INTERPERSONAL PROBLEM AREAS IN IPT FOR SAD

In IPT for SAD, the most common interpersonal problem is role transition, followed by role dispute. The two are also sometimes a combined focus of IPT. Grief is rarely a compelling context for understanding SAD, although we have, on occasion, used this formulation. Interpersonal deficits, while inevitably appropriate for nearly all patients with generalized SAD, is too global and also overlaps too much with the definition of SAD. As such this formation may reinforce feelings of demoralization rather than introduce a new perspective and instill hope (goals of IPT). We therefore recommend that when using interpersonal deficits as a focal IPT problem area, the therapist reformulate this as “role insecurity,” emphasizing that the individual’s latent abilities are being held back by SAD.

An individual’s interpersonal approach may need fine-tuning, including encouragement in assertiveness, expressing anger and other emotions. In IPT for SAD, it is expected that social skills will emerge and develop naturally as the patient’s social anxiety is understood and treated. Finally, therapists may propose a “therapeutic role transition” (adapted from dysthymic disorder by Markowitz, 1998; see Chapter 6) in which receiving the diagnosis of SAD itself—clarifying the impact of the disorder and thereby externalizing the symptoms that patients had previously experienced as their personality and identity—provokes patients to adjust how they see themselves and what they expect in social situations.