Chapter written by João Borges Ferreira, Psychiatry Trainee from Psychiatric and Mental Health Department – Baixo Vouga Medical Center – Aveiro, Portugal.
Reviewed by Benjamin Lavigne, MD, Psychiatrist and Psychotherapist in Les Toises, Lausanne, Suisse, and IPT Supervisor in Centre de Recherches et d’Etudes Appliquees à la Thérapie InterPersonnelle (CREATIP), France.
Brief historic overview
What became interpersonal psychotherapy (IPT) was developed and tested in New England in a study designed in 1969, when the late Gerald L. Klerman, M.D., Myrna M. Weissman, Ph.D. and their colleagues added a psychotherapy condition to an 8-month randomised controlled trial for patients with major depressive disorder. IPT thus became part of the first clinical efficacy study of pharmacotherapy and psychotherapy for depression (Klerman, DiMascio, Weissman, Prusoff, & Paykel, 1974). The study yielded a manualised, time-limited psychotherapy, initially called ‘high contact’ and then renamed IPT. IPT was based on the principles of a medical model, defining major depression as a diagnosable and treatable psychiatric illness, and on empirically derived interpersonal factors related to depression (Klerman, Weissman, Rounsaville, & Chevron, 1984).
As scientific evidence accumulated showing that IPT is a treatment that works for several disorders, investigators pursued opportunities to share their ideas about IPT research and training with each other. The earliest gatherings of IPT professionals were held in conjunction with meetings of the American Psychiatric Association in the late 1990’s, organised by John Markowitz, M.D. In 2002, the International Society for Interpersonal Psychotherapy (ISIPT) was formally incorporated in Australia. The organisation moved to the United States in 2010. ISIPT’s first formal elections were held in 2015. Holly Swartz, M.D. was ISIPT’s first elected President, serving for a two-year term (2015-17), in accordance with newly ratified bylaws. In 2016, ISIPT was reincorporated in Brentwood, Tennessee.
Since 2002, the activities of ISIPT have been directed toward furthering IPT research and training, and supporting the professional development of IPT practitioners.
Description
IPT is a time-limited, diagnosis-targeted, well-studied, manualised treatment for major depression and other psychiatric disorders. By improving their lives and providing symptomatic relief, therapists help patients to solve an interpersonal crisis. IPT helps patients to improve interpersonal situations by helping them to understand their emotions as social signals which leads them to mobilise social support. Its success in a series of research studies has led to its inclusion in numerous national and international treatment guidelines.
Diagnosis-targeted: IPT has demonstrated efficacy as an acute and as maintenance treatment for major depression, and for patients from adolescence to old age; with social rhythm regulation, as an adjunct to medication for bipolar disorder; for bulimia and binge-eating disorders; and, more recently in the field of research, for posttraumatic stress disorder (PTSD) and anxiety disorders.
Theoretical Rationale: IPT’s development was influenced by the interpersonal school of psychology and its leaders such as Harry Stack Sullivan and Adolf Meyer. Sullivan argued that psychopathology arose in the context of conflict between an individual and his primary social unit. Meyer extended Sullivan’s argument, drawing the distinction between the psychoanalytic focus on intra-psychic conflict as a primary locus of psychopathology versus an emphasis on interpersonal conflicts as the genesis of psychopathology in the interpersonal school. IPT also draws on the work of Frieda Fromm-Reichmann who emphasised the social roots of depression, Jerome Frank who articulated a sociocultural definition of psychotherapy, and attachment theorists such as John Bowlby.
Medical Model: IPT uses the medical model as a conceptual framework for patients’ mood symptoms. In the context of initiating IPT, the therapist conducts a psychiatric history and diagnoses a current episode of major depression according to DSM 5 criteria. The IPT therapist likens the depressive episode to other medical illnesses (“no different than asthma or diabetes or pneumonia”) and further explains that the patient has an inherited, biologic vulnerability to depression. Using the medical model as a framework, the IPT therapist stresses that it is not the patient’s “fault” for developing depression–any more than it is someone’s “fault” for developing pneumonia. Using a stress-diathesis model to explain the interaction between biological vulnerability and stressful life events, IPT further posits (and makes explicit to patients) that although individuals are not to blame for their illness, they are in an excellent position to help themselves recover from depression by attending to the interpersonal factors that may serve as triggers for the underlying biologic illness.
Key IPT Strategies
Time Limited: IPT was originally conceptualised to be delivered as 12-16 weekly, 45-50 minute, individual sessions. IPT has been tested in an even shorter, 8-session, brief format.
Interpersonal Inventory: The inventory is an extended psychosocial assessment. The therapist carefully reviews the important people in the patient’s life and the quality of those relationships. The therapist seeks to understand the sources of social support, nature of confiding relationships, romantic attachments, interpersonal communication style, and relationship difficulties that may be a cause or consequence of the depressive episode. The therapist uses information from the interpersonal inventory to select the interpersonal problem area.
Interpersonal Problem Areas: In IPT, the therapist selects one of four interpersonal problem areas as the focus for treatment. The four IPT problem areas are:
Grief or Complicated Bereavement
Role Dispute
Role Transition
Interpersonal Deficits
Structured Treatment: IPT has three phases: beginning, middle, and end. The initial phase can last up to three, four sessions. During that time, the therapist has specific tasks (obtain a psychiatric history and interpersonal inventory, offer a case formulation). The middle phase is focused on resolving the chosen interpersonal problem area in order to improve mood symptoms. The final phase focuses on termination or a “good goodbye”(the last 3-4 sessions)
Main uses
Major Depression
Depression in adolescence
Post-partum depression
Depression in the geriatric population
Depression in the medically ill population
Recurrent Major Depression
Bipolar disorder (adjunctive treatment)
Bulimia
Minor affective crisis
PTSD
Efficacy
At this juncture, IPT had repeatedly demonstrated efficacy for major depression and might have begun to spread into clinical practice. Klerman, Weissman and their colleagues were more researchers than popularisers, however, and the death of Gerald Klerman in April 1992 further delayed the dissemination of IPT (Weissman, 2006). Thus, well into the 1990s, there were probably more published papers on IPT than IPT therapists. IPT was adapted for depressed patients with differing characteristics and depressive subtypes, such as adolescence (Mufson, Pollack Dorta, Moreau, & Weissman, 2004), post-partum (O’Hara, Stuart, Gorman, & Wenzel, 2000), geriatric (Reynolds et al., 1999), and the medically ill (Markowitz et al., 1998; Schulberg et al., 1996) patients with major depression; patients with dysthymic disorder (Browne et al., 2002; Markowitz, 1998) and subthreshold depression (Klerman et al., 1987; Mossey, Knott, Higgins, & Talerico, 1996); adjunctive treatment to pharmacotherapy for bipolar disorder (Frank et al., 2005; Swartz, Frank, Frankel, Novick, & Houck, 2009).
Lately, researchers began to test IPT for patients with diagnoses other than mood disorders: bulimia (e.g., Fairburn et al., 1995) and substance abuse (Carroll, Rounsaville, & Gawin, 1991; Rounsaville, Glazer, Wilber, Weissman, & Kleber, 1983).
In its most novel application, IPT was tested as a treatment for depression in Uganda in communities that had suffered from war, HIV and poverty as well as high rates of depression. Two controlled trials demonstrated the efficacy of group IPT for adults (Bolton et al., 2003) and adolescents (Bolton et al., 2007) in this setting. Recently, further research highlighted the interest of interpersonal approach in treatment of post-traumatic stress disorders (Markowitz et al., 2015)
Comment from an expert and or quote from a famous psychotherapist
“While depression may be a genetic disorder, it has a strong environmental component. And, for a child, a parent's illness is a very strong environmental effect. You want to reduce that effect so that you can have a beneficial effect on the child”.
Myrna Weissman
“The field of psychiatry is the field of interpersonal relations, under any and all circumstances in which these relations exist“
Harry Stack Sullivan
Before IPT, he was a 20th century psychiatrist who stressed the importance of interpersonal connections and developed interpersonal psychoanalysis.
Comment from a trainee with some kind of experience
“IPT is a modern evidence-based psychotherapy, limited in time, with great and fast results which allows the psychotherapist and patients to have a real contract on the way of recovery".
João Borges Ferreira
Psychiatry Trainee
Psychiatric and Mental Health Department – Baixo Vouga Medical Center – Aveiro, Portugal
Books, manual, videos, application, published online courses or international association
Klerman, G., Weissman, M. (1984) Interpersonal Psychotherapy of Depression. Basic Books.
Stuart, S., Robertson, M. (2012) Interpersonal Psychotherapy: a clinician’s guide. Hodder Arnold Press.
Markowitz, John (2017) Interpersonal Psychotherapy for Posttraumatic Stress Disorder. Oxford Press.
Ravitz, P., Maunder, R. (2013) Psychotherapy Essentials To Go: Interpersonal Psychotherapy for Depression. Norton Professional Books. Include DVD with role plays.
Weissman, M., Markowitz, J., Klerman, G. (2017) The guide to Interpersonal Psychotherapy: Updated and Expanded Edition.
Site of Interpersonal and Social Rhytmn Therapy (IPSRT) with online training - https://www.ipsrt.org.
There are a lot of research possibilities: Columbia University, Pittsburgh University, and so on. Anyone can contact the ISIPT and ask for more information of research projects and funds. There are also a WHO project for IPT Group in Uganda and Group Interpersonal Therapy (IPT) for Depression manual in lower income countries (http://www.who.int/mental_health/mhgap/interpersonal_therapy/en/).
Contacts worldwide
ISIPT-Australasia
Situated in Christchurch headed by Associate Professor Sue Luty and Professor Marie Crowe.
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