interpersonal relations psychotherapy

Although IRP is a therapy model developed primarily for the treatment of depression, it has recently been used effectively in the treatment of many mental disorders and in marital, family and relationship problems.

Although it has a short history, it is developing day by day, it is adapted to group therapies and applications are made together with cognitive-behavioral therapies. As with all therapy methods, ICP is not a magic wand that can cure every problem. However, in a period when short-term and effective therapy methods are in demand, IMP is a therapy method that can be easily learned and used effectively by many mental health professionals.

Persons psychotherapy is a technique developed by Harry Stack Sullivan, Adolf Meyer, and John Bowlby, using a defined and idiosyncratic model for the treatment of depressive problems and symptoms. It is a proven psychotherapy

IMP is based on the assumption that mood is related to current interpersonal relationship problems. In therapy, it is aimed to reduce the patient’s symptoms and to gain the necessary social skills to analyze their current interpersonal relationships.

Interpersonal psychotherapy is a short-term psychotherapy that focuses on interpersonal problems and aims to reduce depressive symptoms and improve interpersonal functionality. The aim of the treatment is to help the patient to improve their interpersonal relationships or to change their expectations about these relationships. It also aims to help patients develop their social support systems to help them cope with stress.[1]
Interpersonal psychotherapy was first developed in the USA in the 1970s by Myrna Weismann and Gerald Klerman for use in the acute treatment of bipolar and non-psychotic major depression, and was systematized as a guideline by Klerman in 1984.[2] Interpersonal psychotherapy has been used in many different populations with depression. Studies have shown that it is effective in patients with perinatal depression, including both antepartum and postpartum depression.[3,4,8]

1) MIP is a time-limited (12-16 sessions) psychotherapy model. It is not open-ended and long-term. The limited and specific time is motivating for both the psychotherapist and the client.

2) KIP focuses on “here and now”. It focuses on “here and now” rather than the past life and childhood of the client.

3) IMP is a goal-oriented and focused psychotherapy.

4) In IMP, the therapist is on the side of the client, not neutral. He is optimistic, supportive and reassuring in the therapy process.

5) In IMP, the therapist is active, not passive. Actively guides and manages the client in the therapy process.

6) The therapeutic relationship is of great importance in ICP. Establishing a solid therapeutic relationship is important for the success of the process. However, the therapist-client relationship is not considered and interpreted as a “transference”.

7) Psycho-education has an important place in KIP. The therapist raises awareness of the negativities and inadequacies experienced in the field of interpersonal relations and helps the client gain new skills.

8) The GMP is based on an easy-to-understand theory. It is a psychotherapy method that is easy to learn and apply because it has many similarities with other psychotherapy methods. .

[9] With the demonstration of the efficacy of IIP in many clinical studies, it has been widely used in treatment guidelines and clinical practice. IRP has been adapted for other disorders besides mood disorders

Specifically, IPT is supported by three theoretical pillars: attachment theory, communication theory, social theory. It builds on interpersonal theory, attachment theory, and studies that emphasize the importance of social roles.

The basic assumption of interpersonal psychotherapy is that a person’s mood and events in his interpersonal world are interrelated. It uses the biopsychosocial model to understand patients. It does not ignore biological or other psychological causes that cause or predispose to depression, and conceptualizes depression as a medical disorder that occurs in a social context.[5]As an intervention area, it deals with interpersonal problems that arise in the acute period, cognitive processes and past relationships are not the focus of treatment.[1]Generally, it is short-term (12-20 sessions) when used for acute treatment.[6]

Therapy consists of 45-50 minute weekly sessions over a period of 3-4 months. Interpersonal behavior is seen as the cause and a method of treatment for depressive disorders. The therapist gives direct advice, contributes to the patient’s decision making, and helps by explaining areas of conflict. Transfer is given little or no attention.

There are five basic phases of interpersonal psychotherapy:

1. Evaluation

2. Initial negotiations

3. Interim talks

4. Termination of acute treatment

5. Maintenance treatment.

EVALUATION INTERVIEW

In the evaluation interview, the clinician makes a standard interview and decides whether the patient is suitable for interpersonal psychotherapy.
The first thing to do at the start of therapy is to educate the patient about depression, its interpersonal effects, depression is a treatable medical condition, and the goals of treatment.
An interpersonal relationship inventory is created to learn about the important people in the patient’s life and the details of their current and past relationships with these people.[1,7]

Information about the patient’s relationships in the perinatal period should include information about the patient’s expectations of social support from important people in his life before the birth of the child, the nature of their relationships and communications, the satisfactory and unsatisfactory aspects of their relationships, and how they want to change these relationships.

In addition, the patient’s expectations about motherhood, her feelings about her child, her relationship with her child, the details of her pregnancy and her relationships with other important people in the care of the child should also be learned.[5]

After the inventory is complete, the patient and clinician together identify one or two problematic relationships to focus on. The problem area is tried to be the area that can be most associated with the onset or continuation of the patient’s current depressive episode. The therapist should frame the patient’s problem at an interpersonal level and show by giving specific examples how this problem fits into one of the four problem areas. In the interim meetings, the therapist and the patient work on the problem area they have determined.

Problem Areas of Interpersonal Psychotherapy

Problem areas addressed in interpersonal therapy: 1. grief and loss; 2. interpersonal conflicts; It is called the third role change and the fourth interpersonal disability. Interpersonal problems experienced by patients are similar. Almost all result from the addition of an acute interpersonal stressor to the social support system that does not sufficiently empower the patient. Therefore, efforts should always be directed towards improving the patient’s social support while addressing the problem.[1,7]

1 year

Grief is a problem area, especially related to the death of an important person for the patient.[6] Bereavement and loss is a common issue in perinatal patients. Patients may have had a miscarriage or may have lost their baby in the postpartum period. They may have signs of bereavement due to the loss of someone important to them, or they may be mourning a loss they experienced during the antepartum period in the postpartum period.
When a bereavement issue is the focus of treatment, the therapist’s goal is to facilitate the patient’s grieving process, to help the patient move on, develop new interpersonal relationships, and adjust existing relationships to provide greater social support.[6]

2-Interpersonal Conflicts

Interpersonal conflicts often result from poor communication or mismatch of mutual expectations.[5]

For example:

It is a situation that women in the perinatal period experience very often, especially with their spouses. Especially in our country, patients in extended families may experience problems with other family members they live with. At this point, it is important to understand the adaptation of both the mother and her partner to the newborn, how they perceive it, and their expectations about childcare or spending time with each other. The financial and moral support of the spouse, the roles of important people in the family, including other children, and the status of all these relations before and after pregnancy are evaluated.[5]

In therapy, primarily the patient’s communication and behavioral patterns are examined. Because our primary goal is to assist the patient in regulating the way of communication. The details of mutual communication are tried to be learned with the technique called communication analysis. The patient is asked to describe in detail both verbal and nonverbal reactions over a recent discussion. Then, it is tried to find ways to deal with this situation with the patient and how to communicate differently. Brainstorming is done and the positive and negative sides of these different possibilities are evaluated. The therapist may use the role-playing technique in the session to model how to communicate more openly to the patient.[1]

3-Role Change

Role changes are events such as puberty, marriage, divorce, birth, retirement, ending a relationship, which cause major changes in the important social roles in a person’s relationships and include life changes.

The main challenge for women in the perinatal period is to integrate their new social roles as mothers with their previous social roles in the family, society and workplace. Each new social role will bring its own requirements and responsibilities.[1,5] In this period, while women try to adopt the role of mother, on the other hand, they will be faced with the responsibilities of this social role that require more dependency. He will experience changes, his career will be interrupted, he will not be able to see his friends as often as before.
Typical problems in this area are sadness at the loss of the old and familiar role and poor adaptation to the new role or complete rejection of the new role. When such a change occurs, important social supports or commitments in the patient’s life may also be lost. Adaptation to the new social role may require learning different social skills.

While working on this field, first of all, the positive and negative aspects of the patient’s former role, that is, the situation of women in the perinatal period before the baby is born, are evaluated in the therapy process.
In fact, as in the case of mourning, it is tried to help the patient to experience the sadness of his loss and to give up his old role.

They are encouraged to talk about their feelings of loss, including negative feelings such as anger and guilt.
The difficulties and opportunities of the newly emerging role are evaluated together, priorities are determined, the patient is encouraged to evaluate the opportunities. The patient’s communication is evaluated and social support is tried to be strengthened as in every problem area.[1]

4-Interpersonal Disability

Interpersonal disability means that the patient has difficulties establishing and maintaining interpersonal relationships.[1] Such patients may have little to talk about in therapy. The patient’s only relationship may be with family members, or the therapy relationship may be his only attachment.

First, the relationship between the patient’s depressive symptoms and social isolation is shown.

The patient is given feedback by evaluating the behavior patterns in his past relationships, current problems and communication style.
The therapeutic relationship and transference can be used and role-playing techniques can be used in the session to exemplify how to interact with others. The patient is encouraged to practice newly learned skills by engaging in social activities, contacting old friends or making new friends and going out with them.[1]

maintenance therapy

The purpose of terminating the treatment is to help the patient understand the resources and skills he has to overcome his problems and to attribute the gains of the treatment to the patient himself.

Treatment gains are reviewed, strengthened, changes in the severity of symptoms are evaluated, and actions are planned in case of recurrence of depression.[7]Studies have shown that providing maintenance therapy with interpersonal psychotherapy after depression has resolved helps to prevent relapse.

In maintenance treatment, follow-up meetings are held in order to ensure the continuation of interpersonal functionality with monthly or wider meetings.

RESOURCES

1.Stuart S. Brief interpersonal psychotherapy. In The Art and Science of Brief Psychotherapies: A Practitioner’s Guide. Eds (MJ Dewan, BN Steenbarger, RP Greenberg):119-155. Arlington, American Psychiatric Publishing, 2004.

2. Klerman GL, Weissmann MM, Rounsaville BJ, Chevron ES. Interpersonal Psychotherapy of Depression. New York, Basic Books, 1984.

3. Stuart S, O’Hara MW. Treatment of postpartum depression with interpersonal psychotherapy. Arch Gene Psychiatry 1995; 52:75-76.

4. Spinelli MG. Interpersonal psychotherapy for depressed antepartum women: a pilot study. Am J Psychiatry 1997; 154:1028-1030

5. Grigoriadis S, Ravitz P. An approach to interpersonal psychotherapy for postpartum depression. Can Fam Physician 2007; 53:1469-1475.

6. Stuart S, Robertson M. Interpersonal Psychotherapy: A Clinician’s Guide. London, Edward Arnold, 2003.

7. Robertson M, Rushton P, Wurm C. Interpersonal psychotherapy: an overview. Psychotherapy in Australia 2008; 14:46-54.

8. O’Hara MW, Stuart S, Gorman LL, Wenzel A. Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gene Psychiatry 2000; 57:1039-1045

9.Sapmaz F,Doğan T. Past, Present and Future of Interpersonal Psychotherapy, Symposium: XI. National Psychological Counseling and Guidance Congress,2011.

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