Curriculum For Practitioner Training In Interpersonal .
Curriculum forPractitioner Training inInterpersonal Psychotherapy(Trainee)CONTINUING PROFESSIONAL DEVELOPMENTFOR QUALIFIED THERAPISTS DELIVERINGHIGH INTENSITY INTERVENTIONSDr Roslyn ur use of the content provided on the website at www.iapt.nhs.uk is subject to the terms ofthis Copyright Statement.‘The copyright in the content provided on this website including all training materials,curricula and text is owned by the Department of Health except where otherwise indicated. Crown. All rights reserved.’The training materials, text and curricula have been produced on the condition that they shallnot, by way of trade or otherwise, be lent, sold, hired out or otherwise circulated in any form,binding or cover other than that in which they appear on this website and including thiscondition being imposed on any subsequent reader of the materials, text or curricula.Provided that ownership of the Department of Health is fully acknowledged, all materials, textand curricula on this website may be freely copied for teaching and clinical purposes only.’Interpersonal Psychotherapy for Depression: Trainee Pack March 20111
Contents1. IntroductionAims of the Training2. Overarching Meta-competency for IPT for Depression:Ability to maintain a focus on the interpersonal context of the symptomsOverarching elements common to High Intensity Psychological Therapies forDepression in IAPT:Knowledge of depressionWorking with differenceIdentify and manage risk of self harm in clients with depressionRoutine monitoring of clinical outcomes3. Key Texts4. High Intensity Curriculum – IPT for Depression (Practitioner training)Aims and objectiveStructure of the TrainingSummary of Units5. Method of TrainingDidactic teachingLarge and small group discussionExtensive use of case-discussion and role-playOngoing assessment of role-play6. Supervised Clinical WorkAssessment of CompetenceAccreditation7. The UnitsUnit 1:Introduction to IPT and theoretical originsAim of the unitLearning objectivesCompetenciesLearning and teaching strategyAssessment strategyUnit Two: IPT Assessment – the symptom focusAim of the unitLearning objectivesCompetenciesLearning and teaching strategyAssessment strategyUnit Three: IPT assessment – the interpersonal focusAim of the unitLearning objectivesCompetenciesLearning and teaching strategyAssessment strategyInterpersonal Psychotherapy for Depression: Trainee Pack March 20112
Unit Four: Formulation and working with IPT focus areasAim of the unitLearning objectivesCompetenciesLearning and teaching strategyAssessment strategyUnit Five: Interpersonal Role TransitionsAim of the unitLearning objectivesCompetenciesLearning and teaching strategyAssessment strategyUnit Six: Complicated GriefAim of the unitLearning objectivesCompetenciesLearning and teaching strategyAssessment strategyUnit Seven: Interpersonal Role DisputesAim of the unitLearning objectivesCompetenciesLearning and teaching strategyAssessment strategyUnit Eight: Interpersonal Sensitivity/DeficitsAim of the unitLearning objectivesCompetenciesLearning and teaching strategyAssessment strategyUnit Nine: Endings and MaintenanceAim of the unitLearning objectivesCompetenciesLearning and teaching strategyAssessment strategyUnit Ten: IPT evidence base and modifications for depressionAim of the unitLearning objectivesCompetenciesLearning and teaching strategyAssessment strategyUnit Eleven: Follow up trainingAim of the unitLearning objectivesCompetenciesLearning and teaching strategyInterpersonal Psychotherapy for Depression: Trainee Pack March 20113
Assessment strategy8. Appendices:TRAININGIPT CompetenciesIPT Competencies self assessment toolIPT for Depression Practitioner Training SlidesIPT Competencies Record of ProgressIPT for Depression Targets - Role play evaluation formsKnowledge quiz response formsPRACTICEService user leafletAudio consent formIPT supervision contractIPT PromptsIPT WorksheetsIPT Targets weekly rating formACCREDITATIONIPT for Depression Audio Rating FormIPT Reflective Case Report TemplateIPT for Depression Audio rating Summary SheetIPT for Depression Practitioner Casework Summary SheetInterpersonal Psychotherapy for Depression: Trainee Pack March 20114
1. IntroductionThis curriculum is for a training that enables experienced psychological therapists to providea depression-specific 16 session therapy in an IAPT setting for individuals where there isboth interpersonal distress and depression.The competences required to deliver effective Interpersonal Psychotherapy for Depressionare drawn from the published IPT manuals and NICE-endorsed research studies.The training to deliver this therapy within the IAPT programme consists of two linkedelements: a six-day course (five training days plus one follow up day), and an additionalperiod of supervised clinical work with an IPTUK accredited supervisor, during which fourcases must be satisfactorily completed in order to be accredited as an InterpersonalPsychotherapy for Depression IAPT Practitioner. The accrediting body is IPTUK.Clinicians treating individuals with depression and interpersonal distress within IAPT will beexpected to draw on competencies from their existing practice of psychological therapiesand integrate these with competencies specified for use with this patient group, as outlinedin this training curriculum.Aims of the Training1. To develop practical competencies in Interpersonal Psychotherapy forDepression and integrate with generic competencies in psychological therapy.2. To ensure clinical practice in accordance with local and national IAPT servicepolicy, including the need to work appropriately with difference and toroutinely monitor clinical outcomes.3. To enable Interpersonal Psychotherapy for Depression practitioners to act asan expert resource to professional colleagues, thus ensuring appropriatereferrals for Interpersonal Psychotherapy for Depression and informed patientchoice.Interpersonal Psychotherapy for Depression: Trainee Pack March 20115
2. Overarching meta-competency for InterpersonalPsychotherapy for Depression:Ability to maintain a focus on the interpersonal context of symptomswww.ucl.ac.uk/clinical-psychology/CORE/IPT framework.htmOverarching elements common to high intensitypsychological therapies for depression in IAPTKnowledge of depressionWorking with differenceIdentifying and managing risk of self harmRoutine monitoring of clinical RE/competence frameworks.htmInterpersonal Psychotherapy for Depression: Trainee Pack March 20116
4.Key TextsDepression-focused textsBhugra, D. & Bahl, V., 1999. Ethnicity: an agenda for mental health. London: Royal Collegeof Psychiatrists/Gaskell.Department of Health, 2002. A sign of the times: modernising mental health services forpeople who are deaf. London: HMSO.Department of Health, 2005. Delivering race equality in mental health care: a summary.London: Department of Health.Department of Health, 2007. Positive steps: supporting race equality in mental healthcare.London: Department of Health.Ethnicity Online. Useful web oodpracticeguidelinesatEquality Act 2010: http://www.equalities.gov.uk/equality act 2010.aspxHM Government Office for Disability Issues: D information on different community groups:http://www.mind.org.uk/help/people groups and communities/O’Hagan, K., 2001. Cultural competence in the caring professions. London: JessicaKingsley.Prior, P., 1999. Gender and mental health. Basingstoke: Macmillan.Rogers, A. & Pilgrim, D., 2003. Mental health and inequality. Basingstoke: PalgraveMacmillan.Royal National Institute for the Blind at http://www.rnib.org.uk/Pages/Home.aspxRyan, T. & Pritchard, J. eds., 2004. Good practice in adult mental health. London: JessicaKingsley.Stokes, G., 2000. Mental health problems in older people. In Bailey, D. (ed.) At the core ofmental health: key issues for practitioners, managers and mental health trainers. Brighton:Pavilion Publishing Ltd, p.80-128.Thornicroft, G., 2006. Shunned: discrimination against people with mental illness. Oxford:OUP.Interpersonal Psychotherapy for Depression: Trainee Pack March 20117
IPT focused textsElkin, I.M, Shea, M. T., Watkins, J.T. et al (1989) National Institute of Mental HealthTreatment of Depression Collaborative Research program: general effectiveness oftreatments. Arch of Gen Psych, 46, pp 971-982.Frank, E. et al (1990): Three Year Outcomes for maintenance Therapies inRecurrent Depression. Arch Gen Psych 47, Dec: pp 1093-1099Sotsky S.M et al (1991) Patient predictors of response to psychotherapy andpharmacotherapy: Findings in the NIMH Treatment of Depression CollaborativeResearch Program. Am J of Psych, 148: pp 997-1008Frank, E. et al (1991) Efficacy of Interpersonal Psychotherapy as a MaintenanceTreatment of Recurrent Depression. Arch Gen Psych 48, pp 1053-1059Elkin I.M et al, (Oct 1995) Initial Severity and differential treatment outcome in theNational Institute of Mental Health Treatment of Depression Collaborative ResearchProgram. Journal of. Consulting & Clinical Psychology, Vol 63(5) ,pp 841-847Frank, E. , Spaner, C. (1995) Interpersonal Psychotherapy for Depression:Overview, Clinical Efficacy, and Future Directions. Clinical Psychology: Science andClinical Psychology: Science and Practice, V2, N4, Winter.Markowitz, J.C. & Swartz, H.A. (1997). Case Formulation in InterpersonalPsychotherapy of Depression in T.D. Eells (Ed) 192-222Psychotherapy Case Formulation. N.Y., London, Guilford Press.HandbookofWeissman, M.M., Markowitz, J.C., & Klerman, G.L. (2000) Comprehensive Guide toInterpersonal Psychotherapy. Basic BooksFrank E et al (Jan 2000) Interpersonal Psychotherapy and antidepressantmedication: evaluation of a sequential treatment strategy in women with recurrentmajor depression. Journal of Clincal Psychiatry61 (1), pp51-57Stuart, S. & Robertson, M. (2003). Interpersonal Psychotherapy: A Clinician's Guide.London, ArnoldInterpersonal Psychotherapy for Depression: Trainee Pack March 20118
Weissman, M.M., Markowitz, J.C.& Klerman G.L. (2007) Clinician's Quick Guide toInterpersonal PsychotherapyFrank, E & Levenson, JC (2010)Psychotherapy)Interpersonal Psychotherapy (Theories ofLaw, R (2011) Interpersonal Psychotherapy for Depression. Advances in PsychiatricTreatment, Jan.In addition trainees are provided with a summary of the IPT literature 2005-1010.Interpersonal Psychotherapy for Depression: Trainee Pack March 20119
5. High Intensity Curriculum - Interpersonal Psychotherapy forDepressionInterpersonal Psychotherapy (IPT) is an effective treatment option for depression,and is among those evidence-based treatments recommended in the NationalInstitute for Health and Clinical Excellence (NICE) guidelines for depression. Therehas been extensive evaluation of its practice and more recently a focus on wideningthe dissemination and availability of this treatment approach. IPT’s evidence base,short-term nature and interpersonal focus have made it attractive to clients,practitioners and service purchasers.Many clinicians have had some exposure to IPT; few have had the opportunity todevelop competent practice. Courses for qualified and experienced IAPT workers,delivering services at levels 3 and 4, will aim to provide a post-qualification CPDtraining in evidence based IPT for adults with depression. The courses will be aimedat experienced psychological therapists from a range of mental health disciplines.The training will support trainees to reach a level of competence that would enablethem to obtain the outcomes reported in the relevant NICE guidance. It will also benecessary for trainees to be familiar with conditions that are commonly co-morbidwith depression such as anxiety, although this will not be the primary focus of theintervention.The trainees will work in IAPT services, providing the high-intensity IPT component.NICE recommends a stepped-care approach to the management of many cases ofdepression and IAPT services will be organised around these principles. In additionIAPT services will provide choice across a range of evidence treatments for thetreatment of common mental health problems. For the services to work efficiently, itis important that the high-intensity trainees are also familiar with the low-intensitywork that many patients may have received before being ‘stepped-up’ to highintensity treatment as well as the other treatment approaches which are representedin the care pathway. The trainees will also need to be able to use the IAPT nationaloutcomes monitoring system (which includes session-by-session symptommeasures). IPT and linked interventions aim to have a meaningful impact on clients’lives, improving social inclusion, employment and productivity as well as alleviatingdepressive symptoms. Trainees will therefore need to be able to assess employmentopportunities and develop close working relationships with employment coaches inorder to maximise patients’ chances of returning to the workplace.Interpersonal Psychotherapy for Depression: Trainee Pack March 201110
Course aims and objectivesThe course will have an integrated theoretical base, reflecting the integration ofmedical and interpersonal models. In addition to providing practical, intensive anddetailed skills training to a defined standard of competence, the course will aim toincrease trainees’ knowledge base of theory and research in IPT, and to promote acritical approach to the subject.It will aim to equip trainees to become skilled and creative independent IPTpractitioners, in accordance with IPTUK accreditation guidelines, and to contribute tothe further development of IPT.The course will provide opportunities for trainees to develop and demonstrateknowledge, understanding and skills as follows:1. To develop practical skills in delivering IPT for depression.2. To develop critical knowledge of the theoretical origins and research literaturerelating to IPT for depression.3. At the end of the course trainees will be able to:i.ii.iii.iv.v.vi.vii.viii.ix.demonstrate a systematic knowledge of the principles of IPT and theapplication of IPT techniques to the treatment of depressiondemonstrate a critical understanding of the theoretical and researchevidence for IPT for depression and an ability to evaluate the evidencepractise IPT with depression systematically, creatively and with goodclinical outcomesidentify an IPT focus area and construct a interpersonal formulation fordepressiondeal with complex issues arising in IPT practicetake personal responsibility for clinical decision making instraightforward and more complex situationsdemonstrate self-direction and originality in tackling and solvingtherapeutic problemsdemonstrate an ability to adapt IPT sensitively, and to ensure equitableaccess for people from diverse cultures and with different values.demonstrate cultural competenceEquality and cultural competenceCourse objective to acquire cultural competence aligns with statutory duties underthe Equality Act 2010, requiring public authorities who exercise public functions andorganisations carrying out public functions on behalf of a public authority, to advanceequality of opportunity, eliminate unlawful discrimination and foster good relationsInterpersonal Psychotherapy for Depression: Trainee Pack March 201111
between people of shared protected characteristics and those who do not. Achievingcultural competence is a lifelong learning process. Cultural competence for highintensity IPT therapists will aim to develop the student’s ability to recognise their ownreaction to people who are perceived to be different and values and belief about theissue of difference (cultural competence module). The assessment criteria willincludei.Developing an ability to recognise one’s own reaction to people whoare perceived to be different and values and belief about the issue ofdifference.ii.Understanding a definition of culture, related values and factorseffecting culture e.g. age, disability, marital status, ethnicity, parentalstatus, sexual orientation, gender, education, language, socioeconomic status, and religion or belief.iii.Capable of taking responsibility for responses and actions taken withpeople who are different or are perceived to be differentiv.Developing ability to accept ambiguity of not knowing what to expector what to do initially during an inter-cultural situation.v.Risk taking in order to communicate effectively with people fromdiverse cultures.vi.Working effectively with interpreters, establishing ways of workingtogether and considering clinical implications.vii.Raised awareness of one’s reaction to people who are different andthe implications of these reactions during sessions.Interpersonal Psychotherapy for Depression: Trainee Pack March 201112
Structure of trainingThe IPT practitioner training course is delivered over five consecutive days and onefollow up day. The five day course is broken down into ten units, plus one single dayfollow up. Each unit is half a day. The training covers all of the specificcompetencies for IPT for Depression and the current evidence base for IPT practice.Prior to attending the course trainees use the IPT competencies self assessment toolto identify the general psychotherapy competencies and IPT specific competenciesthey bring to the training. This exercise is repeated after the training in order tomonitor the acquisition of specific IPT competencies and to inform the supervision ofinitial IPT casework.Following completion of the initial five days of training trainees begin casework withclients with depression using IPT. NICE guidelines recommends IPT for patientsacross the severity spectrum for Major Depression, However in practice trainees aredirected to select cases with moderate to severe symptoms for their initial casework.This offers some protection against early discontinuation of treatment in the event ofrapid symptom resolution and facilitates the process of linking current symptoms tocurrent interpersonal difficulties for new practitioners. Trainees submit four casesfor assessment with a view to completing IPT practitioner accreditation. It isadvisable that trainees should stagger the start of new cases over approximately sixweeks, and where possible, begin with a supervised non accreditation case to gainfamiliarity with the practical application of the model before being subject toaccreditation evaluation.Trainees attend weekly supervision for the duration of the casework. Traineescomplete a brief self assessment following each IPT therapy session and use this asa basis for clinical reflection and supervision. Trainees submit a minimum of threerecorded therapy sessions for evaluation per case. Trainees complete a detailedcompetency-based self-assessment prior to submitting recordings, using the IPTAudio Rating Scale, and receive written feedback on the same competencyassessment form following the supervisor’s or external rater’s review of therecordings of therapy.At the midpoint of the casework trainees attend a follow up day to provide a refresherto the initial training and to review the transfer of theory into practice. Trainees willalso use the IPT competencies self assessment tool again at this stage to monitorthe development of competencies and identify areas for specific supervision.Weekly supervision continues until conclusion of the casework. Trainees produce areflective statement on each IPT case undertaken and repeated the IPTcompetencies self assessment for a final time.Interpersonal Psychotherapy for Depression: Trainee Pack March 201113
Summary of the units1. Unit One: Introduction to IPT and theoretical origins2. Unit Two: IPT Assessment – the symptom focus3. Unit Three: IPT assessment – the interpersonal focus4. Unit Four: Formulation and working with IPT focusareas5
Interpersonal Psychotherapy for Depression: Trainee Pack March 2011 9 Weissman, M.M., Markowitz, J.C.& Klerman G.L. (2007) Clinician's Quick Guide to Interpersonal Psychotherapy Frank, E & Levenson, JC (2010) Interpersonal Psychotherapy (Theories of Psychotherapy) Law, R (2011) Interpersonal Psychotherapy for Depression.
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