Middle Phase of Treatment
During the middle phase of IPT-A, the therapist and adolescent discuss the problem area in greater detail, focusing on the identification and implementation of communication and problem-s olving skills that can improve the adolescent’s relationships. Although the specific strategies differ for the various problem areas, a number of techniques are frequently used in the middle phase of IPT-A. These techniques, including expression of affect, clarification of expectations for relationships, communication analysis, decision analysis, interpersonal problem solving, role playing, and work-at-home assignments, tend to be used across all four problem areas. Communication analysis is an in-depth analysis of a specific interaction that occurred between an adolescent and another person. The goal of communication analysis is to help the adolescent understand the impact of his or her words and nonverbal communication on others and how modifying aspects of the communication can lead to changes in the interaction and associated feelings. This is typically followed by a discussion of specific communication strategies that are relevant to the problem area, such as acknowledging the other person’s point of view to defuse an argument and having different solutions in mind so a compromise can be met. After the therapist and adolescent identify more adaptive communication strategies, it is helpful to role-play the communication using these techniques.
Once the adolescent and therapist have a better understanding of the interpersonal problem, including any communication issues, it is useful to conduct a decision analysis to determine the best course of action. This includes identifying a problematic interpersonal situation, encouraging the adolescent to generate solutions, evaluating the pros and cons of each solution, selecting a solution to try first, and role-playing the interaction needed for the chosen solution. Decision analysis helps the adolescent develop interpersonal problem-solving skills that he or she can use within and outside of session. Role playing is a key technique used in the middle phase of IPT-A that helps the adolescent practice new interpersonal skills and techniques that he or she can apply to important relationships. Following the role-play practice in session, the adolescent is often assigned “work at home,” or an interpersonal experiment to have the practiced conversation on his or her own, outside of the session. This at-home conversation would then be reviewed in detail in the following session. Throughout the middle phase, the therapist links improvement in the adolescent’s mood and depressive symptoms to his or her improved communication and decision making in important relationships.
Termination Phase of Treatment
The goals of the termination phase of IPT-A are to clarify warning symptoms of future depressive episodes, to identify successful strategies used in the middle phase, to foster generalization of skills to future situations, to emphasize mastery of new interpersonal skills, and to discuss the need for further treatment. During the termination sessions, the therapist and adolescent review the adolescent’s progress, especially regarding the identified problem area. Changes in interpersonal relationships are linked to improved mood and decreased symptoms. The therapist and adolescent highlight which strategies have been most helpful, and the therapist emphasizes the importance of continued implementation of these strategies after termination. The conclusion of the relationship with the therapist also needs to be addressed during the final sessions of IPT- A, as well as a plan of action if the depression recurs.