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Interpersonal Psychotherapy for Depression

What is Interpersonal Psychotherapy?

Interpersonal psychotherapy (IPT) is a brief, time limited psychotherapy that was initially developed in the late 1960s for the treatment of adult depression (Weissman, Markowitz, & Klerman, 2000). The underlying assumption of IPT is that the quality of interpersonal relationships can cause, maintain, or buffer against depression. When someone is depressed, it affects one's interpersonal relationships, and the quality and stability of one's relationships in turn affect one's mood. This view is consistent with interpersonal theories of depression articulated by Harry Stack Sullivan (Sullivan, 1953) and Adolf Meyer (Meyer, 1957). In addition to these theories, IPT has its roots in Bowlby's attachment theory, specifically in its emphasis on the importance of relational bonds for mental health. When there are conflicts in relationships or losses of important attachment bonds, the outcome is emotional distress and often specifically depression. IPT has been shown to be an effective treatment for adult (Weissman et al., 1979; Elkin et al., 1989) and adolescent depression (Mufson et al., 1999; 2004). It has also been adapted for use with a number of other conditions, including eating disorders, bipolar disorder, and postpartum depression.

Basic Principles

The two main goals of IPT are to 1) decrease depression symptoms and 2) improve social functioning within significant relationships. IPT views depression as a medical illness and approaches the treatment from this perspective to remove blame for the illness from the client. The primary strategies for achieving treatment goals include the following: 1) identifying a specific problem area; 2) identifying effective communication and problem-solving techniques to use with the problem area; and 3) practicing in session and eventually experimenting outside the session with the use of these techniques in the context of significant relationships. The four problem areas include grief, interpersonal role disputes, role transitions, and interpersonal deficits.

Course of Treatment

The treatment is divided into three phases: initial, middle, and termination. The initial phase focuses on diagnosing the depression, providing psychoeducation about the illness, exploring the client's significant relationships with family members and peers, and identifying the problem area that will be the focus of the remainder of treatment. During the middle phase of treatment, the therapist educates the client about the link between one's mood and problems that are occurring in one's relationships, and teaches the client how new skills in communication and problem-solving can improve these relationships which can then lead to recovery from depression. The therapist focuses on identifying specific strategies that can help the client negotiate his/her interpersonal difficulties more successfully. For example, the client may be taught communication skills to express his/her feelings regarding conflicts or disappointments in his/her relationships and/or life circumstances (e.g., the death of a parent, conflict with his spouse, or loss of a job). Techniques include expression of affect, clarification of expectations for relationships, communication analysis, interpersonal problem-solving, and role playing new methods of interaction. Over the course of treatment, the therapist links improvement in the client's mood to constructive and direct communication and effective decision-making. Finally, the goal of the termination phase is to clarify warning symptoms of future depressive episodes, identify successful strategies used in the middle phase, foster generalization of skills to future situations, emphasize mastery of new interpersonal skills, and discuss the need for further treatment.

 

References & Recommended Readings

Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., Glass, D. R., Pilkonis, P. A., Leber, W. R., Docherty, J. P., Fiester, S. J., & Parloff, M. B. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program: General effectiveness of treatments. Archives of General Psychiatry, 46, 971-983.

Meyer, A. (1957). Psychobiology: A science of man. Springfield, IL: Charles C. Thomas

Mufson, L., Dorta, K. P., Moreau, D., & Weissman, M. M. (2004). Interpersonal psychotherapy for depressed adolescents. New York: Guilford Press.

Mufson, L., Dorta, K. P., Wickramaratne, P., Nomura, Y., Olfson, M., & Weissman, M. M. (2004). A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 61, 577-584.

Mufson, L., Weissman, M. M., Moreau, D., & Garfinkel, R. (1999). Efficacy of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 56, 573-579.

Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: W.W. Norton.

Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). A comprehensive guide to interpersonal psychotherapy. New York: Basic Books.

Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2007). Clinician's quick guide to interpersonal psychotherapy. New York: Oxford University Press.

Weissman, M. M., Prusoff, B. A., DiMascio, A., Neu, C., Goklaney, M., & Klerman, G.L. (1979). The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes. American Journal of Psychiatry, 136, 555-558.

 
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