Interpersonal psychotherapy

Interpersonal Psychotherapy (IPT) is a time-limited psychotherapy that focuses on the interpersonal context and on building interpersonal skills. IPT is based on the belief that interpersonal factors may contribute heavily to psychological problems. It is commonly distinguished from other forms of therapy in its emphasis on interpersonal processes rather than intrapsychic processes. IPT aims to change the person's interpersonal behavior by fostering adaptation to current interpersonal roles and situations.

History

Interpersonal psychotherapy largely stems from the interpersonal psychoanalysis work of Harry Stack Sullivan, who, although coming from a psychodynamic background, was strongly influenced by ideas in sociology and social psychology. Sullivan thought that the most significant factors in triggering emotional reactions in individuals were the interpersonal behaviors of others.

Interpersonal therapy was first developed as a theoretical placebo for the use in psychotherapy research by Gerald Klerman, et al. IPT was, however, found to be quite effective in the treatment of several psychological problems. IPT was later developed in the 1970s and 80s as an outpatient treatment for adults who were diagnosed with moderate or severe non-delusional clinical depression.

IPT takes structure from psychodynamic psychotherapy, but also from contemporary cognitive behavioral approaches in that it is time-limited and employs homework, structured interviews, and assessment tools.

Applications

Although originally developed as an individual therapy for adults, IPT has been modified for use with adolescents and older adults.

IPT for Adolescents
IPT for kids is based on the premise that depression occurs in the context of an individual's relationships regardless of its origins in biology or genetics. More specifically, depression affects people's relationships and these relationships further affect our mood. The IPT model identifies four general areas in which a person may be having relationship difficulties: 1) grief after the loss of a loved one; 2) conflict in significant relationships; 3) difficulties adapting to changes in relationships or life circumstances; and 4) difficulties stemming from social isolation. The IPT therapist helps identify areas in need of skill-building to improve the client's relationships and decrease the depressive symptoms. Over time, the client learns to link changes in mood to events occurring in his/her relationships, communicate feelings and expectations for the relationships, and problem-solve solutions to difficulties in the relationships.

IPT has been adapted for the treatment of depressed adolescents (IPT-A) to address developmental issues most common to teenagers such as separation from parents, development of romantic relationships, and initial experience with death of a relative or friend (see "What is IPT for Adolescents?". Evidence-Based Mental Health Treatment for Children and Adolescents. http://www.abct.org/sccap/?m=sPublic&fa=pub_WhatIsInterpersonal. ). IPT-A helps the adolescent identify and develop more adaptive methods for dealing with the interpersonal issues associated with the onset or maintenance of their depression. IPT-A is typically a 12-16 week treatment. Although the treatment involves primarily individual sessions with the teenager, parents are asked to participate in a few sessions to receive education about depression, to address any relationship difficulties that may be occurring between the adolescent and his/her parents, and to help support the adolescent's treatment.

Medical indications

• Bipolar disorder
• Bulimia nervosa
• post-partum depression
• family therapy
• Major depressive disorder
• Cyclothymia
• Various other disorders

Stages

Interpersonal psychotherapy typically proceeds in several stages. In the initial stages, therapeutic goals typically include diagnosis, completing the requisite inventories, identifying the patient's major problem areas, and creating a treatment contract.

In the intermediate stages, the patient and therapist, focusing on the present, work on the major problem areas identified. Four major problem areas are commonplace in IPT. The first is grief, and patients typically present with delayed or distorted grief reactions. Treatment aims include facilitating the grieving process, the client's acceptance of difficult emotions, and their replacement of lost relationships. The second major problem area is role dispute, in which a client is experiencing nonreciprocal expectations about a relationship with someone else. Here, treatment focuses on understanding the nature of the dispute, the current communication difficulties, and works to modify the client's communication strategies while remaining in accord with their core values. A third major problem area is role transition, in which an individual gives up an old role and takes on a new one. In this case, treatment attempts to facilitate the client's giving up of the old role, expressing emotions about this loss, and acquiring skills and support in the new role they must take on. A final problem area commonly broached with IPT is interpersonal deficits. Clients presenting interpersonal deficits commonly engage in an analysis of their communication patterns, participate in role playing exercises with the therapist, and work to reduce their overall isolation, if applicable.

In the end stages of IPT, the therapist works to consolidate the client's gains, discuss areas which still require work, talk about relapse prevention, and process any emotions related to termination of therapy.

Criticism

A 2002 study comparing IPT therapy to Cognitive behavioral therapy approaches in treating depression found that external observers had difficulty differentiating the two approaches. The request of the study show that therapists using either CBT or IPT saw more gains from treatment the closer they adhered to an "ideal" CBT model. This conclusion casts doubt on the evidence supporting IPT as a stand-alone Evidence-based practice.

See also

• Harry Stack Sullivan
• Timothy Leary

References

• Leary, Timothy (1957). Interpersonal diagnosis of personality: a functional theory and methodology. 

External links

• http://www.abct.org/sccap/?m=sPublic&fa=pub_WhatIsInterpersonal What is IPT for Adolescents?
• "Interpersonal Psychotherapy". www.med.umich.edu. http://www.med.umich.edu/depression/ipt.htm. Retrieved 2009-08-23. 
• Myrna M. Weissman, John C. Markowitz, Gerald L. Klerman (2000). Comprehensive guide to interpersonal psychotherapy of depression. Basic Books. http://books.google.com/books?hl=en&lr=&id=lO-hKTOCocUC&oi=fnd&pg=PP15&dq=interpersonal+therapy&ots=tYzSd7bebv&sig=NBpMnFnSMukDrpd6VOOWpOVGy00#v=onepage&q=interpersonal%20therapy&f=false. Retrieved 2009-08-23. 
• Hanna Levenson, Theodore A Powers, Stephen F. Butler, Bernard D. Beitman (2002). Concise Guide to Brief Dynamic and Interpersonal Therapy. American Psychiatric Publishing, Inc.. http://books.google.com/books?id=Vm_rIxiIOYUC&printsec=frontcover&dq=interpersonal+therapy&ei=RlWRSrT5JZKUyQT90sGVBw#v=onepage&q=&f=false. Retrieved 2009-08-23.