Interpersonal psychotherapy (IPT) was developed at Yale University as a targeted, time-limited approach to treating depression.
The research underlying IPT was conducted in the late 1960s, at a time when patients struggling with depression were typically prescribed antidepressants. Gerald Klerman, MD, entrusted then-recent social work graduate student Myrna Weissman, PhD, with designing "high contact" counseling in a controlled trial for patients with major depressive disorder. The researchers were interested in why symptoms of depression often returned if patients stopped taking medications. Psychiatrists didn't have good data on how long a person should take antidepressants, and very little research existed on the role of psychotherapy in preventing relapse. The researchers ultimately wanted to see how antidepressants worked alongside—and without—psychotherapy.
"There was not an assumption that psychotherapy would be efficacious, but that psychotherapy should be subjected to testing in a clinical trial," Weissman recalls in an article posted on the IPT Institute's website.
Additional documented research showed that, when combined with medication, psychotherapy actually fared better than just therapy or medication alone as a short-term treatment for depression. The research raised important questions about depression: When do depressive episodes emerge? Could interpersonal conflicts and personal relationships trigger depression and anxiety? And if patients could understand their thoughts and feelings related to specific relationship problems, could they prevent relapse?
According to Weissman, "When people first develop symptoms [of depression], something usually has gone on in their life to trigger it."
Published in 1984, Interpersonal Psychotherapy for Depression, the manual for the research project, explored those triggers. According to Weissman, "Whether it's disputes, grief, big changes in life or people who have difficulty forming or maintaining attachments, the patient is taught to see depression as an illness. It's not their fault; it's something they can recover from."
In other words, depression is a treatable medical illness, and your mood and your life situation are related.
Unlike other forms of psychotherapy such as cognitive-behavioral therapy (CBT), holistic therapy or psychoanalysis, interpersonal psychotherapy doesn't remedy the past or attempt to correct negative thoughts. Rather, the approach focuses on the here-and-now of emotions, relationships and experiences. More specifically, IPT focuses on tensions and conflicts in marital, family, friend, work-based and community interactions. At its core, we live in a social world, and our interactions with others affect our well-being. The goal isn't to change other people, it's to develop self-awareness, make changes in how we relate to and communicate with those in our social circles, and harness anger or sadness into empowerment.
According to Advances in Psychiatric Treatment, Vol. 17, "The patient learns to understand the interactions between symptoms and interpersonal difficulties, and the ways they are mutually reinforcing. Patients are helped to break this pattern and achieve a reduction in depressive symptoms and improvement in interpersonal functioning through improved communication, expression of affect and proactive engagement with the current interpersonal network."
Clinical research studies further support the efficacy of the model. A study in the American Journal of Psychiatry recently showed that interpersonal psychotherapy, as a nonpharmacologic approach leading up to and during the maintenance phase of treatment, was beneficial in treating women who suffer repeated episodes of depression. "Some women with quite recurrent depression—about 50 percent—can achieve and maintain remission with a depression-specific psychotherapy alone," explained Ellen Frank, PhD.
The therapeutic model has been tested as a clinical treatment for a range of mental health disorders, and adapted effectively in treatment for depressed adolescents, the elderly, women with postpartum depression, patients with eating disorders (bulimia, anorexia and binge eating) and those struggling with substance use disorder, PTSD, and anxiety disorders, as well as for individuals in communities with high rates of depression following war, HIV infection or poverty.
We asked clinicians at the Hazelden Betty Ford Foundation to discuss this approach and its relation to substance use disorders, treatment and recovery.
The idea is that our emotional problems are linked in one way or another to our interpersonal patterns. Healing happens when we gain awareness of those patterns, identify which ones are serving us and which ones are not, and build new, more effective ways of relating to ourselves and others.
The approach begins by assessing a patient's past and present relationships, paying special attention to attachment patterns and early learned behavior about how to relate to others. The therapist works with the patient to help them gain insight about these patterns, which were at one time adaptive to the environment and even necessary for emotional safety, but have now become ingrained, inflexible patterns that are contributing to current problems like anxiety, depression, addiction and other forms of emotional distress. Through a variety of methods the therapist then helps the patient experience a corrective emotional experience in the therapeutic relationship with the hope of transferring newly learned interpersonal patterns to other relationships outside of therapy.
Interpersonal therapy fosters personal growth as well as symptom relief for emotional difficulties. According to the theory, patients can make behavior changes to alleviate mental health symptoms and increase confidence to manage emotional problems when they can both gain insight about how their early learning in family of origin relationships translates to present-day relationship patterns and learn and practice new, more adaptive ways of connecting. For example, a therapist might ask a patient to reevaluate expectations, negotiate conflicts, adapt to new circumstances and/or make use of social support.
Most patients can benefit from the approach of working collaboratively to resolve/manage/negotiate their problems and activate change mechanisms. Individuals with severe and persistent mental illness may need a more structured, skills-based approach, though, before focusing on interpersonal work.
Almost all mental health disorders can be treated by interpersonal therapy. It is not, however, the best approach for those in active psychosis.
Substance use disorders have biopsychosocial aspects. IPT can help patients address the psychological and sociological aspects of the disease, including attachment and relational factors that can contribute to the development and maintenance of the disease. This helps patients better understand why relational patterns need to be changed for successful recovery.
There are brief intervention models that require as few as three sessions, but the full comprehensive approach is designed to be more long term—perhaps six months to a year.
A collaborative relationship between therapist and patient are goals shared by motivational interviewing (MI) and interpersonal psychotherapy. With MI, therapists work with ambivalent patients to see how conflicting goals prevent them from living their best lives. Through adopting a supportive, respectful, non-confrontational approach, the therapist can help the individual find the motivation to change their behavior. According to both theories, patients have good reasons for not wanting to change. Providing validation and empathy for those reasons is a critical step in helping patients reduce shame and increase their willingness to want to change.
Interpersonal therapy places a strong emphasis on building a trusting, emotionally safe and authentically connected therapeutic relationship. Active listening, empathy, validation, an egalitarian approach and selective self-disclosure help to foster a corrective emotional experience in the relationship. There is also an emphasis on techniques that help the patient connect with present moment and inner experience, while paying particular attention to emotions.
Feelings of depression can follow major changes in life. Techniques were developed to manage four categories: unresolved grief, role transitions (life changes that require new roles—divorce, disease diagnosis, job change), interpersonal role disputes (often stemming from differing role expectations); and interpersonal deficits (inadequate or unsupportive interpersonal relationships, the absence of a fulfilling relationship or a major life event).
Therapists often ask about family, social and relational history. They may "check in" frequently with what the patient is thinking/feeling/remembering in the immediate moment of the session. If the patient brings forward indications of some sort of conflict or reaction to what the therapist is doing in session, the therapist will often focus on this as an opportunity to practice healthy communication and attachment in the here-and-now of the session.
One of the goals of interpersonal work is to help patients translate what they are learning in therapy to their relationships. So we may suggest the patient acknowledge mixed feelings and experiment with new ways of relating to loved ones—always in a collaborative manner and when the patient feels ready.
IPT is one of many therapies offered at Hazelden Betty Ford's treatment centers.