8 Psychotherapy8.6 Other therapeutic and skills-based approaches
8.6.1 Interpersonal psychotherapy
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Written by Resident Doctor Committee · Published
Origins and model
Gerald Klerman and Myrna Weissman developed interpersonal psychotherapy (IPT) in the 1970s to treat depression.
Harry Stack Sullivan originated interpersonal theory, one of the foundations of IPT.
IPT links emotional disturbance to current, here-and-now relationships and social roles, so assessment centres on present relationships, not childhood origins, dreams or the unconscious.
The interpersonal inventory maps each significant relationship and how it bears on mood.
IPT aims to resolve a current interpersonal problem, typically by settling a role dispute with a significant other.
The four problem areas
Therapy works on one, occasionally two, of four fixed areas.
Problem area | What it covers |
|---|---|
Grief | Complicated bereavement, worked towards mourning |
Interpersonal role disputes | Conflict with one particular person, renegotiated or ended |
Role transitions | Leaving an old role for a new one, such as parenthood, redundancy, retirement or migration |
Interpersonal deficits | Relationships impoverished for years without a precipitant; the residual area, with the weakest outcomes |
Structure and technique
IPT grants the sick role by framing the disorder as a treatable medical illness, which lifts blame but still asks the patient to work at recovery.
A time-limited course runs to 12 to 16 weekly hour-long sessions in three phases.
Phase | Sessions | Work |
|---|---|---|
Initial | First 2 to 3 | Confirms the diagnosis, completes the inventory, agrees the problem area, grants the sick role |
Middle | Remainder | Links symptoms to relationship events and works on the chosen area |
Ending | Final 3 to 4 | Reviews change, treats the ending as a role transition, plans for relapse |
The therapist takes an active, supportive stance as the patient's advocate, encouraging change between sessions and reviewing it afterwards.
Techniques include role play, problem solving, communication analysis and work on grief.
Free association belongs to psychoanalysis, not to IPT.
Indications and evidence
IPT is best supported in unipolar, non-psychotic major depression, the condition it was built for.
Depression that arises from and is kept going by a current interpersonal problem, such as bereavement, points towards IPT.
In acute depression IPT works as well as antidepressants and cognitive behavioural therapy (CBT), and it works without medication.
Perinatal depression after childbirth is a recognised adaptation, framed as a role transition.
Condition | Evidence for IPT |
|---|---|
Bulimia nervosa, binge eating disorder | Firmest outside depression |
Anorexia nervosa, anxiety disorders, substance dependence | Weak, negative or absent |
IPT does not suit psychotic depression, alcohol dependence, antisocial personality disorder or adolescent conduct disorder.