214 CHAPTER 6
Targeting Social Factors
Treatment for depression can also directly target a social factor—personal relation-
ships. Such treatment is designed to increase the patient’s positive interactions with
others and minimize the negative interactions.Interpersonal Therapy
Interpersonal therapy for depression (IPT, explained in Chap-
ter 4) emphasizes the links between mood and events in a pa-
tient’s recent and current relationships (Klerman et al., 1984).
Relationships that function poorly can contribute to poor
mood and depression, and improved relationships can reduce
depression. IPT addresses four general aspects of relationships,
generally in about 16 sessions:- a defi ciency in social skills or communication skills, which
results in unsatisfying social relationships; - persistent, signifi cant confl icts in a relationship;
- grief about a loss; and
- changes in interpersonal roles (for example, a partner with a
new job may have become less emotionally available).
IPT is effective in a wide range of circumstances and settings. For example, in
an innovative study of depressed people in 30 Ugandan rural villages, researchers
randomly assigned depressed residents from 15 villages to group IPT, consisting of
16 weeks of 90-minute sessions. The depressed residents from the other 15 villages
received no treatment (the control group). Those who received group IPT had a
signifi cant decrease in their depressive symptoms (and were better able to provide
for their families and participate in community activities) than those in the control
group (Bolton et al., 2003). IPT has also successfully reduced the occurrence of
postpartum depression in pregnant women at high risk for the disorder (Zlotnick
et al., 2006). In addition to alleviating depressive symptoms, maintenance IPT—
either alone or in combination with CBT—may also prevent relapse (Frank et al.,
2007; Klein et al., 2004).Family Systems Therapy
A family’s functioning may be a target of treatment; this usually occurs when a
family member’s depression is related to either a maladaptive pattern of inter-
action within the family or a confl ict that arose within the family. Confl icts—
particularly over values—may arise within families that have immigrated to the
United States; immigrant parents and their children who grow up in the United
States may experience tension because what the parents want for their children
confl icts with what the children (as they become adults) want for themselves. Im-
migrant parents from Mexico, for instance, may want to be very involved in their
children’s lives, just as they would be in their native hometown. But their children,
growing up in the United States, may come to resent what the children perceive
of as their parents’ intrusive and controlling behavior (compared to the parents of
their peers; Santisteban et al., 2002). The parents, in turn, may think that their
children are rejecting both their Mexican heritage and the parents themselves.
Caught between two cultures—the old and the new—and wanting to maintain
aspects of their heritage but also feel “American,” the resulting confl ict can con-
tribute to depression (Hovey, 1998, 2000; Hovey & King, 1996). Family systems
therapy might help family members to talk about and understand the cultural and
personal meaning of each others’ behavior.
A similar cultural conflict can develop when members of a couple bump up
against each other’s different backgrounds (Baltas & Steptoe, 2000). As Ruben and
Angie in Case 4.2 discovered, systems therapy can help clarify such a confl ict and fi nd
adaptive ways to resolve it.Interpersonal therapy seeks to improve patients’
relationships, and thereby alleviate depression.Spencer Grant/Photo Edit