Cognitive, Interpersonal and Other Individual Therapies 341one, as well as identify and experience the associated feelings. As the
patient begins to grieve appropriately and the symptoms dissipate, the
loss should be better understood and accepted and the patient freed to
pursue new relationships.
2 Interpersonal role disputesoccur where one of the parties has different
expectations to the other about the relationship. The therapist helps
the young person to identify the dispute, to make choices about ne-
gotiations, to reassess expectations for the relationship, to clarify role
changes, and to modify communication patterns to enable resolution of
the dispute. Parents may be brought in to facilitate negotiations if they
are a party to the dispute.
3 Role transitionsoccur when adolescents need to negotiate puberty, cope
with sexual desires and the wish for intimate relationships, separate
from parents and family, and achieve success in planning work or
further education. There may be feelings of loss about letting go of old
roles, or of fear or inadequacy about their ability to take on new roles.
The therapist aims to help the young person to come to terms with these
feelings and negotiate a viable future.
4 Interpersonal deficitsare apparent when the individual appears to lack the
social skills to establish and maintain appropriate relationships within
and outside the family. As a result, the adolescent may be socially
isolated or lacking close friends, which can lead to feelings of depression
and inadequacy. The therapist reviews significant past relationships and
identifies repetitive or inappropriate ways of behaving. New strategies
are identified and discussed, and the young person is encouraged to
apply these to current issues. Role-play may be used to identify prob-
lematic interpersonal situations and enable the adolescent to explore
and practise new communication skills and interpersonal behaviours,
for example, learning how to make friends. Practising within the ses-
sion and in small increments at home can engender a sense of social
competence in the young person that generalises to other situations.
5 Single-parent familiesmay arise from divorce, separation, imprisonment
of one parent, absence of a parent from the outset, or death of a parent
by medical illness or violence. Each of these situations presents unique
emotional conflicts for the adolescent and the custodial parent. Therapy
aims to help the young person come to terms with the current situation
and negotiate appropriate adaptations. There is often a need to grieve
for the loss of the previous situation.
In the termination phase, progress is reviewed, often with other family
members present. Symptoms and conflicts are presented in four categories:
(1) those representing symptoms specific to the depressive episode; (2)
those secondary to it; (3) more enduring conflict areas that represent per-
sonality style; and (4) those areas of conflict that are part of a normal de-
velopmental process. The adolescent will have already addressed feelings
relating to termination of contact with the therapist, and a slight increase
of depressive feelings following termination is predicted. Trials of IPT