Interpersonal Therapy
Interpersonal Therapy is based on a principle that events in a person’ life can affect their mood and their mood can affect events (Markowitz, 2016).
It aims to alleviate a person’s psychological distress, especially depression, by improving their interpersonal relationships and effectiveness in social and relational roles (Weissman et al., 2017) and in the process builds social skills (Markowitz, 2016) and social supports (Stuart & Robertson, 2012).
Unique differences
It is time limited and highly researched for efficacy in major depressive disorder (Weissman et al., 2017).
It is present-focused and explores current interpersonal relationships rather than schema and thoughts or unconscious processes (Stuart & Roberston, 2012).
It is based on a biopsychosocial/cultural/spiritual model and conceptualises the person’s psychological functioning in broad terms (Stuart & Roberston, 2012).
Theoretical basis
Interpersonal theory and attachment theory which propose that a person’s sense of self and the patterns of how they relate to others is a product of their social interactions and familial bonds and relationships over time (Markowitz, 2016).
Social theory is reflected in the focus on social interventions to improve social functioning and the importance of social supports (Stuart & Robertson, 2012).
Social work context
Interpersonal Therapy takes a strengths-based approach in focusing on protective factors and social supports (Stuart & Roberston, 2012).
It considers the person’s place in broader social context, including family, community and within social systems (Stuart & Roberston, 2012).
It defines depression as an illness that affects an otherwise healthy person, not as a personality deficit (Markowitz, 2016).
Key methods
Interpersonal therapy is regarded as time limited in the acute phase—of anywhere from 4 to 20 sessions—but thereafter requiring ongoing maintenance work (Stuart & Roberston, 2012). Therapy focuses on the context, both social and interpersonal, that precipitated the depression to help the client to understand the causes and to start developing ways to deal with people and situations to build resilience for the future (Weissman et al., 2017). The aim is to help the person link the onset of a depressive episode to something that has happened or is happening in their life or vice versa (Markowitz, 2016).
A simplified sequence of therapeutic intervention would consist of:
- Exploration of person’s history (Markowitz, 2016) and creation of a strong therapeutic relationship (Stuart & Robertson, 2012);
- Bio-psychosocial/cultural/religious case formulation (Stuart & Robertson, 2012) presented to the person and linked to a diagnosis and major life event (Markowitz, 2016);
- Formulation as the focus of treatment
In the session the practitioner should:
- link recent mood and life events and make interpersonal relationships the primary focus (Markowitz, 2016);
- identify maladaptive communications (Stuart & Robertson, 2012) and shift blame away from the person (Markowitz, 2016);
- explore alternative approaches to situations that improve communications and create realistic expectations (Stuart & Robertson, 2012); and
- use role-plays or other practical techniques to achieve change as required (Stuart & Robertson, 2012).
Practitioner’s role
A supportive and active role as “helpful coach” (Markowitz, 2016) who directs discussion and is prepared to be flexible to meet the person’s needs, to explore options, and help the person develop supportive resources outside (Weissman et al., 2017).
Person’s role
The person is a “patient” (Weissman et al., 2017) but one who has to do all the “hard work” (Markowitz, 2016, p. 46).
Applications
Interpersonal Therapy is aimed at people who need interpersonal support to overcome a crisis (Stuart & Robertson, 2012). It is for major life crises such as grief or bereavement, role disputes, role transitions (e.g. changing or losing a job, the end of a relationship, diagnosis of a serious illness and dying) and interpersonal deficits of attachment (e.g. social isolation) as they relate to current relationships or circumstances (Markowitz, 2016).
Expected outcomes
Better communication, healthier relationships, improved mood and a “coherent understanding of how to respond to symptoms” (Weissman et al., 2017, p. 7).
Advantages
Is a time-limited structured intervention with a strong evidence base that lends itself to being a prescriptive therapy in the healthcare system (Stuart & Robertson, 2012).
Limitations
IPT has limited application and requires patient selection (Stuart & Robertson, 2012). Due to the need for the person to be able to relate an intelligible narrative it is less applicable to people with severe cognitive distortions (Stuart & Robertson, 2012).
References
Markowitz, J. (2016). Interpersonal Psychotherapy for Posttraumatic Stress Disorder. Oxford University Press. http://ebookcentral.proquest.com/lib/uwa/detail.action?docID=4706620.
Stuart, S., & Robertson, M. (2012). Interpersonal psychotherapy: A clinician’s guide (2nd ed.). Taylor and Francis Group.
Weissman, M., Markowitz, J. & Klerman, G. (2017). The guide to interpersonal psychotherapy: Updated and expanded edition. Oxford Academic. https://doi.org/10.1093/med-psych/9780190662592.001.0001
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