How Does Interpersonal Therapy Work?
Interpersonal psychotherapy (IPT) is a specific type of psychotherapy that is used in the treatment of a number of different mental health disorders, such as depression, anxiety disorders, eating disorders, and substance use disorders. It can be used over a wide age range of different clients.
Interpersonal therapy has been recognized as being an empirically validated form of psychotherapy by the American Psychological Association and the American Psychiatric Association. There are hundreds of studies documenting its effectiveness for a number of different conditions. IPT is a time-limited form of therapy that focuses on interpersonal issues. The delivery of IPT will range anywhere from six to 20 sessions (although generally delivered in 12-16 sessions) and may include additional sessions over the long run as a form of maintenance treatment.
The development of IPT occurred in the 1970s as a result of investigations into the effectiveness of combinations of therapy and antidepressants for depression. The types of psychotherapies used for depression at that time were largely based on the principles of behavioral therapy and cognitive therapy. The principles of interpersonal therapy were developed in the context of attempting to maximize these types of therapies for depression, particularly psychotherapy for individuals who had recovered from depression but were at risk for relapse. The initial studies resulted in the techniques associated with interpersonal therapy being included in the treatment of acute depression as opposed to just those in recovery and also being used in the treatment of other mental health disorders.
The foundations for interpersonal therapy come from:
- Attachment theory: This is a developmental psychology theory that focuses on the importance of personal attachments in regard to an individual’s development physically, emotionally, and mentally. The general premise of attachment theory is that the ability of a person to a form an attachment (physically and emotionally) to another person gives that individual a sense of stability and security that is necessary for them to grow and develop as a person.
- Interpersonal theory: This theory was developed by psychoanalyst Harry Stack Sullivan. It is based on the foundation that the details of a person’s interpersonal interactions with other people can provide understanding and treatment of different types of mental health disorders.
- Communication theory: This is a multidisciplinary paradigm that includes psychology, linguistics, mathematics, sociology, computer science, and other fields. Communication theory deals with the principles and methods by which information is conveyed from one source to another.
Techniques of Interpersonal Therapy
- Beginning phase: The therapist will attempt to identify the initial problem, often attempting to formally diagnose the issue, and identify the interpersonal context in which the problem presents itself. This requires the use of a number of different psychological assessment instruments, depending on the specific situation. The therapist also attempts to review the client’s patterns of relationships, the client’s capacity for intimacy with others, and evaluate the state of the client’s current relationships. This is done through a formal interview and specific assessment measures, and it can also involve interviewing other important people in the client’s life.The therapist sets the interpersonal inventory based on the information gathered. The interpersonal inventory describes all aspects of the individual’s relationships and patterns of attachment. Once this formal assessment is complete, the therapist will discuss their impressions with the client and may even allow the client to accept an initial status as a patient (often referred to as giving them the “sick role”) to allow them to recognize that their issues are interfering with their functioning.
- Middle phases: The middle phases represent the bulk of the treatment. Information gathered in the initial phase is organized into its relevance concerning four problem areas for individuals. The actual treatment during therapy may concentrate on one or more of these four problem areas.
- Grief: At some point, everyone has an experience of grief and loss. If grief is relevant to the particular problem identified in the assessment, the therapist will help the client accept the painful emotions and circumstances associated with their experience of loss, help the client communicate their feelings to others, help the client utilize their existing social supports or develop new attachments to deal with the grief, and even recreate the lost relationship in the therapeutic environment. This allows the client to use existing relationships outside the therapy as a means to help them deal with their grief.
- Interpersonal disputes (role disputes): This becomes the area of focus when disputes with others are main contributors to the problem. These disputes may often be difficult to actually identify as clients may not think that these are relatively important in terms of their presenting problem. Some examples of disputes include hostile conflicts (e.g., verbal abuse or domestic violence), betrayal (e.g., infidelity, conflicting loyalties with family members or friends, or improprieties in relationships), disappointments (e.g., unmet expectations with family, work, or school), and inhibited conflicts (e.g., being angry at a partner or family member’s disability or illness but not overtly expressing this anger or disappointment). IPT assumes that the disruption that occurs as a result of issues with interpersonal disputes can result in a number of issues and vulnerabilities to psychological distress. The therapist uses specific techniques to deal with the specific interpersonal dispute and helps them resolve the issues associated with it.
- Role transitions: One of the core experiences that individuals must face is adapting to changes. Interpersonal therapy recognizes that clients often experience distress as a result of change. Change as a result of role transitions are often experienced as a form of loss. They can include changes in job status, changes in relationship status (e.g., divorce, parenthood, etc.), being diagnosed with an illness, and the results of traumatic stressors, such as accidents. The therapist attempts to use techniques to define the old role and the new role in a manner that are balanced and realistic to the client, help the client accept the emotional impact of the loss of the old role and the insecurity associated with any changes, and help the client develop and implement new attitudes and skills to overcome the perceived challenges of the new role status.
- Interpersonal sensitivity: This problem relates to difficulty in forming and maintaining relationships, which can often lead to feelings of isolation and loneliness. Individuals with interpersonal sensitivity often feel that their needs are not being met in some way. The therapist attempts to optimize the client’s current relationship functioning, help the client establish new and supportive relationships (including the relationship with the therapist), and resolve the acute interpersonal stressors associated with feelings of emptiness and loneliness.
- Final phase: As progress is made in the middle phase of therapy, the therapist begins to prepare the client for termination of therapy. This includes addressing any issues with insecurity (interpersonal sensitivity) that may be associated with the termination of therapy. Clients are offered participation in maintenance sessions following the termination of the formal therapy that can include returning periodically for updates and restructuring.
IPT therapists are trained in a number of different assessment and therapeutic approaches to address all of these problem areas.
The therapy is typically targeted at the specific presenting problem that the client brings with them. IPT tends to be solution-focused and is not intended to be a long-term process.
Typically, clients do not demonstrate severe issues in all four problem areas listed above, although this is certainly possible. The goal of the therapy is to address the specific problem and focus on the problem area that is relevant to the presenting problem. The goal of the therapist is to deliver the treatment in as efficient manner as possible and to concentrate on only the issues that brought the client to therapy. Therapy sessions are focused and intense. Clients are encouraged to practice the principles that are discussed in sessions outside of the therapy, and there are often “homework assignments” given to help the client apply principles discussed in sessions in the real world.