Training

Until very recently, IPT was delivered almost entirely by research study therapists. As the research base of IPT has grown and it has become included in treatment guidelines, there has been a growing clinical demand for this empirically supported treatment. Interpersonal therapy training is now increasingly included in professional workshops and conferences, with training courses conducted at university centres in the United Kingdom, Canada, continental Europe, Asia, New Zealand and Australia in addition to the United States. Interpersonal therapy is taught in a still small but growing number of psychiatric residency training programmes in the United States (Markowitz, 1995) and has been included in family practice and primary care training. It was not, however, included in a recent mandate for psychotherapy proficiency of US psychiatric residency programmes.

There has been no formal certificate for IPT proficiency and no accrediting board. When the practice of IPT was restricted to a few research settings this was not a problem, as one research group taught another in the manner described above. As IPT spreads into clinical practice, issues arise about standards for clinical training and questions of competence and accreditation gain greater urgency. Training programmes in IPT are still not widely available, as a recent US Surgeon General's report noted (Satcher, 1999). Many psychiatry residency and psychology training programmes still focus exclusively on long-term psychodynamic psychotherapy or on CBT. In these programmes, too, the lack of exposure to time-limited treatment has been noted (Sanderson & Woody, 1995).

The principles and practice of IPT are straightforward. Yet any psychotherapy requires innate therapeutic ability and IPT training requires more than reading the manual (Rounsav-ille et al., 1988; Weissman, Rounsaville & Chevron, 1982). Therapists learn psychotherapy by practising it. Interpersonal therapy training programmes are generally designed to help already experienced therapists refocus their treatment by learning new techniques, not to teach novices psychotherapy. This makes sense, given its development as a focal research therapy: IPT has never been intended as a universal treatment for all patients, a conceptualization of psychotherapy that in any case seems naively grandiose in the modern era.

Until there is a formal certification process, we recommend that clinicians interested in learning IPT follow the training guidelines for researchers. Interpersonal therapy candidates should have a graduate clinical degree (MD, PhD, MSW, RN), several years of experience conducting psychotherapy, and clinical familiarity with the diagnosis of patients they plan to treat. The training developed for the TDCRP (Elkin et al., 1989) became the model for subsequent research studies. It included a brief didactic programme, review of the manual, and a longer practicum in which the therapist treated two or three patients under close supervision monitored by videotapes of the sessions (Chevron & Rounsaville, 1983). Rounsaville et al. (1986) found that psychotherapists who successfully conducted an initial supervised IPT case often did not require further intensive supervision, and that experienced therapists committed to the approach required less supervision than others (Rounsaville et al., 1988). Some clinicians have taught themselves IPT using as the IPT manual (Klerman et al., 1984) and peer supervision to guide them. For research certification as well as for training in the community, we recommend at least two or three successfully treated cases with hour-for-hour supervision of taped sessions - not a lot to ask to learn a psychotherapy well (Markowitz, 2001). When first learning IPT, the first two to three cases should be patients with acute major depression. Only after mastering the basics of IPT for major depression, should clinicians attempt one of the adaptations of IPT.

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