Maintenance IPT

Ellen Frank, Ph.D.

The implementation of IPTas a preventative maintenance treatment (IPT-M; Frank, 1991) is based on the original form of IPT, developed by Klerman, Weissman, and colleagues (Klerman et al., 1984).  IPT-M maintains some key characteristics of IPT in its original form, but other aspects of treatment, including the goals of treatment, the number of problem areas addressed, and timing of treatment, are adapted to the objectives of maintenance treatment (Frank, 1991).  While the goal of IPT is to treat depressive episodes, the main goal of IPT-M is to prevent recurrences of depression and to maintain the well state.  Thus, a patient entering IPT-M should have already reached remission of a depressive episode.

To maintain the well state, the patient and therapist first look for signals of a return of depressive symptoms, as well as for interpersonal disturbances or challenges that might trigger a depressive episode.  Returning symptoms may be similar to the symptoms that preceded previous depressive episodes, or they may be different prodromes entirely. Nonetheless, if these signals appear, the patient and therapist then work together to prevent the return of a depressive episode.

A second goal of IPT-M is to resolve some of the more chronic interpersonal difficulties experienced by patients with recurrent depression. It may be more suitable to address these difficulties during maintenance treatment than during short-term treatment of a depressive episode, where the focus is on resolving the acute depressive symptoms and more acute interpersonal or social role problems.

Since the patient is well and the goal of treatment is to prevent depressive recurrence, sessions may occur less frequently than the typical weekly sessions seen in IPT.  This difference in timing is yet another way that IPT-M differs from that of acute IPT (Frank, 1991).  IPT-M sessions may be as infrequent as once per month, perhaps over several years’ time.  But given the aim of resolving some of the more chronic interpersonal and personality difficulties faced by the patients, consistent and enduring treatment seems to suit these patients quite well.  Some patients may benefit from the increased time between sessions to process therapeutic work.  Others may initially have difficulty adapting to less frequent sessions, and in some cases they may experience this change as a loss.  In this case it is recommended that the therapist address the patient’s discomfort in order to resolve his or her feelings of discouragement or anger at the loss of more frequent contact (Frank, 1991, p. 264).

The problem areas are another way in which IPT-M differs from IPT.  While the four problem areas of IPT are maintained, treatment typically focuses on a greater number of problem areas over the course of IPT-M.  This is partly based on the longer course of treatment, but also the fact that long-standing interpersonal patterns may become the focus of therapeutic work.  Thus, at least two IPT problem areas will become the focus of treatment during the maintenance phase.

By design, individuals entering the maintenance phase of IPThave recently transitioned from being depressed to being well, a state that may be somewhat new to them if they have been depressed for a significant portion of their lives.  Thus, one major role transition that is almost always explored in IPT-M is that of depressed person to well person.  This may be an example of a new role that is welcomed, but that is still unfamiliar. The therapist guides the patient to examine the positive and negative aspects of his or her situation, as would be done with other role transitions. Other problem areas are approached in a similar manner as in IPT, though the focus may be on more long standing interpersonal challenges that are not necessarily linked to an acute episode of depression.

For more information about Maintenance IPT, contact Ellen Frank, Ph.D. at FrankE@upmc.edu

Bibliography

1. Frank, E. (1991). Interpersonal psychotherapy as a maintenance treatment for patients with recurrent depression. Psychotherapy and Psychosomatics, 28(2), 259-266.

2. Klerman, G. L., Weissman, M. M., Rounsaville, B., J., & Chevron, E. S. (1984). Interpersonal Psychotherapy of Depression: Basic Books.