IPT West Midlands

Dr Marie WardleProgramme Director

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 Ø Adults, adolescence, elderly, veteransØ CAMHS Ø Eating Disorders ServiceØ P.T.S.D.Ø Depression with HIV, medical illnessØ Depression with post/peri-natal and post-

partum, parent/child, pre-adolescents, abuse

Ø Depression with P.D. or Bi-polar

What is IPT?

Treatmentspecificprocesses

Therapeuticalliance

IPT

Depression associated with..........Ø Interpersonal Role Transition

• Role change, subjectively experienced as a loss

Ø Interpersonal Role Disputes• Current overt or covert dispute with a significant

other

Ø Grief - complicated• Bereavement related depression associated with

withdrawal from current relationships

Ø Interpersonal Sensitivity/Deficits• Long standing difficulty establishing and/or

maintaining relationships

Introducing the IPT modelØ Evidence based treatment for depression – IPT with and

without medication

Ø Symptom and interpersonal focus combined

Ø 3 phases of treatment and associated goals

Ø Task of selecting an interpersonal focus and agreeing an interpersonal formulation

Ø Engaging others in the work

Ø Here and now timeframe

Ø 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 ModelØ 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.

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

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

understandable.Ø It is therapeutically beneficial to the patient to identify

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

a short time)

Attachment Theory Ø Attachment theory hypothesizes that individuals have

difficulties when they experience disruption in theirattachments with others.

Ø 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.

Ø 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 TheoryØ Maladaptive attachment styles lead toinappropriate or inadequate interpersonalcommunication that prevents individuals’attachment 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.

Ø 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.

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

Social TheoryØ Having few social relationships contributes

to psychological distress regardless of levelof adversity.

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

Ø Interventions which affect current socialrelationships will lead to improvedfunctioning.

Ø 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 MeyerØ Placed great emphasis on the

patient’s current psychosocialand interpersonal experience

Ø Insisted that patient’s couldbe best understood byconsideration of their lifesituations

Ø Psychobiology focuseddetailed attention on thebiological, psychological andsocial aspects of theindividual’s experience –protective and vulnerabilityfactors

Harry Stack SullivanØ Viewed psychiatry as the detailed

study of people and the processeswhich go on among them.

Ø Focused on direct and verifiableobservation.

Ø Attention to the interactional ratherthan the intrapsychic.

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

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

Ø 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 InventoryØ Significant contemporary relationships –

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

relationships and vice versa i.e. expand onexisting assessment

Ø Communication styles & patterns ofinteraction

Ø Level of social supportØ Relationship expectations and satisfactionØ Facilitates planning of treatment interventionsØ Evolves and changes during treatment and

may re-orientate therapyØ 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