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Book Reviews |
Key Words: Books Reviewed
The evolution in the past 20 years of interpersonal psychotherapy (IPT) from an effective, short-term, focused treatment for ambulatory patients with major depression toward use in other affective and nonaffective disorders is astonishing. When Klerman, Weissman et al. published the treatment manual Interpersonal Psychotherapy of Depression (Basic Books) in 1984, IPT was considered an effective treatment for acute mild to moderate depression and was used generally in the research setting under well-controlled conditions. Since then, talented researcher-clinicians have stretched the boundaries of its use to include other affective disorders such as dysthymia and bipolar disorder, as well as nonaffective disorders such as bulimia nervosa. Formerly confined to major research centers, IPT is being taught to an increasing number of clinicians and psychiatry residents across the country.
This monograph, Interpersonal Psychotherapy, is a collection of articles by leading researchers on the development, future directions, and current applications of IPT. Besides an overview of IPT, the book includes one chapter on the important work in Pittsburgh on maintenance IPT and three chapters on current applications of IPT to adolescent depression, bulimia nervosa, and depression in HIV-positive men and women.
No monograph on IPT would be complete without one chapter written by Myrna Weissman, Ph.D., who has been involved in the research development and promulgation of IPT since its inception. She and John Markowitz, M.D., lead off the book with an overview of IPT and its concepts and techniques, along with a description of the efficacy data and ongoing research on IPT with mood and other disorders. This section will be very helpful to anyone interested in doing research with IPT because the authors are familiar with investigators around the world who are adapting IPT to special populations. In addition, it directs clinicians to articles and resources that could prove useful in the adaptation of IPT to clinical practice, such as Weissman's patient IPT self-guide and a training videotape put out by Kingsley Communications. However, outside of research centers, relatively few clinicians are trained in IPT. Once trained in IPT, a therapist may be rather isolated, with little opportunity for supervision and peer support. The authors mention these issues as important and deserving of attention, but it will clearly take some time and ingenuity to address them. A related conundrum is the assertion of the authors that IPT training programs are not meant to teach psychotherapy to novices but to "help experienced therapists refocus their treatment by learning new techniques." This makes the teaching of IPT in residency problematic, since residents are by definition "novices." Until we resolve the training and supervision dilemmas regarding IPT, its usefulness clinically will remain limited.
The chapter on maintenance interpersonal psychotherapy (IPT-M) is an excellent overview of this modality's development, description, research data, and future directions. It describes not only the unique three-year IPT-M trial by Frank and colleagues at Pittsburgh, but also their attempts to identify biological and psychological correlates that may predict which patients are more likely to respond to IPT-M. It seems clear, for example, that treatment specificity, the "extent to which therapists conform to specific principles, goals, and techniques of IPT," is correlated with greater protection from recurrence even in those patients whose biological correlates place them at increased risk. Although dense, this chapter is worth working one's way through because this kind of research promises to inform our clinical decision-making and shape the direction of future research in psychotherapy and depression.
The three chapters on IPT's application to patients with adolescent depression (IPT-A), patients with bulimia nervosa (IPT-BN), and depressed HIV-positive patients (IPT-HIV) are solid and lively. Each of the chapters is strengthened by the liberal use of clinical vignettes and "pearls" to illustrate the application of IPT to these special populations. For instance, in IPT-A, the authors have added to the usual four problem areas of IPT (abnormal grief, role transitions, interpersonal disputes, and interpersonal deficits) the problem area of single-parent families because of the frequent occurrence of this problem and its correlation with depression. These are the chapters for clinicians that make performing IPT with these groups seem possible and worth pursuing and leave us looking forward to the results of further research in the efficacy of IPT with these disorders.
Although repetitious at times, this is a worthwhile monograph for experienced therapists and trainees who want in one place an overview of IPT and the recent research applying it to depression and other disorders. It will not teach you how to do IPT; that requires more intensive training and supervision. However, as one trained in IPT, I found that the clinical wisdom shared in the book partially satisfied a hunger for more collegial interaction regarding my work with IPT. In applying IPT in the clinical setting, I often feel as if I've just read one of the best novels I ever read in my life but have no one to share it with. The challenge to the researchers involved in IPT is how to get it out of the ivory tower and into the clinical setting intact and still therapeutically powerful. The researchers in this monograph are clearly trying to figure this out, and I applaud their efforts. How about an IPT casebook as a follow-up?
Footnotes
Dr. McCarthy is Training Director, Department of Psychiatry, Brigham and Women's Hospital, and Associate Training Director, Harvard Longwood Psychiatry Residency Training Program, Boston, MA.
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