Introduction
Depression is a psychological pain and affects everyone from children to the elderly. According to Stuart, (2006), depression normally occurs among individuals as a result of disruptions in significant relationships. As a result, the individual may lose social support, leaving him or her vulnerable to depression.
According to Long (1998), severe depressive illness is even worse than physical illness. Depressive illness may lead to most premature deaths and disability in the future, particularly in the Western world where depression has even been seen to result in suicide-related deaths (Long, 1998).
Depressive disorders include unipolar depression, chronic and mild depression, and bipolar depression. All these impact significantly on the functioning and adjustment of behavior among the adolescents. It is important to note that adolescence is a critical stage of development in an individual since it is characterized by various psychological, emotional, social and physical changes. As a result of depressive disorders adolescents are at a higher risk of being diagnosed with psychosocial and mental illnesses.
According to Dorta, Gallagher, Mufson and Young (2004), the most commonly diagnosed disorder in the adolescents is depression with a prevalence rate of up to 8.9%, particularly for adolescents of 18 years and below. These disorders in adolescents increase their chances for committing suicide and substance abuse. Signs of depressive disorders in the adolescents include mood swings, social isolations, drug abuse, anxiety, and defiant behavior and may sometimes talk about committing suicide.
These depressive disorders can be treated by applying various therapeutic methods which may include interpersonal therapy, family solution focused therapy among many others. Long (1998) regards interpersonal therapy as a form of psychotherapy in which a therapist assists the client in the identification of problems and issues that are likely to have an impact on the interpersonal relationship that the client enjoys.
This is normally a short-term psychotherapy and takes between 12 and 16 weeks of sessions (Bernal and Rosselo, 1999). It is normally applied in treating major depressions and mostly focuses on treating current social dysfunctions that directly affect the individual’s social relationships.
It begins by exploring the adolescent’s life history in order to find out the individuals problem areas so as to work towards correcting them. It has been proven to be successful in treating adolescents’ depression (Lee, 1997). Interpersonal therapy has been applied in treatment in adolescents’ depression. According to Bernal and Rossello, (1999), this therapeutic approach has been tested in clinical trials and has shown strong positive results. It enables the teens to rectify their behavior both at school and home.
As opposed to the interpersonal approach that mainly involves the interaction of a therapist and the client only, on the other hand, the family therapy perspective entails an exploration of the problems that could be found within not just the extended family, but also within the group dynamics of a family, as these have been seen to have an impact on the possible causation of mental problems to a member of the family.
The family is a complex system and the therapist helps the every member of the family understand their role in shaping the affected individual’s health. Family therapy is normally applied in treating adolescents whose behaviors are seen to be a result of family interaction patterns. It’s very effective in treating mood disorders. According to Lee (1997), the second study that was carried out at Family Therapy Center reported an 80% success rate.
Differences between Interpersonal and Family solution-focused Therapy
Family therapy approach involves including all members of the family to directly participate in the adolescent’s therapy sessions. This way, the family members better understand their role in helping the adolescent regain his or her psychosocial health. However, in interpersonal therapy, the therapist help the adolescent recover by preventing the parent from interfering with the treatment progress. The therapist instead evaluates the patient’s interpersonal competencies in solving the interpersonal skills and reinforces it.
Family solution-focused therapy normally pays much attention to finding solutions but gives little attention to understanding the presenting problems (Lee, 1997). According to de Shazer, (1988), this therapy provides a short-term treatment intervention.
The approach views the family the presenting problem to be as a result of human interactions within the family. Therefore the therapy should focus on helping the patients change their interactive behaviors or their perceptions of behaviors and situations so as to achieve the desired change or solution (de Shazer et al., 1985).
According to Cade and O’Hanlon, (1993), this therapeutic approach assumes that a person’s anticipation of the future determines how his or her future would be and thus therefore solutions to the patient’s problems are subject to the individual’s construction and interpretation of the situation.
Therefore the patient and the therapist have to co-construct new positive solutions to the patient’s problems. Interpersonal approach is a problem solving approach and is based on the notion that the possible cause of depression can be traced from problems in interpersonal relationships (Bernal and Rosselo, 1999). Therefore the focus of intervention measures on depression should be directed towards interpersonal conflicts.
According to Lee, (1997), the family solution-focused therapy does not analyze the historical background of the patient’s problem. Instead, the therapy applies questions in helping the client identify solutions to his or her problems. The questions are categorized into problem coping questions, relationship questions, outcome questions, exception questions and scaling questions.
Exception questions are used to determine how often the problem is less intense, absent or has been dealt with in a manner acceptable to the patient. This would help find some clues to the solutions of the problem. Scaling questions are meant to help to evaluate and quantify the situations in which patient is in by asking him or her to rank his or her situation and establish goals. This enables patients establish clear indicators for change by themselves.
Relationship questions inquire from the patients about the perception of their significant others on their situations and progress. This helps the therapist guide the patient to develop solutions that are realistic to their real life environments (Berg, 1994).
Copying questions are meant to help the therapist understand how the patient manages to cope and endure the problems that they undergo (Berg, 1994). Finally outcome questions are meant to help the patients formulate visions for their anticipated futures (de Shazer & Molnar, 1984). The therapist helps the patients to envision how they can achieve concrete and observable behaviors.
According to Bernal and Rosselo (1999), interpersonal therapy is a short-term psychotherapy that takes approximately 12 weeks and is done in four sessions. It explores the underlying cause of the depression in order to obtain information on depression and its development.
It evaluates the resulting interpersonal relationship and identifies the main problems. This helps in development of a treatment plan and the goals for the therapy. Due to the tendency of overlapping interpersonal problems, many are the times that a therapist is forced to utilize specific precipitating events with a view to aiding him or her to unearth the underlying problem.
Thus the goals and strategies for treating the disorder must be described within each of the primary problem area. Interpersonal therapy focuses on the current problems in regards to important interpersonal relationships. It carries out an evaluation on the current situation and solves the problematic situation. However, family solution-focused therapy focuses on achieving the patient’s stated goals.
It does not examine the realities behind the problem but instead focuses on helping the patient develop a more articulated vision without dwelling on the problem behavior. It may also include other problems of life that the patient wishes to be treated while the interpersonal therapy focuses mainly on the presented problem (McCollum, Kent, Ray, Smock, Trepper & Wetchler, 2008).
Family therapy approach assumes that change is constant and therefore other than using the questions to find solutions for the patient’s problems, it also encourages the patients to “think small” (Lee, 1997). It assumes that if a patient successfully achieves a small change in his or her situation then he or she is bound to find solutions to his or her other more difficult problems (Peller & Walter, 1992).
This means that therapy should begin with the simplest solutions so as to help acquire solutions to the more complex solutions. It also implies that complex problems do not necessarily require complex solutions. This therapeutic approach also applies the use of task assignment for patients where the patient is given the opportunity to think and weigh the available possible solutions to his or her problems. The patient’s resourcefulness as well as construction of realities is respected.
In interpersonal therapy, the therapist initiates the desired changes in the individual. He or she develops the goals for the therapy and helps the adolescent choose the desired change for the interpersonal problem. For example, if the primary problem area is found to be associated with grief my as a result of separation or loss of a loved one then the focus of treatment will be directed towards that. The strategies will aim at reconstructing the adolescent’s relationship with the significant other or behavior and feelings.
If the underlying problem is role transition that might have resulted from divorce of the parents of the adolescent or even change of the physical environment, then the goal of the therapy would focus on enabling the adolescent develop self esteem and to develop positive perception towards the new perceptions. In family solution focused therapy, the parents help the adolescent choose the goals for the therapy.
According to Lee (1997), parents tend to choose goals focus on changing the adolescent’s behavior while neglecting goals that focus on the emotional development of the child.
According to Lee (1997), a study that was carried out by the Brief Family Therapy Team to determine the effectiveness of family solution-focused therapy found out that this approach is perceived by many to be rigid, insensitive and artificial or to be too positive. On the other hand, interpersonal therapy is relatively flexible since it does not necessarily follow a step-by-step protocol of its treatment sessions (Bernal & Rosselo, 1999).
Similarities
Both the interpersonal therapy and family therapy focus on helping the adolescents recover from their social dysfunctions. In both cases the therapist help the adolescent develop goals for the treatment. They both focus on offering solutions for depressive disorders although they take different paths for in coming up with solutions. However both do not address the unconscious phenomena like internal conflicts and many others. They are both concerned with helping the patients recover from depression without examining the unconscious.
In both cases the therapist helps the patient choose an interpersonal problem to work on and the therapist helps the patient monitor the depressive feelings. The therapist has to monitor and keep record of the progress of the patient. The therapists help the patient develop a positive therapeutic relationship and to recover from the depression.
The therapist helps the adolescent find alternatives to his or her undesired social behavior and interactions. Thereafter, a post treatment follow-up is done in both approaches so as to check the progress of the recovery process and the improvement of the adolescent’s interpersonal skills after the termination of the treatment
Applying Combined Family Solution-Focused Therapy and Interpersonal Therapy
According to Hall and Mufson (2009), social support as well as good relationships provides the foundation for treatment of depression. Interpersonal relationships are very important and depressions normally arise due to disruption on interpersonal relationships.
Treatment of these depressions also normally aims at improving communications and changing problem solving skills that would facilitate recovery by reducing the depression symptoms. Therefore for any therapy to be successful, it has to include the involvement of the significant other people in the program. This implies that interpersonal therapy combined with family solution-focused therapy is bound to produce the best result.
Modifying the interpersonal psychotherapy to include the involvement of parents and schools in treating the depressed adolescents helps change the nature of peer relationships in adolescents. According to Hall and Mufson, this has proved to be effective in reducing depressive symptoms in adolescents and in improving their interpersonal and social functioning.
Applying a combined strategy starts by understanding the underlying primary problem for the depression. The parent or the significant other person can better help the therapist understand the underlying problem.
The parents are involved in the first phase of treatment to help gather diagnostic information and also to help the therapist and the adolescent child set realistic goals and expectations. Parents are also encouraged to report their concerns on the situation throughout the program. They are normally updated on the progress and may be called upon to attend the middle phase sessions if need arises. The parents also participate in the post assessment and post treatment follow up assessment.
Parent engagement in the program help improve parent-adolescent relationships and thus better parent management of depressions in the adolescents. This would better help the parents identify depressive symptoms in the adolescents (Connel & Dishion, 2008). Parent-adolescent conflict is normally bound to hinder full recovery and instead facilitate the depressive symptoms to be more chronic.
Carrying out therapy without solving the problems between the adolescent and the significant would increase the likelihood of relapse of the problem. The involvement of family members’ help the family realize the small differences in the directions which it aspires to achieve in order to solve the existing situation on the particular member. It also enables family members to develop useful and realistic goals. It also helps the therapist feel supported and gain support from the family members in finding a solution to the problem.
Another effective area for applying a combined therapy for depressed adolescents is in the schools. Since interpersonal psychotherapy mainly focuses on improving interpersonal skills and communication in the adolescent, combining the approach with family solution-focused therapy would enable the application of group therapy in schools which would better help change the course of the depressive occurrence and hence a more effective recovery will be achieved (Dorta, Gallagher, Mufson & Young, 2004).
While in school, the adolescent meets with the peers who provide the social support needed to help make the treatment more realistic to the adolescent’s environment.
The individuals are asked to set their own goals for the treatment and to determine the outcomes of the therapy as opposed to letting the therapist dictate the course of the therapy (McCollum et al, 2008). Group treatment would help the adolescent practice the desired new communication skills as well as the problem solving skills. He or she begins to understand that he or she is not alone in the experience and therefore they can practice the new interpersonal skills together.
Group treatment provides the depressed adolescent with peers who experience the same difficulties. It gives an opportunity for realistic role play in different interpersonal interactions and communication skills. The patient can also receive advice from his or her peers on how to go about the problem. The peers also validate the experiences of one another.
This approach enables the depressed adolescents to learn by exploring someone else’s problems as opposed to exploring just their own experiences. Each person within the group receives an individual attention while also benefits from the discussions of others’ problems. Parents are also involved in supporting the adolescent to practice the new communication and problem solving skills.
The parents are also asked to attend in the middle phase sessions and take part in collateral sessions with the therapist and the adolescents so as to review the progress made and therefore help refocus the treatment goals and strategies for the rest of the sessions. The parent is also asked to attend the last sessions before terminating the treatment so as to help the understand how to manage any future reoccurrence of such problem.
Applying this approach of treatment is also cost-effective in treating depression among the adolescents in school-based health clinics or even in community mental health clinics in meeting the needs of many depressed patients (McCollum et al, 2008).
Conclusion
Depression in adolescents is dangerous since this is the most critical stage of transitional development in life. Depressive disorders may lead to development of serious antisocial problems or even loss of life when the teen decides to take away his or her life. It is therefore essential to help the adolescent to seek treatment as soon as depressive symptoms are noticed.
The earlier the treatment the better the chances of the individual’s well being. It is also important that parents and teachers understand the difference between the children’s true self and the symptoms of depression in the children so as to provide early intervention measures for depressive disorders in children.
Reference List
Berg, I. K. (1994). Family-based services: A solution-focused approach. New York: Norton.
Bernal, G., & Rosselo, J. (1999). The Efficacy of Cognitive-Behavioral and Interpersonal Treatments for Depression in Puerto Rican Adolescents. Journal of Consulting and Clinical Psychology, 67(5). Puerto Rico, University of Puerto Rico.
Cade, B., & O’Hanlon, W. H. (1993). A brief guide to brief therapy. New York: W.W. Norton.
Connel, A. M., & Dishon, T. J. (2008). Reducing depression among at-risk early adolescents: Three-year effects of a family-centered intervention embedded within schools. New York, J Fam Psychol Journal for Marital and Family Therapy. Vol. 10(3), 297-304. New York, Wiley- Blackwell.
Dorta, K. P., Gallagher, T., Mufson, L., & Young, J. F. (2004). A Group Adaptation of Interpersonal Psychotherapy for Depressed Adolescents. American Journal of Psychotherapy, 58(2). Rockville Pike, American Departmental of Mental Health.
Hall, E. B., & Mufson, L. (2009). Case studies in evidence-based practice: Interpersonal psychotherapy for depressed adolescents (IPT-A): A Case Illustration. New York: Routledge.
Lee, M. Y. (1997). A study of solution-focused brief family therapy : Outcomes and issues. The American Journal of Family Therapy, 25(1). New York, Norton.
Long, P. W. (1998). Major depressive disorder: Treatment. Internal Mental Health. Web.
McCollum, E. E., Kent, P., Ray, R., Smock, S. A., Trepper, T. S., & Wetchler, J. L. (2008). Solution –focused group Therapy for level 1 substance abusers. Journal of Marital and Family Therapy, 34(1).
Stuart, S. (2006). Interpersonal Psychotherapy: A guide to the basics. Psychiatric Annals, 36: 542. New York: Oxford Press.