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  • IPT West Midlands

    Dr Marie WardleProgramme Director

    ipt.westmidlands@nhs.net

    mailto:ipt.westmidlands@nhs.netmailto:ipt.westmidlands@nhs.netmailto:ipt.westmidlands@nhs.net

  • Interpersonal Psychotherapy (IPT)

    A focused treatment plan for depression

    and other psychiatric disorders

    Maintains a focus on the interpersonal context

    of the symptoms

  • NICE stepped-care model of depression

    STEP 1: All known and suspected presentations of depressionn Assessment, support, psychoeducation, active monitoring and referral for further

    assessment and interventions

    STEP 2: Persistent subthreshold depressive symptoms; mild to moderate depressionn Low-intensity psychosocial interventions, psychological interventions, medication and

    referral for further assessment and interventions

    STEP 3: Persistent subthreshold depressive symptoms or mild to moderate depression with inadequate response to initial interventions; moderate and severe depressionn Medication, high-intensity psychological interventions, combined treatments,

    collaborative care and referral for further assessment and interventions

    STEP 4: Severe and complex depression; risk to life; severe self-neglectn Medication, high-intensity psychological interventions, electroconvulsive therapy, crisis

    service, combined treatments, multiprofessional and inpatient care

    3

  • Efficacy and Research Adults, adolescence, elderly, veterans CAMHS Eating Disorders Service P.T.S.D. Depression with HIV, medical illness Depression with post/peri-natal and post-

    partum, parent/child, pre-adolescents, abuse

    Depression with P.D. or Bi-polar

  • What is IPT?

    Treatmentspecificprocesses

    Therapeuticalliance

    IPT

  • Depression associated with.......... Interpersonal Role Transition

    Role change, subjectively experienced as a loss

    Interpersonal Role Disputes Current overt or covert dispute with a significant

    other

    Grief - complicated Bereavement related depression associated with

    withdrawal from current relationships

    Interpersonal Sensitivity/Deficits Long standing difficulty establishing and/or

    maintaining relationships

  • Introducing the IPT model Evidence based treatment for depression IPT with and

    without medication

    Symptom and interpersonal focus combined

    3 phases of treatment and associated goals

    Task of selecting an interpersonal focus and agreeing an interpersonal formulation

    Engaging others in the work

    Here and now timeframe

    Time limited delivery

  • DiagnosisInterpersonalInventoryInterpersonalformulationContract

    MonitoringsymptomsInterpersonalworkSpecificTechniques

    SeparationresponsesReviewofprogressContingencyplanning

    MaintenancecontractPreventionofrelapse

    Initialsessions1-4

    Middlesessions5-12

    GriefInterpersonalDisputesRoleTransitionsInterpersonalSensitivity/Deficits

    Conclusionsofacutetreatment13-16

    Maintenance

    The phases of IPT treatment

  • Medical model

    Attachment Theory

    Social TheoryCommunication Theory

    Interpersonal School of Psychiatry

    Theoretical Influences

  • Medical Model The medical model is one in which illness is seen as the

    result of a physical condition, is intrinsic to the individual ,may reduce the individual's quality of life, and causes cleardisadvantages to the individual.

    As a result, curing or managing illness revolves aroundidentifying the illness, understanding it and learning tocontrol and alter its course.

    In IPT the patient is understood to have a disorder. The disorder is diagnosable and to some extent

    understandable. It is therapeutically beneficial to the patient to identify

    depression as means of understanding current experience. As a consequence he/she should be given the sick role (for

    a short time)

  • Attachment Theory Attachment theory hypothesizes that individuals have

    difficulties when they experience disruption in theirattachments with others.

    This is because of the specific loss of the attachmentrelationship and/or because their social network is not ableto sustain them during significant loss, conflict or transition.

    Insecurely attached individuals are much more vulnerableto difficulties with personal conflicts, such as divorce orseparation, to role transitions such as moving or loss of ajob, and to the loss of significant attachment figuresthrough bereavement, both because of their tenuousprimary relationships and because of their poor socialsupport networks.

  • Communication Theory Maladaptive attachment styles lead toinappropriate or inadequate interpersonalcommunication that prevents individualsattachment needs from being met. The continualand rigid verbal and non-verbal pattern ofcommunication elicits a rigidly restricted range ofresponses from others, usually culminating in arejecting response from others.

    Interpersonal problems occur because individualsunintentionally elicit negative reciprocal responsesfrom others in a recurrent and consistent mannere.g. consistently avoid asking for help,consistently demand help in a manner whichresults in others avoiding.

    Maladaptive attachment styles and communicationpatterns are reinforced by the responses whichthey provoke.Stuart & Roberston, 2003

  • Social Theory Having few social relationships contributes

    to psychological distress regardless of levelof adversity.

    The current social environment is of crucialimportance, independent of past experience.

    Interventions which affect current socialrelationships will lead to improvedfunctioning.

    Those individuals who do not have, or donot perceive that they have, confidants or asufficient social network are much morelikely to have mental health difficulty,especially when faced with a significantsocial stressor.

  • Interpersonal SchoolAdolf Meyer Placed great emphasis on the

    patients current psychosocialand interpersonal experience

    Insisted that patients couldbe best understood byconsideration of their lifesituations

    Psychobiology focuseddetailed attention on thebiological, psychological andsocial aspects of theindividuals experience protective and vulnerabilityfactors

    Harry Stack Sullivan Viewed psychiatry as the detailed

    study of people and the processeswhich go on among them.

    Focused on direct and verifiableobservation.

    Attention to the interactional ratherthan the intrapsychic.

    First reference to the significantother and problems in living inpsychological literature.

    The search for satisfaction via personalinvolvement with others led him tocharacterise loneliness as the mostpainful of human experiences.

    I-You behaviours what an individualdoes is meant to elicit a reaction fromothers. Rigid or limited patterns cancreate interpersonal problems andbarriers in adult life.

  • Interpersonal Inventory Significant contemporary relationships

    recent changes, losses, and gains History of current problems and impact on

    relationships and vice versa i.e. expand onexisting assessment

    Communication styles & patterns ofinteraction

    Level of social support Relationship expectations and satisfaction Facilitates planning of treatment interventions Evolves and changes during treatment and

    may re-orientate therapy Evaluative NOT simply descriptive

  • self

    The hierarchy of relationship involvement

    self

    Intensityofemotionalinvestment

    Mostinvolved

    Leastinvolved

    Mother

    Partner

    Daughter

    Teacher

    Bestfriend

    Colleague

  • Framework for IPT formulation

    BiologicalFactorsGenetics,MedicalIllnessMedicalTreatments

    SocialFactorsIntimateRelationships,SocialSupport,Loss

    PsychologicalFactorsAttachmentStyle,Temperament,

    CopingMechanisms,CognitiveStyle

    UniqueIndividual

    InterpersonalCrisisGrief

    InterpersonalDisputesRoleTransition

    InterpersonalDeficits/Sensitivity

    InterpersonalDistressPsychiatric/PsychologicalSymptoms

    SufficientSocialSupport

    Resolution

  • Driven by resultsPHQ-9 score improvement using IPT

    0

    5

    10

    15

    20

    25

    30

    1 3 5 7 9 11 13 15 17 19 21 23 25 27 29

    Cases

    PHQ

    9 sc

    ores

    Session 1Session 16

  • Trainingp High Intensity for

    qualified mental health practitioners who must also have a qualification in psychological therapies

    p IPTUK Accredited Training

    p Training delivered locally by IPT West Midlands, hosted through SSSFT

    p 1 yr training for Practitioner Level

    p 18 months for Supervisory Level