VANCOUVER, B.C. – Interpersonal therapy for adolescents–a “new kid on the block” for treating adolescent depression–puts relationships in the spotlight as a way to help teenagers get their lives back on track.
The guiding principle behind interpersonal therapy for adolescents (IPT-A) is straightforward, Lorraine Hathaway said at a conference sponsored by the North Pacific Pediatric Society.
“It relies on the notion that depression occurs in the context of relationships … [which] can either trigger symptoms or exacerbate the depression. Depression itself can also affect relationships, so there's an interaction.”
IPT-A was developed by Dr. Laura Mufson at Columbia University in New York. Performed in 12 semistructured sessions, the model focuses on a problem area (grief, role transition, role disputes, interpersonal deficits), with the aim of teasing out destructive and constructive relationship contributors and building skills that make relationships better.
“This makes sense to teenagers. They like it,” said Ms. Hathaway, MSW, a contributor to a mood and anxiety symposium sponsored by faculty members of the University of British Columbia and British Columbia Children's Hospital in Vancouver. Ms. Hathaway is coleading an IPT-A education project with Dr. Elizabeth Hall, a adolescent psychiatrist.
Dr. Susan Baer, an adolescent psychiatrist with the UBC Mood and Anxiety Disorders Clinic, said IPT is a new option among evidence-based strategies that can be used to treat adolescent depression, along with cognitive-behavioral therapy and medication.
Clinicians should be aware of it and, with training, can direct it themselves, Dr. Baer said.
“What's nice about this treatment is it takes basic, good counseling skills and clinical skills, and puts an overlay on them. It uses what you already know if you're a person used to talking to kids, and working with and counseling kids,” Ms. Hathaway said.
In interpersonal therapy, the therapist assists the adolescent in drawing a “depression circle,” topped by a precipitating event that has an impact on relationships and feelings. At the bottom of the circle are the individual's depression symptoms, which in turn, also are driven by and feed into events.
Next, the adolescent conducts an “interpersonal inventory” within concentric circles that represent the closeness of relationships. Which friends and family members are helpful? Which have pulled away?
Framing the context of his or her life allows an adolescent patient to begin to see how depression influences the picture.
The goal is to obtain symptom relief while improving interpersonal functioning and resolving overriding problem areas.
Parents are involved in the first and last session and and elsewhere as needed. Medication can be used in conjunction with IPT-A, but it is not necessary for all teens.
Obviously, each adolescent's experience is different, as will be the IPT-A skills that are required.
Ms. Hathaway used as an example the case of 15-year-old Pamela, whose mother suffered from major depression.
The breakup of a relationship, transfer of three friends to a new school, and a distant relationship with her parents all played a role in Pamela's depression, which was manifested in significant weight loss, suicidal ideation, cutting, poor concentration, irritability, insomnia, and a sharp decline in school performance and social interactions.
Pamela's job in IPT-A was to mourn the loss of her old role as a girlfriend and the close, day-to-day interactions with the former classmates. She needed to accept and work toward building competency and mastery in a new role.
To do this, she had to honestly assess the limits of individual friendships and relationships with family members. She also had to practice her communication skills, actually telling people close to her what she needed and expected from them, and what she was willing to give in return. She needed to make new friends and cultivate new interests.
Ms. Hathaway helped her to recognize how her moods affected relationships, and vice versa, and to practice active problem solving focused on the stresses in her life.
“Our work together is to help you to deal with this big change in your life, voicing your feelings about the relationship[s]. How do you pick up the pieces and go on and look for people who you can be happy with?” she asked.
In a video filmed 6 months after her IPT sessions ended, Pamela said that she realized in retrospect that she had been isolating herself. Her friends, both old and new, commented that she seemed like a new person.
Now, she said, “every second is precious. I'm really excited about biology. I'm actually really cherishing my life.”