Interpersonal psychotherapy for depressed adolescents (IPT-A) is a time-limited (12–16 sessions) individual psychotherapy for adolescents ages 12–18 who are suffering from depression. IPT-A was adapted from interpersonal psychotherapy for depressed adults by Laura Mufson, Ph.D. and colleagues at Columbia University. While IPT-A recognizes that genetic, biological, and personality factors play a role in the development of depression, the focus of IPT-A is on how relationships impact mood and how mood impacts relationships and therefore play a big role in the onset or continuation of depressive symptoms.
The goals of IPT-A are to:
- help adolescents to recognize their feelings and think about how interpersonal events or conflicts might affect their mood;
- improve communication and problem-solving skills;
- enhance social functioning and lessen stress experienced in relationships; and
- decrease depressive symptoms.
Is IPT-A just for adolescents?
Yes. IPT-A was specifically developed as an outpatient treatment for teens ages 12–18 who are suffering from mild to moderate symptoms of a depressive disorder, including major depressive disorder, persistent depressive disorder (dysthymia), adjustment disorder with depressed mood, and depressive disorder not otherwise specified. It is not indicated for those who are bipolar, acutely suicidal or homicidal, psychotic, intellectually disabled, or actively abusing substances. For children younger than 12, IPT-A has been adapted to include more parental involvement in a model called family-based interpersonal psychotherapy (FB-IPT), and there is preliminary evidence for its use with preadolescents ages 8–12 years (Dietz et al., 2015). IPT-A also has been adapted as a group intervention (Mufson et al., 2004), and a preventive intervention for adolescents at risk for depression (Young et al., 2006; 2010; 2016) and depression and social anxiety (LaGreca et al.,2016). IPT-A has been effectively delivered in outpatient mental health specialty clinic as well as school and primary care settings.
What is involved in IPT-A?
Therapy sessions take place once a week, for 12 weeks, with each session lasting about 45–60 minutes. In addition to meeting with the teen, therapists might also meet with parents or guardians for 1–3 sessions as needed for a total of 12-16 sessions. Each session of therapy has a structure and a very specific focus. Therapy is divided into three phases:
Initial Phase (Sessions 1–4)
During this first phase, the IPT-A therapist discusses the teen’s own experiences or feelings of depression, and provides both parent(s) and teens information about depression symptoms. Specifically, the therapist emphasizes the impact of depressed mood on motivation and interest to participate in school and other activities. The therapist explains that the focus of IPT-A is on relationships and the reciprocal relationship between mood and relationships and that specific interpersonal goals will be identified for the adolescent. The therapist encourages both the teen and parent(s) to recognize that depression affects motivation, and yet the road to recovery involves working to try to keep up with daily activities, such as schoolwork and chores, while acknowledging that performance might not be up to the same standards as prior to feeling depressed. They are helped to understand that doing these activities will get easier, and performance will improve as the teen begins to feel better. The therapist completes the “closeness circle” to identify the teen’s significant relationships. Based on the closeness circle, the therapist conducts what’s called an “interpersonal inventory,” in which the therapist and teen discuss the teen’s most important current relationships and how they may be contributing to the depressed mood, looking for strengths and difficulties in communication and problem-solving within these relationships. Finally, the adolescent and therapist establish a “treatment contract,” a clear statement of identified interpersonal problem area, as well as goals and expectations for treatment.
Middle Phase (Sessions 5–9)
During the middle phase, the therapist and teen delve into the identified problem area. The therapist works with the teen or adolescent on recognizing specific difficulties within the problem area. The therapist will then help the teen to develop new skills to resolve or mitigate the identified problems that might be affecting his or her interactions within this relationship utilizing techniques such as communication analysis and decision analysis. The therapist helps the teen with communication tips and problem-solving strategies. They practice using skills that can help the teen to better navigate challenging interpersonal circumstances in the session and then the adolescent is encouraged to try these skills outside of session. If felt to be beneficial, the therapist will either meet alone with the parent/guardian to provide continued psychoeducation about parenting a teen or conduct a dyadic session with the teen and parent to coach them to communicate and problem-solve with each other using specific IPT-A strategies.
Termination Phase (Sessions 10–12)
During the termination phase, or wrap-up, the teen and therapist talk about feelings the teen might have about ending treatment and the progress the teen has made. They review the skills that the teen used in therapy that were most helpful and the goals that were accomplished. The therapist encourages the teen to think about future difficult or stressful events and how he or she might use the newly learned skills in these future situations. The therapist, teen, and parent also review together whether additional treatment is recommended and how the parent can continue to support the teen’s use of these newly learned skills.