Interpersonal psychotherapy: initial casework in a novel standardized psychotherapy
This study examines the supervised casework of seventeen therapists, using Interpersonal Psychotherapy as a treatment for Major Depression for the first time. Adherence and competence were measured using procedures developed with reference to the treatment manual (Klerman & Weissman et al 1984). The capacity of the more diverse population of therapists now undertaking IPT training to meet adherence and competence standards was explored, as was the capacity of current supervisors to employ rating forms reliably. This study demonstrated that practising therapists, with a range of experience and theoretical influences, were reliably found to practice the procedures outlined in the Interpersonal Psychotherapy manual, with a high level of competence. Adherence levels were good in the focus area sessions, but less satisfactory during the initial and final phases of treatment. Less experienced therapists were found to be as capable of meeting training requirements as more experienced therapists, and a significant level of symptomatic relief was reported by the participating patients. Initial symptom severity did not have a detrimental effect on treatment outcome, with patients rated as severely depressed on the BDI-ii at baseline achieving recovery or clinically significant reduction in symptoms as often as patients with a moderate depression. Therapists with a psychology based training achieved a higher standard of competence than therapists trained in a psychiatry model of medicine or nursing, but the two groups could not be distinguished in terms of clinical outcome for patients. Problems in conducting therapy, reflecting potential ruptures in the therapeutic alliance were significantly related to clinical outcome and early competence.