Expert Q&A: Cindy Stulberg, on Interpersonal Psychotherapy
If your teen has tried Cognitive Behavioural Therapy (CBT) and still struggles with depression, you may want to ask your health care provider about Interpersonal Psychotherapy (IPT).
Interpersonal Psychotherapy is an evidence-based, time-limited talk therapy that has proven to be effective in the treatment of major depression, eating disorders and mood disorders.
What’s more, it focuses on all the things that tend to trip up teens (and adults) in life: conflicts and disputes, transitions such as moving or divorce, isolation and loneliness, and unresolved grief. Plus, it’s adaptable for teens, adults, families, or groups.
To learn more, I reached out to Cindy Stulberg, DCS, CPsych, Director of The Institute for Interpersonal Psychotherapy and author of Feeling Better: Beat Depression and Improve your Relationships with Interpersonal Psychotherapy.
What is IPT?
Interpersonal Psychotherapy basically believes if you have good, meaningful constructive relationships you will feel better. And if you are suffering from depression and you have good relationships you will feel better more quickly.
It’s a time-limited model. In 12 sessions or 16 sessions we work on one particular problem or one particular area that is contributing to your depression and help you understand what you did with that problem to help yourself feel better.
So, in order to deal with the next problem, and the next problem, you’re going to be able to have the skills and the tools and the strategies to apply it to handling the next issue.
Why were you drawn to IPT?
It makes sense. It makes a lot of common sense. You get to talk about how you feel. About the relationships that you are in or you are building.
It’s not like you want the client to become dependent on you. You want to create their interpersonal network and inventory so that they have someone to talk to when they’re distressed. So they can have a good, close, meaningful relationship. So they don’t feel isolated, and they feel supported.
And it’s very practical. You teach them what to say and how to start the conversation. You roleplay. And then the client goes out and they bring back the information the next week and then you talk about when did it feel better.
I will tell you that nine times out of 10 you see a lot of improvement. You’d be amazed.
When should you consider IPT?
The four areas of focus for IPT are disputes or conflict, transitions, unresolved bereavement or loss, and, it is called deficits, but basically loneliness and isolation.
Let’s say there’s a lot of stress between a kid and their parent or they’re having a lot of peer conflict or they’ve been dumped by their boyfriend or they’ve had a transition in their life. Let’s say your parents are getting divorced, if you’re moving. Those kind of things will very commonly trigger a depressive episode.
IPT is centered around an interpersonal inventory. What is this?
And then you pick relationships that you want to work on. What do you like about that relationship? What don’t you like about that relationship? And, what would you like to be different?
In the second and third session, we take an interpersonal inventory. You draw your social circle and you say this is where I am and these are the people in my life.
You learn that relationships aren’t all black and white. They’re not all good and bad. That there are things that are good about them and there are things that aren’t, and is there a potential to deal with this relationship differently.
Why do you think it works?
What’s fascinating about this model is that it’s not about blaming people. It’s not about, I’m right and you’re wrong.
What it is a lot of, is saying, these are my expectations of you, and can you, or do you want to meet those expectations? If you can, great. If you can’t, how can I be less bothered by it.
You begin to understand what’s realistic in terms of expectations, and how to resolve conflicts in a constructive fashion. And if something isn’t working, what are my expectations of myself? What am I doing that can help contribute? If I don’t want to do something, then how can I say it in a clear way?
Why is CBT recommended far more often than IPT for teen depression?
I think it’s easier to focus on your thoughts. I think it’s more comfortable then the other. It’s easier to think than it is to feel.
CBT people will tell you that they do address the feelings, but it’s more cognitively based: what is my thought.
IPT is a therapy where you’re going to focus on your feelings in a very intense way. For example, how did it make you feel when you told your mother that she really pissed you off. You can talk about it as a thought, but it’s more important to feel. You practice and you roleplay. You say what’s the worst case scenario, what’s the best case scenario, and what’s the most realistic.
That and marketing.
What do you mean by marketing?
The biggest problem even today is that IPT is just not well known. That’s the dilemma.
In the last ten years, it has changed quite a bit. Now, there is an international organization, the International Society for Interpersonal Psychotherapy. I sit on the certification committee of the organization.
It’s just hard to disseminate.
How can parents sell IPT to a teenager who is reluctant to do therapy?
I would basically say that it’s short term. Number one, you need to go for 12 sessions. So they usually like that.
If a kid is completely resistant, I would say, “Look I understand you may not want to go or you’re not interested, but I need to know how we can relate better. I need to know how I can not argue with you. I need to know how I can be helpful. I need to have your opinion and input to do that. So, let’s go together. Let’s see what the person is like. Let’s see if it makes sense to you and hear more about it and then we’ll decide.”
I think family therapy is hugely important. Seeing a parent
and a kid.
Family therapy is not often recommended to parents of teens. Why do you think that is?
It’s a huge gap. I’m flabbergasted by it. With the people I supervise, I’m constantly saying, why don’t you have the parent in?. Why don’t you see the family?
I’m a huge family therapy proponent. I think family therapy has gone by the wayside. Therapists seem to be afraid to handle it.
I was recommending that to somebody recently and they said, ‘Well I’ve never had a session with the parents before’ and I was thinking you really haven’t? If you look at the American Psychiatric Association, they don’t do family therapy sessions and workshops, and people live in a family.
The parents have an input in this. The parents are the ones who are going to be looking afterwards, not the therapist.
Is IPT better suited to certain types of people or to girls versus boys?
I don’t think so much. I think girls really talk a lot about their feelings so certainly it can be easier to have a conversation, but no one has ever really looked at that issue and said let’s treat girls and let’s treat boys and see which one benefits from it more. Girls are very relationship focused.
The other reason IPT is so good for kids is that’s their world. Their peer group is their world and relationships are so important to them. It appeals to them once you start doing it a little bit.
But I’ve never seen anything about what’s better for women or men.
It’s more the fit. Is the therapist compassionate, easy to relate to. All that kind of stuff matters more than anything else.
What happens after you complete the sessions?
There’s a termination section where you go over what they did that helped them so they can articulate what they did. You talk about warning signs, when do you anticipate running into problems – holiday time or exam time or the anniversary of the death of a loved one.
So you build in, who are you going to talk to? How are you going to manage this? You talk about the difference between normal sadness and clinical depression. So there’s a whole focus on how you terminate the therapy.
And then, yes, the maintenance is that you can see someone once a month for an hour, and sustain them for a period of time.