Presentation on theme: "IPT Background Influences"— Presentation transcript:
1IPT Background Influences Adolf MeyerSwiss 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.
2Background Influences Harry Stack SullivanFounder 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.
3Background Influences Harry Stack SullivanTherapist 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.
4Background 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.
5Background Influences Sullivan used the term parataxic distortion to describe how new relational experiences will always repeat the relational patterns of the past.
6Background 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
7Background Influences John BowlbyFounder of attachment theoryMove 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.
8Background 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.
9Principles of Attachment Theory Relationship is primary needAttachment is a biological driveAttachment is dyadic
10Definition 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)
11The 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)
12Patterns of Attachment in Adults SecureInsecure DismissingInsecure PreoccupiedUnresolved
13Adult 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 unambivalentIn 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
14Features of Secure Attachment Coherent, collaborative discourseValues attachment relationshipsObjective regarding relationships and eventsDescription of attachment-related experiences is consistent, whether favourable or unfavourable
15Adult Psychopathology in Insecure Attachment Insecure Attachment Associated with: more depression, anxiety, hostility, psychosomatic illness: less ego resilience, perceived levels of interpersonal supportIn 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
16Features of Insecure-Dismissing Attachment Dismissing of attachment–related experiences and relationshipsNormalising of early unsupportive relationshipsDescription of attachment related experiences very brief
17Features of Insecure-Preoccupied Attachment Not coherent discoursePreoccupied by or with past attachment relationships or experiences.Description of attachment experiences long, entangled
18Features 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
19Adult Psychopathology in Insecure Attachment Insecure Attachment Associated with: more depression, anxiety, hostility, psychosomatic illness: less ego resilience, perceived levels of interpersonal supportIn 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
20Adult Psychopathology in Insecure (Unresolved) Attachment Unresolved attachment associated with: intense and unstable relationships, identity disturbance and other features of BPDIn 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.
21The 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.
22The 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 figuresPsychological 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.
23IPT 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.
24Background 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.
25Background 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.
26Background 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
27Research developments on the link between life events and illness are relevant to IPT.Severe events and chronic difficulties often precede the onset ofdepression.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, reducesthe vulnerability to depression when severe stressors occur.Lack of a confiding relationship with a partner is associated withan increase in the occurrence of the type of events that are knownto precede depression.
28Background 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.
29Background 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.
30Background 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
31Background 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
32Background 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
33Background Influences Rutter also showed that:Events are less important than the chronic stressorsor difficulty to which they give rise. It is the lack ofcare or chronic discord that follows events such as theloss of a parent that is more likely to lead to later problems.Most of these chronic stressors concern poor socialrelationships in the individual’s immediate social network.
34Background 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.
35Background Influences Robert Weiss, Scott Henderson , Cohen and WillsUnderstanding 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
36What can we take from the literature on social support? Social support needs to be assessed across a range of life domainsthat are important to the individual e.g. family, friends, work,other interests, neighbours, school/college, church etc. Whatthese domains are will be influenced by the individual.Types of social support are effected by wider social factors suchas sex, class and culture.Social support assessment needs to include both:availabilityadequacy.The perceived adequacy of support is a better predictorof mental health than availability.
37What type of network?There is some evidence that diffusenetworks 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 canindividuals make use of the support that is offered?
38Provides reassurance about a person’s worth. SUPPORT FUNCTIONSEMOTIONAL SUPPORTProvides 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 SUPPORTThe provision of direct assistance or practical help.SOCIAL COMPANIONSHIPBeing 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).
39Background Influences A more recent article on theimportance of social factorsso 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)