. Depression. Anxiety. Eating disorders.

6 Theorectical sources. Interpersonal school psychotherapy. Adolf Meyer Henry Stack Sullivan. Emphasis: Interaction between others. Social issues.

7 Interpersonal approach clinical depression I Symptom function. Development depressive affect and neurovegatative symptoms. Assumed to be both biological and psychological. Social and Interpersonal Relations Interactions in social roles with other persons. Derived from: Early learning based childhood experiences Current social reinforcement. Personal mastery and competence.

8 Interpersonal approach clinical depression II Personality and characther problems Endirnng traits Poor psycholgocial communication. Difficult with self esteem. Traits determine Persons reaction to interpersonal experiences. Risk or predisposition to depression.

9 ITP concentraties on: Symptom function Interpersonal relations. Personality acknowledged, but not focus of treatment.

10 Therapist Advocate, not neutral Explicit acknowledgment depression is disease and use medical model. Gentle, positive, empathic. Therapeutic relationship: Is alliance with realistic expectations Not a re enactment of past with exploration of transference. Positive transference ignored. Therapy interfering behaviours addressed only if interrupting progress therapy.

11 Therapist II Not a friendship: address limiting interaction to therapy role. Takes active role in therapy. Does not extend therapy. Stays within (quite limited) role in model does not explore past, teaches skills.

12 IPT and depression There are 4 models for depression: Grief Interpersonal role disputes Role transitions. Interpersonal deficits. (If you believe patient has interpersonal deficits, consider if IPT correct model to use).

13 Maintenance IPT for recurrent depression Goal to delay or prevent relapse. Modifications of acute IPT. weekly to weakly (monthly) time-limited (up to three years) Patients can choose to shift problems to deal with in acute IPT you deal with the most important problem.

14 IPT for dysthymia In assessment, search for periods of euthymia, even though patient will probably deny ever feeling not sad. Brevity has therapeutic benefit. Modified to occur over 16 weeks not longterm helps patient see that there can be a change. Include an iatrogenic role transition into health. Normalisation of emotions. Offer continuation for about six months or a year, monthly.

15 Depressed adolescents. Bring a parent into the evaluation in particular education and naming the disorder. Use telephone (now text?) to maintain contact and schedule sessions. Develop and alliance with the school around modifications of academic programme and to get the adolescent back to school Keep an alliance going with parents. The therapy can be a tool for both parents and adolescents to resolve their conflict with each other particularly if adolescent forced to attend therapy.

16 Late life depression. Allow longer time for reflection. Accept grieving may take longer. Do not fall into therapeutic pessimism, but remind patient that they have options. Assess level cognitive impairment.

17 IPT bipolar disorder (Social Rhythym therapy SRT) In this model, the four areas of attention (greif, role conflict, role change, interpersonal deficit) become five. The new area is Managing symptoms by managing social rhythms. Disruption social rhythms by social demands, tasks and personal relationships may lead to instability in biological cycles relapse bipolar in susceptable people. Self monitoring, goal setting, guided task assignments, cognitive restructuring used to restabilise social rhythym.

18 IPT eating disorders. Interpersonal model unchanged. Patient to avoid talking eating disorder Fairburn in manual bulaemia says therapist should interrupt bulaemia talk after 10 seconds. Emphasis that to break bulaemia, patient must identify the interpersonal conflicts that precipitate it. Therapist is explicity active in first sessions, then becomes less so over time, encouraging patient to take responsibility for therapy. Twice weekly for 1 st month, then weekly 2 months, then fortnightly for 2 months for total 19 seconds (modification to allow compatability with CBT in clinical trial).

19 Borderline PD Addition of a fifth potential focus, self image. Early phase Focus assessment and exploration of symtom pattern, such as anger and impulsivity. Imbue sense hope Indicate issues raised will be dealt with in detail later. As in DBT, relationship difficulties seen as exacerbated by unstable affect. Reassurance, clarification of markers that precede instability, problem solving. De emphasis transference. Aim for acceptance of ambivelance. Toleration of crises and boundary setting while acknowledging distress. Termination involving a weaving together of themes and strategies.

20 Further models. Social phobia. Panic disorder PTSD emphasis on relationship difficulties and relearning cues for danger Body dysmorphic disorder Somatization disorder Primary insomnia