2005 Blackwell Publishing Ltd

Nursing Inquiry 2005; 12(1): 4350

F e a t u r e

Blackwell Publishing, Ltd.

Recovery from depression: a discourseanalysis of interpersonal

psychotherapy

Marie Crowe and Sue LutyDepartment of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand

Accepted for publication 8 April 2004

CROWE M and LUTY S. Nursing Inquiry 2005; 12: 4350Recovery from depression: a discourse analysis of interpersonal psychotherapyThis paper describes a discourse analysis of the process of interpersonal psychotherapy (IPT) in the recovery from depression.It demonstrates how IPT is an effective treatment strategy for mental health nurses to utilise in the treatment of depression.The discourse analysis highlights how the development of more meaningful subject positions enables one woman to recoverfrom her depression. The process of recovery is underpinned by an understanding of womens depression as promoted by con-temporary social and cultural expectations for detachment and reflexivity. This paper shows how IPT provides an opportunityfor recovery from depression for one woman by facilitating a reconstruction of her subject positions in relation to others. Thediscourse analysis revealed that the therapist facilitated this through the use of a range of techniques: seeking information,exploring beliefs/values/assumptions, exploring communication patterns, exploring affective responses and exploring alter-native subject positions.

Key words: depression, interpersonal psychotherapy, mental health nursing, nursepatient relationship, subject positions.

It has been suggested that the development of womensdepression is promoted by contemporary social and culturalexpectations for detachment and reflexivity (Crowe 2002).Contemporary western cultures are imbued with the char-acteristics of modernity which Sass (1992) describes as atendency towards reflexivity and detachment. Reflexivityinvolves a focus on individual self-consciousness, self-referentiality and introspection. Detachment involves a senseof disengagement and alienation and requires displays ofself-control. The more one is expected to focus on ones selfas a source of meaning the more alienated from othersone may become. Connections with others through sharedmeaning may become more tenuous.

These expectations set up particular relations withothers that foster a sense of detachment and excessive

self-reflexivity and encourage a sense of meaninglessness.This can lead to a loss of significance, a fixed pattern of relat-ing and an un-anchoring of intersubjectivity. This paperdemonstrates how interpersonal psychotherapy (IPT) pro-vides an opportunity for recovery from depression for onewoman by facilitating a reconstruction of her subjectpositions in relation to others. This will be illustrated by adiscourse analysis of a course of IPT sessions with a womanwho was experiencing depression. It will be argued that IPTfacilitates the development of more meaningful subjectpositions in relation to others:

The essence of the self and the object of therapeutic inter-vention is not some extra-discursive phenomenon either inthe external world or in the persons psyche but the dis-courses, meanings and practices through which the self hasbeen formed and through which it unfolds in the present(Georgaca 2001, 224).

The subject positions available to individuals are alwaysdiscursively constituted and enacted within a particulardiscursive field. The individuals experiences and their

Correspondence: Marie Crowe, Department of Psychological Medicine,Christchurch School of Medicine and Health Sciences, PO Box 4345,Christchurch, New Zealand. E-mail:

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narratives of those experiences are an important first step inunderstanding what discourses are informing the meaningsthat are made of those experiences.

INTERPERSONAL PSYCHOTHERAPY FOR DEPRESSION

Mental health nursing literature has long been concernedwith the therapeutic nature of the nursepatient relation-ship, dating back to the work of Peplau (1952) who empha-sised the importance of theories of interpersonal relations innursing. In common with Peplau, IPT has its origins in thework of Harry Stack Sullivan (1947). Mental health nursesdevelop interpersonal relations with consumers of mentalhealth services as a core feature of their practice and skills.In her discussion paper, Martin (2001) suggests that IPT pro-vides mental health nurses with an intervention frameworkfor utilising their interpersonal skills to help consumers ofmental health services recover from depression.

IPT for depression has been described by Mufson et al.(1993), Klerman, Chevron and Weissman (1994), Markowitz(1998) and Weissman, Markowitz and Klerman (2000). Itsequivalent efficacy to antidepressants and cognitive behavi-oural therapy in the treatment of depression has beenestablished in a number of randomised clinical studies withoutpatients (Barber and Muenz 1996; Keller et al. 1997; Thase1997; Frank et al. 2000; Blanco, Lipsitz and Caligor 2001;McElwaine et al. 2003). Joiner et al. (1999, 3) note that, regard-less of what other factors may be involved, the interpersonalcontext greatly affects whether a person becomes depressed,the persons subjective experience while depressed, and thebehavioural manifestations and resolution of the disorder.

IPT is a brief psychotherapy that focuses specifically oninterpersonal issues (Klerman, Chevron and Weissman 1994)and is primarily concerned with the relationship betweensymptoms presumed to have biological and psychologicalprecipitants, and social and interpersonal functioning.A particular aspect of this is interactions in social roleswith other persons, derived from learning based on child-hood experiences, concurrent social reinforcement, andpersonal mastery and competence (Weissman, Markowitzand Klerman 2000). The emphasis in IPT is on current dis-putes, frustrations, anxieties and wishes as defined in theinterpersonal context, and therapy aims to help people tochange rather than to simply understand and accept theircurrent life situation (Weissman, Markowitz and Klerman2000).

IPT for major depression has been described (Weissman,Markowitz and Klerman 2000) as involving three treatmentphases that occur over 1214 psychotherapy sessions. These

occur weekly at first and move to fortnightly and monthly innegotiation with the patient: The initial sessions include a review of the depressive

symptoms, a detailed account of important relationships(the interpersonal inventory), relating symptoms to aninterpersonal context, identifying a major problem area(grief, interpersonal role disputes, role transitions orinterpersonal deficits) and explaining the IPT process.

The intermediate sessions focus on the identified prob-lem area. For example, if interpersonal disputes are iden-tified the psychotherapy focuses on relating the symptomsto the dispute, determining the stage of the dispute andhow it is perpetuated, understanding how non-reciprocalrole expectations relate to the dispute and exploringparallels in other relations. If grief is the problem area, workfocuses on dealing with the loss and finding a substitute.If role transitions is the problem area work focuses onadapting to a new role while relinquishing the old role,and if deficits is the problem area then work focuses onsocial skill acquisition.

The termination sessions use the psychotherapy relation-ship as a role model for termination as the patient movestowards recognition of independent competence andnegotiating maintenance treatment.

THE RESEARCH PROCESS

This discourse analysis involved transcription and analysis ofthe 14 psychotherapy sessions in which one woman partici-pated. These sessions were conducted as part of the Psycho-therapy for Depression Study1 and consent was obtained atthe beginning of treatment. All participants in the studywere assessed at the beginning of treatment as havingmoderate to severe depression using a combination self-report(Beck depression inventory-II) and clinician rating (SCID-II). The participants also completed a self-report prior toeach psychotherapy session to ensure that the depressivesymptoms could be tracked throughout treatment. None ofthe participants received antidepressants. A further researchgrant from the University of Otago enabled the transcriptionand discourse analysis of 10 sets of IPT sessions. A decisionwas made to focus on the process of IPT, as there is limitedresearch on this, despite its acknowledged efficacy. The10 sets of sessions were selected by a computer-generated

1 This research was conducted in the Department of Psychological Medicine,Christchurch School of Medicine and Health Sciences and was financed by theHealth Research Council. The study involved the use of two psychotherapies,cognitive behavioural therapy and interpersonal psychotherapy, to treat depression.

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randomisation process from a subset of women who identi-fied interpersonal disputes as the focus of their treatment.This was done because a preliminary analysis of the 67individuals that had completed block treatment in IPT(including dropouts) revealed that 39 of these were womenand the majority of them (29) had chosen interpersonaldisputes. This discourse analysis was conducted on onewomans set of sessions (14 1-hour sessions).

The sessions analysed were those with Trieste (pseudo-nym), a 24-year old woman, who had been married about ayear. She had never been treated for depression and hadopted to take part in the study because she was reluctant touse antidepressants as a first treatment option. At the com-mencement of therapy Trieste had a self-reported BDI-IIscore of 27, which is rated as being in the moderatesevererange. She also met DSM-IV criteria for a major depressiveepisode as assessed by clinician rating. The IPT was providedin an outpatient clinical research unit. The psychotherapistsin this unit come from a range of disciplines mental healthnursing, psychiatry, psychology and social work. Trieste wasnot involved with any other mental health services and hergeneral practitioner was kept informed of her progress. Atthe termination of IPT, Triestes BDI-II score was 5 and sheno longer met criteria for a major depressive episode.

The method of discourse analysis used regards thetranscripts as texts and is based on Faircloughs (1995, 6)description of texts as social spaces in which two funda-mental social processes simultaneously occur; cognition andrepresentation of the world and social interaction. Texts intheir interpersonal functioning constitute social subjects andsocial relations between subjects. This discursive approachemphasises the experience of the individual and the sig-nifications or meanings informing that experience. Theindividuals experience can be understood from the linguisticconnections that occur between individuals and their cul-tural world (Crowe 2002).

Parker (1999) proposes that an effective psychotherapeuticrelationship involves respect for the individuals construc-tion of their experiences and attention to the contradictionswithin that construction:

For as people struggle with and rework their problems andtrace through the patterns they make in their accounts, theyfind themselves elaborating different competing perspec-tives there is a tension as they try and make us see theworld in different ways at one and the same time (3).

This suggests that individuals seek to make meaningthrough different linguistic accounts of their experiences.

This discourse analysis is presented as a sequentialprocess but one that can be regarded as an effect of creatinga comprehensible text. The process of recovery for Trieste

was not, however, a smooth trajectory that proceededconsecutively at a steady pace. It was one in which sheremained stuck in an ambivalent position for most of thesessions while exploring options for other subject positions.It was not until she engaged with a position that was moremeaningful for her that her depression improved. As shewas constructing a new subject position for herself she wasalso constructing a new form of relationship with herhusband and all this was occurring in the context of thepsychotherapeutic discourse of the therapist. The psycho-therapy resulted in a reconstruction of her sense of self inrelation to others. Subjectivity can be regarded as always inrelation to others:

We cannot give an undistorted account of a person withoutgiving an account of his relation with others. Even anaccount of one person cannot afford to forget that eachperson is always acting upon others and is acted upon byothers No one acts or experiences in a vacuum (Laing1969, 81).

To establish a sense of the self in relation to others requiresa sense of ones own and others subject positions. Thesubject positions that Trieste assumed throughout thepsychotherapy process can be described as: I wouldnt fully trust me; I have always thought that you needed someone to be

somebody; I dont want to make a decision; I dont know what makes me happy; I have got to stop living the way everyone else expects me

to do; I realise now nothing is ever the wrong decision.

The subject positions leading up to her improvementin mood could be regarded as demonstrating a self-referentiality that inhibited Trieste from taking action andsubsequently reinforced her sense of detachment fromher husband. Corresponding with a shift in her own subjectposition Trieste was also shifting her construction of herrelationship with her husband to the position where sherealised he could not be responsible for meeting all her needs: He is a gentleman; He is not actively trying to improve himself; I wish he was more, much more; He can only give me so much.

CONSTRUCTING HERSELF

I wouldnt fully trust me

During the initial phase of the IPT sessions and while theinterpersonal inventory was being completed it became

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apparent that Triestes depression was being maintained byher ambivalence towards her relationship with her husband.She felt that their values and aspirations were irreconcilablydifferent well it bothers me, mainly because I notice thedifference between me and him but she was fearful ofmaking a decision to leave I am afraid I will never findanybody to love me the way he loves me. A potential loss ofcertainty underpinned her indecisiveness I guess its theold shoe thing, hard to break out of your comfort zone.

She described feeling this way for the past 2 years andthought that it contributed to her low mood I haventreally sat down and laughed or been happy in a long time,2 years probably. The routine of the relationship was losingits meaning for her:

Sometimes I feel swamped by [husband] like I feel that Ilove you has become very well worn between us like it isalmost like saying hello or goodbye, like it is almost likesaying it out of habit.

Trieste attributed her indecision about continuing orterminating her relationship to an inability to fully trustherself I wouldnt fully trust me. She related this lack oftrust in herself to an inability or reluctance to express howshe was feeling I dont really talk about how I feel.

I have always thought that you needed someone to be somebody

Trieste identified that her indecision about the relationshipwas present even at the time of the marriage: The wholemarriage thing, I was scared, like I felt that it was every girlsdream and I was thinking I dont want to do this, I am notfeeling as I should. She was conflicted by her desire to fulfilwhat she describes as every girls dream and feeling scaredof entering into the commitment. This suggests that culturalexpectations of what girls should aspire to do contradictedhow she was feeling but were sufficiently influential to affecther decision to marry. Her participation in the act ofmarriage could be regarded as a non-decision for her, asense of a lack of control over cultural expectations of how toconduct a relationship I love him but I dont know if thereis enough to be in a marriage.

Her decision to marry had been influenced by anassumption she had made about how the culture she lived inoperated I have always thought that you needed someoneto be somebody, you needed somebody in your life. Shedescribed feeling insufficient unless she was in a relationshipwith a man I have never been alone, never been without aboyfriend. Her realisation of the influence of these culturalvalues encouraged her to consider other subject positionsthat were less dependent on men:

I think I need space, I dont want to live with anyone at themoment. I think I want my own space, moving out would behard but I think it would be quite good and I am starting toenjoy my own company. I dont know, it would be scarygoing alone he will not be there if I need him, when I reallyneed him.

The consideration of alternative subject positions is bothappealing and daunting for Trieste, which she manages bymoving into a position of blame towards herself We prom-ised to be together forever and I will have destroyed that.

I dont want to make a decision

The indecision that Trieste experienced could be regardedas contributing to and maintaining her low mood but also aneffect of the low mood I dont want to make a decisionwhile I am up and down. She constructed her indecisivenessas a sign of weakness, which had been suggested to her by herhusband He has said if that is what you want let me know,dont be weak, you have to make a decision and stick to it.

Trieste decided that to overcome her indecisiveness sheneeded to be strong I think I need to get strong at somestage in my life. The need to make a decision was also linkedto maturity:

I know we really have to sort it out now before it goes too farand things get involved with kids and houses and we are stillyoung enough to move on with our lives. I am just trying tomake the mature decision.

The pressure to make a decision was experienced byTrieste as overwhelming and she cited a preference for herhusband to make the decision for her: I dont know what todo, it is quite scary and I wish I didnt have to make the deci-sion. Part of me would like it if he made the decision.

Trieste had constructed only two options for herself staying in the relationship which she assumed would alwaysremain the same, or move out and live on her own which sheregarded as threatening to her sense of self. Her inability totake action is influenced by her construction of there beingonly one right option and a fear of taking the wrong one.The more she thought about it, the more self-conscious shebecame about the need to make the right decision, and theworse she felt: I am just sick of thinking about the wholething, I just try and keep going through the day. I have gotto the avoidance stage.

She reached a point where she chose to avoid the intro-spection associated with her need to make the right decision.In response to the therapist question about what happens toher mood when she avoided making decisions Trieste acknow-ledged that it impacted on her mood: It makes me unhappy.I dont know what makes me happy anymore, I havent reallysat down and laughed or been happy in a long time.

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I dont know what makes me happy

The focus shifted from the relationship to helping Triesteidentify what she wanted for herself and what would makeher happy:

I dont know what to do to have a good time I want to bemature about this whole thing. I want to figure everythingout and work out who I am and what I like and what makesme laugh.

Trieste identified that she needed to think about whatsubject position could bring her more happiness I like myindependence, I like having a job. She was also prompted toarticulate what she expected from her marriage:

Affection, love and trust, commitment to one person, hon-esty, reliability, appreciation of the things that you do andappreciation of the person that you are. Freedom to be likethe person that you are. Love and I think friendship is reallyimportant too, and passion.

She identified what she expected from her husband: Justto put more thoughtfulness into stuff, more spontaneity,create surprises in our lives. I dont want to have to drive therelationship, which I feel I do. Her main concern was to feelhappy I just want to be happy and I dont feel like I amhappy at all. It was at this stage that she made a decision tohave a trial separation from her husband.

I have got to stop living my life the way everyone else expects me to do

During the separation Trieste struggled to develop satisfyingsubject positions as a single woman: I have got used to doinga lot by myself but I dont know about leading my own life.

The time on her own was not easy for Trieste. She feltunsupported by some of her friends I feel as though[friend] is judging me, but also saw it as an opportunityto do things for herself I have never done stuff for me Ihave always sacrificed stuff for other people and Im a littledisappointed because I dont think some people havesacrificed stuff for me.

One of the problems she encountered was the conflict-ing advice she was receiving from friends: I feel like Imgetting pulled in all these directions Maybe my problemis that I tell people too much.

During this time Trieste realised she was dependent onthe judgements of others and that she needed to becomeless reliant on others advice and more confident in her ownjudgement:

I have got to stop living my life the way everyone else expectsme to do I always worry about what everyone else thinks

and worry about what people will say I have always donewhat everyone else wants me to do.

She was also able to identify positions of guilt that she haddeveloped in relation to her own self-imposed expectationsof what it meant to be a wife. When asked about whatthings she did not miss about her relationship she identifiedaspects of the traditional role of a wife: Cooking all the time,housework, the pressure of having to feel guilty about notdevoting all my time to him.

Her indecisiveness about the relationship continuedthroughout most of the separation I just wish I could closemy eyes and wake up and everything would be the way it usedto be. She missed the relationship and also felt guilty aboutleaving her husband I feel so guilty about it all, I feel sosorry for hurting him.

The turning point came when she decided not to keepblaming herself for the demise of the relationship I haveto get myself out of beating myself up. At this point shestarted going out on dates with her husband and discussingwhat they both wanted.

I realise now nothing is ever the wrong decision

By the final two sessions of IPT Triestes mood had signific-antly improved Better, I feel chirpier, I have a lot moreenergy. Her explanation for this was that she and her hus-band had decided to give the relationship another go andthat they were discussing their expectations of the relation-ship: We have been spending lots of time together and wehave been communicating really well. She had decided thatthe support she received from her husband was very impor-tant to her. She had also engaged with a suggestion made bythe therapist, that he may not be able to meet all her needsand that other relationships may be able to provide what herhusband was unable to provide:

I am confused it might be important to be stimulated andinterested but support is important too. Maybe I couldget my stimulation from my colleagues and stuff I thinkhe would be happy with that it would take some pressureoff.

Trieste had been able to identify what she needed fromthe relationship from her husband and what her responsibil-ities were in meeting her own needs:

I know his limitations, like he can only give me so much ofwhat I need and I need to find the other stuff elsewhere andthat I learned heaps of lessons and that he is not responsiblefor my happiness. I am responsible for that, he only adds toit, and we cant force each other to like the same things butthat we do have common ground and we enjoy doing thingstogether as well. And I guess a marriage is always growing.

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She suggested that a shift in her previously dichotomousthinking to a more flexible perception of herself and othersenabled her to recognise grey areas where she had previ-ously been perceiving them as either black or white:

I realise now nothing is ever the wrong decision and I guessit is how you look at it. Theres always fors and againsts some gains and losses. Like I want to give my marriage a go,I want it to work but I know the signs that if it is not workingnot to get into the same trap again.

She concluded her psychotherapy by describing thehopelessness she had been experiencing as part of herdepression: I feel a lot better now, I didnt know if I was goingto get through it, I thought I was going to stay depressed.This suggests that her sense of hopelessness could have beenas a result of her depression, or that her depression couldhave been maintained by her sense of hopelessness abouther relationship with her husband.

CONSTRUCTION OF THE OTHER

While Triestes construction of herself was shifting throughoutthe psychotherapeutic process so was her construction ofher husband. In the initial sessions when she was asked todescribe her husband she focused on his masculine attributes He is a gentleman. To Trieste being a gentleman involvedthe traditional construction of men as protectors and pro-viders. Despite this being initially attractive to Trieste she wasnow becoming frustrated with it and felt that her husbandneeded to improve himself He is not actively trying toimprove himself. She was dissatisfied with her initial con-struction of her husband as a gentleman and wanted morefrom the relationship I wish he was more, much more.

Through the psychotherapeutic process and by distanc-ing herself from the relationship in a trial separation Triestebegan to reconstruct her expectations of her husband Hecan only give me so much. She began to appreciate her hus-band for what he could give her and shifted her expectationsfrom wanting him to meet all her needs to seeking satisfac-tion for those needs outside their relationship. This could beregarded as an illustration of how there is often an expecta-tion that the nuclear family provide and sustain all of itsmembers emotional needs and the resultant strain that thisputs on that relationship.

Therapeutic interventions

The psychotherapeutic process enabled Trieste to recon-struct her own sense of self and her relationship with herhusband. The discourse analysis revealed that the therapistfacilitated this through the use of a range of techniques.

Seeking information

The therapist explored with Trieste what was happeningin her relationships. The formulation of an interpersonalinventory enabled the therapist to identify who was signifi-cant in Triestes life and any relationship issues that shefound unsatisfactory.

Exploring beliefs/values/assumptions

The therapist then was able to explore what values andassumptions underpinned Triestes expectations of herselfand in particular her husband. Through this process itbecame clear that Trieste was basing her expectations ontraditional constructions of what it meant to be a husband anda wife. It was also clear that Trieste had not made a decisionto get married that was based on meeting her own and herhusbands needs but occurred as a result of social pressureto conform to cultural expectations.

Exploring communication patterns

This psychotherapeutic intervention involved clarifying howTrieste communicated her feelings and wishes and any lackof clarity in communication that may have been causingproblems in the relationship. The therapist encouragedTrieste to try different ways of communicating by exploringissues from her husbands perspective.

Exploring affective responses

Throughout the sessions the therapist drew connectionsbetween how Trieste was feeling and how she expressed herfeelings to others and how certain patterns such as indeci-siveness contributed to feelings of depression.

Exploring alternative subject positions

The psychotherapeutic process provided Trieste with theopportunity to engage with different subject positions in herinteractions with her husband. The experimentation withalternative subject positions within the support of the psycho-therapeutic relationship enabled Trieste to establish a senseof meaning in her relationship. The subject positions she hadadopted could be seen to be contributing to her feelings of de-pression, and encouragement to try alternative subject positionschallenged old assumptions about herself in relation to others.The engagement with alternative subject positions helpedreconstruct a sense of self in relation to others that was lessdisabling, more emotionally fulfilling and more meaningful.

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CONCLUSION

At the commencement of IPT Trieste had been disabled byself-referentiality and introspection regarding her relation-ship with her husband. This self-reflexivity promoted a senseof detachment from her husband and a sense of alienationin her quest to find meaning in her relationship. The moreTrieste focused on herself as a source of meaning the morealienated from her husband she became. Connections withhim through shared meaning became more tenuous becauseTriestes depression amplified a sense of meaninglessness.Her depressive symptoms and her experience of reflexivityand alienation acted to reinforce each other leading to asense of hopelessness, indecision and stuckness. Triesteexperienced a loss of significance, a dissatisfying pattern ofrelating and an un-anchoring of intersubjectivity.

IPT enabled Trieste to resolve both her depression andher relationship with her husband by helping her movethrough the inertia of indecision that had been sustained byher introspective and detached position in relation to herhusband. The indecision could also regarded as promotedby Triestes ambivalence towards the traditional culturalexpectations for the wife and husband relationship. Thevacillation occurred between two options, neither of whichwere what she really wanted. It was only when Triesteengaged with broader possibilities that she was able to estab-lish a subject position that was more meaningful for her andher relationship, and her depression improved.

While IPT or any form of psychotherapy could be regardedas promoting self-reflexivity, its focus is primarily on the selfin relation to others with an emphasis on action rather thanreflection. The problem is externalised so that is not consid-ered to be a fault of the individual or the other person butrather a relationship problem. IPT is also concerned withhelping individuals make more meaningful connectionswith others and works to resist detachment from others.

People have a range of subject positions from which theycan respond to others. The performance of particular sub-ject positions can be regarded as particular intersections ofculture, gender, class and race. A sense of self is constitutedby the repeated performance of particular subject positionsand meaning is determined by the subject positions to whichpeople have access. Sass (1994) suggests that therapeuticchange does not merely rely on the malleability of reality butinvolves an active creation of meaning. Mental health nursescan be actively involved in helping consumers of mentalhealth services experiencing depression to develop newmeanings in their lives by using interpersonal psychotherapyas a framework for psychotherapeutic intervention in theireveryday practice.

ACKNOWLEDGEMENTS

The Christchurch Psychotherapy of Depression Study wasfunded by the Health Research Council of New Zealand. Wethank the investigators (Profs Peter Joyce and Roger Mulder,Drs Jan McKenzie, Sue Luty and Janet Carter), staff andtherapists of the longer study. This study on the qualitativeaspects of psychotherapy was funded by a University ofOtago research grant.

REFERENCES

Barber JP and LR Muenz. 1996. The role of avoidance andobsessiveness in matching patients to cognitive andinterpersonal psychotherapy: Empirical findings fromthe treatment for depression collaborative researchprogram. Journal of Consulting and Clinical Psychology 64:9518.

Blanco C, J Lipsitz and E Caligor. 2001. Treatment ofchronic depression with a 12-week program of inter-personal psychotherapy. American Journal of Psychiatry158: 3715.

Crowe M. 2002. Reflexivity and detachment: A discursiveapproach to womens depression. Nursing Inquiry 9: 12632.

Fairclough N. 1995. Critical discourse analysis. London:Longman.

Frank E, VJ Grochocinski, CA Spanier et al. 2000. Inter-personal psychotherapy and antidepressant medication:Evaluation of a sequential treatment strategy in womenwith recurrent major depression. Journal of Clinical Psych-iatry 61: 517.

Georgaca E. 2001. Voices of the self in psychotherapy: Aqualitative analysis. British Journal of Medical Psychology 74:22336.

Joiner TJ and J Coyne Blalock. 1999. On the interpersonalnature of depression: Overview and synthesis. In The inter-actional nature of depression, eds T Joiner and J Coyne, 320.Washington, DC: American Psychological Association.

Keller MB, S Panico, BS Arons et al. 1997. Efficacy of inter-personal psychotherapy as a maintenance treatment ofrecurrent depression. Contributing factors. [erratumappears in Archives General Psychiatry 1992 May; 49 (5):401]. JAMA 277: 33340.

Klerman GL, E Chevron and M Weissman, eds. 1994. Inter-personal psychotherapy for depression: A brief, focused, specificstrategy. New York: Jason Aronson.

Laing R. 1969. Self and others. Harmondsworth: Penguin.Markowitz JC. 1998. Interpersonal psychotherapy for dysthymic

disorder. Washington, DC: American Psychiatric Press.

M Crowe and S Luty

50 2005 Blackwell Publishing Ltd, Nursing Inquiry 12(1), 4350

Martin E. 2001. Using interpersonal psychotherapy. Profes-sional Nurse 16: 12336.

McElwaine S, M Spinelli, A Rinaldi et al. 2003. Controlledclinical trial of interpersonal psychotherapy versusparenting education program for depressed pregnantwomen. Lancet 361: 161720.

Mufson L, D Moreau, M Weissman and GL Klerman. 1993.Interpersonal psychotherapy for depressed adolescents. NewYork: The Guilford Press.

Parker I. 1999. Deconstruction and psychotherapy. InDeconstructing psychotherapy, ed. I Parker, 1938. London:Sage Publications.

Peplau H. 1952. Interpersonal relations in nursing. New York:Putnam.

Sass L. 1992. Madness and modernism. New York: Basic Books.Sass L. 1994. The paradoxes of delusion. Ithaca, NY: Cornell

University Press.Sullivan HS. 1947. Conceptions of modern psychiatry. Washing-

ton, DC: William Alanson White Psychiatric Foundation.Thase ME. 1997. Psychotherapy of refractory depressions.

Depression and Anxiety 5: 190201.Weissman M, JC Markowitz and GL Klerman. 2000. Compre-

hensive guide to interpersonal psychotherapy. New York: BasicBooks.