Interpersonal Psychotherapy

Interpersonal psychotherapy is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery (WikipediaOpens in new window).

The principles and general philosophy of interpersonal psychotherapy are based in the interpersonal theory of American psychiatrist and psychodynamic theorist Harry Strack SullivanOpens in new window, who emphasized that personality difficulties arise primarily in relationships with others, and in attachment theory, which holds that interpersonal loss and attachment issues are at the core of psychological problems.

The actual techniques and form of the therapy were developed by clinical researchers Gerald KlermanOpens in new window and Myrna WeissmanOpens in new windowin the 1970s and 1980s. They adapted techniques from both psychodynamic (Freudian and neo-Freudian) therapists and the more modern cognitive-behavioral therapists. The treatment was originally designed for adults diagnosed with moderate or severe clinical depression.

The basis of interpersonal psychotherapy is the idea that psychological problems are largely caused by interpersonal issues. According to the theory, one or more of four major areas of interperaonal problems may be associated with depression.

  • The first is interpersonal loss. The client’s grieving process following the death of a loved one may have become problematical (i.e., excessive or prolonged).

    The interpersonal therapist would encourage the client to explore the lost relationship and express feelings that may be unresolved. The client would create a new way of thinking about the lost person and, by the end of treatment, would be prepared to seek new connections and relationships with people.
  • A second area is interpersonal role disputes, which may occur in romantic relationships, families, or work or other settings. In a romantic relationship, the client may find that she and her partner have different expectations of their relationship or different interaction styles that lead to conflict. For example, one partner may expect the partner to follow traditional sex roles while the other finds this expectation to be too restrictive. Treatment would involve questioning whether the beliefs of the client are realistic and constructive; and teaching behavioral techniques such as new methods of communication and problem solving.
  • A third area is interpersonal role transition. An individual may have experienced a major life change such as the birth of a child, moving across country, divorce, or marriage. It may be difficult to navigate the new roles that are required by these life changes. Therapy would encourage the person to seek out support from others (social support) and develop the skills that are required by the new role.
  • A fourth area is interpersonal deficits, such as poor social skills or extreme shynessOpens in new window. Treatment would involve helping the client to see that he has a “problem” (e.g., engaging in role-play and showing his behavior might be viewed or received by received by others). In addition, behavioral or cognitive-behavioral techniques would be used to teach the social skills that are required, for example, assertiveness or anger management.

Interperaonsl psychotherapy is brief, typically designed for 12 to 16 one-hour, weekly sessions. According to the theory, three main issues that should be addressed in depressionOpens in new window are symptom formation, social functioning, and personality.

Interpersonal psychotherapy works on social functioning, which helps to reduce symptom formation. Personality is not directly a focus of treatment since this therapy is of short duration and personaoity restructuring is time-intensive. Sessions begin by collecting information from the client.

The therapist interprets the client’s presenting problems in an interpersonal context and explains the interpretations to the client. Treatment proceeds from this framework, using a variety of cognitive, behavioral, psychodynamic (Freudian), and other techniques.

The goal of therapy is to create new ways of thinking, feeling, and behaving. The new person is (it is hoped) less vulnerable to future depressions.

Interpersonal psychotherapy is an effective treatment for depression. Several well-designed studies compared interpersonal psychotherapy to other treatments of demonstrated effectiveness (i.e., cognitive-behavioral therapy, antidepressant medication), and results revealed that interpersonal psychotherapy is at least as effective as the other treatments for depression (e.g., Elkin et al., 1989; Weissman et al., 1979).

Interpersonal psychotherapy has been adapted to treat other conditions, including bipolar disorder, eating disorders, posttraumatic stress disorder, anxiety disorders, and substance use disorders. Studies of therapy effectiveness for several of these conditions are ongoing.

See also:
  1. Elkin, I., Shea, M.T. Watkins, J.T., Imber, S.D., Sotsky, S.M., Collins, J. F., et al. (1989) National Institute of Mental Health Treatment of Depression Collaborative Research Program: General effectiveness of treatments. Archives of General Psychiatry, 46, 971 – 982.
  2. 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.