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IPT Theoretical underpinnings

Attachment theory, Communication & social theory

Attachment theory

way in which individuals form, maintain & end relationships - humans

Communication theory

communication of distress is highly dependent upon the client's

social theory

client's ability to generate social support

Attachment Theory of Psychopathology

Relationships affect mood, & mood affects; Relationships, Interpersonal disruption causes and results from depression; Disorders surface when situational stressors expose inability to cope

Interpersonal Distress

Acute Interpersonal Crisis

Interpersonal Distress

Acute Interpersonal Crisis (stressor) + Social Support + Biopsychosocial (Vulnerability)

(Establishing) Interpersonal Problems Areas

1-Interpersonal loses ( grief; loss of a loved one) 2-Role Disputes 3- Role Transitions 4-Deficits


Time-limited, Focused, About current relationships, Interpersonal, Improving relationships, Identifying assets, Learning how to cope

IPT Therapeutic Process Theory

Short-term, present-oriented therapy, therapist should not address additional problems, but remain focused on primary problem, No ideological hesitation to use medication

Opening Phase of IPT

Diagnose, interpersonal inventory,Establishing the interpersonal problem area, Making the interpersonal formulation,Obtaining the patient's agreement to the formulation, Establishing the therapeutic relationship, psychoeducation, hope

IPT Diagnosing

medical model, Defining psych problem as independent of the client's personality or character, Offers a hopeful, optimistic, empowering & forward looking approach, Assigned the sick role - excuses the person from self-blaming

Interpersonal Inventory

catalogue of important relationships, informal, Inquire about important people, Explore omissions as well as those easily discussed

IPT Example of case formulation

"Your move from CA to NY has been very difficult for you. Your role transition has meant coming to a new city while loosing touch with friends & giving up a house you loved. We'll focus on how this role transition is related to your depression and explore how you can make this transition more manageable for you.

Obtaining client agreement

1. Client MUST agree on the salience of the problem proposed and to work on it. 2. Need to limit the choice to one area to avoid diffuse Tx 3. Client buy in suggest you have chosen a "good enough" focus

IPT Therapuetic Relationship

Patient advocate, not neutral commentator, Not a manifestation of transference, IPT rarely nalyzes the interpersonal relationship in psychotherapy, Therapist expresses empathy and warmth but not unconditional acceptance

IPT after formulation

Tx focuses on the interpersonal problem area

IPT Treatment example (Bereavement related depression)

- help client mourn, then explore new replacement relationships and activities

IPT Treatment example (Role dispute)

Role dispute - help client examine dispute & seek resolution

IPT Treatment example (Role Transition)

Role transition - redefine & label the chaos felt as a role transition involving the loss of a familiar old role & potential assumption of a new one

Empirically Supported IPT Applications

Deppression, bulimia

Possible IPT Applications

substance abuse, Axis I

Unsupported ipt applications

psychosis< severe

Albert Ellis

sick as a child, decided not to be miserable, trained as a psychoanalyst, dissatisfied with inefficiency, read a lot of Greek and Asian philosophy, apprehensive about asking women on dates so forced himself to ask out 100 women

REBT Relationship Cognitive (thoughts, beliefs, attitudes)+emotions+behaviors(actions)

all interconnected

Development of REBT

Adler's emphasis on social system & importance of goals & purpose, changed names -RT -RET -REBT, emphasizes thoughts but views emotions, behaviors & thoughts intertwined

REBT View of Human Nature

inborn potential for rational and irrational thinking, biological/cultural tendency to think crookedly and needlessly disturb ourselves, we learn/invent disturbing beliefs and keep ourselves disturbed through self-talk, we have capacity to change our cognitive, emotive, and behavioral processes

REBT Psych health

Appreciation of others, social interest, self-direction & creative pursuits, Acceptance of ambiguity, flexibility, high frustration tolerance, thinking logically/scientifically/rationally, taking sensible risks, accept responsibility for own emotional difficulties, realizing we can't always be happy

REBT's Theory of Psychopathology

Psychopathology occurs when irrational beliefs cause emotional consequences, Psychopathology explained by ABC's

REBT ABC Theory of Personality

activating event (A)+belief (B)=consequences (C);Change Beliefs and create a new consequence (new feeling) by disputing intervention (D)+ effective philosophy (E)= new feeling (F)

REBT Change through Thoughts

accept responsibility for creating your emotional problems, stem from irrational beliefs, focus on present thoughts, doesn't focus extensively on roots, forceful and creative strategies used, positive results occur when clients gain awareness of irrational beliefs & take effective action to change them, teach client the skills to become own therapist

REBT 3 levels of insight

1 Choose to upset ourselves, 2 Learn and maintain irrational beliefs, 3 See we need to work to change

REBT Emotions

changed by changing irrational beliefs, not changed directly

REBT Behaviors

secondary focus, measure of progress

REBT Main Qualities of Self-Disturbing Philosophies

rigid/dogmatic beliefs (musturbatory thinking), beliefs generate unrealistic & over-generalized attributions (catastrophizing)

REBT Mustabatory Thinking

rigid and dogmatic beliefs

REBT Catastrophizing

unrealistic and over-generalized attributions generated by beliefs

REBT Mustubatory evaluations

involve overgeneralizations, judgments of self & others, and inflexibility

REBT Mustabutory belief systems examples

I must be perfect and loveable ALL the time, Other people must always treat me kindly & fairly or I can't stand it & they are evil people who should be punished for mistreating me, Life must go the way I want it to go & must never be too difficult or frustrating

Rational Emotive Behavioral Therapy

1 stresses thinking, judging, deciding, analyzing, and doing 2 Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship 3 highly didactic, very directive, and concerned as much with thinking as with feeling 4 Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations

REBT Goals

Goal oriented, focus on changes in beliefs & symptom reduction, de-emphasizes process, enabling people to learn the cognitive skills that promote rationale thinking

REBT Therapeutic Alliance

collaborative; clinician teaches client about rationale & irrational; clinician helps identify, dispute & modify Irrational Beliefs; clinician facilitate development of more rational philosophy; clinician uses influence, persuasion, praise, instruction & humor

REBT's Theory of Therapeutic Processes

consciousness raising (aware of irrational thinking patterns), counterconditioning (replace irrational thinking with rational thinking), contingency management (rearrange reinforcements to support behavior changes)

REBT Therapeutic Process

Therapy is seen as an educational process; Clients learn to identify the interplay of their thoughts, feelings and behaviors; Clients learn to identify and dispute irrational beliefs that are maintained by self-indoctrination; Clients learn to replace ineffective ways of thinking with effective and rational cognitions; Clients learn to stop absolutistic thinking, blaming, and repeating false beliefs

REBT Disputing Irrational Beliefs

logic, empirical evidence, pragmatic/functionalism, constructing alternate rational beliefs

REBT Common Irrational Beliefs About SA

IB: I NEED to use drugs to relax, IB Alternative:I want to use drugs, but don't have to use them

REBT Evaluation

needs more study with problems and different groups, may pay too little attention to history, efficient, teaches/empowers, straightforward, can be integrated

REBT Applications

Family/Couples, Individual, Groups (Mild to mod/severe mental disorders, Anger-aggression, anxiety, depression, contraindicated in psychotic disorders, impulse control, suicidal/homicidal ideation, more research needed on diverse groups

Person-Centered Therapy is a reaction

against the directive and psychoanalytic approaches,

PCT Challenges

the assumption that "the counselor knows best," the validity (of advice, suggestion, persuasion, teaching, diagnosis and interpretation), belief that clients cannot understand and resolve their own problems without direct help, the focus on problems over persons

PCT 6 Conditions for Personality Change

1 two persons are in psychological contact, 2 The client, is experiencing incongruence, 3 The therapist is congruent or integrated in the relationship 4 The therapist experiences unconditional positive regard or real caring for the client 5 The therapist experiences empathy for the client's internal frame of reference and endeavors to communicate this to the client 6 The communication to the client is, to a minimal degree, achieved

PCT Theory of Personality

Basic motivating force is actualization, inborn with actualizing forces that motivate us, valuing processes that regulate us, We create our subjective world, Acquire conditions of worth, Need for unconditional positive regard

PCT Theory of Psychopathology

positive correlation between psychopathology and the level of conditional parents' love, Incongruence between experience and self-concept, reflects a divided personality due to lack of wholeness, defensive reactions prevent awareness, defenses cause inaccurate perceptions due to distortions and selective omission of information

Person-Centered Therapy Emphasis

Therapy as a journey shared by two fallible people, The person's innate striving for self-actualization, The personal characteristics of the therapist and the quality of the therapeutic relationship, The counselor's creation of a permissive "growth-promoting" climate, People are capable of self-directed growth if involved in a therapeutic relationship

PCT Therapeutic Process Goal

increase congruence between self and experience

PCT Therapeutic Processes

combination of consciousness raising and corrective emotional experience, Therapists control the process of therapy but not the content, use facilitative conditions (genuineness, positive regard, empathy)

PCT Therapeutic Relationship

Genuineness/congruence, positive regard, accurate empathy

PCT Growth-Promoting Climate

Congruence (Genuineness), Unconditional positive regard ( Acceptance of clients as a valuable person and as they presently are but not approval of all client behavior), Accurate empathic understanding (ability to deeply grasp the client's subjective world, helper attitudes are more important than knowledge

Rogers' Core Conditions for the Therapeutic Environment (Therapist)

Empathy, Unconditional Positive Regard, Congruence create an environment of trust

Rogers' Core Conditions for the Therapeutic Environment (Client)

self-concept (low at beginning), Locus-of-Evaluation (what others think), Experiencing (initially rigid) are all addressed in an environment of trust

PCT Therapist

focuses on quality of the therapeutic relationship, provides a supportive therapeutic environment in which the client is the agent of change and healing, serves as a model of a human being struggling toward greater realness, Is genuine (integrated, and authentic), can openly express feelings and attitudes that are present in the relationship with the client, is invested in developing his or her own life experiences to deepen self-knowledge and move toward self-actualization

Practicalities of PCT

Psych testing rarely conducted, Efforts to enhance trainee's empathy confused with mindless parroting or sterile technique, Modest effects of such training on empathy

Motivational Interviewing History

William R. Miller, Combines elements of person-centered style and strategy, Found therapist empathy (not tx method) predicted success of therapy for problem drinkers, Research supports MI's effectiveness, developed by psychologists, confront and persuade equals resistance

MI Communication Style

elicit internal motivation, gentle and active listening, respect for patient values and autonomy

Motivational Interviewing

a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence

M Spirit

focus on client's concerns, arguments for change elicited from client, counselor helps client examine ambivalence, direct persuasion, confrontation & argumentation are avoided, collaborative

Principles of MI

Express Empathy, accept resistance, Support self-efficacy, Develop Discrepancy

MI Strategies

Examine pros/cons of change and staying the same, Assess importance and confidence, Use hypothetical, Agenda setting, Provide information/feedback (with client permission)

MI Key Qualities

Flexibility, Tolerance of uncertainty, Encouraging thoughtfulness, Handing over responsibility, Respect for patient choice, Avoidance of righting reflex, Collaborating (not arguing)

MI is not

transtheoretical model, A way of tricking people into doing something they don't want to do, a technique, a form of PCT, Consciously goal directed & strategic

Effectiveness of PCT

Research on empathy, genuineness, and positive regard are valuable contributors to outcome but are neither necessary nor sufficient; Meta-analyses found PCT was clearly superior to no treatment but barely better than placebo, PCT is slightly less effective than CBT

PCT Applications

Addictive behaviors (Largest evidence base), Health Behaviors (HIV risk reduction, adopting exercise & healthy eating habits,

PCT Importance of Treatment adherence

Large effects in treatment engagement, retention, and adherence

MI Applications

Anxiety (integration with CBT), OCD (motivation Tx refusing clients), Depression (prelude to & integration with CBT), Eating disorders (engagement, feedback), Substance use & addictions (Mandated clients)

Limitations of the PCT

Cultural considerations, Lack of focus on the use of specific techniques makes standardization difficult, Beginning therapists may find it difficult to provide both support and challenges to clients, Limits of the therapist as a person may interfere with developing a genuine therapeutic relationship

PCT Cultural Considerations

some clients may prefer a more directive, structured treatment, Individuals accustomed to indirect communication may not be comfortable with direct expression of empathy or creativity, Individuals from collectivistic cultures may disagree with the emphasis on internal locus of control,

Future Directions of PCT

Methods assimilated by mainstream therapies, Slowly declining in popularity in USA, Empathy making a comeback, Needs to maintain openness to integration with other psychotherapy systems and active and eclectic methods in era of short-term treatments, Motivational Interviewing is on the rise

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