7
IPT for PTSD— Role Transitions
“No tongue can tell,
no mind conceive, no pen portray the horrible
sights I witnessed this morning.”
— Union Captain John Taggert,
9th Pennsylvania
Reserves Antietam, September 17
th
, 1862
You have to know when to let the old life go, and go on and not look
back and have regrets, I always say. Otherwise you will be sad, because
you are always losing something. That’s the way life is,
if you let mis-
fortunes strike you too hard, you won’t see the new chance coming.
— Susan Sontag:
The Volcano Lover
. (New York:
Picador,
1992, P. 402)
Most IPT manuals work their way through the sequence of interpersonal
problem areas by starting with complicated grief. In our randomized study,
40 patients were randomly assigned to IPT. Thirty- eight of them actually
began treatment and agreed upon a treatment focus. Of those 38 patients, 30
(79%) were treated for role transitions. Because role transitions are the most
common focal interpersonal problem area for patients with PTSD, we will start
with them. This and the succeeding chapters will be built on case examples to
illustrate the focal problem areas. All cases have been
disguised to protect the
confidentiality of patients.
CASE E X AMPLE 1
Martina, 25- year- old single white woman clerical worker, presented with more
than four years of PTSD and major depression. Her chief complaint was: “I’ve
80
I P T F O R P T S D
been feeling weird, cut off.” She had nearly been killed by debris from the
World Trade Center, where she fortuitously had arrived late for her job and
joined the walking exodus from downtown Manhattan. The destruction there
put her out of work. A month later, in October 2001, she was mugged at knife
point in the lobby of her apartment building. Her assailants stole her brief-
case, which contained the only diskettes of the novel she had been working on
for the previous two years.
She met full
DSM- IV
criteria for PTSD, including
flashbacks, hypervigilance, detachment, and suspiciousness of others. Her
Clinician- Administered PTSD Scale (CAPS, Blake et al., 1995) score was 60,
indicating severe PTSD (Weathers et al., 2001). She also met criteria for a mod-
erately severe major depressive episode, scoring a 23 on the 24- item Hamilton
Depression Rating Scale (Hamilton, 1960). She had trouble enjoying anything,
felt frightened, felt that other people could not be trusted,
that life was hope-
less. She subsequently broke up with a boyfriend who she felt did not under-
stand what she had been going through.
The therapist gathered this history in the first two sessions and collected
an interpersonal inventory. Martina was the youngest of three sisters. She
denied prior trauma. From childhood, she had generally been passive and
avoidant in dealing with other people. She announced to the therapist that
she had never liked confrontations, preferring to keep her feelings to her-
self, and taking a rather passive, nonassertive role with others. She had
friends, and occasional brief sexual encounters, but had always had diffi-
culty getting close to other people. There was
no one she thought of as a
confidant.
She was an alert, quiet white woman appearing roughly her stated age, well
groomed, dressed in rather conservative and drab clothing. Her movements
were mildly agitated, her speech soft and hesitant, fluent and unpressured. She
avoided eye contact. Her mood was anxious and depressed, with a constricted,
minimally reactive affect. Her thoughts appeared goal- directed, if marked by
ruminations about her failings (“I’m a weak person”). She reported passive su-
icidal ideation without plans or intent. Sensorium was grossly clear.
In the
context of her recent trauma, Martina reported having told and
having received “some” support from her family members. Their response
had been to listen briefly, cut her off, and tell her to buck up and get over
it. She said that that was what she had expected, and denied having any
emotional reaction to this interchange. She reported a similar interaction
with her female roommate in their shared apartment. She nonetheless said
she was left feeling alone and misunderstood.
She withdrew from her few
friends and kept a distance from co- workers at a new job she had found.
She also made no attempt to write, felt that her life was over, and that a new
disaster was surely waiting around the corner.
Role Transitions
81
In session 3, Martina’s therapist framed her situation as a role transition:
Therapist: You’ve given me a lot of helpful history. Can I ask you if
I understand what you’ve told me? You have been through not one
but two traumas, both life- threatening and extremely upsetting. As
a result of those traumas, you have a CAPS score of 60, which means
you have severe posttraumatic stress disorder.
PTSD is a treatable
disorder, though, and you have a good chance of getting better in this
14- week treatment. And it’s not your fault that this happened to you.
It’s bad enough that you had to go through these terrible events, but
even worse that the PTSD is affecting your life day to day, making it
hard to enjoy things or interact with other people. It’s left you more
isolated and unhappy, not knowing whom to trust. This brief therapy
is a chance to
Do'stlaringiz bilan baham: 
