Session 12: Planning for the End of FB-IPT

Chapter 15 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents introduces the termination phase of treatment, in which the therapist prepares the preadolescent and parent for the completion of family-based interpersonal psychotherapy (FB-IPT). In Session 12, the therapist continues to support the preadolescent’s practice of interpersonal skills and begins to review with the preadolescent and the parent the progress the preadolescent has made in treatment. There is continued emphasis on the link between improvement in the preadolescent’s depressive symptoms and the preadolescent’s use of communication and problem-solving skills. With both the preadolescent and the parent, the therapist begins to talk about the process of terminating this course of FB-IPT and next steps for the preadolescent, which may be ending outpatient therapy, referral to a maintenance group or individual maintenance therapy, or more intensive treatment, depending on the preadolescent’s degree of improvement and severity of residual depressive symptoms.

Sessions 10 and 11: Designing Interpersonal Experiments for Comorbid Anxiety

Chapter 14 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents presents the tenth and eleventh sessions of family-based interpersonal therapy (FB-IPT), in which the therapist introduces interpersonal approach strategies to help socially isolated or avoidant preadolescents increase their interactions peers. Working collaboratively with the preadolescent, the therapist helps identify peers and situations where the preadolescent could initiate a brief interaction and scripts examples of saying hello, asking a question, or giving a compliment. After role-playing, the therapist encourages the preteen to implement this approach in the upcoming week as an “interpersonal experiment,”, with the hope that more frequent initiation with peers will result in more positive moods. The therapist enlists the parent as support for the preadolescent in completing the interpersonal experiment.

Session 3: Conducting the Interpersonal Inventory

Chapter 7 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents presents the third session of family-based interpersonal psychotherapy (FB-IPT), in which the therapist begins by orienting both the preadolescent and the parent to the structure of treatment. The therapist has already made the mood thermometer a part of the common language in the check-in and continues linking shifts in the preteen’s mood with particular interpersonal events. The therapist begins conducting the interpersonal inventory with the preadolescent and continues to do so in the next session. The therapist also has obtained information from the parent about the relationship with his or her child as well as the parental perspective about the preadolescent’s peer relationships. An understanding of how the preadolescent’s depression has affected the parent–child relationship provides a context for discussing Parent Tips in the next session.

Developmental Adaptations for FB-IPT for Depressed Preadolescents

Chapter 3 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents presents the basics of family-based interpersonal therapy (FB-IPT), which is a psychosocial intervention for treating depression in preadolescents (ages 7–12). Adapted from interpersonal psychotherapy for depressed adolescents (IPT-A), FB-IPT includes several developmental modifications, including systematically involving a parent weekly in treatment, presenting treatment strategies visually, teaching communication skills in age-appropriate language, and having the preteen experiment with initiating social interactions outside of sessions in order to improve her engagement intreatment and acquisition of new skills. FB-IPT identifies treatment targets for both preadolescents and parents and is easily modified to target younger children’s (ages 7–8) cognitive and verbal abilities.

IPT and IPT-A

Chapter 2 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents presents the basic principles of interpersonal psychotherapy (IPT) and of interpersonal psychotherapy for depressed adolescents (IPT-A), empirically supported interventions for depression in adults and adolescents. IPT is a structured, time-limited treatment for depression that identifies one of four interpersonal problem areas (i.e., grief, role transitions, role disputes, and interpersonal deficits) that may be related to an individual’s onset of symptoms. IPT seeks to reduce depression by helping patients improve their relationships with others through effective communication and interpersonal problem-solving. IPT-A is a developmental adaptation that is designed to treat adolescents, ages 12 to 18 years, with depression. Both models include three phases of treatment (initial, middle, and termination), as well as a large psych educational component and a focus on helping depressed patients acquire better communication and problem-solving skills.

Empirical Evidence for FB-IPT

Chapter 19 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents reviews the results of author-led trials that support family-based interpersonal psychotherapy (FB-IPT) as an efficacious psychotherapy for increasing remission from MDD and decreasing preadolescents’ comorbid anxiety and interpersonal impairment. This chapter also emphasizes that psychotherapy for preadolescents with depression presents an opportunity to reduce family and interpersonal risk factors that may increase the likelihood of recurrent depression in adolescence, and highlights FB-IPT as meeting a need for a developmentally appropriate treatment especially for preadolescents experiencing depression. Future directions for additional research and studies on implementing and disseminating FB-IPT to community-based agencies are also outlined.

Session 14: Reviewing Progress and Saying Goodbye

Chapter 17 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents presents the fourteenth (and last) session of family-based interpersonal therapy (FB-IPT), in which the preadolescent reviews with the therapist the ways in which the preadolescent has implemented new communication and problem-solving skills and how these skills could help in future situations. The therapist provides the preteen with the opportunity to explore his feelings about therapy termination. Together they review the preadolescent’s early warning signs and contract with the parent to regularly check-in with child after treatment ends. The therapist acknowledges the parent’s role in treatment and gives parent an opportunity to share her own feelings about ending therapy. Lastly, the therapist expresses appreciation to the parent-child dyad for their hard work. The therapist shares with the family that they may contact her at any time in the future with questions or concerns.

Session 9: “Have a Few Solutions in Mind”

Chapter 13 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents presents the ninth session of family-based interpersonal therapy (FB-IPT), in which the therapist introduces problem-solving strategies (“Have a Few Solutions in Mind”)with the preadolescent and the parent. The therapist revisits the depression circle to identify a problem to solve and presents techniques that encourage compromise (“Meet in the Middle”) and negotiation (“Let’s Make a Deal”). In working with the preadolescent to propose a solution to an identified problem, the therapist incorporates many of the communications skills presented in earlier sessions, such as “Give to Get” and “Make ‘I Feel’ Statements.” Dyadic role-plays focus on helping preadolescents and parents identify and communicate their wants and/or concerns about problematic issues, as well as possible solutions that can be implemented and revised.

Session 8: “Make ‘I Feel’ Statements”

Chapter 12 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents presents the eighth session of family-based interpersonal therapy (FB-IPT), in which the therapist introduces the Tween Tip for how to “Make ‘I Feel’ Statements.” The therapist encourages the preadolescent and the parent to directly communicate feelings in response to situations related to the identified problem area. By expressing feelings, including softer feelings of sadness, worry, or disappointment, preadolescents can experience what it is like to let a parent or friend understand where she is coming from and possibly increase the support she experiences. Dyadic role-plays and home practice assignments increase uptake. Four Therapist Tips are provided.

Session 2: Completing the Closeness Circle and Identifying Parenting Challenges

Chapter 6 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents presents the second session of family-based interpersonal therapy (FB-IPT), in which the therapist outlines the structure for the remainder of the initial phase of treatment (check-in, time with the preadolescent, and time with the parent). The preadolescent rates their feelings using the mood thermometer during the check-in and the therapist helps to link changes in her mood to interpersonal events in the last week. The therapist completes a closeness circle with the preadolescent, a visual mapping of important relationships with family members and friends. When meeting with the parent individually, the therapist helps the parent to identify a challenging aspect of parenting his or her preteen where the limited sick role can be applied.