Interpersonal Psychotherapy for Depressed Adolescents Adapted for Self-Injury (IPT-ASI): Rationale, Overview, and Case Summary

Article excerpt

Non-suicidal self-injury (NSSI), the intentional destruction of one's own body tissue without the conscious intent to die, is a significant health concern among adolescents, however, there are few psychosocial interventions designed to treat NSSI. The current paper describes an adaptation of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) to be used with adolescents who have symptoms of depression and are engaging in NSSI. Specifically, we describe the rationale for the adaptations made to IPT-A for self-injury (IPT-ASI), and a case vignette to illustrate the implementation of IPT-ASI. Non-suicidal self-injury is often triggered by interpersonal stressors, and IPT-ASI directly aims to help clients to improve their interpersonal relationships by increasing emotional awareness and understanding, and teaching communication and problem solving skills via supportive and didactic techniques. The case vignette demonstrates the successes and challenges of using IPT-ASI for an adolescent with moderate depression and NSSI behaviors who began treatment with much difficulty expressing her emotions.

KEYWORDS: adolescents; self-injury; interpersonal psychotherapy

INTRODUCTION

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) is an empirically supported treatment for adolescent depression (Mufson et al., 2004) and has been proven to decrease depressive symptoms and improve interpersonal functioning (Mufson, Weissman, Moreau, & Garfinkel, 1999; Mufson, Dorta, Wickramratne, Nomura, Olfson, & Weissman, 2004; Rossello & Bernal, 1999). Interpersonal psychotherapy for depressed adolescents helps teens better negotiate their interpersonal relationships and learn how their relationships are linked to mood and well-being. These tasks are accomplished by increasing emotional awareness and understanding, and teaching communication and problem-solving skills via supportive and didactic techniques. Interpersonal psychotherapy for depressed adolescents has been adapted for use in both individual therapy and group format for preteens and teens with early signs of depression. The current paper describes another adaptation of IPT-A for use with adolescents who have symptoms of depression and engage in non-suicidal self- injury: IPT-A for Self- Injury (IPT-ASI). Specifically, we describe the rationale for IPT-ASI, the adaptations made to IPT-A for self-injury, and a case vignette to illustrate the implementation of IPT-ASI.

Non-suicidal self-injury (NSSI) involves intentional destruction of one's own body tissue without the conscious intent to die. Common methods of NSSI include cutting and burning one's skin. In recent years, clinicians and researchers have turned their attention toward NSSI as the rates for this behavior among adolescents and young adults are staggering: Lifetime prevalence estimates among community samples of high school students range from 13.0% to 23.2% (Laye-Gindhu & Schonert-Reichl, 2005; Lloyd-Richardson et al., 2007), indicating that between 2.2 and 4 million high school students have purposefully injured themselves. In addition to the disturbing nature intrinsic to NSSI, adolescents who engage in it are at an increased risk for attempting (and therefore completing) suicide (Jacobson et al., 2008; Lipschitz et al., 1999; Nock et al., 2006).

Despite the significance of this public health problem, Dialectical Behavior Therapy ([DBT]; Linehan, 1993) (a therapy designed for women with Borderline Personality Disorder (BPD) that balances acceptance and change strategies and includes formal skills training in four modules - interpersonal effectiveness, distress tolerance, mindfulness, and emotion regulation), is the only psychosocial intervention that has demonstrated clear efficacy at decreasing self-injurious behaviors ( [note: primarily among adults with BPD] Stanley et al., 2007). More recently, small-scale, quasiexperimental research has suggested that DBT-A (DBT adapted for adolescents) may be effective at decreasing NSSI among teenagers (Fleischhaker et al. …