For new therapists learning IPT, a significant challenge is lack of experience with some of the nonspecific factors of psychotherapy, such as managing, but not interpreting, transference and counter-transference, tolerating negative affects, using language to alleviate anxiety, and avoiding advice giving (Markowitz, 1995; Markowitz & Milrod, 2011). Additional challenges include worry about making a non-IPT intervention, concern that video recording will harm the patient and embarrass the resident, and belief that a brief treatment for a profoundly depressed patient may be insufficient. However, IPT is a flexible treatment that can accommodate the style of the therapist. Video recording is an essential component of residency psychotherapy training that leads to better therapist skills and better care (Abbass, 2004). Although IPT is not a panacea, it can be a very effective treatment for complex cases of depression, as this case reflects.
Even for otherwise experienced therapists who are new to IPT, keeping the frame of the treatment with an end date, an interpersonal inventory, and IPT formulation using one of the four foci can be challenging at first. Clinical flexibility and a clear view to the goal of treatment, remission of depression, are learned through supervision and experience with the model.
A common challenge, and a particular one for me early in the therapy, was Joy’s desire to focus significant time on the history of her parents’ marriage during her childhood. Whenever Joy expressed dissatisfaction with her current relationship with her mother, she would return to details of her parents’ arguments from more than two decades before and then excuse her mother’s perceived cold behavior as a consequence of the bad marriage. I came to IPT with the preconceived idea that I should be making the patient’s early emotional traumas the focus of the treatment. The supervisor noted that IPT would be “a different kind of therapy altogether,” and suggested that focusing on early traumas interfered with Joy’s here-and-now experiences and feelings, which are part of the IPT framework. The supervisor encouraged me to stay with the IPT frame. When the patient spent too much of a session relating a childhood experience, I was encouraged to say, “Next time, let’s talk about how that experience affects your life today”
The other challenge for me was my concern that a brief treatment would not suffice to deal with the complex relationships that included a child and patient who had so many social stressors. I appreciated how the interpersonal inventory enabled me to take what felt like an overwhelming case and develop a formulation based on current interpersonal patterns of behavior. I also appreciated that antidepressant strategies in IPT, combined with nonspecific factors of all therapies and a predetermined end date, catalyze positive change in depressed patients.
Lichtmacher JE, Eisendrath SJ, Haller E: Implementing interpersonal psychotherapy in a psychiatry residency training program. Academic Psychiatry 2006;30(5): 385-391
Markowitz JC: Teaching interpersonal psychotherapy to psychiatric residents. Academic Psychiatry 1995;19:167-173