Interpersonal psychotherapy for depressed adolescents PDF
Preview Interpersonal psychotherapy for depressed adolescents
INTERPERSONAL PSYCHOTHERAPY FOR DEPRESSED ADOLESCENTS Interpersonal Psychotherapy for Depressed Adolescents Second Edition LAURA MUFSON KRISTEN POLLACK DORTA DONNA MOREAU MYRNA M. WEISSMAN THE GUILFORD PRESS New York London ©2004TheGuilfordPress ADivisionofGuilfordPublications,Inc. 72SpringStreet,NewYork,NY10012 www.guilford.com Allrightsreserved Nopartofthisbookmaybereproduced,translated,storedina retrievalsystem,ortransmitted,inanyformorbyanymeans, electronic,mechanical,photocopying,microfilming,recording, orotherwise,withoutwrittenpermissionfromthePublisher. PrintedintheUnitedStatesofAmerica Thisbookisprintedonacid-freepaper. Lastdigitisprintnumber: 9 8 7 6 5 4 3 2 LibraryofCongressCataloging-in-PublicationData Interpersonalpsychotherapyfordepressedadolescents/LauraMufson.—2nded. p.cm. Includesbibliographicalreferencesandindex. ISBN-10:1-59385-042-5(hardcover:alk.paper) ISBN-13:978-1-59385-042-5(hardcover:alk.paper) 1.Depressioninadolescence—Treatment. 2.Interpersonalpsychotherapy. 3. Adolescentpsychotherapy. I.Mufson,Laura. RJ506.D4I582004 616.85′27′00835—dc22 2004002941 AAbboouutt tthhee AAuutthhoorrss About the Authors Laura Mufson, PhD, is Director of the Department of Clinical Psychol- ogy at the New York State Psychiatric Institute and Associate Professor of Clinical Psychology in Psychiatry at Columbia University College of PhysiciansandSurgeons.Dr.Mufsonwasthefirsttoadaptinterpersonal psychotherapy (IPT) for adolescents and has been conducting research on interpersonal psychotherapy for depressed adolescents for over a de- cade. She travels extensively, training clinicians in treatment techniques for IPT. KristenPollackDorta,PhD,isaclinicalpsychologistcurrentlyinprivate practice.Dr.Dortahasbeeninstrumentalintheimplementationofinter- personal psychotherapy for depressed adolescents in school-based men- tal health clinics and the training of school-based clinicians. DonnaMoreau,MD,isClinicalAssociateProfessorofPsychiatryatCo- lumbia University College of Physicians and Surgeons and Director of the Children’s Anxiety and Depression Clinic at Children’s Hospital of New York–Presbyterian Hospital. Myrna M. Weissman, PhD, one of the originators of interpersonal psy- chotherapy, is Professor of Psychiatry and Epidemiology at Columbia University College of Physicians and Surgeons and the Joseph L. Mail- man School of Public Health. She is also Director of the Division of Clinical and Genetic Epidemiology at the New York State Psychiatric Institute and has published extensively on interpersonal psychotherapy, includingcoauthoring(withJohnC.MarkowitzandGeraldL.Klerman) A Comprehensive Guide to Interpersonal Psychotherapy. v PPrreeffaaccee Preface T his book has three aims: (1) to provide a general overview of the nature and current treatment practices of adolescent depression; (2) to introduce the experienced adolescent therapist to the theoretical for- mulation and practical application of interpersonal psychotherapy for depressed adolescents (IPT-A); and (3) to update our original IPT-A treatmentmanualpublishedin1993toincludeoveradecadeofexperience using the manual to treat myriad adolescents suffering from depression. IPT-Aisa12-week-longpsychotherapywithweeklyface-to-facesessions interspersedwithtelephonecontacts.Treatmentfocusesprimarilyonthe depressed adolescent but frequently also involves the parents. The four problem areas originally developed in IPT for adults are applied to ado- lescents and include grief, interpersonal role disputes, role transitions, and interpersonal deficits. PartIofthisvolumeprovidesabriefoverviewofadolescentdepres- sion, including diagnosis, assessment, clinical course, and other treat- mentsforadolescentdepression.TherationalefortheadaptationofIPT to treat adolescent depression is presented in this section. Part II of the book is the actual treatment manual written for the clinician who is trained to conduct psychotherapy for adolescent disorders. It is orga- nized as a step-by-step description of the therapeutic tasks for the three phases of the psychotherapy. Part III addresses the special issues that arise when working with adolescents and how they can be addressed while staying within the IPT-A treatment framework. Part III also in- vii viii Preface cludes a discussion of the current and future research in IPT-A that is currently under way. The results of our efficacy study of IPT-A, as well as the study con- ductedbytheIPTresearchgroupinPuertoRico,demonstratedthatIPT- A is an efficacious treatment for depression in adolescents. The recently completed effectiveness study of IPT-A in comparison to treatment as usual for depressed adolescents in school-based health clinics also dem- onstrates the effectiveness of IPT-A in a community setting and in treat- ing adolescents with a spectrum of depression disorders. As a result of thismostrecentstudy,wehavegainedexperienceandinsightintotrain- ing therapists from diverse backgrounds to work in a range of settings with varied constraints on training and supervision. This book includes manyoftheinsightswegainedfromtrainingtheseclinicianstoconduct IPT-A. More studies on the effectiveness of IPT-A that include larger, more heterogeneous samples conducted in a variety of community set- tings are needed. Currently there are few formal training programs in IPT-A inde- pendent of the research setting. We hope to develop more training sites to offer a variety of levels of training in IPT-A. We believe that, even without attending one of these formal training programs or conference- sponsoredworkshops,clinicianswithexperienceinthetreatmentofad- olescents will be able to adopt elements of the IPT-A approach by re- viewing the manual presented here. Similarly, for those less experienced practitioners,wehopethatexposuretoIPT-Athroughthisbookwillen- courage them to seek further training in IPT-A and its use in clinical practice. Our ultimate goal is for more clinicians to have exposure to IPT-A and to utilize the elements of IPT-A both in research and in clini- calpracticebecausewebelieveittobeaneffectivetreatmentmodelthat is acceptable to adolescents. This second edition provides new and more extensive scripts and clinicalvignettestohelpguidethereaderintheimplementationofIPT-A andupdatestheefficacydatafromclinicaltrialsconductedusingIPT-A. The most significant modification of the manual in this edition is the elimination of the single-parent-families problem area and inclusion of theseissuesinasubgroupcategoryunderroletransitions.Thismodifica- tion is an outgrowth of our continued experience using the manual, which suggested that the majority of the adolescents who experienced theproblemareaofsingle-parentfamiliesdidsolargelyinthecontextof aroletransition.WhilewewereawareofthisfromtheinceptionofIPT-A, at that time we felt that the special issues for adolescents dealing with family structural change needed to be separated into a distinct problem area. Continued experience has changed our perception and has led us to conclude that the issues once addressed under single-parent families Preface ix arebestunderstoodasaspecialcircumstanceinthecontextofroletran- sition. Nonetheless, we still believe that the circumstances are often unique and require some separation from the larger transitional issues. The transitions associated with changes in family structure are typi- cally outside of the control of the adolescent and are generally not normative or expected. The problems that arise from the structural change are often a result of the parents’ difficulty in negotiating the change or transition, and their difficulties lead to stress and depression in their adolescent. In addition, the adolescent, in trying to deal with these stresses, often finds himself in the middle of many disputes with both the custodial and noncustodial parents in addition to having dif- ficulties in making the transition to the new family structure. By incor- porating these problems into the role transitions problem area, we also are able to acknowledge that these family structural changes not only occur in single-parent families but also can characterize the challenges adolescents face in adapting to stepfamilies and foster families. We therefore are returning to the four-problem-area model for IPT-A, with a special subproblem area of family structural change under the prob- lem area of role transitions. Our continued clinical work with depressed adolescents and the challengeswefacedwhendisseminatingthetreatmentinthecommunity provided the impetus for revising the book at this time. We have gained significant experience over the past decade treating depressed adoles- cents and training a multitude of clinicians, so that we strongly felt we couldenhancetheoriginalmanualandmakethetreatmentmoreaccessi- ble to clinicians and researchers alike. We are acutely aware of the potentially crippling effects of depression on adolescents, and we have been motivated to improve the dissemination of effective treatments to more clinicians. Many depressed adolescents will improve within the first few weeks of nonspecific psychotherapeutic interventions and will leavetreatmentdespiteconcertedeffortsonthetherapist’sparttomain- tain the therapy. Many of these adolescents will return with future de- pressive episodes, but many others will not return to receive necessary treatment. Instead, the latter group will suffer the impairing social and interpersonal consequences of their depressive episode until many years laterwhentheymayagainseektreatmentasadults.WehopethatIPT-A, specificallytailoredtotheadolescent’sdevelopmentaltasks,willaddress theneedforeffectivetreatmentsforadolescentdepression.Wealsohope that the enhanced explication of techniques, strategies, and guidelines forthestructuringofthetherapysessionswillfacilitateclinicians’useof theprinciplesandtechniquesofIPT-Ainnewresearchendeavorsaswell as in general clinical practice.
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