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adolescents may feel differently at different times (‘I can ask her later
when she’s feeling better’).
2 Social information gathering. Games are played to develop skills in reading
situations, listening for clues and asking others what they mean.
3 Understanding motives. Children and adolescents are taught to go beyond
another person’s behaviour to think why they might be acting that way,
and to generate solutions appropriate to these motives.
Having developed these skills, most programmes go on to apply them,
initially in hypothetical situations, and then in real situations. The cogni-
tive steps may be spelt out to the child, for example, they are encouraged
to count off on each finger as they go through the sequence of STOP-
THINK-DO-REVIEW in generating and enacting solutions.
Outcome studies show strong effects in hypothetical situations, but more
mixed results in real-life situations. These programmes are considerably
enhanced if adults around the children and adolescents have also been
taught the thinking, and thus can reinforce it in the heat of the moment.
Under these circumstances short-term results are good, but long-term
follow-ups have not yet been carried out.
Interpersonal psychotherapy (IPT)
This mode of therapy was developed for treating depression by Gerald
Klerman and Myrna Weissman in New York, and then specifically mod-
ified for use with adolescents. IPT is a time-limited, brief psychotherapy
based on the premise that depression occurs in the context of interpersonal
relationships. The two main goals are to identify and treat, first, the
patient’s depressive symptoms and, second, the problem areas associated
with the onset of the depression. Five specific areas are reviewed, and one
or two worked on. Four are the same as in adult IPT: grief, interpersonal
role disputes, role transitions and interpersonal deficits. A fifth area, single-
parent families, was added because of its frequent occurrence and the
conflicts it engenders for adolescents. The emphasis is on issues in current
relationships rather than those in the past.
There are three phases of treatment. In the initial phase, depression as
a clinical disorder is explained, and an effort is made to demystify the
experience. The adolescent is encouraged to think of him or herself as
in treatment and is assigned the sick role. Despite this, the adolescent is
encouraged not to avoid the usual social expectations, but to see friends,
attend school and behave in the family as normally as possible. Parents are
seen and encouraged to be supportive rather than hostile or critical. The
school is approached, and the effect of depression on school performance
and behaviour explained.
In the middle phase the focus is on the problem area(s) selected:
1 Grief is not considered a problem unless it is prolonged or becomes
abnormal. The therapist helps the adolescent discuss the loss of a loved