Interpersonal Psychotherapy for Medically IIl Depressed Patients

MARCELA HOFFER, JOHN C. MARKOWITZ, AND CARLOS BLANCO

IPT relates depressive symptoms to interpersonal difficulties, with the goals of diminishing the depressive symptoms and improving the patient’s interpersonal functioning. This chapter describes therapeutic work with a woman presenting with two medical illnesses: breast cancer and major depressive disorder (MDD). Medical illnesses are dramatic life events that affect the individual’s life in profound ways. To quote some of our patients struggling with breast cancer on how the illness affected their lives:

“It was like a bucket of cold water on my head"

“It will never be the same as before, when I wasn’t ill"

“I feel strange, like I’m not myself. My life has been shaken up dramatically"

IPT fits a depressed medically ill population nicely. These patients face a built-in, dramatic role transition, the kind of life-changing event IPT therapists like to work with. In our experience of treating depressed women with breast cancer with IPT, patients often have difficulties making the role transitions particularly concerning physical symptoms (pain, chemotherapy), loss of parts of their body (hair and breasts), fertility, and consequently dealing with meaningful relationships. Facing the possibility of dying as well as challenges in romantic and sexual relationships were also difficult adjustments. Each transition also requires “reevaluation of responsibilities to others and oneself" (Markowitz, Klerman, & Perry, 1992). IPT therapists encourage medically ill patients to take action such as adhering to treatment regimens, following healthy lifestyles, and resisting social isolation. The therapists work with patients to assist them in adjusting to the new roles and being able to negotiate with doctors, ask for help and support, and find the new and more positive aspects of their new lives in the aftermath of the unwanted change.

Patients sometimes have two medical illnesses as part of their role transition: in this example, breast cancer and MDD. This conjunction of psychiatric and other medical disorders can help to reinforce the medical model of IPT. Medical illness or its treatment, however, may complicate the diagnosis of major depression by making the neurovegetative symptoms of depression such as sleep, appetite, or fatigue more difficult to interpret.

 
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