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Psychodynamic
Interpersonal Theory (PIT)
Devised by Hobson (1985) and originally called ‘conversation model’
since it is based on the therapist and patient having a ‘therapeutic
conversation.’
The basic assumption of the treatment is that depression arises from
disruption of personal relationships. These are explored during therapy
as part of another relationship, the one between therapist and patient.
The treatment is designed as a short term measure that explores past
relationships, particularly those during childhood and adolescence, many
of which might have failed. Its primary aim is to reduce the symptoms
of depression ad improve social adjustment. PIT claims to produce more
satisfying current relationships by exploring what has gone wrong with
previous ones.
In order to keep the therapy as brief as possible, the patient and
therapist agree during the first few sessions which relationships will
be explored. Future sessions then concentrate on these. In this way,
PIT is unlike the more typical open-ended therapies preferred by the
psychodynamic approach.
Three components of
depression
-
Development of
symptoms due to biological, genetic and/or psychodynamic factors.
-
Social
interactions that are learned and change over the course of a
lifetime
-
Personality; the
enduring dispositional characteristics which may predispose a person
to depression
IPT tackles the first two. It doesn’t consider or attempt to influence
personality.
Although PIT has been used to treat a host of psychological issues such
as eating disorders, panic disorder and issues relating to HIV, its main
focus has always been on depression. In particular PIT is designed to
manage four basic problem areas:
1. Unresolved grief
Grief is normal following bereavement. However, this considers delayed
grief or grief that has become distorted. For example grief that lacks
sadness but manifests itself in non-emotional ways such as odd
behaviours.
Aim of PIT: to facilitate mourning
2. Role disputes
When there are differing expectations about the nature or outcome of a
relationship between the people involved. Perhaps one wanting it to
become more serious when the other doesn’t.
Aim of PIT; to recognise the nature of the dispute and decide a plan of
action that will resolve the misunderstanding.
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3. Role transitions
Depression caused by an inability to cope with life changes and events.
Typical examples would include divorce, retirement, leaving home. The
depressed person is far more likely to see these as a loss rather than
an opportunity.
Aim of PIT: Get the patient to give up the old role and accompanying
sadness, guilt or anger.
4. Interpersonal
deficits
The patient has too few or total lack of supportive relationships, for
example no intimate relationships resulting in feelings of inadequacy
and low self-esteem.
Aim of PIT: to reduce social isolation. In this case PIT is more likely
to focus on past relationships.
Does PIT work?
Paley et al (2008) concluded that PIT is as effective as CBT.
They followed 62 patients over a 52 month period. The effectiveness of
the PIT was measured using the BDI (Beck Depression Inventory). 34% of
patients showed significant reduction in depressed symptoms.
However, this study was poorly controlled (by the authors’ own
admission) so it is difficult to be certain that it was just the PIT
bringing about the improvements.
Brief interventions can also be useful. 54 NHS patients were either
given 12 weeks of PIT or placed on a waiting list for treatment (control
group).
In the 33 patients that completed the study there were significant
improvements. However, there was a very high drop out rate, mostly from
the ones on the waiting list.
Overall evaluation
Many psychologists consider CBT to be too limited in its approach,
considering mostly the cognitive processes underlying the negative
cognitions. PIT recognises the importance of relationships in the
development and treatment of depression so adds a new dimension to
therapy.
PIT is especially useful in depression known to be at least partly due
to relationship issues, such as divorce and bereavement.
Done Depressed!
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