1. Interpersonal Therapy

2. Overview of Interpersonal Therapy
Short term intervention directed at focusing on client’s interpersonal problems in order to treat mental health challenges
NOT theoretically unique
Utilizes principles of psychodynamic theory (client’s emotional and interpersonal life) as well as cognitive and behavioral theories (rationality of thoughts and behavior change)

3. Focus of Interpersonal Therapy
Three issues addressed:
Client’s use of defenses
Underlying cognitive structures of self and others
Working alliance as model for other relationships
Goal of treatment: mastery of social roles and adoption to interpersonal situations
Treatment typically ranges from weeks in one hour sessions

4. History of Interpersonal Therapy
Evolved from progressive psychiatrists who saw the impact of the environment on people's functioning
Connection between psychiatric disorders and interpersonal relations for children and adults (Harry Stack Sullivan, 1930’s)
Self as a changeable consciousness that arises out of interaction with significant others
Relationship between engaging within social roles (family members, student, employee, friend, partner) and psychopathology ( and vice versa)

5. History of Interpersonal Therapy (cont.)
Attachment theory (Bowlby): people are innately inclined to form attachments and this allows species to survive
Family experiences, as a child, determines the way emotional bonds are made
Mental illness arises from inability to make and keep those bonds
Treatment focus is to examine patterns of current interpersonal relationships and understand their etiology from prior experiences with attachment figures

6. History of Interpersonal Therapy (cont.)
IPT as a distinct therapy modality developed by Weissman and Klerman in 1970’s
Unit of intervention may be face to face involvement of client with one or more significant others
Clients learn about the relationship between their symptoms and what is going on within their interpersonal life

7. Major Concepts: Interpersonal Therapy
Assumption that depression is a medical illness manifested by:
Symptoms
Quality of social functioning
Personality style
Life events affect mood
Improving life situation promotes improving mood
Psychopathology not caused exclusively by interpersonal relationships; but occurs within an interpersonal context
Improving social functioning can reduce symptoms

8. Synthesis of IPT Concepts
Time-limited, focus on current interpersonal relationships
Client has social functioning problems originating in one or more of the following areas:
Interpersonal disputes
Role transitions
Grief processes
Interpersonal deficits
IPT seeks to change how a client thinks, feels and acts in problematic interpersonal relationships
Areas where therapist may assist:
Increasing assertiveness
Reducing guilt
Poor social skills
Over-emphasis on unpleasant events
Manner of expressing negative emotions

9. Comparing IPT with Cognitive Behavioral and Psychodynamic Interventions
Attention called to distorted thinking only within context of relationships with others (not in uncovering core cognitive schema)
Not the depth of CBT into source of cognitions
Utilizes reassurance, clarification of feelings, communication training, testing perceptions and performance through interpersonal contacts
More emotional expression than with CBT
IPT effective for client’s with a tendency to avoid addressing interpersonal problems

10. Examples of Change Within 4 Major IPT-focused Types of Problems
Interpersonal disputes.
Practitioner identifies faulty communication patterns plus invalid or unreasonable expectations
Worker assists with adapting communication patterns or reassessing expectations
Role transitions:
May be result of maturational or situational crises
Therapist seeks to modify or develop new sources of support; reappraising old and new roles
Grief:
Determine how client’s relationship capacity has been affected
Establishing new relationships; clarify mourning cognitions, experience feelings
Interpersonal deficits:
Modify problematic relationship patterns such as excess dependency or hostility

11. IPT and Manualization
To “manualize” means that specific activities are covered within each week of a week session
it is critical to have “fidelity” with the manual’s approach
1-4: Assessment and planning ( uses an interpersonal inventory)
5-8: Attention is directed to one or more of the four IPT focus areas (as goals)
9-12: Acknowledging feelings around grieving, recognizing gains, generalizing outcomes
Assist client to acknowledge new areas of competence

12. Client/Worker Relationship in IPT
Present-focused but with clarity of need to work within a time frame (hence goal orientation is ever present)
Transference and countertransference assessed but not interpreted
This assists the worker in understanding the dynamics of the client’s interpersonal patterns

13. IPT Assessment
Presenting challenge assessed and its attendant symptoms
Diagnosis of symptoms is shared with client
Allows client to know their symptoms have a “name” for which there is a solution
Interpersonal Inventory
Client lists all significant past and current relationships
Information is shred about each person with whom client has had significant relationship

14. Nature of interaction ( frequency of contact and activities shared)
Interpersonal Inventory ( undertaken for all significant relationships)
Nature of interaction ( frequency of contact and activities shared)
Expectations of each person within the relationship and extent to which those were met
Satisfactory and unsatisfactory aspects of relationship (examples)
How client would like to change relationship

15. Use of Interpersonal Inventory
Social worker analyzes patterns of interaction and behavior related to themes of:
Dominance and submission
Dependency and autonomy
Intimacy and trust
Cooperation or competition
Separation and loss
Based on inventory results, client and worker agree on a primary relational problem for intervention

16. IPT Intervention Techniques
Nondirective exploration: Supportive listening to build trust and normalize problems
Encouragement of affect: encouraging expression of unpleasant emotions previously defended against
Clarification of beliefs and perceptions: uncovering cognitive distortions, calling attention to contradictions and promoting logical thinking
Communication analysis: reflecting patterns that can be problematic such as silence, contradictory and indirect messages, plus “double bind” messages

17. IPT Intervention Techniques (cont.)
Use of therapeutic relationship: encouraging client to share feelings about worker and the therapeutic process (not probing for “roots” as in psychodynamic theories)
Behavior change strategies: modeling and role playing to facilitate experiments outside of session
Also limit setting with impulsive clients

18. IPT Evidence of Effectiveness
Clinical trials have found IPT equally effective or more effective than antidepressant therapy
Used together there is an additive effect
Used with adolescents, older adults, women with post-partum depression, bulimics
Outcomes of IPT can be maintained over time

19. Critique of IPT
Supports a “medical model” in sense of DSM diagnosis and possible use of antidepressants
Requires formal training in order to subscribe to “manualized” approach

20. Summary of IPT
Short term intervention, manualized, with 3 decades of effectiveness data on treatment of depression
Combination of ego psychology/psychodynamic and cognitive behavioral approaches
Problems of clients conceptualized as emanating from:
Interpersonal disputes
Role transitions
Grief processes
Interpersonal deficits
Above demonstrated through problematic interpersonal relationships
Goals focus on client changing thinking, feeling and behavior within problematic interpersonal relationships