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Chapter: Essentials of Psychiatry: Time-limited Psychotherapy (Including Interpersonal Therapy)

Overview of Interpersonal Psychotherapy

In order to acquaint the reader with IPT, we offer brief overview of this modality, introducing IPT-specific con-cepts such as the interpersonal inventory, the four interpersonal problem areas and the interpersonal formulation.

Overview of Interpersonal Psychotherapy

 

In order to acquaint the reader with IPT, we offer brief overview of this modality, introducing IPT-specific con-cepts such as the interpersonal inventory, the four interpersonal problem areas and the interpersonal formulation. The reader is referred to the treatment manual (Weissman et al., 2000) for a more thorough discussion of IPT.

 

IPT was developed in the 1970s by Klerman and Weissman as a 16-session psychotherapy for outpatients with nonpsychotic depression (Klerman et al., 1984). IPT grew out of the interpersonal theories of Harry Stack Sullivan and Adolf Meyer as well as sev-eral empirical studies demonstrating the bidirectional link be-tween interpersonal stresses and onset of depression. In its original form IPT is an acute treatment for depression. It can be used alone or in combination with medication to treat the patient’s depres-sive symptoms and the interpersonal problems that contribute to or are affected by the depression. IPT makes no inference about causality, simply linking the depressive symptoms to a patient’s particular interpersonal issues. Regardless of which came first, IPT assumes, based on empirical evidence, that one can achieve improvement in mood by addressing interpersonal problems.

 

IPT uses a medical model of psychiatric illness. The ther-apist explains to the patient that he or she has “major depres-sion” which is a medical illness, like diabetes or heart disease, and instills the hopeful and empirically validated idea that IPT is a good treatment for this specific disorder. Using Parsons’s concept of the “sick role” (Parsons, 1951), the patient is assigned the responsibility to work toward better health in exchange for being relieved of unmanageable social obligations. The patient is also educated about the relationship between depression and interpersonal problems and, in collaboration with the therapist, selects an “interpersonal problem area” (see later) as the focus of treatment.

 

In the process of assessing the patient, the IPT therapist conducts the “interpersonal inventory”. The interpersonal inven-tory consists of a review of all important past and present rela-tionships as they relate to the current depressive episode. The therapist asks about the patient’s life circumstances and requests a description of the important people in his or her life. In addition to outlining the “cast of characters” in the patient’s life, the thera-pist probes the quality of those relationships, asking the patient to describe satisfying and unsatisfying aspects, unmet expectations with others, and aspects of relationships that the patient would like to change. The interpersonal inventory helps the therapist establish the “interpersonal problem area”.

 

One of four interpersonal problem areas – grief, role dis-pute, role transition, or interpersonal deficits – serves as the ex-plicitly agreed upon focus of treatment. It typically consists of issues such as the incompletely mourned loss of a loved one (i.e., complicated bereavement), conflict with a spouse or an employer (i.e., role dispute), an important life event (i.e., role transition) or, in the absence of one of these acute precipitants, longstand-ing, impoverished interpersonal relationships (i.e., interper-sonal deficits). The therapist offers the patient an “interpersonal formulation”: having emphasized that depression is a medi-cal disorder with a constellation of psychological and physical symptoms, the therapist links the patient’s current interpersonal problem to the depression and offers IPT as a powerful treatment for both the depression and the interpersonal problems. In the ensuing weeks (total of 16 weekly sessions), the therapist uses a variety of techniques outlined in the manual to help the patient work through these “real-life” problems.

 

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