Strategies and techniques

The overall strategy of IPT is that by solving an interpersonal problem—dealing with complicated bereavement, a role dispute or transition, or an interpersonal deficit—the patient will both improve his or her life situation and simultaneously relieve the symptoms of the depressive episode. This coupled formula has been validated by the randomized controlled trials in which IPT has been tested, hence it can be offered with confidence and optimism. This optimistic approach, while hardly specific to IPT, very likely provides part of its power in remoralizing the patient.

IPT is an eclectic therapy, using techniques developed in various psychotherapies. It is not its specific techniques but rather its overall strategies that make it a unique and coherent approach. Although IPT overlaps to some degree with psychodynamic psychotherapies, it also differs from them in significant ways: in its focus on real life change, its medical model, and its avoidance of the transference and of genetic and dream interpretations. (18) And while it shares with cognitive behavioural therapy a focus on a syndromal constellation (e.g. major depression), attention to the 'here and now', and techniques like role playing, IPT is considerably less structured, requires no explicit homework, and has a very different feel. Each of the four IPT interpersonal problem areas—grief (complicated bereavement), role disputes, role transitions, and interpersonal deficits—has discrete, if to some degree overlapping, goals for the therapist and patient to pursue.

The techniques of IPT aid the patient's pursuit of these interpersonal goals. The therapist repeatedly helps the patient to link life events to mood and symptoms. These techniques include the following:

• an opening question—'How have things been since we last met?'—which leads the patient to provide an interval history of mood and events

• a communication analysis, a re-creation of recent, affectively charged life circumstances

• an exploration of the patient's wishes and options to achieve those wishes in particular interpersonal situations

• decision analysis, to help the patient decide which options to employ

• role playing, to help patients rehearse tactics for real life.

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