1. IPT Background Influences
Adolf Meyer
Swiss trained psychiatrist, practical pragmatic approach, move away from abstraction.
Famous for the psychobiological life history approach, developed the LIFE CHART father of modern life events research. LIFE SPAN APPROACH.
Sets the scene for a genuine integration of the biological, the psychological and the social.

2. Background Influences
Harry Stack Sullivan
Founder of the Interpersonal School of Psychoanalysis. Emphasised importance of social and cultural context.
Use of basic language, emphasised the drive for attachment, sceptical of too much emphasis on unconscious processes. Real experience more important.

3. Background Influences
Harry Stack Sullivan
Therapist should adopt the role of expert. As this would inspire confidence and motivate the patient to continue with therapy.
Sullivan saw the therapeutic relationship as a real relationship with some reciprocal elements. Not a blank screen.

4. Background Influences
Sullivan’s view was that anxiety does not stem from the frustration of biological need but is introduced through interaction with the care giver.
Early on the child learns what type of interaction produces a positive response as oppose to an anxiety producing response in close relating with a care giver.

5. Background Influences
Sullivan used the term parataxic distortion to describe how new relational experiences will always repeat the relational patterns of the past.

6. Background Influences
Sullivan identified two competing needs a person has in interpersonal relationships through the life course: 1.The need for satisfaction 2. The need for security The relative balance between these needs is a key factor in determining emotional Health

7. Background Influences
John Bowlby
Founder of attachment theory
Move away from stage theories of development, many recent developments regarding implications for therapy examining attachment patterns and their potential for change even in adult life.

8. Background Influences
Attachment theory can be seen to bring Object relations, internal working models of relating into main stream psychology and research in psychotherapy .
Attachment styles inform our understanding of relating through out life.

9. Principles of Attachment Theory
Relationship is primary need
Attachment is a biological drive
Attachment is dyadic

10. Definition of Attachment
“The propensity of human beings to make strong affectional bonds to particular others” throughout the life-cycle (Bowlby, 1977)
“It is a primary motivational system with its own workings and interface with other motivational systems” (Bowlby, 1973)

11. The Role of Relationships
“Not only young children.., but human beings of all ages are found to be at their happiest and to be able to deploy their talents to best advantage when they are confident that, standing behind them, there are one or more trusted persons who will come to their aid should difficulties arise.”
(Bowlby, 1973:359)

12. Patterns of Attachment in Adults
Secure
Insecure Dismissing
Insecure Preoccupied
Unresolved

13. Adult Psychopathology in Secure Attachment
Secure Attachment Associated With: Lower anxiety & hostility, greater ego resilience, greater ability to regulate affect through interpersonal relatedness; relationships are relatively unambivalent
In therapy: Favourable outcomes (good response to brief interventions & strong therapeutic alliance); linked to ability to reflect on mental states of both others and self & metacognitive monitoring

14. Features of Secure Attachment
Coherent, collaborative discourse
Values attachment relationships
Objective regarding relationships and events
Description of attachment-related experiences is consistent, whether favourable or unfavourable

15. Adult Psychopathology in Insecure Attachment
Insecure Attachment Associated with: more depression, anxiety, hostility, psychosomatic illness: less ego resilience, perceived levels of interpersonal support
In therapy: initial anxiety in response to making changes leads to resistance. Work needs to address alterations in attentional, emotional & relational patterning. Use of the therapeutic relationship

16. Features of Insecure-Dismissing Attachment
Dismissing of attachment–related experiences and relationships
Normalising of early unsupportive relationships
Description of attachment related experiences very brief

17. Features of Insecure-Preoccupied Attachment
Not coherent discourse
Preoccupied by or with past attachment relationships or experiences.
Description of attachment experiences long, entangled

18. Features of Unresolved Attachment
During discussion of loss or abuse individual shows striking lapses in the monitoring of reason or discourse, eg that someone dead is alive

19. Adult Psychopathology in Insecure Attachment
Insecure Attachment Associated with: more depression, anxiety, hostility, psychosomatic illness: less ego resilience, perceived levels of interpersonal support
In therapy: initial anxiety in response to making changes leads to resistance. Work needs to address alterations in attentional, emotional & relational patterning. Use of the therapeutic relationship

20. Adult Psychopathology in Insecure (Unresolved) Attachment
Unresolved attachment associated with: intense and unstable relationships, identity disturbance and other features of BPD
In therapy: 16 session IPT unlikely to be effective because identity disturbance militates against short-term interventions. However there is a modification of IPT for BPD.

21. The Secure Base (SB) Phenomena
Initially SB is care-giver to whom the child turns when distressed.
Infants & young children experience SB behaviourally; at times of threat or illness infant turns to caregiver/s. Their protection ensures the child’s survival.

22. The Secure Base Phenomena in Adults
In adulthood SB is internalised and experienced as a representation within the individual’s mind.
Under stress individuals regulate affect by self-soothing (using the representation) and/or make contact with attachment figures
Psychological survival impossible without an SB. SB exists within both secure and insecure attachment style.
The relationship with a therapist provides the opportunity for a new SB representation.

23. IPT and Neurological Change
IPT emphasises importance of a positive therapeutic alliance and of interpersonal relationships. Positive and attuned interpersonal / therapeutic relationships enhance neural plasticity and learning.
IPT encourages the expression of affect in the context of cognitive appraisal. Optimal levels of emotion and stress stimulate production of neuro-transmitters and neural growth hormones, enhancing learning and cortical reorganisation.

24. Background Influences
There is also a third type of life event that is referred to in the literature:
History graded events – these are events that a whole cohort or community experiences. Examples would be the Great Depression, World War 2, 9/ 11 , the current recession. Consider age of patient when event experienced and social context.

25. Background Influences
Two Main types of life events we are interested in.
Normative or transition events that characterise the life course.
Non Normative events that are usually unexpected are always stressful and upsetting they involve long tern threat to the individual.

26. Background Influences
Social approach, especially the role of LIFE EVENTS and CHRONIC STRESSORS to cause and exacerbate mental health problems.
See the work of George Brown and Tirrel Harris, Michael Rutter, Jean Paykel and many others important in 1970’s and 80’s

27. Research developments on the link between life events and
illness are relevant to IPT.
Severe events and chronic difficulties often precede the onset of
depression.
These stressors also impede recovery.
Stressors are often interpersonal in nature.
Events that disrupt key social roles are particularly important.
A confiding relationship, particularly with a partner, reduces
the vulnerability to depression when severe stressors occur.
Lack of a confiding relationship with a partner is associated with
an increase in the occurrence of the type of events that are known
to precede depression.

28. Background Influences
We can’t usually prevent stressors in the form of life events and chronic difficulties form occurring .
Social support protects against stressors IPT aims to intervene by improving social support.

29. Background Influences
Rutter demonstrated that a child’s relationship with others beside the Mother can also create attachment bonds and the disruption of these bonds can contribute to the onset of depression.
This supports IPT’s focus on the importance of the wider network and relationships with close others in a broader sense.

30. Background Influences
Rutter also demonstrated that forming positive, supportive relationships with peers and others at school and work can be protective particularly for those at risk as a result of early adversity . One way they can protect is to help the individual make positive choices and effectively plan important transitions such as co-habitation and marriage

31. Background Influences
Rutter also demonstrated that forming positive, supportive relationships with peers and others at school and work can be protective particularly for those at risk as a result of early adversity . One way they can protect is to help the individual make positive choices and effectively plan important transitions such as co-habitation and marriage

32. Background Influences
Rutter also demonstrated that forming positive, supportive relationships with peers and others at school and work can be protective particularly for those at risk as a result of early adversity . One way they can protect is to help the individual make positive choices and effectively plan important transitions such as co-habitation and marriage

33. Background Influences
Rutter also showed that:
Events are less important than the chronic stressors
or difficulty to which they give rise. It is the lack of
care or chronic discord that follows events such as the
loss of a parent that is more likely to lead to later problems.
Most of these chronic stressors concern poor social
relationships in the individual’s immediate social network.

34. Background Influences
The literature on the impact of social support on mental health is vast and complex but also very useful for IPT.
IPT is all about understanding and using the client’s network and the potential for support within it to promote better mental health.

35. Background Influences
Robert Weiss, Scott Henderson , Cohen and Wills
Understanding of the role of SOCIAL SUPPORT in mental health, especially its protective function in the face of adversity (conceptualised as life events and chronic difficulties.)
More about this when doing inventory

36. What can we take from the literature on social support?
Social support needs to be assessed across a range of life domains
that are important to the individual e.g. family, friends, work,
other interests, neighbours, school/college, church etc. What
these domains are will be influenced by the individual.
Types of social support are effected by wider social factors such
as sex, class and culture.
Social support assessment needs to include both:
availability
adequacy.
The perceived adequacy of support is a better predictor
of mental health than availability.

37. What type of network?
There is some evidence that diffuse
networks are more protective than dense networks.
Reciprocity is important.
Social support can be both negative and positive.
Social support is influenced by personality. To what extent can
individuals make use of the support that is offered?

38. Provides reassurance about a person’s worth.
SUPPORT FUNCTIONS
EMOTIONAL SUPPORT
Provides reassurance about a person’s worth.
Linked to concept of unconditional positive regard.
Synonymous with confiding.
Usually provided by close relationships of long standing.
INSTRUMENTAL SUPPORT
The provision of direct assistance or practical help.
SOCIAL COMPANIONSHIP
Being in the company of known others while engaging in activities
- often for pleasure or leisure.
MOTIVATIONAL SUPPORT (Wills 1985)
Consistently helps to maintain hope in chronically difficult circumstances.
Helps to sustain a belief in a chosen course of action (plan).

39. Background Influences
A more recent article on the
importance of social factors
so topical in the 1980’s.
Entitled “Slings and arrows: Depression and Life Events” Even in an age of genomics, neuro imaging and Prozac, our understanding of emotional disorders continues to involve the ups and downs of everyday experience. That’s what IPT’s about. (Oatley, 2007)