Best Practices Evidence-Based Best Practices: Interpersonal Psychotherapy

Best Practices

Evidence-Based Best Practices:

Interpersonal Psychotherapy and Depression

Psychological diagnoses are often resistant to many treatments because the therapist is conducting therapy based on what they have seen works in the past. The problem with this approach is that although it may be a correct assumption and the therapist may have many years' experience to fall back on, this is actually an anecdotal means to a therapeutic end. The therapist most likely has the consumers best interests in mind, but they are not focused on the individual as much as what has worked in the past and may not be the best treatment for what the consumer is bringing to the sessions. The fact is that therapists, well-meaning of course, often fall into a rut in which therapy is much the same regardless the diagnosis. If examined carefully, this is not only shoddy practice it can be considered malpractice because the wrong therapy, or a therapeutic system that only provides temporary or minor help, may have been applied where a better was warranted.

That is why the movement for evidence-based practice has gained such momentum in the therapeutic community. The issue is not that therapists do not care, few with such potential would be employed in such a financially restrained profession without the intangible benefits it provides to "help" people, but that it is sometimes difficult to keep up with the research and provide the treatments for specific diagnoses that research evidence has deemed the best for that particular diagnoses. The evidence can even be so specific that it provides best treatment options for subcategories of major diagnoses (such as extreme grief that leads to a major depressive episode). This paper looks at the evidence-based best treatment for depression of interpersonal psychotherapy which is conducted by a Toronto-based company called Alliance Psychotherapy Services.

Evidence-Based Practice

The Canadian Psychological Association commissioned a task force to examine therapies and the evidence provided by research for those therapies and determine though thorough examination which could be said to be evidence-based practices (CPA, 2012). The task force first wanted to define what was meant by evidence and wrote that "(1) peer-reviewed research evidence is central; (2) psychologists should be evidence-based not only in their general fund of knowledge but also in session-by-session work; (3) the process involves one of collaboration with a client/patient (rather than a top down process) (CPA, 2012). Armed with this understanding of what they were looking for, the team examined the research to find the best practices for specific diagnoses.

The study concluded that there were many evidenced-based treatments that could be used for specific diagnoses, but they also wanted to determine the evidence-based best treatment if that was possible. In many cases, determining a best treatment was not possible because of the evidence was too scant or the diagnosis was too broad. However, the reviewers did produce "extended vignettes" for four cases that proved evidence-based best treatments. These four were: cognitive therapy for dysthymia, emotion-focused therapy for dysthymia, psychodynamic psychotherapy for dysthymia, and interpersonal psychotherapy for depression (CPA, 2012). Practitioners of this therapy were researched, and it was found that Toronto-based Alliance Psychotherapy Services was a practitioner with a specific track record in providing interpersonal psychotherapy for depression.

Interpersonal Psychotherapy for Depression

Depression is a rather broad diagnosis that has many different subcategories. Of course, it can be a situational issue which would be provided for under the single episode classification and multiple episodes, etc. The DSM lists all of the criteria that must be met for it to be considered a mental health issue rather than normal situational cause and not all of the different diagnoses are appropriately treated by interpersonal psychotherapy (IPT). The CPA (2012) found that there are "four IPT domains (grief, role transition, role disputes, interpersonal deficits)" one of which would be the "critical precursor to the depressive episode and should be the focus of treatment." Thus, the treatment is specified as a best practice only for one of these four examples of depression.

It has to be noted that the recognition of IPT as an evidence-based best practice treatment for depression comes with some caveats. Besides the fact that it is recommended as a best practice only for the listed types of depression, other factors must be considered. The CPA (2012) study first recognized that "DSM diagnosis and assessment of severity of depressive symptoms are central aspects of IPT." This means that a correct diagnosis must be made concurrent to the discovery of severity and distinct type. A therapist can use a variety of instruments (Beck Depression Inventory, Hamilton Depression Rating Scale, etc.) to assist with these requirements. The study also noted that;

"Depression can be complicated by the presence of comorbid disorders and research suggests that chronic depression, presence of an anxiety disorder, substance abuse, and certain personality disorders (e.g., borderline or avoidant personality disorder) predict poor antidepressant response to IPT. In patients with comorbid conditions, the therapist might consider adjunctive pharmacological interventions, modifications of IPT to address comorbid issues, or use of alternative treatments that "fit" both the depression and the comorbid disorder" (CPA, 2012).

So, rating a specific treatment as a best practice requires that the therapist follow the specific guidelines of the treatment, and the specified types of cases that the research indicates are best matched with this therapy.

Alliance Psychotherapy Services

This Toronto-based consortium of psychotherapists of different educational level, handles a great variety of case-types. The goal of the agency is to help people find and equitable alternative to, or co-therapy with, drug therapy. The company's website states that;

"Research findings have indicated that although psychotherapy may take slightly longer to begin alleviating acute symptoms of depressive mood disorder than does active treatment with the faster-acting antidepressants, it does improve symptoms. Further, when compared with pharmacotherapy, psychotherapy appears to result in longer-lasting benefits and maintenance of a higher quality of psychosocial adjustment" (Alliance Psychotherapy Services, 2010).