The Geezer’s Dirty Dozen on Interpersonal Psychotherapy

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This is another psychotherapy presentation. Interpersonal psychotherapy is a time-limited, dynamically informed psychotherapy designed to ease suffering and improve interpersonal functioning. The earliest description is that of the developers, Gerald. L. Klerman and Myrna. M. Weissman, in their book, Interpersonal Psychotherapy for Depression, published in 1984, and from which the following quotation is lifted:

The field of psychiatry is the field of interpersonal relations, under any and all circumstances in which these relations exist…a personality can never be isolated from the complex of interpersonal relations in which the person lives and has his being.–Harry Stack Sullivan, Conceptions of Modern Psychiatry.

Interpersonal psychotherapy (IPT) has been validated for many psychiatric issues, and one of the most important is for postpartum depression. It has been found to be effective and acceptable in this population. One of the main reasons is that many women would rather not take antidepressants. In fact, a systematic review found that patients with major depressive disorder in primary care prefer psychotherapy over antidepressants for treatment if psychotherapy is available. This preference is stronger among postpartum women. While the evidence base for effectiveness of antidepressant in this population is not empirically validated, there is a great deal of evidence supporting the efficacy of IPT. In fact, IPT had an edge over CBT in one study [1].

One of my colleagues, Dr. Scott Stuart, M.D., has been conducting research for many years here at The University of Iowa. His most recent study is:

“TITLE:  PLACEBO CONTROLLED TRIAL OF SERTRALINE AND INTERPERSONAL PSYCHOTHERAPY (IPT) FOR POSTPARTUM DEPRESSION (PPD)

PI:  Scott Stuart, MD

DESCRIPTION:  The overall aim of this project is to determine the most efficacious treatment for women with PPD. We plan to conduct a randomized clinical trial with 300 outpatients diagnosed with PPD. Women are assigned to one of three groups (IPT, Sertraline and Mothercrafting, placebo and Mothercrafting) for 12 weeks of treatment at no cost. Treatment providers are available in Iowa City, Cedar Rapids, Des Moines, and the Quad Cities. Compensation is provided for completing interviews and questionnaires. The study is also being conducted at Brown University.”

Mothercrafting is the placebo condition, which includes basic counseling about child development, breastfeeding, and other childcare issues. Dr. Stuart also alerted me to the International Society for Interpersonal Psychotherapy (ISIPT)  5th international meeting to be held in Iowa City from June 11-15, 2013, see web link for details Events isIPT 5th Meeting in Iowa City, Iowa June 11-15, 2013 | International Society for Interpersonal Psychotherapy.

According to Dr. Stuart: Consider IPT as a work of fine culinary art. Our patients’ fundamental need to be nourished and cared for must be met. The basic recipe is clear, but it is the nuanced and peculiar skill of each chef that brings out the right flavors for the unique patient who needs help that truly satisfies [2].

Slide 3: This is a basic definition of IPT. It’s dynamically informed because it takes a person’s past experiences into account but doesn’t explore them in the detail that psychodynamic therapists would. It focuses on here and now relationships with the people most important in the patient’s life. The goal is to identify what needs to change and foster the patient’s awareness of that and move them towards making it happen.

Slide 4: Research empirically validates the practical effectiveness of IPT in a number of disorders including those that have a both/and relationship between somatic and psychic syndromes. A large body of research demonstrates the efficacy of IPT for perinatal and postpartum depression.

Slide 5: IPT essentially focuses on important interpersonal relationships as the point of intervention. IPT is time-limited for the most part and generally lasts 12-16 sessions. The therapist is warm, validating, and empathic but does not foster the development of a transference relationship. Transference is a dynamic concept denoting a past relationship, often between a patient and key persons like parents or other parental role models, that is replicated in the patient-therapist relationship. That is, the patient may experience the therapist and interact with her almost as though she were the parent.

Slide 6: One of the underlying premises of IPT is that interpersonal distress often underly the development of symptoms and that analyzing communication can foster greater understanding of what goes wrong. This can lead to adjusting expectations we have from others and help us develop more nurturing relationships which help us cope with adversity.

Slide 7: This contrasts IPT with CBT and psychodynamic psychotherapy. CBT focuses more on your thoughts and how they influence emotions and behaviors. Psychodynamic psychotherapy helps us look back into our past relationships in order to gain better understanding of why we are the way we are. IPT, on the other hand, focuses on the here and now communication we engage in with others. The idea is to improve our social connections, which can provide a bulwark of support tending to protect us against symptoms.

Slide 8: The theoretical basis of IPT rests on attachment and communication theories. We tend to thrive on our attachments to other people. We can tend to have secure or insecure attachments which can determine the way we ask for help or drive us to avoid support altogether.

Slide 9: The problem areas of focus for IPT are interpersonal conflict, grief and loss, and role changes. IPT depends less on technique than on fostering a safe, secure, and working relationship that moves patients toward change in the real world. Interpersonal sensitivity/deficit is no longer considered a problem area for focus in IPT.

Slide 10: There are 3 main phases in conducting IPT. The early phase is about making a diagnosis, setting up what treatment will concentrate on, and focusing on symptom relief. This typically takes 2 or 3 sessions. The middle phase is taken up working on identifying specific interpersonal situations that elicit feelings, validating them, and developing strategies for exploring them in session and working on them in the real world. Role playing can also be helpful.The concluding phase emphasizes the patient’s independence and accountability for healing. There can be a maintenance phase in which the patient touches bases with the therapist periodically and in which there could be occasional booster sessions to reinforce what was previously learned.

Slide 11: What therapist and patient work on in therapy is often about communication analysis and discussing in detail what goes on in problematic interactions, called interpersonal incidents. Gently calling attention to or clarifying the emotion displayed in session (process affect) with the content of what the patient describes is going on his life (content affect) can elicit the patient’s awareness of what is going on in key interactions at home.

Slide 12: References and Resources

1. Stuart, S. (2012). “Interpersonal Psychotherapy for Postpartum Depression.” Clinical Psychology & Psychotherapy 19(2): 134-140. Perinatal depression is prevalent and has a great impact on both mother and infant. There are empirically validated treatments for both postpartum depression and depression during pregnancy. Primary among these is Interpersonal Psychotherapy, which has been shown to be effective for postpartum women across the spectrum from mild to severe depression. At present, Interpersonal Psychotherapy is the best validated treatment for postpartum depression and should be considered first-line treatment, especially for depressed breastfeeding women. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message * IPT is a first-line evidence-based treatment for postpartum depression. * IPT can be easily modified for postpartum depression. * Partners can be included in IPT for postpartum depression. * Group IPT for postpartum depression is effective for depression.

2. Stuart, S., M.D. (2006) Interpersonal Psychotherapy: A Guide to the Basics. Psychiatric Annals 36,

Interpersonal psychotherapy (IPT) is a time-limited, dynamically informed psychotherapy that aims to alleviate patients’ suffering and improve their interpersonal functioning. IPT focuses specifically on interpersonal relationships, with the goal of helping patients to either improve their interpersonal relationships or change their expectations about them. In addition, IPT also aims to assist patients to improve their social support so they can better manage their current interpersonal distress.

Stuart S, Robertson M: Interpersonal Psychotherapy: A Clinician’s Guide, 2nd ed. Oxford University Press, London, in press ( October 2012); Oxford University Press: Interpersonal Psychotherapy: Scott Stuart

International Society for Interpersonal Psychotherapy

Public Access | International Society for Interpersonal Psychotherapy

About IPT | International Society for Interpersonal Psychotherapy

IPT Quiz:

1. Problem areas for focus in IPT include all but which one of the following:

A. Role transitions

B. Grief and loss

C. Interpersonal deficits

D. Interpersonal disputes

2. IPT focuses on developing and exploring transference

A. True

B. False

3.  IPT features include:

A. Time limited

B. Dynamically informed

C. Aims to alleviate suffering and improve interpersonal functioning

D. All of the above

4. Role playing in IPT involves:

A. Acting on YouTube

B. Therapist and patient adopting specific roles to help the patient deal with specific communication issues outside therapy

C. Practicing pathologic lying

D. Coping with stage fright

5. IPT is an empirically validated treatment for postpartum depression

A. True

B. False

IPT Quiz Answer Key:

1. C; 2. B; 3. D; 4. B; 5. A

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