Psychotherapy & Liaison Skills
Depression is one of the most common reasons for psychiatric consultation in medically ill patients (1). Given that the majority of depressed medical patients receive a limited number of outpatient psychotherapy sessions, CL psychiatrists may provide the most substantial psychotherapeutic intervention these patients will experience (2). Interpersonal psychotherapy (IPT) and the psychodynamic life narrative are two brief and flexible approaches that lend themselves particularly well to depressed medical patients from a variety of backgrounds; yet, they remain underutilized in the CL setting.
This interactive workshop will feature four psychiatrists spanning from PGY-4 resident to CL service chief from two academic programs who will describe and model two therapeutic approaches intended to provide rapid relief for depressed medical patients. The aim of this workshop is for participants to become familiar with and then engage in active learning with IPT, a structured, evidenced-based, and time-limited therapy in which mood is linked to life events, and the psychodynamic life narrative, a brief intervention that explains patients’ depression in the context of their life trajectory.
Dr. Shapiro will present the evidence for IPT in the treatment of depressed medical patients for 15 minutes.
Dr. Sotsky will present a trainee case of a depressed young woman with cancer and then model the IPT formulation and approach for 15 minutes.
Dr. Levenson will discuss his use of the psychodynamic life narrative in depressed patients for 15 minutes.
Dr. Schmajuk will discuss creative approaches to teaching psychodynamic life narrative techniques to residents who wish to utilize these methods at the bedside for 15 minutes.
We will present a sample case in which either approach might be used. Participants will break up into groups of 4-5 people and construct a formulation of the case using each approach. They will then engage in improvisation exercises in which they discuss their formulations with the patient, a critical feature of each approach, for 15 minutes.
We will then compare and contrast the two approaches, and discuss participants’ experiences and questions for the remaining 15 minutes.
IPT and the psychodynamic life narrative offer useful and accessible concepts and skills to clinicians at a variety of levels for treating depressed medical patients. More research is needed on how to best teach and apply these therapies.
As psychiatry moves increasingly towards the adoption of evidence-based and shorter-term psychotherapies, CL psychiatrists at all training levels would benefit from increased knowledge and skill in such therapies for treating depression in medically ill patients.