Interpersonal Therapy

Question 1

Underlying Theory

Answer 1

• Once patients become depressed, symptoms of the illness compromise their interpersonal functioning, and bad events follow.
• Whether life events follow or precede mood changes, the patient’s task in therapy is to resolve the disturbing life event(s), building social skills and helping to organize his or her life.
• If the patient can solve the life problem, depressive symptoms should resolve as well.
• This coupled effect has been borne out in clinical trials demonstrating the efficacy of IPT for major depression.

Question 2

Practice Context

Answer 2

• IPT is a time-limited and structured psychotherapy for Moderate to Severe Depression.
• A central idea in IPT is that psychological symptoms, such as depressed mood, can be understood as a response to current difficulties in our everyday interactions with others.
• In turn, the depressed mood can also affect the quality of our relationships.
• The main focus of IPT is on difficulties in relating to others and helping the person to identify how they are feeling and behaving in their relationships. When a person is able to interact more effectively, their psychological symptoms often improve.

Question 3

Techniques and Strategies

Answer 3

• Identification of Emotion — Helping the person identify what their emotion is and where it is coming from.
• Example — Roger is upset and fighting with his wife. Careful analysis in therapy reveals that he has begun to feel neglected and unimportant since his wife started working outside the home. Knowing that the relevant emotion is hurt and not anger, Roger can begin to address the problem.
• Expression of Emotion — This involves helping the person express their emotions in a healthy way.
• Example — When Roger feels neglected by his wife he responds with anger and sarcasm. This in turn leads his wife to react negatively. By expressing his hurt and his anxiety at no longer being important in her life in a calm manner, Roger can now make it easier for his wife to react with nurturance and reassurance.
• Dealing With Emotional Baggage — Often, people bring unresolved issues from past relationships to their present relationships. By looking at how these past relationships affect their present mood and behavior, they are in a better position to be objective in their present relationships.
• Example — Growing up, Roger’s mother was not a nurturing woman. She was very involved in community affairs and often put Roger’s needs on the back burner. When choosing a wife, Roger subconsciously chose a woman who was very attentive and nurturing. While he agreed that the family needed the increased income, he did not anticipate how his relationship with his own mother would affect his reaction to his wife working outside the home.

Question 4

Historical Development - Dates and Key Figures

Answer 4

• Interpersonal therapy began in 1969 at Yale University, where Dr. Gerald Klerman was joined by Dr. Eugene Paykel from London to design a study to test the relative efficacy of an antidepressant alone and both with and without psychotherapy as maintenance treatment of ambulatory nonbipolar depression.
• IPT takes structure from contemporary Cognitive Behavioral Therapy (CBT) approaches in that it is time-limited and employs homework, structured interviews, and assessment tools.
• Yet the content of therapy was inspired by Harry Stack Sullivan’s psychodynamic Interpersonal Theory (Sullivan, 1953, Interpersonal Theory of Psychiatry).
• IPT focuses on a specific vulnerability to social stressors, such as differing role expectations in a dyadic relationship (Weissman, et al, 2007), but does not include a personality theory or attempt to conceptualize or treat personality (Prochaska, 1984, Systems of Psychotherapy: A Transtheoretical Analysis).
• This makes IPT quite distinct from its psychodynamic influence, which is fundamentally a personality theory. However, other theorists have developed contemporary Interpersonal psychotherapies that remain true to the psychodynamic origin.
• Over the past 20 years, IPT has been carefully studied in many research protocols, has been demonstrated to successfully treat patients with depression, and has been modified to treat other psychiatric disorders (substance abuse, dysthymia, bulimia) and patient populations (adolescents, late-life, primary medical care).
• From the beginning, IPT has been tested in various clinical trials and found to be effective in treating acute episodes of depression and preventing or delaying the onset of subsequent episodes.
• A large multicenter collaborative study was conducted by the National Institute of Mental Health (NIMH), comparing IPT, CBT, imipramine and placebo.

Question 5

Applications

Answer 5

Interpersonal Psychotherapy (IPT) is a structured therapy for people with moderate to severe depression. IPT can typically focuses on the following relationship areas:

• Conflict with another person
• Life changes that affect how you feel about yourself and others
• Grief and loss
• Difficulty in starting or keeping relationships going

Interpersonal psychotherapy has been proven as an effective treatment for the following:
• Bipolar disorder (Weissmann & Markowitz, 1998)
• Bulimia nervosa (Weissmann & Markowitz, 1998)
• post-partum depression (Weissmann & Markowitz, 1998)
• family therapy (Weissmann & Markowitz, 1998
• Major depressive disorder (Joiner, Brown & Kistner, 2006)
• Cyclothymia
• Various other disorders (Markowitz, 1990)

Question 6

Evidence Base

Answer 6

• Fairburn (1997) patients with bulimia prefer IPT to CBT
• Paley et al (2008) found no difference in efficacy of CBT and IPT
• RObinson, Berman and Neimeyer (1990) both CBT and IPT showed tendency for symptoms to recur

Question 7

Stregnths of IPT

Answer 7

• IPT’s minimal use of jargon and format allows psychotherapist to become quickly competent
• Approach easily modified for a range of conditions
• Likely to be applicable to a wide range of patient disorders