Introduction

• Denise Wilfley and colleagues at Yale University performed the first major study of IPT-G. This group applied IPT in a closed group format for atypical eating disorder (Eating Disorder Not Otherwise Specified in DSM-IV terms) over16 sessions.



• The use of IPT in-group format appeals as it offers patients the opportunity to learn by osmosis and modeling as well as providing more opportunity for reinforcement and a sense of support. Groups also seem to provide and "interpersonal laboratory" in which there are greater opportunities for developing interpersonal interactions for patients within the therapeutic frame, hence more material for interpersonal work is uncovered.



• In the Yale study the investigators observed that some group members continually attempted to compel the other group members and therapist to focus on eating behaviour rather than keeping the interpersonal focus of the group. This was formulated as being a psychodynamic equivalent of binge eating or other pathological process and highlighted the need of the group therapist to keep groups focussed upon the interpersonal focus, as is the case with individual IPT. Another observation of these investigators was the inhibited style of communication shown by group members as well as the finding that "Interpersonal Deficits" commonest interpersonal problem area nominated by group members.

Conducting Interpersonal Therapy in Groups

Selection of Patients

• As in other group therapy modalities, the scientific literature does not offer consistent findings to confidently predict who will and wont benefit from the group IPT process. In common practice there are several types of patient who would not in the first instance be seen as being suitable for the group format.

Relative Contraindications to Group Interpersonal Therapy

• Limited motivation to participate
• Acute Suicidality
• Active Psychosis
• Anti-Social Personality
• Ongoing Substance Misuse
• Paranoid, Schizoid or Schizotypal Personality
• Severe cognitive impairment

Composition of Group

• Ideally the group is composed of 5 - 10 members (excluding therapist). Some diagnostic Homogeneity is desirable as is the potential of including members with similar problem areas e.g. Grief or Role transition in elderly .



• Stratify the group where possible

Pre-Group Therapy Phase

• Ideally each group member should have an individual session or two to:



1. Orientate and Explain Group Process



2. Compile Interpersonal Inventory as per Individual Model perhaps refined to 1 or 2 foci



3. Provide written interpersonal formulation and interpersonal problem areas



4. To explain therapeutic contract and rules of the group process, often with the provision of Reading Material

Group Stages

• In IPT-G the closed groups move through a variety of sequential stages:



1. Engagement - the group is initially united by common focus and common goals and there is the establishment of a collaborative approach



2. Differentiation - individual differences become apparent, conflicts emerge, group roles develop, subsystems evolve and aspects of the group as a closed system e.g. alliances, subsystems become apparent



3. Interpersonal Work - Each group member's individual focus is addressed and interventions occur. Changes, often occult occur. The mechanisms of change included the processes of 'modeling' and 'social reinforcement' from therapist and group members



4. Termination - As in the individual model there is a sense of loss and grieving reactions as well as the possible emergence of symptoms

Running the Sessions -The Therapist Tasks

• At the beginning of each session the therapist ensures each group member "checks in" and feeds back from last session and the time since



• Each member must be given equal time for discussion



• The Therapist functions as chair and invites feedback from group members



• The Therapist may invite 'role plays', 'brain storming' and 'communication training' between group members



• The Therapist must attempt to allow group members to resolve conflicts themselves but must also avoid allowing members to be excessively negative or critical



• The Therapist must not allow members to avoid participation



• The therapist must open and close the group sessions and ensure the groups keep to time

Current Research in IPT-G

• The Yale group and several groups in Canada have evolved IPT-G as a clinical and research tool



• In Australia, experimental use of IPT-G for Post Natal depression, Patients with Bipolar disorder and War veterans with combat related Post Traumatic Stress Disorder is being evaluated in pilot studies