Intermediate Treatment Phase (Six to Eight Individual and Four to Eight Group Sessions)

In the individual sessions, the therapeutic work focuses on emotional aspects of the relevant problem area, while the group setting is used to enhance problem-solving

Table 21.3 Interpersonal Group Sessions in the Inpatient Setting

Module I

Basic interpersonal skills

Two to four sessions

  • • Skills: How to build a social network, basic communication and social skills, interpersonal impact of depressive vs. non-depressive communication, encouragement of new relationships
  • • Goal: Overcome isolation and loneliness, find social support, recognize the linkage of interpersonal problems and depression

Module II

Interpersonal conflicts and disputes

Three or four sessions

  • • Skills: How to identify conflicts, create a plan of action, learn communication skills, deal with emotions in conflicts, find solutions
  • • Goal: Clarify and solve interpersonal conflicts

Module III

Role transitions and mourning losses

Three or four sessions

  • • Skills: Mourn the loss of old roles, evaluate positive aspects of the new role, build self-esteem, deal with grief, substitute for loss
  • • Goal: Successful adaptation to life changes and coping with grief

strategies and interpersonal skills. The training of interpersonal skills takes place once or twice a week for approximately ninety minutes and includes four to ten participants. The group is usually conducted by a clinical psychologist or a psychiatric resident and—depending on the size of the group—co-therapeutically by a psychiatric nurse. The therapists of the individual sessions are psychiatric residents or clinical psychologists, preferably those who conduct the group treatment. The typical IPT problem areas are addressed in three modules: basic interpersonal skills/overcoming social isolation, dealing with interpersonal disputes, and coping with role transition and grieving losses (Table 21.3).

Grief about the death of a significant other turned out to be too stressful and emotionally intense for patients to address in an open group setting. Therefore, the IPT focus “complicated grief” is worked on in individual sessions only. Grief and loss as a part of role transitions are included in module III (role transition).

The program is half open, meaning that newly admitted patients can join at the beginning of each module. Each patient knows his or her personal problem area, which was negotiated in the individual sessions. Each patient is expected to contribute his or her own examples in the relevant group sessions. The examples are worked through using typical IPT strategies: for instance, in role transition, by naming positive and negative aspects of the old and the new roles. The group interventions have a structured and practicing character and include homework. Written material (e.g., about helpful communication strategies) is offered and between-session homework is assigned to facilitate the transfer of learning to everyday situations. Here is an example from the module “interpersonal conflicts”:

Now you told us that you wanted to go hiking with your partner last Sunday, but

he took off to watch a basketball game without you. You felt frustrated, helpless, and angry. Let’s go through this scenario and practice how you can communicate your wish to him in a powerful way. How can you be clear and insistent in negotiating a solution for your different needs? Let’s use the guidelines for effective communication which I passed around in the last session.

In addition, the IPT problem areas can be addressed creatively, using traditional inpatient treatment strategies like art or physical therapy. The following example from the art therapy group manual addresses role transitions:

topic: Perception of the old role and expectations for the new role task: Paint a hill. Imagine yourself on the top of this hill. What lies behind you, where are you standing right now, and what is in front of you? Put your imagination into creating the picture.

In the inpatient setting, all interventions on the ward should be compatible with the interpersonal, educative, supportive, and focused character of IPT.

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