InterPersonal Therapy of Depression-Role Disputes

InterPersonal Therapy of

Depression-Role Disputes

“a situation in which the patient and at least one significant other person have non-reciprocal expectations about their relationship”

IPT focuses on Role Disputes if they seem important in the genesis and perpetuation of the depression.Generally, the dispute is stalled or repititious, with little hope for improvement.

The patient feels they can no longer control the dispute, and there is threatened loss of what the relationship provides, or they feel incompetent to manage their lives.

The dispute is perpetuated byDemoralised sense that nothing can be done

Poor habits of communication

Truly irreconcilable differences

*Diagnosis of a Role Dispute

There must be evidence of current, covert or overt, conflict with a significant other.In studies, usually with a spouse.If there is no clear precipitant for the depression, look for covert conflicts, as much what is omitted from the interpersonal inventory as what is said, and for changes in relationships over the period of onset of the depression.

*Goals for the patient

Identify the dispute.Make choices about a plan of action.Modify communication patterns or reassess expectations, or both.

Ie: accept status quo, improve communication to fix it, or get rid of the relationship.

IMPORTANT: The therapist has no commitment to guide the patient to any particular resolution of the difficulty.

*Staging the Role Dispute

1) Renegotiation-need to improve the communication.

2)Impasse-restart negotiation or consider dissolution.

3)Dissolution-need to integrate the relationship so patient is free to move on.

*Roles for the Therapist

Identify the stage at which the Role Dispute is stuck.Help the patient understand how non-reciprocal expectations relate to the dispute.Help patient to choose to take action to alter their InterPersonal situation.

Ie: overall movement from exploration to action

Be aware that patterns od interpersonal disputes can occur. Ask about them. If parallels occur:

What does the patient gain by the behaviour?

What are the central unspoken assumptions that lie behind the behaviour?

Why does the patient get into similar unpleasant situations?

Paying attention to the communication strategies of the disputants may reveal problems in communication patterns.Eg: fear of confrontation and expression of negative feelings.If communication difficulties arise, resolution of these can be part of the action plan.

“a Role Dispute can be negotiated successfully if the patient becomes able to express needs and wishes directly to the other person and together they are able to work out a resolution that takes the needs of both into account. There will be some understanding of each others needs and some compromise on both parts.”