The two main goals of IPT are to: 1) decrease depressive symptoms and 2) improve social functioning within significant relationships. The strategies for achieving these goals include: 1) identifying a specific problem area; 2) identifying effective communication and problemsolving techniques to use with the problem area; and 3) practicing in session, and eventually experimenting outside the session, with the use of these techniques in the context of significant relationships. Clinical depression is conceptualized in IPT as consisting of three components: 1) symptom formation, 2) social functioning and 3) personality (1). IPT is originally conceptualized as intervening in symptom formation and social functioning and less in personality, given its short duration. More recently, colleagues are adapting IPT for the treatment of adults with borderline personality disorders and so the focus may be broadened.

IPT has been selected for use with adolescents due to its developmental relevance to the adolescent population. Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) is active, structured, and includes a large psychoeducational component. As treatment progresses, the adolescent takes more control and develops a more active, action-oriented way of problemsolving (8) that is consistent with appropriate developmental changes in their approach to problemsolving (9). IPT-A emphasizes interpersonal competencies and skills training. Treatment works by addressing the difficulties and enhancing the strengths of the individual, with the goal of increasing independence and interdependence. Thus, IPT-A supports the task of individuation and increased autonomy that is so important to adolescents and therefore makes the treatment attractive to them.

Several alterations have been made to the IPT manual to increase the model’s appropriateness for the treatment of adolescent depression. Although the overall goals and problem areas of IPT are employed in IPT-A, the latter also includes a discussion, within the specific problem area, of role transitions for adolescents that are due to family structural change (divorce). This separate discussion of a specific transition is included given the frequency with which it occurs for adolescents, the empirically demonstrated connection to depressive symptoms, and the interpersonal challenges and difficulties that are associated with this situation (10). A second adaptation is the addition of a parent component to the treatment protocol. Although IPT-A is an individual treatment, some degree of involvement on the part of the parent or guardian is needed to promote the wellbeing of the adolescent and to facilitate the success of the treatment. Parent involvement in IPT-A is flexible, though it should minimally include involvement in the initial phase of treatment so as to provide education about the disorder and its treatment. The parent may also be involved as needed in the middle phase to work on specific relationship strategies and it is best if the parent attends a final session to review his or her child’s progress in treatment and future treatment needs. The role of the parent or guardian in treatment is presented for each phase of the treatment in the manual (11).

The objectives of treatment have been altered slightly to take into account developmental tasks including individuation, establishment of autonomy, development of romantic relationships, coping with initial experiences of death and loss, and managing peer pressure. Second, the techniques employed in the treatment for working toward the goals of decreasing depressive symptoms and improving interpersonal functioning have been geared toward adolescents. Techniques employed specifically with adolescents include giving them a rating scale from 1 to 10 to rate their mood, which is concrete and makes it easier for them to monitor improvement; doing more basic social skills work; conducting explicit work on perspective-taking skills to counteract adolescent black-and-white thinking about solutions to problems; and learning how to negotiate parent– child tensions. Additional strategies have been identified to address special issues that arise in the treatment of adolescents, such as school refusal, physical or sexual abuse, suicidality, aggression, and involvement of a child protective service agency.

IPT-A meets four conditions that permit its inclusion as an efficacious treatment: 1) the treatment is manual based (1,11); 2) the sample characteristics are detailed; 3) the treatment has been tested in randomized clinical trials (12,13,14); and 4) at least two different investigator teams demonstrated the intervention’s effects (15,16). The efficacy work on IPT-A began with an initial open clinical trial (17) that provided preliminary support for the use of IPT with depressed adolescents and for further study of IPT-A in controlled clinical trials. Since that study, the efficacy of IPT-A has been demonstrated in three randomized controlled clinical trials (12,13,14). The efficacy clinical trial conducted by Mufson and colleagues (12) included adolescents who met DSM-III-R criteria for major depression. The study showed that IPT-A (N = 24) was superior to clinical management (N = 24) (monitoring of symptoms) with respect to decreasing depressive symptoms, rates of recovery from depression, and rates of retention in treatment for depressed adolescents. In addition, adolescents who received IPT-A demonstrated significant improvement in certain areas of social functioning and interpersonal problemsolving skills compared to adolescents who received clinical management.

Rosselló and Bernal (13), who used a different modification of the adult IPT manual (18), similarly provided independent replication in their study that showed that both IPT (N = 23) and CBT (N = 25) were superior to waitlist control (N = 23) for the treatment of depressed adolescents (N = 71) who met DSM-III criteria for major depressive disorder, dysthymic disorder or both. They also found that IPT was significantly better than the waitlist condition at increasing self-esteem and improving social adaptation. They found that 82% of the adolescents receiving IPT compared to 52% of the adolescents receiving CBT met recovery criteria by the end of treatment.

Current empirical investigations of IPT-A aim to reach a broader range of depressed adolescents by providing treatment in community-based practice settings. A recent effectiveness study compared IPT–A to treatment as usual (TAU) in the school-based health clinics in New York City for depressed adolescents with a broader diagnostic picture including major depression, dysthymia, depression disorder NOS, and adjustment disorder with depressed mood (14). In addition, adolescents were included with comorbid diagnoses including anxiety disorders, ADHD, and oppositional defiant disorder. School-based clinicians delivered both treatments. Treatment as usual consisted of the psychological treatment the adolescents would have received had the study not been in place (generally supportive, individual counseling). Adolescents treated with IPT-A compared to TAU showed greater symptom reduction, significantly better social functioning, and greater decrease in clinical severity of depression and improvement in overall functioning. In addition, the study demonstrated the ability to train community clinicians to deliver IPT-A effectively using a streamlined therapy training program, thereby demonstrating the transportability of IPT-A from the university lab setting to the community (19).

An integral part of the assessment process is determining an adolescent’s suitability for IPT-A based upon diagnosis, severity of illness and impairment, as well as on an assessment of the family environment and willingness to engage in treatment. Based on our clinical experience, the following characteristics of an adolescent make IPT-A a good treatment choice: 1) the adolescent’s willingness to work in a one-to-one therapeutic relationship in a time-limited therapy; 2) recognition by the adolescent that there seem to be difficulties of an interpersonal nature that may be causing problems at this time; and 3) a family willing to support the therapy or at least allow the adolescent to participate in treatment.

An adolescent is felt to be suitable for treatment first and foremost if he is willing to acknowledge the depression and is willing to discuss the impact the depression is having on his relationships. An adolescent who is willing to discuss feelings and problems, and explore connections among feelings, events and relationships, is a particularly good candidate for IPT-A. IPT-A is probably most effective with adolescents who have had an acute onset of depressive symptoms and historically have not had chronic and severe interpersonal problems with friends or family. The acute onset increases the likelihood of being able to identify an interpersonal precipitant to the depression and/or exacerbation of a longer standing interpersonal problem. IPT-A may also be helpful to adolescents with longstanding interpersonal problems, but the goals for improvement may need to be more circumscribed.