Volume XXXIII, Number 2, Fall 2008
Dossier : Interpersonnal Psychotherapy
J’ai lu :
Marie-Claude Thifault, Peut-on guérir d’un passé asilaire? survol de l’histoire socio-organisationnelle de l’hôpital Rivière des Prairies, par Hubert Wallot.293
Interpersonal Psychotherapy was developed in the years 1969-84, specifically at that time, for the treatment of depression (later called Major Depression). Today, its indications have been extended to numerous other clinical syndromes and situations. This article describes the empirical basis on which IPT was developed until it evolved to its current format. A description of the phases of treatment is presented and the four problem areas commonly encountered in IPT are more explicitly detailed. Several techniques utilized in the course of this treatment are enumerated and the strategy underlying their usage is explained. IPT is an evidence-based psychotherapy and a clarification is made about its specificity, compared to other commonly used forms of psychotherapy.
Interpersonal psychotherapy for depressed adolescents (IPT-A) is a brief, evidence-based psychotherapy that has been found to be successful in treating unipolar depression in non-bipolar, non-psychotic adolescents. This article provides an overview of the theoretical principles, developmental adaptations, interpersonal focus and techniques of IPT-A. Treatment specifically targets communication skills and social support in current relationships from a skills perspective. Therefore, the therapeutic focus is on improving the adolescent’s relationships with the underlying assumption that this will improve the adolescent’s mood. The empirical support for the effectiveness of IPT-A, preliminary findings from clinical trials of adaptations of IPT-A and future directions for research in unipolar adolescent depression are presented briefly.
In this paper, the authors explain why Interpersonal Psychotherapy (PTI) is a particularly apt psychosocial treatment for depression in older adults ; they discuss issues that can emerge in the process of implementing PTI with older adults ; review the research conducted on older adults treated with PTI, and present two case summaries to illustrate the application of PTI to this population. PTI suits depressed older adults especially well because its foci match many of the issues that older adults face and that for some can trigger depression. In addition, PTI is a good fit for older adults because of its psychoeducational component, use of the medical paradigm, and collaborative, problem-focused, time-limited nature. PTI necessitates very little adaptation for older adults but should be informed by knowledge of gerontology and geropsychology. Some research and their clinical practice suggest that acute (i.e., weekly) PTI reduces depression symptoms in older adults but more research needs to be conducted. Interpersonal Counseling, a modified version of PTI, has been found to be effective in the treatment of depressive symptoms in older adults with medical problems. Continuation/Maintenance (i.e., monthly) PTI has been shown to be beneficial to some but not all older adults with major depression. Two cases are described that illustrate the implementation of PTI. One case focuses on interpersonal disputes and the other focuses on role transition.
Perinatal depression is a prevalent disorder with a high degree of morbidity for both mother and infant. There are now empirically validated treatments for both postpartum depression and depression during pregnancy. Among these is Interpersonal Psychotherapy (IPT), which has been shown to be effective for postpartum depression across the spectrum of mild to severe depression. In fact, the limited evidence of efficacy for medication and concern about medication side effects have led some to suggest that IPT should be the first line treatment for depressed breastfeeding women. There are similar concerns about medication usage during pregnancy. Recent clinical and research experience also suggest that Interpersonal Counseling (IPC) may be effective for selected postpartum women as well. IPC, an abbreviated form of IPT, appears to be effective for mild to moderate depression, and has the potential advantage of being more amenable to delivery in primary care or OB settings.
Interpersonal Psychotherapy was conceived as a psychotherapeutic approach to treating Depression, but has since now been broadly used to treat many other disorders. It has also recently been adapted to delivery in the group setting, with both advantages and disadvantages as other group psychotherapies. This adaptation, first used by Wilfley and colleagues, maintained the main features of IPT, i.e. the central role of the interpersonal focus and identification of one (or two) out of four problem interpersonal areas (Grief; Role Transition; Role Disputes; Interpersonal Deficits). It also kept the active role of the therapist and individual patient within the group. To date, G-IPT has been used for several diseases (Eating Disorders not Otherwise Specified, Bulimia Nervosa, Depressive Disorder, Posttraumatic Stress Disorder) and several populations (Adolescents, Older People, Pregnant Women or “New-Mothers,” Substance-abusing Female Prisoners). Although the overall quality of most of outcome studies is to date quite poor, the review of the current state of knowledge shows the G-IPT may be helpful and present a number of advantages to treat different psychiatric disorders in several populations of patients.
Amongst the many modifications and applications of Interpersonal Psychotherapy (IPT), its utilisation in the treatment of psychological trauma is amongst the most complex. Psychological trauma is usually defined as Post Traumatic Stress Disorder (PTSD) in the Anglo-American literature. Despite the focus of the scientific literature on PTSD, psychological trauma engenders profound disturbances of mood, affect regulation, self-concept, interpersonal adjustment and a profound existential crisis in the lives of those afflicted. In the light of this, no one psychological therapy is positioned to ‘treat’all aspects of psychological traumatic stress. Through its focus upon the individual and his or her experience of their interpersonal world, IPT provides scope for a psychological intervention which, whilst aiming at relief of distress, approaches issues not usually addressed in symptom focussed treatments. In this paper, I will attempt to outline the rationale for the use of IPT in psychological trauma and PTSD and then provide some evidence of its utility in the clinical setting.
Bipolar II (BP II) disorder is a common, recurrent, and disabling psychiatric illness. Individuals suffering from this disorder comprise a large segment of the outpatient mental health treatment population, and yet little is known about how best to manage it. Psychotherapy, although untested in this population, represents a potentially important treatment modality for individuals suffering from this disorder. Because BP II disorder is characterized by subsyndromal, non-psychotic, episodes of mania (hypomania), there are no clear contraindications to the use of psychotherapy as monotherapy in BP II disorder (in contrast to BP I disorder where the risk of mania makes medication the sine qua non of treatment). In addition, unlike medication, psychotherapy has the potential to help patients address the multiple psychosocial problems associated with this chronic illness. Thus, an effective psychotherapy for BP II disorder may provide an appealing alternative for patients, especially for those who prefer to avoid the risks and discomfort associated with current pharmacotherapeutic options. Interpersonal and social rhythm therapy (IPSRT), a treatment combining a behavioral approach to increasing the regularity of daily routines with interpersonal psychotherapy (IPT), has demonstrated efficacy BP I disorder when in combination with medication. The current report gives brief overviews of BP II disorder and IPSRT, describes the process of adapting IPSRT for the treatment of BP II disorder, and then presents a series of vignettes based on our experience using IPSRT as monotherapy for the acute treatment of BP II depression. We argue that IPSRT warrants further systematic study to formally assess its efficacy as a treatment for BP II disorder.
The purpose of the study is to determine whether pattern of association with psychological, social and family correlates are similar for oppositional defiant disorder (ODD), conduct disorder (CD), and ODD + CD. Participants were 336 boys and girls (age range from 6 to 13 years) in treatment for disruptive behaviour disorders including 123 children with ODD, 39 with CD “only”, and 174 with ODD + CD. Results showed that parent’s antisocial personality and poor supervision characterized children with CD whereas children with ODD presented with more attention deficit/hyperactivity symptoms and inconsistent discipline. All these correlates characterized children with ODD + CD. These results suggest the importance of taking into account these differences between groups in children treatment.
The objective of this article is to systematically assess the quality of web-based information in French language on the alcohol dependence. The authors analysed, using a standardised pro forma, the 20 most highly ranked pages identified by 3 common internet search engines using 2 keywords. Results show that a total of 45 sites were analysed. The authors conclude that the overall quality of the sites was relatively poor, especially for the description of possible treatments, however with a wide variability. Content quality was not correlated with other aspects of quality such as interactivity, aesthetic or accountability.
In this article, the author examines the temporal dimensions of suicide by taking into account the multiple existing approaches-circadian physiology, psychiatric or sociological epidemiology of suicide-however promoting a socio-anthropological perspective. From this perspective, suicide is examined as a social phenomenon inscribed in time. By beginning with a concern that is characteristic of anthropology of time, knowingly the relation between time of nature and time of society, the author addresses a key issue of the study of suicide already elaborated by Durkheim, in the relation between change that is a basic expression of the passage of time and suicide. After presenting different scientific contributions on the subject, the author proposes an hypothesis allowing integration of the influence of time related to natural phenomenon (cosmobiological rhythms) and the relation of time to social phenomenon (politico-economic rhythms) in relation with suicide and this, according to Gabennesch’s theory of “failed promises.”
This article presents the results of an exploratory study on housing preferences of 315 people with serious mental illness living in seven types of housing in Montreal. The overall portrait that emerged from the study revealed that 22,0 % of the participants prefer to live in their own apartment, 16,0 % in HLM or OSBL, 14,1 % in a supervised apartment, and 11,5 % in a foster home. In addition, 31,7 % prefer the type of housing they were living in at the time of the study. The authors conclude that a variety of housing resources are necessary to meet the diverse needs of consumers.
Whereas the immediate consequences of institutionalized placements on children have been documented, no study has investigated adults who were raised in orphanages or institutions. In Quebec, les enfants de Duplessis offer a unique testimony of the long term consequences of an institutionalized childhood. Stories collected from 40 men and 41 women who grew up in institution in Duplessis’era indicate a high number of abuse and aversive experiences, including physical, psychological and sexual aggressions. In addition, the environment was poor in stimulation and opportunities to develop positive attachment relationships with adults. When matched and compared to adults from the Santé-Québec survey, les enfants de Duplessis report a higher number of health problems associated with stress and more psychological distress. Moreover, our results indicate that those who had fewer strengths and aptitudes in childhood are the most affected by unfavourable experiences.