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Interpersonal therapists use a few simple principles to explain the patient's situation and illness. These are simple enough for dysphoric patients with poor concentration to grasp them. First, they define depression as a medical illness, a treatable condition that is not the patient's fault. This definition displaces the burdensome guilt of the depressed patient from the patient to her illness, making the symptoms ego-dystonic and discrete. It also provides hope for a response to treatment. The therapist uses ICD-10 or DSM-IV (American Psychiatric Association, 1994) criteria to make the mood diagnosis, and rating scales such as the Hamilton Depression Rating Scale (HDRS) (Hamilton, 1960) or Beck Depression Inventory (BDI) (Beck, 1978) to assess symptoms.

Indeed, the therapist temporarily gives the patient the 'sick role' (Parsons, 1951), which helps the patient to recognize that he or she suffers from a common mood disorder with a predictable set of symptoms - not the personal failure, weakness, or character flaw that the depressed patient often believes is the problem. The sick role excuses the patient from what the illness prevents him or her from doing, but also obliges the patient to work as a patient in order to ultimately recover the lost healthy role. I am told that in the United Kingdom (unlike the United States), clinicians hear the term 'sick role' as tainted term associated with long-term psychiatric disability. This is not at all its IPT connotation. On the contrary, the sick role is intended as a temporary role, coincident with the term of a time-limited treatment, to relieve self-blame while focusing the patient on a medical diagnosis. The time limit and brief duration of IPT, and the IPT therapist's frequent encouragement of the patient to take social risks and improve his or her situation, guard against regression and passivity.

A second principle of IPT is to focus the treatment on an interpersonal crisis in the patient's life, a problem area connected to the patient's episode of illness. By solving an interpersonal problem - complicated bereavement, a role dispute or transition - the IPT patient can both improve his or her life situation and simultaneously relieve the symptoms of the depressive episode. Since randomized controlled outcome studies have repeatedly validated this coupled formula, IPT can be offered with confidence and optimism similar to that accompanying an antidepressant prescription. This therapeutic optimism, while hardly specific to IPT, very likely provides part of its power in inspiring the patient.

Interpersonal therapy is an eclectic therapy, using techniques seen in other treatment approaches. It makes use of the so-called common factors of psychotherapy (Frank, 1971).

These include building a therapeutic alliance, helping the patient feel understood (through use of a medical disease model and relating mood to event), facilitation of affect, a rationale for improvement (if you fix your situation, your mood should improve), support and encouragement, a treatment ritual, and success experiences (viz., actual life changes). Beyond this, its medical model of depressive illness is consistent with pharmacotherapy (and makes IPT highly compatible with medication in combination treatment). Interpersonal therapy shares role playing and a 'here-and-now' focus with cognitive behaviour therapy (CBT), and addresses interpersonal issues in a manner marital therapists would find familiar. It is not its particular techniques but its overall strategies that make IPT a unique and coherent approach.

Although IPT overlaps to some degree with psychodynamic psychotherapies, and many of its early research therapists came from psychodynamic backgrounds, IPT meaningfully differs from them. Unlike psychodynamic psychotherapies, IPT focuses on the present, not the past; the IPT therapist relates current symptoms and interpersonal difficulties to recent life events, not to childhood experiences. Interpersonal therapy focuses on real-life change rather than self-understanding and on building social skills rather than character change. It employs a medical model approach to psychoeducation about depression rather than a conflict-based approach. The IPT therapist takes a more active stance than the psychodynamic therapist and avoids exploration of the transference and dream interpretations (Markowitz, Svartberg & Swartz, 1998). Interpersonal therapy is like CBT in that it is a time-limited treatment targeting a syndromal constellation (such as major depression). However, IPT is much less structured, assigns no explicit homework, and focuses on affect and interpersonal problem areas rather than automatic thoughts. Interpersonal therapy emphasizes that depression is a medical illness, whereas CBT describes depression as a consequence of dysfunctional thought patterns.

Each of the four IPT interpersonal problem areas has discrete, if somewhat overlapping, goals for therapist and patient to pursue. Interpersonal therapy techniques help the patient to pursue these interpersonal goals. The therapist repeatedly helps the patient relate life events to mood and other symptoms. These techniques include an opening question, which elicits an interval history of mood and events; communication analysis, the reconstruction and evaluation of recent, affectively charged life circumstances; exploration of patient wishes and options, in order to pursue these goals in particular interpersonal situations; decision analysis, to help the patient choose which options to employ; and role playing, to help patients prepare interpersonal tactics for real life. The reformulation of cases using an IPT focal problem area often makes difficult cases more manageable both for patient and clinician.

Interpersonal therapy deals with current interpersonal relationships, focusing on the patient's immediate social context rather than on the past. The IPT therapist attempts to intervene in depressive symptom formation and social dysfunction rather than enduring aspects of personality. It is, in any case, difficult to assess personality traits accurately when confounded by the state changes of an Axis I disorder such as a depressive episode (Hirschfeld et al., 1983). Interpersonal therapy builds new social skills (Weissman et al., 1981), which may be as valuable as changing personality traits.

Natural Depression Cures

Natural Depression Cures

Are You Depressed? Heard the horror stories about anti-depressants and how they can just make things worse? Are you sick of being over medicated, glazed over and too fat from taking too many happy pills? Do you hate the dry mouth, the mania and mood swings and sleep disturbances that can come with taking a prescribed mood elevator?

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