Interpersonal therapy, as the name suggests, focuses on the impact that people’s communication patterns, social interactions, and relationships with others play in various psychological problems. Interpersonal therapy was originally developed as a treatment for depression, although it has been found to be helpful for several other psychiatric disorders and emotional issues as well.
Often referred to as IPT for short, interpersonal therapy is based on the premise that depressive symptoms can be reduced by helping therapy clients improve their relationships and strengthen their social supports. The focus of therapy is fairly narrow due to the time-limited nature of the treatment. Key interpersonal issues are identified and worked on over the course of treatment. Although some discussion about past relationships can provide valuable information, IPT focuses primarily on clients’ current relationships.
Learning to express emotions in an appropriate and healthy manner is also an important part of interpersonal therapy. Since depression and other psychological problems (e.g. unresolved grief or trauma), it’s important to examine the impact that clients’ mood, anxiety, and behaviors may be having on their relationships with others. By exploring these issues, clients can make adjustments in the way they interact with others so that not only do their relationships benefit, but their emotional struggles do as well. Through the process, clients also learn to look at their relationships more objectively, which also helps benefits them emotionally.
Interpersonal therapy is an evidence-based manualized treatment. In other words, the treatment protocol – which is supported by empirical research – is clearly outlined, and therapists who offer IPT are expected to follow it closely.
Since IPT is structured as a short-term therapy (usually 3 to 4 months of weekly sessions), underlying personality issues that may be contributing to depression are not addressed. Personality issues tend to be complex in nature and are best addressed in longer-term therapy models. Symptoms are also not addressed in IPT, except to touch base with the client regarding their intensity and whether or not treatment is helping. Rather, the primary focus of this particular type of therapy is the client’s interpersonal interactions – when those are adequately addressed, symptoms improve.
That being said, it’s important to note that the short-term nature of IPT limits the number of issues that can be addressed. In the initial sessions, the therapist works with the client to identify just one or two prominent interpersonal issues upon which to focus. This allows for more intensive focus on those areas, rather than barely (and ineffectively) scraping the surface of multiple issues over the relatively brief course of therapy.
Not only is IPT beneficial for adults with depression; it’s also a highly effective therapy for depression in children and adolescents as well. Symptom reduction and improvements in interpersonal functioning comprise the immediate treatment goals. But it doesn’t stop there: the skills and insights obtained from IPT enable therapy clients to more effectively manage their depression by making necessary adjustments in their interpersonal interactions.
Interpersonal therapy is recognized and recommended in the U.S. by the American Psychiatric Association and in the U.K. by the National Institute for Health and Care Excellence (NICE) and the National Health Service (NHS) as an effective form of therapy for depression. Research over the years has found that IPT can be at least as effective for alleviating symptoms of depression as taking an antidepressant.
Basic Premise of IPT
Interpersonal therapy is based on the premise that psychological problems often stem from conflicted or problematic interactions with others. For example, it’s not uncommon for someone who battles depression to view himself as worthless or a burden. His mood symptoms may interfere with his relationships, causing others to pull away if he is often negative, irritable, or is quick to assume the worst. Of course, these situations perpetuate a vicious cycle, as the depression is easily exacerbated by these negative or unsupportive interactions. By helping the person make positive adjustments in the way he interacts with others, his symptoms of depression will improve.
Key Characteristics of IPT
The key characteristics of interpersonal therapy include:
- It’s a short-term treatment approach
- It’s time-limited rather than open-ended
- It’s highly focused on specific issues identified in the initial sessions
- Focus is on interpersonal problems rather than intrapsychic problems (conflicts within the person rather than with others). Underlying unconscious issues are not explored.
- Emphasis is on current interpersonal issues and relationships, rather than on past relationships (some therapies place a strong emphasis on childhood events). Past relationship issues are acknowledged and may be briefly discussed if pertinent, but they are not the focus.
- Primary focus is on interpersonal patterns that are contributing to mood symptoms, not cognitive distortions and beliefs (which is the focus of cognitive-based therapies like cognitive behavioral therapy)
Four Areas of Focus
In the vast majority of cases, the areas of depression that are linked to interpersonal problems fall into one of the following four categories:
- Interpersonal conflicts
- Role transitions
- Unresolved grief
- Interpersonal deficits
In interpersonal therapy, the focus of treatment is on one or more of these problem areas.
Interpersonal conflicts – Conflicts with other people are a normal part of life. They inevitably occur from time to time whenever two or more people interact frequently. Disputes take place between family members, couples, friends and acquaintances, peers at school, and coworkers. The underlying issue for any conflict is a difference in expectations. These conflicts are discussed in IPT when they are a significant cause of distress for the client.
Role transitions – Life is full of transitions. Sometimes a transition or change in one’s role – for example, going from being single to being in a romantic relationship – is a positive, happy thing. But sometimes role transitions – for example, a breakup or divorce – are undesirable and cause emotional pain. These transitions can trigger or worsen depression because they’re experienced as a painful loss in the person’s life. If the person is unable to adapt to his or her new role, then discussing it in IPT can be helpful.
Unresolved grief – Grief occurs when a loved one dies (or has to go away for a long time). While grieving a loss is a normal and healthy process, some people – particularly those vulnerable to depression – get stuck in the process. Depression tends to increase a person’s sensitivity to loss, so the death or loss of someone important can be especially difficult to handle and should be discussed in IPT.
Interpersonal deficits – Interpersonal deficits refers to any lack in the quality or number of relationships a person has. For some individuals, the issue here might be having too few close or supportive friendships. For others, it would pertain primarily to the quality of their relationships (e.g. toxic or one-sided relationships). In IPT, it’s important to identify any relationship deficits and discuss the best way to remedy them.
By addressing these four areas in IPT, it helps therapy clients make the connection between their symptoms and their interpersonal struggles. The problems may be with anyone in their life, such as family members, a significant other, or friends.
History of IPT
Interpersonal therapy was developed back in the 1970s by two recognized experts on depression: Gerald Klerman, M.D., and Myrna Weissman, Ph.D., along with Dr. Eugene Paykel from London.
Interpersonal therapy developed out of their investigation of the efficacy of treating unipolar depression with tricyclic antidepressants alone as well as combined with psychotherapy. A treatment manual was developed for therapy. It was initially called “high contact” counseling, but over time – and with further development – the name was changed to interpersonal therapy. Their research showed that the most effective treatment for depression was a combination of therapy and antidepressant medication. Today, the treatment manual is used as a strict guideline for therapists who offer IPT.
Since the development of IPT, a multitude of research studies have been conducted to further investigate this particular approach to treating depression in adults, as well as numerous other psychiatric disorders including bipolar disorder, eating disorders, and depression in adolescents and other demographic groups.
The late Dr. Klerman was a clinician, research director, university professor, and author. He was appointed by President Carter in 1977 as chief of the Alcohol, Drug Abuse and Mental Health Administration. He held that post until 1980. In 1984, he was awarded with the Solomon A. Berson Medical Alumni Achievement Award in Clinical Science. Dr. Weissman is currently a psychiatry professor at Columbia University, and former professor at Yale University School of Medicine, where she received her doctorate. She is also the director of Yale University’s Depression Research Unit at Connecticut Mental Health Center. Dr. Klerman and Dr. Weissman have co-authored several books on depression and interpersonal therapy, including New Applications of Interpersonal Psychotherapy (1993) and Interpersonal Psychotherapy of Depression: A Brief, Focused, Specific Strategy (with Bruce Rounseville and Eve Chevron – 1994).
Since the development of IPT, other related therapies have been developed to address specific disorders or problems. They include dynamic interpersonal therapy and interpersonal and social rhythms therapy.
Dynamic interpersonal therapy (often referred to as simply DIT) is structured in the same time-limited manner as traditional IPT. The focus is still on the connection between problematic interpersonal interactions and current symptoms. However, where DIT deviates from IPT is that rather than focusing on current relationships, the focus is on the impact of past events on your current problems.
In DIT, you’ll explore unhealthy interpersonal patterns that may have started clear back in childhood, but that continue to create problems in your current relationships. You’ll be encouraged to consider the influence those past events have on your current thoughts and feelings. From there, you’ll look at the changes you can make to handle current relationship issues in a healthier, more positive manner.
Interpersonal and social rhythms therapy is a variation of IPT that was developed specifically for individuals with bipolar disorder. The underlying premise is that people with bipolar disorder have circadian rhythms – the body’s internal clock that regulates sleep and wake cycles – that are easily thrown out of kilter. This occurs when their day to day schedules – their “social rhythms” are disrupted. IPSRT is designed to help them adopt regular daily routines or “social rhythms” (e.g. eating, sleeping, and exercising) that prevent this disruption and keep their moods stable. This is achieved with a combination of IPT principles (to improve their relationships), proper medication, and educating them about their disorder.
What to Expect in IPT
Interpersonal therapy is designed to be a short term therapy. A typical course of treatment lasts between 12 and 16 weekly one-hour therapy sessions. The focus of the first 1 to 3 sessions is to obtain information about your depression (or other presenting problem), and to discuss your concerns and treatment goals. Together with the therapist, you’ll choose one or two primary interpersonal problems to focus on during the course of therapy. The therapist will also orient you regarding IPT.
The heart of the therapy process occurs over the next 8 to 10 sessions. During this time, you’ll work on gaining a better understanding of your key interpersonal issues, and explore ways you can improve them. You’ll also take what you’re learning in therapy, and apply it outside of therapy. The therapist will implement various techniques to facilitate this process, including:
- Clarification of key issues
- Communication analysis
- Role playing
The last few sessions will focus heavily on terminating therapy. This is a crucial element of IPT because ending therapy often elicits strong feelings of loss. Even though the short term, time limited nature of IPT was discussed at the onset of therapy, some clients still struggle with ending therapy – particularly when they have a strong rapport with the therapist. During this time, you will discuss your feelings about terminating therapy, and look at ways you can apply the interpersonal skills you’ve recently learned to cope effectively with the feelings of loss. This also provides an ideal opportunity to practice and hone those skills.
Although IPT is structured to be time-limited, exceptions can be made when necessary. For individuals experiencing severe depression, for example, the number of therapy sessions may be extended by a small amount (e.g. 4 to 6). IPT is not intended to be an ongoing, open-ended therapy, however.
What happens after Termination?
For many individuals, depression doesn’t occur as a single episode. Recurrent bouts of depression are very common. For this reason, IPT often includes ongoing monthly maintenance sessions. These sessions reduce the risk of relapse and help reinforce the gains of the initial course of therapy. Knowing that they can check in with their therapist on a regular basis also eases the termination process and gives them the reassurance that they’ll still have some degree of ongoing support.
Disadvantages of IPT
Perhaps one of the greatest disadvantages of interpersonal therapy is that it can be a difficult adjustment for clients who have had more traditional therapy prior to starting the process. For example, in psychodynamic psychotherapy the process isn’t structured and there is no time limit. Therapy may last for many months, a year, or even a few years. This can make adapting to the highly structured, narrowly focused, time-limited approach used in IPT a bit challenging.
Interpersonal Therapy Techniques
There are a variety of techniques used in IPT. They include:
Supportive listening – As the name suggests, the therapist listens closely to your issues, experience, and concern, in a matter that is supportive rather than judgmental or critical. This helps establish rapport, creates a safe therapeutic atmosphere, and helps you feel more comfortable opening up in therapy.
Clarification – Your therapist will use clarification to help you identify and understand how your own personal biases and misperceptions are playing a role in your interpersonal issues. Clarification also helps identify patterns in how you feel and think when interacting with others.
Role playing – Role playing involves acting out potential scenarios that will enable you to look at things from a different perspective, as well as practice new behaviors during therapy sessions. For example, the therapist may take on the role of a close friend or family member with whom there is frequent conflict, while you try out different ways of interacting. Role playing also allows you to explore and discuss the emotions you experience during certain interactions. What you learn from role play can then be applied in real life situations outside of therapy.
Communication analysis – Communication analysis is probably one of the most important techniques used in IPT. This involves the therapist having you recall, in detail, a troubling interaction you had with someone in your life. Important details include the tone of voice, hand gestures, body language, and specific statements that were made by you and the other person. This enables the therapist to identify problematic communication patterns that are common in depressed individuals, such as passive behavior that leads to resentment or feeling used by others. These unhealthy patterns serve to reinforce the depression. For example, if you feel worthless or disrespected when others take advantage of you, one of the goals of therapy may be to learn to stand up for yourself and express your feelings in a calm, appropriate manner.
Decision analysis – This technique involves exploring and learning new ways in which to resolve conflicts and other problems that occur in your relationships with others. As you discuss alternative options, you’ll also consider the possible outcomes of using them. This will enable you to choose courses of action which are most likely to yield desired results.
Identifying emotions – Many individuals find it difficult to identify the emotions they’re actually experiencing, particularly if they’re used to suppressing those feelings. For example, sadness may be misinterpreted as anger, and vice versa. Learning to identify your emotions objectively – i.e. without bias, judgment, or moralizing them (i.e. labeling them as “good” or “bad”) – is a valuable skill. When you judge yourself harshly for feeling a certain way, it reinforces depression.
Expressing emotions appropriately – Most people experience painful and / or intense emotions from time to time – particularly during difficult interactions with others. If they’re expressed in an unhealthy manner, it typically makes a conflict much worse. During IPT, you can experience uncomfortable emotions in a safe setting, learn how to accept them, and learn how to express them in a healthy, appropriate manner.
Addressing past issues – Although not a focus of therapy, there may be times when discussing past relationships that are impacting your current interactions is essential to moving forward. This can also help identify problematic patterns that stem from those past issues.
Benefits of IPT
There are many potential benefits to be gained from interpersonal therapy. Following are some of the most common:
- More positive and healthy relationships with others
- A rapid decrease in symptoms
- Improved problem-solving skills
- Greater ability to manage and work through grief and loss
- Healthy coping skills that will continue to benefit individuals long after therapy
- Enhanced communication skills
- Greater ability to express emotions appropriately
- Increased self-awareness of problematic interpersonal patterns
- Decrease in anger and hostility
- Decrease in behavior patterns that are self-destructive
- More stable mood
Disorders and conditions that can benefit from IPT
As mentioned previously, IPT was initially developed to help adults with depression, and reduce the risk of future episodes. It has been adapted and used to treat the following disorders, conditions, issues and populations as well*, including:
- Major depression in children, adolescents, perinatal women, and the elderly
- Bipolar disorder
- Dysthymic disorder
- Eating disorders – binge eating disorder, anorexia, and bulimia
- Recovery from substance use disorders
- Anxiety disorders
- Posttraumatic stress disorder (PTSD) and trauma recovery (see more below)
- Social phobia
*More research needs to be done with some of these disorders and conditions, but most the research that has been done has yielded positive result.
Studies have also explored the efficacy of IPT in various cultural settings, therapy formats (couples and groups), and delivery methods (e.g. therapy done via phone).
PTSD and trauma recovery – With regards to individuals with PTSD (and those recovering from trauma but who don’t meet the criteria for a PTSD diagnosis), one of the biggest advantages of IPT is that it doesn’t require the individual to relive the trauma via re-exposure during therapy. This is important because many individuals have troubling interpersonal issues due to trauma-related symptoms, but are reluctant to seek treatment due to the exposure aspect that’s often involved.
Interpersonal therapy allows them to focus on the ways their disorder is causing problems in their significant relationships (e.g. emotional detachment, intimacy problems, anger, or aggressive behavior). By focusing on improving these relationships, IPT helps improve current symptoms and strengthen the buffer these relationships provide against developing PTSD in those who haven’t already. Initial research has shown positive results in terms of using this therapy approach instead of exposure therapy.
Interpersonal Therapy in a Group Setting
Although IPT is often conducted in a one-on-one therapy format, it also works well in a group setting. Many individuals are initially reluctant to be part of therapy group. Reasons for this include concerns about privacy within the group and a general discomfort about sharing such personal issues with a group of strangers. However, a group format has several advantages over individual IPT:
- The other members in the group – unlike the therapist – serve as peers who often have similar experiences to each other. For many people, this makes them feel more genuinely understood, as their interacting with others who have walked in their shoes.
- Group members can learn a lot just by observing what other members in the learning from therapy.
- A group setting provides an ideal opportunity to explore and practice new skills in a safe environment before attempting to apply them outside of sessions. Instead of getting feedback from just the therapist, members can also get feedback from other members.
- As members interact with each other, other members can observe and learn from these interactions within the group. This will help them make more beneficial adjustments in their own relationships outside of therapy.
- Although therapists are generally very supportive, a group format multiplies the amount of support any given member receives. This additional support can be very empowering.
Finding an Interpersonal Therapist
If interpersonal therapy sounds like something that may be beneficial for you, it’s important to work with a therapist who is properly trained in this particular therapy. One of the best ways to find a therapist in your area is to search online for interpersonal therapy [your city]. Treatment providers will likely include psychologists, clinical social workers, professional counselors, and other mental health professionals.
You can select a few from the list and contact them to inquire about their services. This will also give you a sense of whether or not the therapist is a good fit for you. Be sure to contact your health insurance provider to determine if they will cover all or part of the cost of treatment if you’ve already been diagnosed with depression or another psychiatric disorder appropriate for IPT. If cost is an issue, some therapists will work with you on a sliding fee based on your income. If group IPT is an option, that will usually cost much less than individual sessions.