IPT for Depression

In the Markowitz & Weissman (2012) article, the authors explain the history of interpersonal psychotherapy for depression as well as what key aspects of depression it emphasizes. Here, the authors discuss how IPT was among the first to use randomized clinical trials and wait to disseminate their research until they had done multiple tests. This made me think about the difference in psychology compared to other disciplines. In psychology, as long as a researcher can achieve a significant result, they can publish and spark interest in the field. Then, a therapist read the article and use some techniques proposed. Although this is part of the scientific process, it feels very different than science processes like food science or biology where some type of governing body has to approve of it based on the research in order to disseminate it to the public. Although the APA often comes out with lists of evidence based treatments, it is interesting that there is not much of a limit on what people can do in a "therapy" room (eg. life coaching). Considering IPT for depression, I liked that this article highlighted the limits of it (anorexia, dysthymia) and admitted that their original goal was not to make an all encompassing theory that was perfect. At the end of the paper, the article talked about how their group of researchers and practitioners were collegial. Although it pointed to the overhead and lack of approval as a potential issue within IPT, I could see this as a strength. Often, it feels like a very rigid position that has strong rules may suffer from internal issues and be unable to accommodate change in a cohesive way. In addition, I think it is important to think about theory as a tension between covering everything and covering so little that it can be quickly reduced into non-existence when a treatment with a slightly bigger effect size comes along. I think this is a hard balance to hit, and one that is theoretically and ethically a question for the field to struggle with.   

In the Wurm et al., 2008 reading, the article broke down key pillars of IPT and how it is used in a therapy room. They also provided the case example of Brendan, some research, and the focuses of IPT sessions. I did think it was interesting that IPT seems to have a fairly structured protocol (assessment, initial, and middle sessions), but also seems to require therapist approval to move to the next stage. For example in the case of Brendan, the therapist thought that he was not ready to move on to the next stage yet. I wonder if there are any guidelines on how to know this. I also thought it was interesting that the potential for a good support system was sort of a requirement for using IPT as that is what it intends to solve. However, the focus on interpersonal does make sense as to why it not may very useful for disorders. In some ways, IPT to me feels like it is treating the symptoms as they pop up instead of the root cause. I did like the outline of the different problem areas that was laid out by Wurm and colleagues, and wondered how they would deal with populations such as prisoners who may not have a lot of freedom to problem solve their way into new relationships. I also do not think I agree with their statement “interpersonal disputes are of clinical significance when their resolution is beyond the patient”. Although I understand what they are getting at here, it feels like much less of a collaborative process when they claim that the patient is unable to resolve it on their own. I am not sure to take this as the therapist is solving the problem, or if they are simply giving the client the tools to solve the problem. I also can see this therapy being used in more counseling settings. Often, some of these role transitions are addressed in counseling instead of a clinical practice. 

In the Lipsitz & Markowitz (2013), the authors discuss possible mechanisms of change in interpersonal therapy. Here, they propose that enhancing social support, interpersonal stress, facilitating emotions, and improving interpersonal skills are the mechanisms in which IPT helps clients with their symptoms of depression. I thought this article was interesting, for it was a lot of speculation. Initially, I thought this was going to be about the evidence that these mechanisms decrease symptoms. However at the end of the paper, the authors said that these mechanisms needed to be investigated. This make me think about if its necessary to understand why a theory works before giving it to the public. Personally I feel like yes, because there may be issues with applicability across diagnoses (anorexia, personality disorders) as well as potential harm to clients. Although this is unlikely and I understand why IPT arose, I feel like it may not be a great strategy moving forward. I also have realized that I have a bit of an aversion to terms such as "maternal embrace". I think I often equate these to explanations in psychology that are similar to evolution, for they cannot be easily disproved. The authors also talked throughout the paper about how solving problems was a big focus. Although I understand that this may help develop skills and goals, I wonder if it could foster dependence on the therapist? I also wonder in IPT therapy how much of goals are from the client and how often goals are directed from the therapist. Lastly, in this article they emphasized that IPT was more than common factors. However, I feel like processing emotions and reflective statements are very common among therapies. 

Grade: 24/25