Interpersonal psychotherapy has been adapted from the original IPT manual for use with depressed adolescents (IPT-A). The treatment is well-defined in a manual (Mufson et al., 1993). Three major modifications for adolescents are the shortening of treatment duration from 16-20 weeks to a 12 weeks of individual psychotherapy, the reconceptualization of the sick role to be a limited one and the involvement of parent(s) in the adolescents' treatment. Teens and their parents are informed that the teen has an illness that may affect their school performance and energy to do their normal activities. The therapist informs them that it is important for the teen to continue to engage in as many of the normal activities as possible but they shouldn't be punitive when the performance is not as good as it was previous to the depression. They are told that the teen's performance and motivation will improve as the depression lifts and that participation in activities will help with the lifting of the depression. Parents, in IPT-A, are requested to participate in the initial and termination phases as well as in the middle phase for role playing as is needed. During the initial phase, the therapist provides psychoeducation to the parent(s) about depression, about the limited sick role, and about the treatment procedures, emphasizing the need for familial support for the teen's treatment. The family member is asked to participate as needed in the middle phase to facilitate work on communication between the teen and family member if that is the identified problem area. The family member is then invited to participate in termination phase to discuss the progress in treatment, changes in the family as a result of treatment and the need for further or future treatment.

The treatment has been adapted to address developmental issues most common to adolescents which include separation from parents, exploration of authority in relation to parents, development of dyadic interpersonal relationships with members of the opposite sex, initial experience with death of a relative or friend, and peer pressures. A fifth problem area of single parent families has been added to the four problem areas from the original manual. IPT-A is very appealing to depressed adolescents because of its brief format and orientation to current social and interpersonal problems. A large number of depressions first occur in adolescence when major life choices in education, friends, values, family relationships are being made. IPT-A helps the adolescent identify and develop more adaptive methods for dealing with these interpersonal issues associated with the onset of depression that may prevent recurrent episodes and associated morbidity.

Mufson et al. (1999) demonstrated the acceptability and efficacy of IPT-A in an urban, Latino adolescent population. Results of a controlled clinical trial of individual IPT-A in comparison to clinical management, reported significantly greater decreases in depressive symptomatology and greater improvements in overall social functioning and certain social problem-solving skills. Rosello and Bernal (1999) similarly demonstrated the efficacy of interpersonal psychotherapy for depressed adolescents in comparison to cognitive-behavior therapy and a waitlist condition.

Mufson and colleagues are currently conducting an effectiveness study of IPT-A in comparison to Treatment as Usual in school-based mental health clinics in an impoverished urban area. IPT-A has been adapted to allow 8 weeks of weekly individual sessions and up to 4 additional sessions over the ensuing 8 weeks to address the time constraints of delivering a treatment during the school day. Students are recruited through a screening in their school-based mental health clinic and are randomized to IPT-A or TAU provided by the existing school clinic social workers. One social worker at each school has been randomly assigned to receive training in IPT-A and receives ongoing supervision on their treatment cases. We will assess the effectiveness of delivering IPT-A in a community setting delivered by community mental health care providers already working in the setting as well as consumer satisfaction and cost-effectiveness of IPT-A versus Treatment as Usual.

IPT-A also has been adapted into a group format (IPT-AG) that is currently being studied in a pilot controlled clinical trial. The group setting appeals to adolescents' need for peer support and allows patients to try new strategies in an actual interpersonal context and to obtain feedback on their execution. Other adolescents in the group can provide validation of the experiences or speak to how they might have dealt differently. The therapists can generalize from the group to the adolescent's interactions with his or her family and outside peer group. The immediate interpersonal context of the group reduces the burden on the patient to independently try new communications and behaviors outside the session.

References

Mufson L., Moreau D., Weissman MM, & Klerman GL. (1993) Interpersonal Psychotherapy for Depressed Adolescents. Guilford Press, Inc.: New York.

Mufson L, Moreau D, Weissman MM, Wickramaratne P, Martin J, Samoilov A.(1994). The modification of Interpersonal Psychotherapy with Depressed Adolescents (IPT-A): Phase I and II studies. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 5:695-705.

Mufson L., Weissman MM, Moreau D., Garfinkel R. (1999) The Efficacy of Interpersonal Psychotherapy for Depressed Adolescents. Archives of General Psychiatry; 56;573-579.