Positive-Productive and Negative-Oppressive Attitudes of Social Workers' Towards Implementing an Interpersonal Therapy Intervention for Postpartum Depression

Background and Purpose: Implementation fidelity is crucial for successful intervention results. As attitudes towards a behavior are known to effect its execution, attitudes towards implementing an evidence-based intervention may impact the way it is carried out and ultimately influence its fidelity. Critical perspectives in social work look at evidence based practices as having oppressive aspects, along with their proven productivity. These factors often relate to the oppression of workers who are often not encouraged to provide holistic care, in favor of offering narrower focused services. As universal screening initiatives for postpartum depression (PPD) are being implemented around the world, appropriate evidence-based early treatment interventions for PPD are of necessity in order to ensure mothers' mental health and healthy development of their infants. Social workers' have vast experience in treating people with mental illness and therefore may play a major role in the early treatment of women with PPD; however there is a paucity of research regarding social workers attitudes towards implementing interventions for postpartum depression. As Interpersonal Therapy (IPT) is one of the evidence-based treatments for PPD, this exploratory study aimed to understand social workers' attitudes towards implementing an IPT intervention with women who have PPD symptoms.

Methods: This qualitative study included open-ended semi-structured interviews with eight experienced social workers from a large Israeli HMO, who were trained in IPT techniques, and with five supervisors and IPT trainers. Social workers were interviewed regarding their attitudes towards implementing an IPT intervention for PPD, after participating in training and before implementing the intervention. Supervisors and trainers were interviewed regarding their perception of the social workers' attitudes. The interviews were manually transcribed to protect confidentiality. The data was analyzed using the constant comparison method of grounded theory. Through this process, the investigators assigned basic coding categories to the data, and then grouped these categories into larger aggregates, from which general themes were abstracted.

Results: Attitude themes were divided into negative-oppressive/positive-productive attitudes. Negative-oppressive attitudes included feeling that the IPT approach may negatively affect the therapeutic relationship, does not allow expression as an experienced therapist, its themes do not apply to all patients, not enough skill was acquired in order to implement IPT, and that it is difficult to recruit women for such an intervention. Positive-productive attitudes included the desire to experience a new therapeutic approach and the fact that IPT supervision helps with implementation. The oppression and proven productivity poles of tension will be discussed in the context of our findings.

Conclusions and Implications: Understanding that SWK's attitudes towards implementing IPT for PPD may affect the quality of intervention suggests that when implementing such an intervention attention should be given by trainers and supervisors to workers' attitudes in order to ensure good implementation fidelity.