Interpersonal psychotherapy for depressed adolescents

336 Pages·2004·0.98 MB·English

by  Laura Mufson

INTERPERSONAL PSYCHOTHERAPY
FOR DEPRESSED ADOLESCENTS

Interpersonal Psychotherapy
for Depressed Adolescents
Second Edition
LAURA MUFSON
KRISTEN POLLACK DORTA
DONNA MOREAU
MYRNA M. WEISSMAN
THE GUILFORD PRESS
New York London
©2004TheGuilfordPress
ADivisionofGuilfordPublications,Inc.
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Interpersonalpsychotherapyfordepressedadolescents/LauraMufson.—2nded.
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Includesbibliographicalreferencesandindex.
ISBN-10:1-59385-042-5(hardcover:alk.paper)
ISBN-13:978-1-59385-042-5(hardcover:alk.paper)
1.Depressioninadolescence—Treatment. 2.Interpersonalpsychotherapy. 3.
Adolescentpsychotherapy. I.Mufson,Laura.
RJ506.D4I582004
616.85′27′00835—dc22
2004002941
AAbboouutt tthhee AAuutthhoorrss
About the Authors
Laura Mufson, PhD, is Director of the Department of Clinical Psychol-
ogy at the New York State Psychiatric Institute and Associate Professor
of Clinical Psychology in Psychiatry at Columbia University College of
PhysiciansandSurgeons.Dr.Mufsonwasthefirsttoadaptinterpersonal
psychotherapy (IPT) for adolescents and has been conducting research
on interpersonal psychotherapy for depressed adolescents for over a de-
cade. She travels extensively, training clinicians in treatment techniques
for IPT.
KristenPollackDorta,PhD,isaclinicalpsychologistcurrentlyinprivate
practice.Dr.Dortahasbeeninstrumentalintheimplementationofinter-
personal psychotherapy for depressed adolescents in school-based men-
tal health clinics and the training of school-based clinicians.
DonnaMoreau,MD,isClinicalAssociateProfessorofPsychiatryatCo-
lumbia University College of Physicians and Surgeons and Director of
the Children’s Anxiety and Depression Clinic at Children’s Hospital of
New York–Presbyterian Hospital.
Myrna M. Weissman, PhD, one of the originators of interpersonal psy-
chotherapy, is Professor of Psychiatry and Epidemiology at Columbia
University College of Physicians and Surgeons and the Joseph L. Mail-
man School of Public Health. She is also Director of the Division of
Clinical and Genetic Epidemiology at the New York State Psychiatric
Institute and has published extensively on interpersonal psychotherapy,
includingcoauthoring(withJohnC.MarkowitzandGeraldL.Klerman)
A Comprehensive Guide to Interpersonal Psychotherapy.
v

PPrreeffaaccee
Preface
T
his book has three aims: (1) to provide a general overview of
the nature and current treatment practices of adolescent depression; (2)
to introduce the experienced adolescent therapist to the theoretical for-
mulation and practical application of interpersonal psychotherapy for
depressed adolescents (IPT-A); and (3) to update our original IPT-A
treatmentmanualpublishedin1993toincludeoveradecadeofexperience
using the manual to treat myriad adolescents suffering from depression.
IPT-Aisa12-week-longpsychotherapywithweeklyface-to-facesessions
interspersedwithtelephonecontacts.Treatmentfocusesprimarilyonthe
depressed adolescent but frequently also involves the parents. The four
problem areas originally developed in IPT for adults are applied to ado-
lescents and include grief, interpersonal role disputes, role transitions,
and interpersonal deficits.
PartIofthisvolumeprovidesabriefoverviewofadolescentdepres-
sion, including diagnosis, assessment, clinical course, and other treat-
mentsforadolescentdepression.TherationalefortheadaptationofIPT
to treat adolescent depression is presented in this section. Part II of the
book is the actual treatment manual written for the clinician who is
trained to conduct psychotherapy for adolescent disorders. It is orga-
nized as a step-by-step description of the therapeutic tasks for the three
phases of the psychotherapy. Part III addresses the special issues that
arise when working with adolescents and how they can be addressed
while staying within the IPT-A treatment framework. Part III also in-
vii
viii Preface
cludes a discussion of the current and future research in IPT-A that is
currently under way.
The results of our efficacy study of IPT-A, as well as the study con-
ductedbytheIPTresearchgroupinPuertoRico,demonstratedthatIPT-
A is an efficacious treatment for depression in adolescents. The recently
completed effectiveness study of IPT-A in comparison to treatment as
usual for depressed adolescents in school-based health clinics also dem-
onstrates the effectiveness of IPT-A in a community setting and in treat-
ing adolescents with a spectrum of depression disorders. As a result of
thismostrecentstudy,wehavegainedexperienceandinsightintotrain-
ing therapists from diverse backgrounds to work in a range of settings
with varied constraints on training and supervision. This book includes
manyoftheinsightswegainedfromtrainingtheseclinicianstoconduct
IPT-A. More studies on the effectiveness of IPT-A that include larger,
more heterogeneous samples conducted in a variety of community set-
tings are needed.
Currently there are few formal training programs in IPT-A inde-
pendent of the research setting. We hope to develop more training sites
to offer a variety of levels of training in IPT-A. We believe that, even
without attending one of these formal training programs or conference-
sponsoredworkshops,clinicianswithexperienceinthetreatmentofad-
olescents will be able to adopt elements of the IPT-A approach by re-
viewing the manual presented here. Similarly, for those less experienced
practitioners,wehopethatexposuretoIPT-Athroughthisbookwillen-
courage them to seek further training in IPT-A and its use in clinical
practice. Our ultimate goal is for more clinicians to have exposure to
IPT-A and to utilize the elements of IPT-A both in research and in clini-
calpracticebecausewebelieveittobeaneffectivetreatmentmodelthat
is acceptable to adolescents.
This second edition provides new and more extensive scripts and
clinicalvignettestohelpguidethereaderintheimplementationofIPT-A
andupdatestheefficacydatafromclinicaltrialsconductedusingIPT-A.
The most significant modification of the manual in this edition is the
elimination of the single-parent-families problem area and inclusion of
theseissuesinasubgroupcategoryunderroletransitions.Thismodifica-
tion is an outgrowth of our continued experience using the manual,
which suggested that the majority of the adolescents who experienced
theproblemareaofsingle-parentfamiliesdidsolargelyinthecontextof
aroletransition.WhilewewereawareofthisfromtheinceptionofIPT-A,
at that time we felt that the special issues for adolescents dealing with
family structural change needed to be separated into a distinct problem
area. Continued experience has changed our perception and has led us
to conclude that the issues once addressed under single-parent families
Preface ix
arebestunderstoodasaspecialcircumstanceinthecontextofroletran-
sition.
Nonetheless, we still believe that the circumstances are often
unique and require some separation from the larger transitional issues.
The transitions associated with changes in family structure are typi-
cally outside of the control of the adolescent and are generally not
normative or expected. The problems that arise from the structural
change are often a result of the parents’ difficulty in negotiating the
change or transition, and their difficulties lead to stress and depression
in their adolescent. In addition, the adolescent, in trying to deal with
these stresses, often finds himself in the middle of many disputes with
both the custodial and noncustodial parents in addition to having dif-
ficulties in making the transition to the new family structure. By incor-
porating these problems into the role transitions problem area, we also
are able to acknowledge that these family structural changes not only
occur in single-parent families but also can characterize the challenges
adolescents face in adapting to stepfamilies and foster families. We
therefore are returning to the four-problem-area model for IPT-A, with
a special subproblem area of family structural change under the prob-
lem area of role transitions.
Our continued clinical work with depressed adolescents and the
challengeswefacedwhendisseminatingthetreatmentinthecommunity
provided the impetus for revising the book at this time. We have gained
significant experience over the past decade treating depressed adoles-
cents and training a multitude of clinicians, so that we strongly felt we
couldenhancetheoriginalmanualandmakethetreatmentmoreaccessi-
ble to clinicians and researchers alike. We are acutely aware of the
potentially crippling effects of depression on adolescents, and we have
been motivated to improve the dissemination of effective treatments to
more clinicians. Many depressed adolescents will improve within the
first few weeks of nonspecific psychotherapeutic interventions and will
leavetreatmentdespiteconcertedeffortsonthetherapist’sparttomain-
tain the therapy. Many of these adolescents will return with future de-
pressive episodes, but many others will not return to receive necessary
treatment. Instead, the latter group will suffer the impairing social and
interpersonal consequences of their depressive episode until many years
laterwhentheymayagainseektreatmentasadults.WehopethatIPT-A,
specificallytailoredtotheadolescent’sdevelopmentaltasks,willaddress
theneedforeffectivetreatmentsforadolescentdepression.Wealsohope
that the enhanced explication of techniques, strategies, and guidelines
forthestructuringofthetherapysessionswillfacilitateclinicians’useof
theprinciplesandtechniquesofIPT-Ainnewresearchendeavorsaswell
as in general clinical practice.