Friday, October 1, 2010

The Beginning of a Plan

O My Soul:

I met with my therapist for the second time.  Still answering some intake questions.  She answered my questions and even brought up the "P" word before I did. 

The "plan" may be put together for next week's session.

Although tentative, she is leaning toward Interpersonal Psychotherapy as her tool of choice.  Yeah, I never heard of it before either, but that's why I'm the patient.

She explained it to me and I think this could be good.  I've posted a few things below that I found on the internet that helps explain it. 

To conclude the afternoon, I met with my pastor for individual absolution.  

What Happens in a Course of IPT for Treatment of Depression?

Beginning Phase
The therapy has three phases. In the beginning (sessions 1 to 3), a psychiatric assessment focuses on interpersonal relationships to assess suitability and establish the focus of the therapy. The need for medication is evaluated and depression is discussed as a medical illness in a social context, with interpersonal antecedents and sequelae. The focal problem areas are derived from research on the determinants of health and disease. This research has demonstrated the protective function of interpersonal support (15,16), as well as the associations between interpersonal adversity and depression (17–21). The focus of therapy is determined according to the current interpersonal problems that appear to be most related to the onset and perpetuation of the individual’s current depressive episode. The goals are then explained to the patient: to remit depression and to help resolve the selected interpersonal problem area(s), thereby instilling positive expectations. With more complex patients or patients with severe and chronic depression, combined treatment with medication is often recommended (1,4,22).  

Middle Phase and the Focal Problem Areas
IPT focal areas guide therapeutic interventions through the middle phase of therapy, linking symptoms and affect to interpersonal events, losses, changes or isolation.  Klerman, Weissman, and others (1,4) offer direct content guidelines to frame life experiences into four main focal areas: inter- personal disputes, role transitions, bereavement and interpersonal deficits. In addition to focusing on specific goals, throughout its course the therapy highlights interpersonal patterns linked with dysphoric mood. Relationship expectations and communication are examined to develop social supports and a more effective interpersonal behavioural repertoire, in which empathic responsiveness and clearer expression of emotions and needs are encouraged (Figure 3).

Interpersonal Disputes. These are defined as nonreciprocal role expectations” with significant others (for example, a marital dispute) and are often accompanied by poor communication or misaligned interpersonal expectations. During the course of therapy, behaviour patterns are often revealed in which the patient interacts with significant others in such a way as to inadvertently exacerbate conflicts through acts of commission or omission.  Different ways of understanding and communicating within relationships are explored to facilitate more satisfactory interpersonal relatedness. In some instances,
patients will decide to end relationships, and the focus of the therapy then shifts to role transition.

Role Transitions. These involve life events that lead to significant interpersonal changes. Examples might include becoming a new parent, moving, changing jobs, ending a relationship or adjusting to a loss of functioning. The tasks of the therapy involve systematically exploring both positive and negative aspects of the old role in addition to examining the challenges and opportunities of the new role.

Bereavement. This focus is chosen in IPT when the onset of major depressive disorder coincides with the death, or an anniversary event related to the death, of a significant other.  Ambivalence is typical in these relationships, yet the lost other is sometimes idealized. Therapy facilitates grieving and examination of the relationship’s positive and negative aspects to achieve a more realistic view of the lost loved one. In the latter stages of the treatment, patients are encouraged to replace aspects of what was lost in the relationship and begin to move forward in their lives.

Interpersonal Deficits.
This final focal area is chosen when specific life events coinciding with the onset of the depression are absent, particularly for individuals who have difficulty forming or sustaining relationships. These patients are often interpersonally hypersensitive (5,p. 209,18). Since they have few relationships in their social network, the therapeutic relationship can be used to build social skills through role plays.

Ending Therapy
In the concluding, or termination, phase of IPT, therapeutic gains are reviewed and consolidated along with contingency planning in the event of a recurrence of depression.  Normative sadness is differentiated from clinical depression, and the feelings associated with the ending of therapy are openly discussed. In the spirit of not leaving things unsaid as the therapy comes to an end, this is opportunity for a “good goodbye” and for exchange of honest feedback. If the therapy has failed to achieve the goals of remitting the depression, one might contract to extend the course of treatment or re-evaluate it and suggest sequencing with a different form of treatment. In research protocols for acute major depression, the course
of treatment is usually 12 to 16 once-weekly sessions; however, some authors suggest a tapering schedule and maintenance monthly sessions, especially for individuals with chronic or recurrent depression (4,5,23).


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