|
participants that can bring aspects of the treatment to life.
c.
Supervision
: The only way to really learn a psychotherapy is to
do it. The best way to practice it, at least at first, is with feedback,
so that you know whether you are actually doing IPT or not.
Supervised cases should include:
i. Audio- or videotaping sessions, inasmuch as process notes are
unreliable (Chevron & Rounsaville, 1983) and the supervisor
can provide more accurate help if you and the supervisor have
an accurate record of the session;
144
I P T F O R P T S D
ii. Using the manual as a guide;
iii. Serial assessment of patients to measure symptomatic
improvement;
iv. Regular (ideally, weekly) supervision sessions based on review
of the taped treatment sessions.
Two kinds of supervision have yielded good IPT therapists. The more ex-
pensive involves hiring an IPT expert for individual or group supervision.
An alternative that has worked quite well for research groups in Canada, the
Netherlands, and elsewhere has been group peer supervision. Interested thera-
pists who have general psychotherapy experience meet regularly together and,
using the above supervisory elements, supervise one another’s taped cases
based on reading an IPT manual.
3.
What about training in IPT specifically for PTSD?
This diagnosis is new
for IPT, and essentially all the therapists trained in IPT for PTSD to
date were trained to conduct research studies (e.g., Krupnick et al.,
2008; Campanini et al., 2010; Markowitz et al., 2015). A purpose of
this manual is to disseminate information about the adaptation of IPT
for PTSD to a wider clinical population. IPT/ PTSD workshops began
in London in 2015 and 2016 and hopefully will continue.
14
Conclusion
Where Do We Go from Here?
This manual was first written before the open trial of IPT for PTSD we pub-
lished in 2005 (Bleiberg & Markowitz, 2005), was fleshed out for the larger
randomized controlled trial we published in 2015 (Markowitz et al., 2015), and
is further expanded now. The principles of this adaptation have remained con-
stant throughout, and remain congruent with earlier IPT manuals that fo-
cused primarily on major depression (Klerman et al., 1984; Weissman et al.,
2000, 2007). Because research on IPT for PTSD is limited and still prelimi-
nary, readers should surely not hold this book infallible or complete.
There is so much we do not yet know. To really confirm the efficacy of acute
(14- week) individual IPT for PTSD requires a confirmatory, randomized rep-
lication trial (Flay et al., 2005), ideally by a separate research group. We do not
yet know whether IPT has similar efficacy in treating PTSD in military per-
sonnel as in civilians, although we hope to explore this in an upcoming study.
We do not know the optimal dosage of IPT for PTSD: is 14 weeks ideal, too
brief, or too long? We have no data on whether IPT augmentation with med-
ication (or vice versa) would have greater benefit than either treatment alone
(cf. Schneier et al., 2012). And, as noted in Chapter 10, we do not know whether
maintenance IPT might benefit patients who respond to acute treatment, yet
continue to have troublesome PTSD symptoms.
We also hope to glean more findings from the research we have already
done. A rich database may yield findings about mediators or moderators of
IPT, neuroimaging findings, follow- up data (did patients who improved stay
better?), and other related outcomes.
We also have not yet demonstrated
why
or
how
IPT works, for PTSD or other
disorders. Theories abound, but no proof of the mechanism exists (Lipsitz &
Markowitz, 2013; Markowitz et al., 2015). We speculate that, in addition to its
beneficial effects on social support and social functioning, IPT works through
146
I P T F O R P T S D
greater emotional understanding of one’s interpersonal life and one’s ill-
ness, which may be measurable through
symptom- specific reflective function
(Rudden et al., 2009), a measure of the patient’s emotional understanding of
his or her PTSD symptoms, which we would expect to change more in affect-
focused IPT than in an exposure- based treatment (see Chapter 4). We hope to
test this hypothesis in an upcoming research trial. Knowing more about the
active processes of IPT might allow a refinement of the treatment approach.
To come full circle, let’s give one last thought to exposure. IPT clearly does
not work through structured exercises of graded exposure to trauma remind-
ers. Think, though, about what happens when a patient does such an exposure
task. The patient faces a feared cue, has a rush of emotion, and then, if the pa-
tient does not flee, habituates: that is, the patient recognizes that the trauma
reminder is no longer dangerous, and the emotions subside. IPT for PTSD
does not do this, but it may have a parallel effect. In working on affect at-
tunement, the IPT therapist elicits a similar range of the patient’s emotions in
response to quotidian interpersonal encounters. A patient with PTSD may feel
a crescendo of anxiety, anger, or some combination of negative effects during a
not- truly- dangerous interchange with a co- worker, family member, or friend.
Or just recounting this incident in the session may evoke such emotions. By
letting the patient sit with and reflect on these feelings, the IPT therapist has
different aims than the exposure therapist, such as helping the patient to un-
derstand the interpersonal meaning of such feelings. Yet toleration of affect is,
in a sense, a form of exposure. Conversely, exposure therapy implicitly teaches
patients not just that trauma cues are not dangerous, but that the feelings they
evoke are not so dangerous either. Thus IPT and exposure therapy differ con-
siderably in approach and technique, but they target the same disorder and
inevitably overlap to a degree.
It further remains to be seen whether IPT for PTSD will disseminate into ge-
neral practice as an alternative to exposure- based treatments. To some degree,
that may depend upon readers of this book who try using IPT for PTSD in
their practice.
APPENDIX
Patient Handout for IPT- PTSD
INTERPERSONAL PSYCHOTHER APY (IPT )
FOR POST TR AUMATIC STRESS DISORDER (PTSD)
A.
Do'stlaringiz bilan baham: | 
