Termination of Treatment
IPT is explicitly defined as time-limited, not open-ended, treatment. Frequency and duration are defined at the outset in a contract the therapist makes with the patient. The duration and frequency of IPT can vary: e.g., for treatment of an acute depressive episode, weekly and sometimes twice- weekly sessions of forty-five to fifty minutes for twelve to sixteen weeks have been used. In maintenance treatment, two dosage schedules have been used: weekly sessions for six months in one study, and monthly sessions for three years, in two other trials. Other dosages are possible and are being tested. The dosages used to date have been primarily determined by research protocols, which may be preferable to the current determination of the length of many therapies by third-party payors and managed care. In any case, it is important to maintain the initial contract. The optimal duration of treatment may vary from patient to patient; nonetheless, in each case, a time frame should be specified at the outset of treatment in order to focus on goals. Changes in this contract should be explicitly renegotiated.
As in other time-limited therapies, termination should be specifically discussed at least two to four sessions before it occurs. At termination, the patient faces the task of giving up a relationship and establishing a sense of competence to deal with further problems without the psychotherapist's help. Failure to accomplish these tasks may lead to a return of depressive symptoms as the end of treatment approaches or shortly after its end. This symptomatic worsening may in turn bring on a renewed sense of hopelessness.