Treatment of chronic depression with a 12-week program of interpersonal psychotherapy.

Abstract

Recent changes in the finance and delivery of health care have increased the interest in time-limited, empirically tested psychotherapy programs. However, clinicians often are concerned that these short-term approaches will not be appropriate for patients with long-standing or multiple problems. We present a case of a middle-aged woman with a chronic mood disorder and multiple psychosocial and economic problems who was treated with a 12-week program of interpersonal psychotherapy. This case illustrates the changes that can occur with time-limited treatment. Interpersonal psychotherapy is a timelimited psychotherapeutic approach that has shown efficacy in the treatment of several psychiatric disorders, including major depression and dysthymia, in several controlled trials (1–4). It rests upon the premise that major depression, regardless of etiology, is initiated and maintained within an interpersonal context (5). The goal of interpersonal psychotherapy is to achieve symptomatic relief for depression by addressing current interpersonal problems associated with the onset of the depression. It does not seek to attribute interpersonal problems to underlying personality characteristics or unconscious motivations. Rather, interpersonal psychotherapy works under the assumption that little can really be said about the patient’s personality until the depression is alleviated. From the technical point of view, sessions are viewed as an opportunity to examine the interpersonal relationships of the patient, link them to the changes in mood, and discuss possible alternatives to the patient’s behavior patterns. The therapist helps the patient devise new strategies to use in similar situations and coaches the patient on how to implement them. The therapist may even engage in role playing to give the patient an opportunity to rehearse these strategies. In contrast to brief therapies of analytic orientation, transference plays a much smaller role. In interpersonal psychotherapy, the therapist is aware of the development of transference and countertransference in the treatment relationship but typically avoids focusing on them and rarely uses transference as a therapeutic tool. Consistent with the emphasis on the relationship of interpersonal problems and mood symptoms, the focus in interpersonal psychotherapy is the “here and now” of the life of the patient outside the session rather than the process of the session and its relationship with the patient’s past.