Summary

This case illustrates the interplay between the role transitions and disputes problem areas to provide an interpersonal framework for understanding a complex story of an adolescent’s struggle with family relationships and depression. While the transitions contributed to the rise of the depression, they also generated conflict between Mariana and her parents that needed to be addressed in the context of these stressful life changes. The number of stressors and transitions the adolescent experienced could easily have left the therapist feeling overwhelmed, but IPT-A provided the therapist with a structure to prioritize and identify which interpersonal problem was most related to the current depression. The therapist focused on this problem to quickly improve symptoms and functioning, while acknowledging the adolescent’s past history within a developmental and interpersonal context. This adolescent was fortunate that her family was receptive to understanding her struggles and willing to change their behavior to support her improvement. When families are less responsive or amenable to change, the therapist needs to help the adolescent develop realistic expectations consistent with his or her circumstances, and to seek other supportive relationships.

Mariana and her family benefited because the therapy was conducted in Spanish by a bilingual, bicultural clinician, allowing the application of IPT-A strategies within appropriate cultural context and norms. Consequently, the therapist was able to address the adolescent’s role in performing household duties in light of cultural expectations for Hispanic girls, and adjust communication strategies for consistency with Latino parental expectations for respeto or respect from their children. The therapist understood cultural nuances of how feelings are communicated within Latino culture and with whom different strategies would be appropriate. (See Chapter 16.)

A pivotal intervention in the treatment was the suicidal crisis that necessitated a visit to the CPEP. While the therapist conducted additional crisis sessions following the adolescent’s discharge, the interventions remained consistent with IPT-A principles and strategies and mobilized the family to make changes sooner than they might have otherwise. IPT-A maintains the flexibility to allow one or two crisis sessions within the twelve-week treatment if needed without disrupting its length, by seeing the adolescent more than once a week during the crisis period. The main objectives of the interpersonal interventions were to decrease family conflict and increase pleasurable family activities. The therapist worked to improve the adolescent’s communication strategies, including her communication style with her parents. Although basic, this strategy greatly improved her ability to explain her emotions to her family and to elicit needed support to address difficulties with her siblings and her school.

Finally, the case illustrates that with adolescents, even when the interpersonal problem has dissipated and depression symptoms have remitted, other issues frequently require therapist attention or referral for more services. School difficulties are common, and academic improvements may lag behind remission of the depression due to identification of learning difficulties or the realization that a different school placement is required. This may necessitate continuation sessions to help the family address the problem or may require referral to another agency better equipped to resolve it. It is critical for the IPT-A therapist to assess and address such issues, which could be risk factors for depressive relapse or recurrence. The case illustrates the universality of the problem areas, the way in which transitions and disputes are often intertwined for adolescents, and the ability to address cultural differences within the IPT-A framework.

SUGGESTED READINGS

Mufson L: Interpersonal psychotherapy: perspective on the treatment of a depressed adolescent. In Barnhill JW, ed. The Approach to the Psychiatric Patient. New York: American Psychiatric Publishing, Inc., 2008:289-292 Mufson L: Interpersonal psychotherapy for depressed adolescents (IPT-A): extending the reach from research to community settings. Journal of the Association of Child and Adolescent Mental Health 2010;15(2):66-72 Mufson L, Dorta KP, Moreau D, Weissman MM: Interpersonal Psychotherapy for Depressed Adolescents (2nd ed.). New York: Guilford Press, 2004 Mufson L, Dorta KP, Wickramaratne P, Nomura Y, Olfson M, Weissman MM: A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry 2004;61, 577-584 Mufson L, Weissman MM, Moreau D, Garfinkel R:. Efficacy of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry 1999;56:573-579

 
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