Treat Depressed Mothers, and Their Children Recover

Sometimes the most effective way to treat children is to work with their parents. A study posted on-line recently by the American Journal of Psychiatry highlights a promising psychotherapy for depressed mothers that seems to help their troubled teen-aged and pre-teen kids.

Holly Swartz, Ellen Frank, and others at the University of Pittsburgh looked at the effects of an “interpersonal therapy” for mothers (IPT-MOMS). IPT is an odd hybrid. Developed as a proxy for psychoanalysis, it has morphed into a treatment that instructs patients in medical views of mental illness, encourages coping skills in relationships, and along the way confers a little insight.

The journal article contains an illustrative vignette. A depressed mother who feels guilty about her weakness as a parent is taught to see her mood disorder as an externally imposed disease. She is helped to recognize her upset when her 14-year-old daughter fails to confide in her. Then, the therapist assigns the mother homework that involves managing her expectations in the course of a conversation. Subsequent sessions focus on communication skills and conflict management.

The data analysis suggests that the therapy works with a time lag. Over the course of nine months, treated mothers improve first, then the children.

The report is welcome, because adolescents and preadolescents are hard to treat, whether with medication or psychotherapy. In the Swartz study, for both mothers and children, the outcomes were better than those found in a recent medication trial which, however, had not specifically selected mothers with mentally ill children.

The Pittsburgh study is clearly preliminary. A number of mothers dropped out. A lot of data were missing. By prevailing standards, the placebo condition was not adequate; subjects in the control group had fewer treatment sessions. Mothers in the psychotherapy group were more likely to be taking antidepressants. Still, the results are promising — and pleasing to psychotherapists. We like to think that our efforts have a ripple effect: work with one family member, and others benefit. The results also support the utility of the medical model of depression; it can be effective quite (or almost) independent of medication.

I have had a special interest in indirect treatments. Almost twenty years ago, I wrote about them in Moments of Engagement, in a chapter titled “Is Empathy Necessary?” A prevailing theory had it that change comes about through therapists’ nuanced awareness of and delicate resonance to patients’ emotions; I wondered whether we could treat patients (the children of parents in our offices) whom we had never met and so for whom, in a direct sense, we could not have precise empathy. I thought we could. (I suspect that I nursed this belief as a way of assuaging my worries about trainees whose strength lay in their intellect, rather than their emotional attunement. ) The Pittsburgh study, whose techniques are reasonably clunky by the psychodynamic standards of a few decades back, suggests that there are, indeed, many ways to skin a cat.