Interpersonal Psychotherapy (IPT) assumes that people need other people to feel good. Depression can develop when relationships with significant others are severely disrupted. Think of the loss of a loved one or a conflict, for example.

IPT does not focus on the past, but on the here-and-now instead. It focuses on a recent reason that may have contributed to the depression. The idea behind this is that we cannot change the past, but we can influence the present.

IPT process

The IPT process starts with making an inventory of all people who are or were important in your life. Particular attention is paid to any changes which occurred prior to the start of your complaints. After a number of conversations about your social network, the focus of the treatment will be determined.

To determine this focus, a number of important questions are asked:

1. Has there been a change in your relationships with significant others? Has an important person disappeared (due to death or divorce, for example) or has there been other changes in regard to your relationships with the people around you?
2. Did the change happen relatively recently and did this coincide with the onset of the depression?
3. Is the change emotionally charged?

IPT is a short-term treatment, therefore, it is often the case that not all your problems are discussed. Experience shows that this is often not necessary; by solving the most central problem, you often find enough motivation to solve the others yourself.

Themes within IPT

Four possible central themes are distinguished within IPT:

• Mourning a significant loss;
• A conflict with a significant other;
• A big change in social roles, or;
• A shortage in interpersonal relationships.

With the help of your practitioner, you will work out which theme fits your complaints the best.

Sources: Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2017). Protocollaire behandelingen voor volwassenen met psychische klachten.

Throughout the day, you are constantly unconsciously thinking about events you have experienced. Sometimes these thoughts are positive, sometimes they are negative. How you think about these events affects how you feel, and these feelings play a role in how you behave. By challenging thoughts, you try to investigate how thoughts influence your feelings and behaviour. You also check whether your way of thinking is realistic and appropriate for the event. Thought Challenging offers a tool to counteract negative thoughts and reduce tension in our lives. Its exact working is explained below.

1. What proof is there for my thoughts?

Do the facts of the situation support your thoughts, or do the facts contradict your thoughts? Find out what evidence there is both for and against your thoughts. For example:“I don’t think the neighbour likes me.”What facts are there that support your thought? “He didn’t respond when I waved at him.” And what facts contradict your thought? “He says good-day when I walk past his house.”

2. Could there possibly by other perspectives considering the event?

There are several ways to view your experiences. Could you look at what happened from a different perspective? Try to come up with as many alternatives as possible. If you consider all these alternatives objectively, which one is the most realistic? Example of alternatives: “It was busy on the road, maybe he didn’t see me”, “He might be caught up in his own thoughts and not paying attention.”

3. What is the effect of my way of thinking?

How do your thoughts influence your feelings and behaviour? What are the advantages and disadvantages of this way of thinking? Am I going to feel better because of these thoughts or do they have a negative influence on how I feel?

 4. What mistakes do I make?

Thinking errors are thoughts that do not correspond to reality. The enumeration below shows an overview of the most common fallacies. Do you recognize one or more thinking errors when looking at yourself?

1. All-or-nothing thinking: you see things too black and white. If you don’t perform perfectly, you see yourself as a total failure.
2. Overgeneralization: you see a single negative event as an endless pattern of failures. For example, think about getting a bad grade. Example: “I have failed. I might as well quit school now!”
3. Selective attention: you focus so much on one negative detail, that your overall view of reality turns black, like a drop of ink that darkens a glass of water.
4. Ignoring the Positive: all positive experiences ‘don’t count’ for some reason. The glass is half empty instead of half full.
5. Hasty conclusions: you have a negative perspective on certain things while there are no facts to support your conclusion, for example by reading thoughts; you conclude that someone is reacting negatively to you without checking whether this is what the person intended.
6. Predicting the future: you predict that certain things will go wrong and you are convinced that your prediction is a fact.
7. Emphasise or understating: you emphasise your mistakes and/or someone else’s successes. Or you understate things, such as your own qualities or someone else’s flaws.
8. Emotional reasoning:you assume that your negative emotions reflect reality. “I feel it, so it must be true.”
9. Box thinking: this is an extreme form of overgeneralization. Instead of describing your mistake, you put yourself in a box: “I’m a loser”. And if you don’t like someone else’s behaviour, you put that person in a box: “He’s a goddamn bastard”. Such statements are often accompanied by very coloured and emotionally charged language.
10. Personalization: you see yourself as the cause of a negative event for which you were not actually responsible. For example, “The butcher was blunt to me, so I must have done something wrong”.

A Thought Record is a tool that can be used to find out which thoughts (both unconscious and automatic) cause a certain event to evoke certain feelings in you. These feelings lead to certain behaviours and, in turn, these behaviours have consequences. In a Thought Record you can write down an event, your thoughts, feelings and their consequences.

Explanation Thought Record

Have you recently experienced an unpleasant event or situation? It can help to write down your experience and how you can deal with it better the next time. You can do this based on these five questions:

1. Event: Be as specific and objective as possible, you want it to be a description of the facts.
2. Thoughts: The dialogue in your head (ideas, fantasies, prejudices, values)
3. Feelings: How did I feel? Can also be physical (scared, angry, sad, happy, ashamed)
4. Behaviour: What did I do? What did I not do? What did others do or didn’t do?
5. Consequences: What consequence did this behaviour have?

An example:

Tip: thoughts are not always easy to be aware of as they often occur automatically. In addition, they are often difficult to distinguish from feelings. Therefore, try to pay extra attention to this. A tip for learning how to make this distinction is to realize that thoughts are experienced inside your head, while feelings are sensations. For example, during a robbery I thought I would not survive, and I felt very anxious about this. This was evident from my body language; I was stiff and sweating a lot. In this case, the thought is “I don’t think I’m going to survive”. The feeling is “I feel anxious”.

Source: Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2017). Protocollaire behandelingen voor volwassenen met psychische klachten.

In a Thought Record, all events, thoughts, feelings and consequences that a person experiences during the day are recorded.

What is a Thought Record for?

 The Thought Record is a tool that can be used to find out which (unconscious or automatic) thoughts cause a certain event to evoke certain feelings in you. These feelings lead to certain behaviors, and in turn these behaviours have consequences.

Explanation “Event schedule”

Have you recently experienced an unpleasant event or situation? It can help to write down how you experienced it and how you can deal with it next time. You can do this based on these four questions.

An example:

How do I fill out a Thought Record?

1. Event: be as specific and objective as possible, you want it to be a description of the facts.
2. Thoughts: the dialogue in your head (ideas, fantasies, prejudices, values)
3. Feelings: can also be physical (scared, angry, sad, happy)
4. Consequences: what did I do? What did I not do? What did others do or not?

Tip: thoughts are not always easy to be aware of as they are often automatic. In addition, they are often difficult to distinguish from feelings. So, try to pay extra attention to this. A tip to learn to make this distinction is that thoughts are experienced inside your head, while feelings are sensations. For example, during a robbery I thought I would not survive, and I felt very anxious about this. This was evident from my body language; I was stiff and sweating a lot. In this case, the thought is: I don’t think I’m going to survive. The feeling is: I feel anxious.

This list contains 141 suggestions for different activities you can do. You can also think of some of your own. Not all the activities will be fun or suitable for everyone.

Write down a list of at least 20 activities that:

• Seem fun
• You used to like but don’t feel like doing at the moment
• You are good at

Activities

1. Watch television
2. Listen to the radio
3. Listen to music
4. Do board or committee work in your spare time
5. Play board games (such as Monopoly, Scrabble, shuffleboard, etc.)
6. Do voluntary work (such as community work, supporting the elderly, work at animal shelters, etc.)
7. Play cards
8. Do a puzzle
9. Read a book
10. Read the newspaper or a magazine
11. Sing or play a musical instrument
12. Meditation and/or yoga
13. Draw or paint
14. Crafts (such as pottery, leather processing, weaving, etc.)
15. Needlework (such as knitting, crocheting, embroidery, etc.)
16. Keep a diary
17. Photography and filming
18. Fishing
19. Gardening
20. Train and/or care for your pet
21. Work on a collection (such as stamps, coins, CDs, plates, etc.)
22. Tidy up your house or room and/or change the interior
23. Do a chore in or around the house
24. Do a strenuous job (sawing or chopping wood, digging, gardening, etc.)
25. Make or sew clothes
26. Do a task for work with colleagues
27. Do a task for work alone
28. Visiting parents, family, etc.
29. Visit friends or acquaintances
30. Eat with friends
31. Throw a party
32. Drink coffee or tea with friends or acquaintances
33. Have some guests over at your house
34. Write a letter or e-mail
35. Talk to a stranger
36. Tell someone about what you have been through
37. Talk about your daily activities (job, school, hobbies, etc.)
38. Attend official ceremonies
39. Call friends or acquaintances
40. Arrange a meeting with someone from the other sex
41. Arrange a meeting with someone from the same sex
42. Give out some advice
43. Ask for help or advice
44. Visit people who are sick or in difficult situations
45. Ask for a massage
46. ​​Make love to someone
47. Hug someone
48. Flirt with someone
49. Arrange a date
50. Kiss someone
51. Drink coffee or tea
52. Tell someone what you think of him/her
53. Enjoy looking at attractive men or women
54. Take a shower or bath
55. Drink something fresh (lemonade, fruit juice, etc.)
56. Cook food
57. Lie or sit in the sun or on tanning beds
58. Just sit quietly
59. Sleep
60. Take a nap
61. Sit on a terrace
62. Go to a hairdresser or beautician
63. Use aftershave, perfume, etc.
64. Go to the movies
65. Spend time on your appearance
66. Cook, try new recipes
67. Bake bread, cake or biscuit yourself
68. Make snacks
69. Eat outdoors
70. Go to a cafe or bar
71. Go to a concert, play, opera or ballet
72. Go to a fun fair, circus, amusement park, zoo or rodeo
73. Go on vacation
74. Go to parties or receptions
75. Go to the market
76. Go to the library
77. Go to auctions, car sales, etc.
78. Go shopping
79. Go to a swimming pool, a sauna, etc.
80. Buy something for yourself
81. Attend a lecture
82. Visit a museum or exhibition
83. Buy something for someone else
84. Travel (car, train, bus, etc.)
85. Make a group trip
86. Dance, do ballet, gymnastics etc.
87. Cycle
88. Take a walk
89. Talk about sports
90. Stay with family
91. Join a sports club
92. Exercise outside of a club (a game of football, table tennis, skating, etc.)
93. Attend sports events
94. Learn astrology from horoscope reading
95. Visit caves, waterfalls, picturesque wonders
96. Go on excursions and outings (or view maps and tour booklets)
97. Take on science hobbies, such as astronomy and nature studies
98. Learn about history
99. Do things with your neighbours
100. Do things with your child(ren) or grandchild(ren)
101. Exercise / train with weights
102. Engage in computer technology and communication
103. Watch movies, series, Netflix or online videos
104. Watch sports events on television
105. Play pool or billiards
106. Do some woodwork
107. Do some motor vehicle engineering (car repair or construction, tuning)
108. Do water polo
109. Go flying or gliding
110. Learn to speak a foreign language
111. Travel to a foreign country
112. Go (indoor) skiing or snowboarding
113. Use the Internet
114. Chat on the Internet
115. Send a text message from WhatsApp
116. Go motorcycling
117. Go car racing or go-karting
118. Go bungee jumping or skydiving
119. Play on a game console (Nintendo, Xbox, PlayStation)
120. Perform for an audience (band, dance, theatre, cabaret, etc.)
121. Go boating (canoeing, rafting, sailing, catamaran, etc.)
122. Play ball sports (football, volleyball, handball, rugby, baseball, etc.)
123. Play tennis
124. Keep an aquarium or terrarium
125. Go quad biking or dirt biking
126. Go to big parties or events (house, rave, disco)
127. Go (kite)surfing
128. Go skating, rollerblading or skateboarding
129. Play hockey or ice hockey
130. Play golf
131. Write or tell stories
132. Do martial arts
133. Go running or jogging
134. Sell stuff (on Facebook marketplace or the market, for example)
135. Do outdoor activities (such as hiking, camping, mountaineering)
136. Go picnicking
137. Go to the park or forest
138. Improve your health (dentist, buy glasses, change diet)
139. Go horseback riding
140. Go laser gaming or paintballing
141. Dress up nicely

Cognitive Behavioural Therapy (CBT) is a type of psychotherapy. Would you like to learn more about CBT or prepare for your treatment? In this 3 minute video, you’ll learn everything you need to know about CBT. You can also read the explanation below the video.

The CBT treatment focuses on discussing and treating the behaviours and thoughts that sustain your problems. You will investigate the connection between your thoughts, feelings and behaviour. And you will learn how to turn the thoughts that generate unwanted feelings into helpful thoughts that instead create desired feelings. The effectiveness of CBT has been shown in scientific research. Treatment is complaint- or problem-oriented and generally takes a short amount of time. The goal is to learn to think more realistically and become more balanced. Even after treatment, you may still find situations difficult, but you will no longer see them as a ‘disaster’.

Part of CBT involves filling out thought records, challenging thoughts, doing exposure assignments and behavioural experiments.

Consistency of thoughts, behaviour and feeling

Thoughts, ideas and perception play an important role in psychological complaints. For example, people with major depressive disorder often find that minor disappointments or setbacks can elicit a pattern of negative thoughts about themselves, about the future, and about the world. These negative thoughts almost become automatic.

The way you think determines your perspective of situations. Two people who find themselves in the same situation may react very differently. As an example, we take Jan and Piet who board the same bus. In this bus is a group of children who suddenly burst out laughing. Jan thinks: “I’m sure they are laughing at me”, giving him a sad feeling. He gets off at the next bus stop because he feels too uncomfortable. Piet thinks: “Oh, those kids are having a good time, they must have had a nice day”, and this gives him a pleasant feeling. Piet stays on the bus until he reaches his destination and gets off cheerfully. This is an example of how the same event can create a different feeling in two people. Because of their automatic thoughts, they interpreted the situation differently. Thoughts influence how you feel and, luckily, our thoughts can be changed!

Cognitive therapy

Cognitive therapy is a systematic method that helps you to understand these thoughts that lead to unpleasant feelings. By learning to think differently, you can reduce your negative feelings.

Three steps are taken:

• You learn to become aware of the negative automatic thoughts;
• You learn to become aware of the underlying beliefs;
• You learn to challenge and investigate the negative automatic thoughts and opinions by asking critical questions about them. You will then consider whether other interpretations or thoughts are possible.

The behavioural part of the therapy

Your thoughts can influence your feelings and behaviour. Conversely, your own behaviour can also reinforce your negative automatic thoughts. Think back to Jan who got off the bus. Because of his behaviour, he did not learn that his thoughts may have been wrong. In fact, the other kids might not like him because he left so suddenly. That is why you will not only examine your thoughts, but you will also work on your behaviour. You do this by doing exercises, such as experiments or exposure exercises. Together with your professional, you will learn to put your new behaviour into practice.

In the end

The CBT treatment aims to teach you how to think more realistically and to be able to deal with your complaints. Remember that you can still experience situations as difficult even after finishing your treatment, but the treatment will help you to no longer see them as a ‘disaster’. You conclude the treatment by making a relapse prevention plan, which gives you the confidence to be able to deal with difficult moments in the future.

Bron: Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2017). Protocollaire behandelingen voor volwassenen met psychische klachten.

Conversational skills are skills that help you take your conversation partner into consideration. These skills are discussed below.

Let the other person finish

Letting the other person finish talking will give you more insight. It also prevents you from speaking at the same time, which can make a conversation chaotic. You can miss information when you don’t let each other finish talking, which can lead to miscommunication. Disputes can also be prevented in this way.

Asking questions

Closed questions:

A closed question is a question to which you can give two or three answers. Consider, for example: “Do you work?”. You can answer “yes” or “no” to this. An advantage of a closed question is that you can control the conversation. A disadvantage is that someone often answers briefly and succinctly, therefore you could miss information.

Open questions:

An advantage of open questions is that they provide a lot of information. A disadvantage is that this information is less specific or relevant. Open questions usually start with the words: ‘what’, ‘where’, ‘why’ and ‘when’. For example, instead of: “Do you work?”, you can ask “Where do you work?”. By asking this question, you will not only find out if a person works, but also where that person works.

Listening to others

 Listening is often the difficult part of communication. Really listening and taking in what is being said happens too little. Try to focus on listening to what someone is saying. You can do this by repeating it to yourself at the end of the story. This helps to make you more aware of the information they have given you.

Adapt your style to other people

 This is important for making sure that your message is communicated well. For example, try not to use words that are too difficult with a child. It can be more convenient to ask children more closed questions.

Silences

Silences during a conversation can be an uncomfortable experience, but they are important as well. Silence gives you time to reflect on what has been said. Try not to fill in these silences, and deliberately introduce silences occasionally during a conversation.

How do I practise?

Practise in a familiar environment and pay attention to the techniques listed above. For example, ask yourself: “Do I look at the person when they talk?”. Or: “Do I really listen to what they are telling me?”. If you find it difficult to recognize these skills in yourself, you can ask your conversation partner for feedback. For example, ask: “How did you experience this conversation?”. Or: “Did you miss anything on my part?”. Feedback is often very informative because it helps you become aware of things you are good at and things you need to improve on. During your next conversation, you can pay attention to whether you are using these skills.

Assertive behaviour focuses on standing up for yourself, with respect to your own goals as well as those of the other person. There are three stages of assertive action:

Passive ——— Assertive —— Aggressive

Passive behaviour means that you consider others before yourself too often, while aggressive behaviour is about when you only think of yourself and of not others. Assertiveness is the middle ground between these two extremes.

How can I be assertive?

Below are eight points that you can follow to be(come) more assertive.

1. Saying ‘no’ is enough

Saying ‘no’ is difficult for many people. We tend to feel the need to explain a rejection, for example: “You can’t borrow that book, because…” In most cases, an explanation is not necessary, a simple ‘no’ should suffice. But if people do ask why, answering “I prefer not to” is also a perfectly good explanation.

2. Confront

If you find it difficult to be assertive, you can use these techniques when practising, as practice makes perfect! The first step to becoming assertive is usually the most difficult. This is because you have to do something you would rather not do. Confrontation is important, it teaches you to be more assertive. Try saying ‘no’ to something small or to someone you know well and trust.

3. Relax

Being assertive can be scary, and you might feel tense. Try to relax in these moments, then the anxiety will automatically begin to decrease. You can do this by, for example, tensing your muscles first and then relaxing them again, or by taking a few deep breaths.

4. Use ‘I’ statements

If you want to indicate that you do not like another person’s behaviour, it is best to start a sentence with ‘I’. For example, “I can’t concentrate if you make all that noise.” Avoid phrases that start with ‘you’, such as, “You are always so loud”. If you do so, people tend to feel attacked more quickly.

5. Act assertively

Being assertive involves more than just the message you are trying to convey. The words you use are important, but the body language and tone of voice you use also play a role. Adopt an open and interested posture. You can do this by relaxing; try to relax your arms and legs as much as possible. Speak loudly and clearly and add variety to your voice, this will make you sound less monotone.

6. Prepare

In many cases, you can prepare for situations in which you need to be assertive. When it comes to situations during which you have trouble being assertive, such as when your colleague asks you to do something at work when you don’t actually have the time, for example. In these cases, you can practice your response and reaction at home beforehand. At least then you know you are prepared to react in the way that you want, making you feel stronger.

7. Observe

Are there people around you who are assertive? Look at the way they move and the words they use. Not only can you learn from them, but, more importantly, you will realise that it is possible to be successfully assertive. Observe the response of the person receiving the assertive message. How does that person react?

8. Don’t be too assertive

Some people learning to become more assertive tend to overstep a little in the beginning. Being assertive is only effective if you take your own interests and the interests of the other person into account. Try to express your opinion in a calm but clear manner. Show that you also understand where the other person is coming from.

You can express positive feelings in many different ways. For example, by complimenting someone or by expressing your appreciation. Below are some tips for giving a compliment.

How do you give a compliment?

• A compliment is specific. You need to make it clear what the other person has done well, for example “I like that you have already cooked!”
• Indicate why you appreciate it so much. Support your compliment with examples“… because I am a bit tired from work.’’
• Preferably give the compliment from a first-person perspective, in the ‘I’ form. This makes it more personal.
• Be positive: focus on what the other has done and not on what the other has forgotten.

How to express a compliment:

• Preferably give the compliment face-to-face. With face-to-face contact, you can use gestures and eye contact. This ensures that the compliment has more of an impact.
• Support your compliment with enthusiasm and body language, but don’t try to exaggerate! This carries the risk that your compliment will come across as disingenuous.
• Make sure your compliments are well directed. Focus the compliment on one or two people for whom the compliment is intended.

How do you receive a compliment?

Many people find it difficult to deal with and receive compliments. You may think you appear arrogant or it can make you feel uncomfortable. Giving thanks is a good first step in accepting a compliment.

An example is: “That’s a nice coat you have on”. Then you can say: “Thank you!”.

The Diagnostic Manual for Psychologists (DSM-5) indicates that the following symptoms are associated with depression:

1.    Depressed mood during most of the day, almost every day;
2.    Reduction of interest or pleasure in (almost) all activities, almost all day, almost every day;
3.     Inadvertent, obvious weight loss or weight gain, or a decreased or increased appetite almost every day;
4.     Sleep complaints: not being able to sleep (sufficiently), sleeping too much, almost every day;
5.     Psychomotor agitation, restlessness or inhibition almost every day;
6.     Fatigue or loss of energy almost every day;
7.     Feelings of worthlessness, or excessive and wrongful guilt;
8.     Decreased ability to think or concentrate, or indecisiveness;
9.     Recurring thoughts of death, suicidal thoughts, suicidal ideation with or without plans, or attempted suicide.

To be diagnosed with depression, 5 or more of the above symptoms must be present for a period of at least two consecutive weeks. With the help of your practitioner, you will determine whether you are suffering from mild, moderate or severe depression.