Dynamic interpersonal therapy (DIT) is psychodynamic therapy that has been specifically developed for the treatment of depression.
Head of service:
Preston Farm Industrial Estate
Stockton on Tees
Tel. 01642 368 582 / 711
Nicky Ablett-Tate, consultant clinical psychologist in psychotherapy
Kate Surgeoner, adult psychotherapist
Lanchester Road Hospital
Tel. 0191 4415750
Thea Vasiyianni, counselling psychologist in psychotherapy
Lesley Kendrick, principal adult psychotherapist
Staff based at these sites cover access for patients across the Trust.
What is dynamic interpersonal therapy (DIT)?
DIT is psychodynamic therapy that has been specifically developed for the treatment of depression. It is limited to 16 weekly sessions. The therapist will discuss with you any planned breaks and what happens if you cancel sessions.
One of the main ideas in psychodynamic therapy is when something is very painful we can find ourselves trying to ignore it (it’s a bit like saying ‘out of sight, out of mind’). Most of the time we know when we’re doing this, but sometimes we can bury something so successfully that we lose sight of it completely. This is why difficult experiences in the past can continue to affect the way we feel and behave in the present. DIT provides people with a safe place to talk openly about how they feel and to understand what might have contributed to becoming depressed.
An example shows how this might work. Someone who was repeatedly rejected by their parents may stop themselves thinking about how painful this is. As an adult they might become depressed, withdraw from relationships, feeling that it is safer to be alone and not having to depend on anyone. Although not getting close to anyone helps them to feel safer, they might also feel lonely and get depressed as a result.
How would a DIT therapist help this person?
By helping them to talk freely about themselves and their relationships it might become clear that whenever someone tries to get to know them, they fear the worst and push them away, just to make sure that no-one ever gets close enough to hurt or disappoint them again.
In everyday life people don’t necessarily notice how they are behaving or responding to others because it becomes second nature – ‘the way things are’. By drawing their attention to this pattern in their relationships, therapy would help them to understand themselves better and change the way they respond. The pattern and how it can help them to understand their depression, then becomes the focus of the therapy.
What does therapy involve?
Everyone’s therapy will be a bit different and the therapist will help you feel respected and comfortable. Many people find it difficult to talk about their problems with someone they do not know. It is important your therapist helps you feel they can be trusted, and you are able to talk about things which you may find upsetting or embarrassed about.
Talking openly about yourself for the first time to a new person can feel difficult and you may be worried about what your therapist thinks about you. Your therapist will be interested in knowing what you think aboutthem. They understand that starting therapy can be difficult and appreciate what life is like for you.
Getting a picture of what you need (assessment)
Your therapist will need to establish what you are finding difficult in your life and how this affects you and the people close to you. They will ask some questions, but they should also make it clear you only need to give as much information as you feel comfortable with. Many people find they are able to talk more openly as therapy commences. In the early stages you shouldn’t find yourself under pressure to say more than you want.
Your therapist will need to gather some basic information about you and your life, and your current and past relationships in particular. However some of the time they will wait for you to talk. This is because they are interested in hearing about what is on your mind rather than asking lots of questions. Sometimes your therapist may remain silent, waiting for you to speak. This may feel a bit uncomfortable – for example, you may feel unsure what to say. However, if this gets too uncomfortable, your therapist will help you talk.
At the start of therapy, your therapist will ask you to complete some questionnaires. This will give them a better idea of the sorts of problems you have (by asking about the sort of difficulties you have), as well as how badly these affect you (by asking how each problem affects you). Your therapist will discuss the results of these questionnaires with you. They will ask you to complete the questionnaires again at every session because this helps you and your therapist see what progress you are making. This is very useful, because not everyone makes progress at the same rate. If the questionnaires show that you are not benefiting from therapy it gives you and your therapist a chance to think about why this might be.
How DIT might work for you
Early on your therapist will explain how DIT works and how the approach makes sense of what you are finding difficult in your life. The assessment should also give you an idea of how therapy works, what is expected of you and what you can expect of the therapist. The therapist will help you see ways in which ideas from DIT could be relevant to you and what you want help with. That does not mean you need to be 100% convinced at this stage – it is more that the idea of DIT needs to make sense to you if you are going to get the best out of it.
Sharing ideas about what you want to achieve
When your therapist has enough information about you they will discuss with you what would be most helpful to focus on over the sixteen sessions. This is also an opportunity to agree what you want out of the therapy. In DIT the therapist will typically aim to help you work on a recurrent pattern in your relationships.
Your therapist is responsible for:
- ensuring your meetings take place at a regular time and in a setting where you can be sure of confidentiality
- letting you know, whenever possible, if they expect to be away or need to change the time of your therapy
- helping you to understand why it may feel difficult to have a break from therapy.
Many patients find that ending therapy is difficult. This is because the relationship that develops between you and your therapist can become quite important.
Ending therapy can feel like a big loss and you are likely to experience a range of feelings about it. Your therapist will know and understand this and you should expect them to help you explore your feelings, including any worries you might have about how you will cope in the future. They should help you think about how you would manage if things became difficult again. After all, the aim of DIT is not to remove your problems – everyone has problems that they need to deal with. The hope is you will have learned how to manage better, and so avoid problems becoming major difficulties again.
Some important features of psychodynamic therapy
One important feature of DIT is that it uses what happens in the relationship between therapist and patient to help think about the problems in your life. For example, remember the person we described at the start of this leaflet, who worries about getting rejected by people. As that person settled into therapy they might start to worry the therapist will reject them too – they could become convinced the therapist was not really interested in them. Because this would provide a clear illustration of where things go wrong in the patient’s relationships, the therapist might comment on their concern. By discussing the similarity between the worries they have about the therapist and worries they have in general, the patient would start to get a better picture of what happens to them in relationships.
In practice, this means the therapist will often draw your attention to what you are currently feeling in the session. The idea is that by exploring the relationship between you and your therapist you can get a better understanding of what is troubling you.
As discussed earlier, you may find your therapist is a bit more ‘silent’ than you might be used to. For example, at the beginning of each session your therapist will greet you, but beyond this may not ask questions. Instead, they will wait to hear from you about what is on your mind. This is not because they are being ‘unfriendly’ but because they want you to have some space to work out what is on your mind. This takes a while to get used to, but your therapist will know how hard it can be and should help if you find this particularly difficult.
Another feature of DIT is that the therapist will not always answer questions directly. Sometimes they may be interested in what lies behind your question. For example, someone who is very worried about starting therapy may not feel able to say this straightforwardly. Instead, they may ask lots and lots of questions about what therapy involves. Rather than answering all of these directly, the therapist may notice that behind the question is the worry about beginning therapy. Helping the patient talk about this, rather than answering all the questions, is probably a more helpful way forward.
A range of data is collected on patients using psychotherapy services. This data is essential to monitor the quality and effectiveness of services provided, read current trends and pressures and therefore assist in accurately planning services for the future. Confidential information in regard to patients’ psychotherapeutic treatment is held as confidential to the specialist psychotherapy team and shared appropriately in order to ensure best care and the safety of everyone involved. All data collected will be dealt with sensitively and stored appropriately. Patient’s privacy and autonomy will be adhered to in accordance with the Data Protection Act and Caldecott guidance.
Supervision and training
All members of this service participate in regular supervision of their work and ongoing professional development.
This service participates in the supervision and training of psychotherapists, psychiatrists, clinical psychologists and other mental health professionals locally and nationally.
The service evaluates its work and participates in approved research. You will always be consulted for permission about this.
We value user feedback and consult user groups about the running of the service.
Further information about psychotherapy
Websites providing information about psychotherapy are:
United Kingdom Council for Psychotherapy (U.K.C.P.)
British Psychotherapy Council (B.P.C.)
Department of Health (D.O.H.)
Dynamic Interpersonal Therapy (DIT)
Improving Access to Psychological Therapies (IAPT)
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