ipt west midlands - south staffordshire and ?· ipt west midlands dr marie wardle programme...
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IPT West Midlands
Dr Marie WardleProgramme Director
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
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?
Depression associated with.......... Interpersonal Role Transition
Role change, subjectively experienced as a loss
Interpersonal Role Disputes Current overt or covert dispute with a significant
Grief - complicated Bereavement related depression associated with
withdrawal from current relationships
Interpersonal Sensitivity/Deficits Long standing difficulty establishing and/or
Introducing the IPT model Evidence based treatment for depression IPT with and
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
The phases of IPT treatment
Social TheoryCommunication Theory
Interpersonal School of Psychiatry
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
The hierarchy of relationship involvement
Framework for IPT formulation
Driven by resultsPHQ-9 score improvement using IPT
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
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