Running Head: Interpersonal Psychotherapy 1

Interpersonal Psychotherapy 5

 

 

 

 

 

 

 

 

Interpersonal Psychotherapy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Introduction

Mary is a 38-year-old female who works from home as a computer programmer. She is only now working intermittently and therefore struggling financially. She request psychotherapy to address her current symptoms of “poor sleep, irritability, and interpersonal conflicts”. She reports history of multiple traumas that she has had and results to her present problems. She states she has been attempting to a “endure the sadness these past sufferings has caused” and move on, although she often feels irritable and is unable to forgive.

Mary was raised by her parents in Los Angeles along with two younger brothers. She reports feeling an incredible amount of pressure to succeed, which she attributes to her father’s persistent displeasure with her accomplishments. She had few friends growing up and has managed to maintain close relationships to two of them. Though, she has had difficulties maintaining relationship as an adult. She had a few short-term intimate relationships when she was in her twenties. She was married briefly and a son, John who was now 13 years old. She states her marriage lack passion. She had no common interest with her husband and describes the marriage as just “okay”. She reports being strongly attached to John from the time he was born until age 2. She states her husband had a serious back injury leaving him bed bound and during that interval she did everything for John. She describes her attachment to her son during this time as “the most beautiful and pleasant bond I had ever experienced with another human being. It was pure bliss”

Trauma History

Mary is currently living with her boyfriend, Sam for 4 years and describes it as a relationship of convenience. She states Sam is loyal and devoted to her. However, she states more frequently the relationship has been explosive and tense. She describes her feelings as having post-traumatic stress disorder (PTSD). She feels Sam is intrusive and she is unable to have private space to work at home and also relax. She generally does not trust others and feel this is another symptom of her PTSD, also adds to the fear of the desire to marry Sam. For example, Mary had some business ties that failed with Sam’s sister and Sam continues to establish a relationship with her, therefore she questions Sam loyalty to her.

Mary recalls multiple event as a young girl that resulted in intense fear and humiliation. She recalls at a frightful memory dating back to when she was 4 years old. She recollects having to go live with her aunty because her mother was ill in the hospital (meeting PSTD Criterion A of Trauma). She remembers being vividly terrified that she will not see her mother again. She recalls one emotional traumatic event whereby her aunty not only beat her for soiling her diaper but shoved the soiled diaper in her face in front of other family members. She was often criticize by her aunty on how she ate, play and even walk (meeting PSTD Criterion B of unwanted upsetting memories/emotional distress).

The most traumatic life altering experience Mary recalls is the abduction of her son. She states when he was 5 years old, his father kidnapped him to his home-town in the UK. She was horrified and felt like her life was taken away from her. She describes her unrelenting love her son. She feared he will have a similar or worse childhood experience she had. She describes the Pre and Post-trauma as if there were two life experiences. Post-trauma of losing her son, she struggled to function, and even find purpose and meaning in her life. She is more socially withdrawn despite seeking numerous therapies and self-help guide over the internet, her PTSD symptoms lingered. She reunited with her son 2 years later after long battles in the court.

She mentions other stressors. She states she is more confused about her recent sexual feelings towards the same sex. She finds herself attracted to pictures of other women on the internet, having sexual fantasy and questioning her sexuality. She has not acted on the arising urges

ASSESSMENT

The staff at the clinic administered the PTSD Scale (CAPS). For PSTD assessment, the CAPS-5 is the gold standard tool based on a 30 item interview to assess the 20 DSM-5 PTSD symptoms. Mary meets criteria for moderate PTSD based her clinical symptoms satisfying the DSM-5 symptoms. Mary did complete the PTSD Symptom Scale – Self-Report Version (PSS-SR) in which is scored 25 suggestive severe PTSD. Hamilton Rating Scale –Anxiety was administered and her score was 16 suggesting mild anxiety.

TREATMENT

Sessions 1 to 3: Initial Phase

The goal for these sessions is to explore in detail Mary present and past relationships and to gain understanding of her interpersonal functioning, to pinpoint interpersonal issues as it connects to the onset of PTSD symptoms, and to take a trauma history. First, the therapist explains the interpersonal psychotherapy therapy (IPT) approach to Mary. She acknowledges the protuberant interpersonal challenges in her current life and expresses her enthusiasm to work on changing her behaviors. Then, the therapist reviews Mary’s current PTSD symptoms. She detects that her avoidance of symptoms were the most prominent. For example, given her history interpersonal conflicts in the work settings, Mary chooses to work from home to avoid any possible reminder of John’s abduction. She appears that she feels “more in control” at home, where she could carefully minimize communicating with others. The therapist records a general history of traumas throughout Mary’s life noting each trauma represents a deep sense of betrayal, which led her to mistrust in others and avoidance to form close relationships.

Mary identifies the most important people in her life was her boyfriend Sam and son, John. She notes that her trauma adversely affected both relationships. She is frequently short-tempered with Sam and distance herself from John to keep from getting hurt. She expresses similar problems in other relationships, and reports that the “major trauma” of her life was by far John’s abduction, exacerbating her tendency to distance herself even more.

Mary many times is found providing unsolicited advice as evidence by excessively talking about computer programing skills and the therapist finding it difficult to interject. She succeeds not gaining guidance from the therapist by deflecting and avoidance talking about relevant issues. Also, when John told her his interest in playing soccer, Mary begins to provide details of his custody battle with her father. She believes this act to supportive and John thought otherwise.

Mary was hurt by John’s decision to live with her father after they reunited. She often grieves the bond she lost with John when he was a baby identifying that bond as the purest connection she shared with another. She believes the struggles with physical romantic intimacy worsen after John’s abduction.

She states she experiences difficulty showing affection to Sam. She notes that when they first met, they had sex regularly and now maybe four to five times in the past 2 years. She states Sam wants to be more intimate, and she was to be intimate for him but every time he gets close to her, she finds even a kiss “repulsive”. They have not slept in the same bed for 2 years.

Mary believes yoga and spirituality has been helpful. Her objective is to be more peaceful and calm. However, she continues to struggle with self-regulating interpersonal situations. All her spiritual exercises are solitary in nature furthering her avoidance of interpersonal contact.

Mary agrees to work on interpersonal focus of mending conflicts with her ex-husband, Son, and boyfriend. She is experiencing role transition in regards to her sexuality.

Session 4 to 10: Middle Phase

Since Mary agrees to focus on her role transition, she and her therapist enters the middle phase of IPT. Mary now understands that her clinical symptoms are related to her past trauma, and it is not her fault and she is indeed suffering from a treatable illness. She will learn to detect and monitor these symptoms in the course of therapy. She will not blame herself for having these symptoms or even the for their impact on her relationships. She will most likely start to feel better and see the symptoms subside.

In her role transition, she is adjusting to changes of her attraction to the same sex. The therapist introduces tactics to improve interpersonal communication, and guide her through emotional responses which surface in the process. She supports Mary in confronting and wrestling with negative thoughts and feelings. Mary needs to understand that her propensity to intellectualize emotional experiences and to blocking unpleasant moods further complicates ability to change. And when she is able to tolerate her affects, it will help become more open, more connected with others, and more open with her sexuality.

With the aid of the therapist, Mary is able to examine closely current conflicts and arguments. This will help Mary determine what she wants in these situations and explore interpersonal options, including role play to practice responses that aids in resolving them. Every session, specific interpersonal incidents from the week are reviewed, eliciting Mary feelings and behaviors, and then sessions allows a chance to practice and improve on interpersonal skills.

The therapist persists on probing weekly, seeking to guide Mary to the here and now, stirring her away from the past negative stories fixed perpetually in her mind. She is improving with her interactions with others, though she may have want to avoid the feelings attached. For example, a recent argument with Sam, or an emotionally charged phone call with John or a negative response from an online communication regarding her work.

Sessions initially was frustrating due to the fact Mary could not stop her old habits of intellectualizing her feelings. For example, she will state the left part of her brain and right part of her brain was making certain decisions and she is appears emotionally detached. The therapist feelings appear similar to the way John may have felt when he hoped for her mother’s support but instead got a lecture, or how Sam may have felt when trying to connect with her, only to be repeatedly rejected. Mary undoubtedly cares deeply about her relationships and suffers from her isolation, but she feels it difficult to break through the facade.

By Session 6, Mary is more equip to recount specific events from her week, and willing to take greater emotional risks when negative feelings arise. She describes having more open and pleasant conversation on the phone with John. Yet, she still hopes to influence his choices and values. She is able to recognize that several of the feelings she often avoids or suppress are related to her Son. She knows now that the years of grieving lost time with John does not matter as much as the present time. She attributes declining to start a family with Sam relates her regrets with John and general mistrust for others.

The therapist introduced role play for improving Mary’s ability to communicate with Sam. Mary was initially uncomfortable with this until they role-played scenarios in session.

Originally, Mary believes that her PTSD is 100 % part of her being and therefore the perceived negative feelings such as anger and sorrow associated can only result in negative outcomes. The therapist is able support Mary in challenging that thought process rather than evading, intense negative feelings. Whenever, Mary set back to intellectualizing language, the therapist will ask her to describe how he was feeling at that moment. Acknowledging her feelings and simply sitting with an intense emotion appear to be the most challenging task for Mary.

This peculiar aspect of acknowledging one’s emotions and experiencing them profoundly is crucial for treatment. This shared core principle shows how IPT differs from other sort therapies. Moreover, IPT create the environment for individuals to understand how a particular emotion develops as a reaction in an interpersonal context and consequently to communicate such feelings appropriately to improve an important relationship. Mary expresses her feeling as “irritability”. Her anger outbursts is the result of avoiding or suppressing intense feelings. If she express her fears, worries, or/and disappointments with Sam as they appear, she is less likely to be explosive. When there was no conflict, Mary did apply strategy taught by practicing talking with Sam about her feelings using “I” statements in avoidance of blame or offensive language. Her communicating skills during her sessions vastly improves from a tactic of deflection by wanting to teach the therapist to verbalizing emotions and exploring interpersonal context.

Prior to the IPT, the PTSD Symptom Scale – Self-Report Version (PSS-SR) was used to assess PTSD symptoms in which she scores 25 suggesting a severe PSTD. As the termination phase approaches, another assessment using the same tool was performed. Her PSS-SR shows drastic improvement from an initial 25 score to 9 by the 8th session. This indicates that she does not meet the full criteria for PTSD any longer.

In the earlier period of treatment, Mary did show hesitancy to the techniques provided by the therapist. She hides behind intellect and refusing to focus on the current problems. She has develop tremendous growth and more willing to leave her comfort zone. A profound shift in thinking and behavior was apparent when Mary acknowledges that having negative moods such as feeling of anger, loss and sadness and should not be attributed to being “bad” and these feelings are useful as socially revealing feelings. She notice she is becoming less irritable with Sam and less avoidant of social situations. She comes to sessions more willing to discuss recent events and resultant feelings. She says this would never come naturally and realizes the advantages in trying. Therefore, Mary is hopeful and feels more peaceful.

Session 11–14: Termination Phase

The final sessions is design to review the treatment course and focus on the progress Mary has made; the many interpersonal strategies her now processes and her feelings about ending therapy. The therapist understand and acknowledges that Mary is sad regarding the coming separation. Nevertheless, the therapist focuses on the improvement she has made, and examines areas that Mary feels more proficient and the ability to independently function without therapy. Both therapist and Mary attempt to anticipate difficulties that may arise post treatment. Mary recognizes her progress, but voice disappointment that treatment is ending and wants to discuss ways to continue therapy. She views “endings” in a negative manner and recalls her childhood separation from her parents, her marriage, and her relationship with her Son. She fears parting ways will bring misery and helplessness, as it has presented in her past.

The therapist expresses that termination is in fact curative experience. As Mary could work through feelings that rises in saying goodbye, and theoretically, see that not only could she tolerate such emotions, on the other hand she deserves a sense of completion, mastery of skills, and growth.

At termination, Mary was engage more socially and communication was more effective. She was able to consider her shift in sexuality more of a curious in nature than an actual change in her identity. She decided that she did indeed want to improve her relationship with Sam and has been more affectionate. They talk more openly about their dreams for the future and her past. Sam knew about John’s abduction and not about the associated traumas that contributed to Mary’s fears of intimacy and lasting relationships. Sam now knows about Mary’s sexual curiosity and is accepting and supportive. Mary reports an improve relationship with her son. They talked more often and he involved her more in his daily life.

Mary anticipates the challenges that will arise post treatment and understand that social insecurities with people might not completely remit and she will continue to challenge herself to approach others and communicate effectively. She feels she is can tolerate the negative moods better and capable to bounce back from conflicts. Mary reports she still thinks about past traumas and the people who had been disloyal to her over the years, although this feelings occur less often and is less intense.

CONCLUSION

There was limitations identified that implicated Mary process of the 16 week course therapy. She many times from it difficult to commit to therapy and often will deflect; discussing unrelated topics such as her job and attempted to dominate conversation by educating the therapist on various subject matter, more particularly geared to computer programming. She often had difficult expressing herself emotional and would intellectualize her feeling. By the end of the therapy session, Mary was more emotional expressive and her interpersonal relationship vastly improved.

 

References

 

Posttraumatic Stress Disorder Symptom Scale: Interview and Self Report (PSS-I and PSS-SR).

Retrieved from: https://eprovide.mapi-trust.org/instruments/posttraumatic-stress-disorder-

symptom-scale-interview-and-self-report