By Chua Sook Ning, PhD
One of the things that drew me to interpersonal psychotherapy (IPT) was IPT’s emphasis on interpersonal relationships. Whereas cognitive behavioural therapy focuses on thoughts/behaviors, emotion focused therapy on emotions, IPT draws attention to a person’s interpersonal functioning. Thus, IPT is particularly well-suited for collectivistic cultures given the importance of relationships in our culture, where problems in living often arise from the tremendous difficulty in balancing the needs of the self vs. the needs of others.
A brief history
IPT was developed in the 1970s by Dr Gerald Klerman and Dr. Myrna Weissman. IPT is heavily influenced by Adolf Meyer, Harry Stack Sullivan (the founders of the interpersonal psychiatry) and John Bowlby (attachment theory). IPT is short-term evidence based psychotherapy and is one of the only two treatments recommended by NICE (National Institute for Health and Care Excellence; NHS UK) for moderate-severe depression (the other being cognitive behavioral therapy).
Goals of IPT
The goal of IPT is to help people cope with current problems and the development of self-reliance (as opposed to reliance on the therapist) through the improvement of interpersonal functioning.
The focus of IPT is on:
1. Current problems in the person’s life
2. People who are important in the patient’s current life
3. The interpersonal problems that affect a person’s mental health
4. Recognizing and accepting emotional responses to current problems
5. Finding new ways of expressing needs to address crises, gather social support and develop healthy relationships.
As a short-term therapy, IPT focuses on present problems, rather than problems in childhood. It teaches clients to address the now relationships, rather than past relationships, as significant as they may be.
What happens in therapy?
IPT has identified four common interpersonal areas to focus on in therapy:
1. Grief/Complicated bereavement (e.g. death of a loved one)
2. Interpersonal role dispute (conflict with a significant other)
3. Interpersonal role transition (changes in life circumstances/a negative life event e.g. a divorce)
4. Interpersonal deficits (e.g. isolation, lack of meaningful relationships)
During therapy, the therapist helps the client to:
1. Identify and accept their feelings as interpersonal signals
e.g. sadness means feeling unsupported or a loss of connection.
2. Examine their capacity to assert their needs and wishes in interpersonal wishes
e.g. when I want to be supported, I drop hints that I am sad and end up feeling rejected when people don’t respond.
3. Encourage the effective expression of feelings
e.g. teaching interpersonal skills through role playing.
4. Take appropriate social risk to resolve current interpersonal issues.
e.g. setting boundaries, asserting need for support.
The client-therapist relationship
IPT does not just focus on helping the client with their interpersonal functioning but in line with its’ attachment and interpersonal traditions, IPT emphasizes the importance of building a strong treatment alliance. The therapist must be skilled in connecting with the client. IPT is not just a theoretical discussion on interpersonal functioning, but an experiential one. The client learns from the therapist’s interactions (verbal and nonverbal) with them. The therapist approaches the client respectfully in a supportive manner as an ally and as a fellow human being.
The grandfather of IPT, Harry Stack Sullivan, famously said: “We are all much more simply human than otherwise, be we happy and successful, contented and detached, miserable and mentally disordered, or whatever.”
References
Markowitz, J. C., & Weissman, M. M. (2004). Interpersonal psychotherapy: principles and applications. World Psychiatry, 3(3), 136.
Markowitz, J. C., & Weissman, M. M. (2012). Interpersonal psychotherapy: past, present and future. Clinical psychology & psychotherapy, 19(2), 99–105.
Treatment manual: Guide to Interpersonal Psychotherapy
Evidence for IPT effectiveness
Ravitz, P., Watson, P., Lawson, A., Constantino, M. J., Bernecker, S., Park, J., & Swartz, H. A. (2019). Interpersonal psychotherapy: a scoping review and historical perspective (1974–2017). Harvard review of psychiatry, 27(3), 165-180.
NICE guidelines
APA Division 12
