Interpersonal Psychotherapy for Major Depression. Role Dispute
JONATHAN LICHTMACHER AND ILJIE FITZGERALD
When IPT focuses on a role dispute, the therapist links acute major depression with non-reciprocal ideas about what the patient and a significant other owe to each other in a relationship. Role dispute-focused IPT may be considered unilateral couples therapy (Weissman et al., 2000, p. 76). The role dispute may be with a marital or domestic partner, a boss, parent, friend, or child, among other relationships. The therapist helps the patient associate the patient’s feelings of depression with interpersonal interactions between himself or herself and the significant other and encourages the patient to try out new, assertive behaviors and communications. The patient and therapist use role-play to test out new communications in session to prepare the patient for a successful outcome. Optimism that the patient will get better, permission to try new behaviors in interpersonal relationships, a renewed sense of agency, clarifi cation and validation of feelings, and successful new experiences are key to the antidepressant effect of role dispute-focused IPT (Miller & Markowitz, 1999).
In this chapter we present a case example of role dispute-focused IPT and demonstrate supervision in an outpatient teaching clinic where IPT is offered to all patients with depression as part of an evidence-based treatment program. The therapist is a third-year psychiatry resident learning IPT as a required part of the residency training curriculum.
Residents see patients with non-bipolar, acute major depression for sixteen weekly, individual sessions with a goal of achieving remission from depression. Supervision groups, consisting of three residents and one or two faculty members, meet weekly in a group supervision format. Supervision entails reviewing cases and discussing clips from video recordings of recent sessions. Video recording brings immediacy to the supervision, offers an opportunity to stop the action and discuss important moments in the therapy, and allows specific instruction about technique. Clinicians obtain consent from the patients for the video recording and its intent: clinical supervision and teaching (Lichtmacher, Eisendrath, & Haller, 2006).