Interpersonal psychotherapy
Encyclopedia
Interpersonal Psychotherapy (IPT) is a time-limited psychotherapy
that focuses on the interpersonal context and on building interpersonal skills. IPT is based on the belief that interpersonal factors may contribute heavily to psychological problems. It is commonly distinguished from other forms of therapy in its emphasis on interpersonal processes rather than intrapsychic processes. IPT aims to change the person's interpersonal behavior by fostering adaptation to current interpersonal roles and situations.
work of Harry Stack Sullivan
, who, although coming from a psychodynamic background, was strongly influenced by ideas in sociology
and social psychology
. Sullivan thought that the most significant factors in triggering emotional reactions in individuals were the interpersonal behaviors
of others.
Interpersonal therapy was first developed as a theoretical placebo
for the use in psychotherapy research by Gerald Klerman
, et al. IPT was, however, found to be quite effective in the treatment of several psychological problems. IPT was later developed in the 1970s and 80s as an outpatient treatment for adults who were diagnosed with moderate or severe non-delusional clinical depression
.
IPT takes structure from psychodynamic psychotherapy
, but also from contemporary cognitive behavioral approaches in that it is time-limited and employs homework, structured interviews, and assessment tools.
s, IPT has been modified for use with adolescents and older adults.
IPT for Adolescents
IPT for kids is based on the premise that depression occurs in the context of an individual's relationships regardless of its origins in biology or genetics. More specifically, depression affects people's relationships and these relationships further affect our mood. The IPT model identifies four general areas in which a person may be having relationship difficulties: 1) grief after the loss of a loved one; 2) conflict in significant relationships; 3) difficulties adapting to changes in relationships or life circumstances; and 4) difficulties stemming from social isolation. The IPT therapist helps identify areas in need of skill-building to improve the client's relationships and decrease the depressive symptoms. Over time, the client learns to link changes in mood to events occurring in his/her relationships, communicate feelings and expectations for the relationships, and problem-solve solutions to difficulties in the relationships.
IPT has been adapted for the treatment of depressed adolescents (IPT-A) to address developmental issues most common to teenagers such as separation from parents, development of romantic relationships, and initial experience with death of a relative or friend (see ). IPT-A helps the adolescent identify and develop more adaptive methods for dealing with the interpersonal issues associated with the onset or maintenance of their depression. IPT-A is typically a 12-16 week treatment. Although the treatment involves primarily individual sessions with the teenager, parents are asked to participate in a few sessions to receive education about depression, to address any relationship difficulties that may be occurring between the adolescent and his/her parents, and to help support the adolescent's treatment.
In the intermediate stages, the patient and therapist, focusing on the present, work on the major problem areas identified. Four major problem areas are commonplace in IPT. The first is grief
, and patients typically present with delayed or distorted grief reactions. Treatment aims include facilitating the grieving process, the client's acceptance of difficult emotions, and their replacement of lost relationships. The second major problem area is role dispute, in which a client is experiencing nonreciprocal expectations about a relationship with someone else. Here, treatment focuses on understanding the nature of the dispute, the current communication difficulties, and works to modify the client's communication strategies while remaining in accord with their core values. A third major problem area is role transition, in which an individual gives up an old role and takes on a new one. In this case, treatment attempts to facilitate the client's giving up of the old role, expressing emotions about this loss, and acquiring skills and support in the new role they must take on. A final problem area commonly broached with IPT is interpersonal deficits. Clients presenting interpersonal deficits commonly engage in an analysis of their communication patterns, participate in role playing exercises with the therapist, and work to reduce their overall isolation, if applicable.
In the end stages of IPT, the therapist works to consolidate the client's gains, discuss areas which still require work, talk about relapse prevention, and process any emotions related to termination of therapy.
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
that focuses on the interpersonal context and on building interpersonal skills. IPT is based on the belief that interpersonal factors may contribute heavily to psychological problems. It is commonly distinguished from other forms of therapy in its emphasis on interpersonal processes rather than intrapsychic processes. IPT aims to change the person's interpersonal behavior by fostering adaptation to current interpersonal roles and situations.
History
Interpersonal psychotherapy largely stems from the interpersonal psychoanalysisInterpersonal psychoanalysis
Interpersonal psychoanalysis is based on the theories of Harry Stack Sullivan , an American psychiatrist, who believed that the details of a patient's interpersonal interactions with others can provide insight into the causes and cures of mental disorder.-Selective inattention:Sullivan proposed...
work of Harry Stack Sullivan
Harry Stack Sullivan
Harry Stack Sullivan was a U.S. psychiatrist whose work in psychoanalysis was based on direct and verifiable observation .-Life and works:Sullivan was a child of Irish immigrants and allegedly grew up in an...
, who, although coming from a psychodynamic background, was strongly influenced by ideas in sociology
Sociology
Sociology is the study of society. It is a social science—a term with which it is sometimes synonymous—which uses various methods of empirical investigation and critical analysis to develop a body of knowledge about human social activity...
and social psychology
Social psychology
Social psychology is the scientific study of how people's thoughts, feelings, and behaviors are influenced by the actual, imagined, or implied presence of others. By this definition, scientific refers to the empirical method of investigation. The terms thoughts, feelings, and behaviors include all...
. Sullivan thought that the most significant factors in triggering emotional reactions in individuals were the interpersonal behaviors
of others.
Interpersonal therapy was first developed as a theoretical placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...
for the use in psychotherapy research by Gerald Klerman
Gerald Klerman
Gerald L. Klerman was an American psychiatrist and researcher whose work included the development of interpersonal psychotherapy, a short-term treatment for depression. He was a chief of the US national mental health agency....
, et al. IPT was, however, found to be quite effective in the treatment of several psychological problems. IPT was later developed in the 1970s and 80s as an outpatient treatment for adults who were diagnosed with moderate or severe non-delusional clinical depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
.
IPT takes structure from psychodynamic psychotherapy
Psychodynamic psychotherapy
Psychodynamic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. In this way, it is similar to psychoanalysis. It also relies on the interpersonal relationship between client...
, but also from contemporary cognitive behavioral approaches in that it is time-limited and employs homework, structured interviews, and assessment tools.
Applications
Although originally developed as an individual therapy for adultAdult
An adult is a human being or living organism that is of relatively mature age, typically associated with sexual maturity and the attainment of reproductive age....
s, IPT has been modified for use with adolescents and older adults.
IPT for Adolescents
IPT for kids is based on the premise that depression occurs in the context of an individual's relationships regardless of its origins in biology or genetics. More specifically, depression affects people's relationships and these relationships further affect our mood. The IPT model identifies four general areas in which a person may be having relationship difficulties: 1) grief after the loss of a loved one; 2) conflict in significant relationships; 3) difficulties adapting to changes in relationships or life circumstances; and 4) difficulties stemming from social isolation. The IPT therapist helps identify areas in need of skill-building to improve the client's relationships and decrease the depressive symptoms. Over time, the client learns to link changes in mood to events occurring in his/her relationships, communicate feelings and expectations for the relationships, and problem-solve solutions to difficulties in the relationships.
IPT has been adapted for the treatment of depressed adolescents (IPT-A) to address developmental issues most common to teenagers such as separation from parents, development of romantic relationships, and initial experience with death of a relative or friend (see ). IPT-A helps the adolescent identify and develop more adaptive methods for dealing with the interpersonal issues associated with the onset or maintenance of their depression. IPT-A is typically a 12-16 week treatment. Although the treatment involves primarily individual sessions with the teenager, parents are asked to participate in a few sessions to receive education about depression, to address any relationship difficulties that may be occurring between the adolescent and his/her parents, and to help support the adolescent's treatment.
Medical indications
- Bipolar disorderBipolar disorderBipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
- Bulimia nervosaBulimia nervosaBulimia nervosa is an eating disorder characterized by binge eating and purging or consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the food consumed, usually by purging and/or by laxative, diuretics or excessive exercise. Bulimia nervosa is...
- post-partum depression
- family therapyFamily therapyFamily therapy, also referred to as couple and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of...
- Major depressive disorder
- CyclothymiaCyclothymiaCyclothymia is a mood and mental disorder in the bipolar spectrum that causes both hypomanic and depressive episodes. It is defined medically within the bipolar spectrum and consists of recurrent disturbances between sudden hypomania and dysthymic episodes. The diagnosis of cyclothymic disorder is...
- Various other disorders
Stages
Interpersonal psychotherapy typically proceeds in several stages. In the initial stages, therapeutic goals typically include diagnosis, completing the requisite inventories, identifying the patient's major problem areas, and creating a treatment contract.In the intermediate stages, the patient and therapist, focusing on the present, work on the major problem areas identified. Four major problem areas are commonplace in IPT. The first is grief
Grief
Grief is a multi-faceted response to loss, particularly to the loss of someone or something to which a bond was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions...
, and patients typically present with delayed or distorted grief reactions. Treatment aims include facilitating the grieving process, the client's acceptance of difficult emotions, and their replacement of lost relationships. The second major problem area is role dispute, in which a client is experiencing nonreciprocal expectations about a relationship with someone else. Here, treatment focuses on understanding the nature of the dispute, the current communication difficulties, and works to modify the client's communication strategies while remaining in accord with their core values. A third major problem area is role transition, in which an individual gives up an old role and takes on a new one. In this case, treatment attempts to facilitate the client's giving up of the old role, expressing emotions about this loss, and acquiring skills and support in the new role they must take on. A final problem area commonly broached with IPT is interpersonal deficits. Clients presenting interpersonal deficits commonly engage in an analysis of their communication patterns, participate in role playing exercises with the therapist, and work to reduce their overall isolation, if applicable.
In the end stages of IPT, the therapist works to consolidate the client's gains, discuss areas which still require work, talk about relapse prevention, and process any emotions related to termination of therapy.
Criticism
A 2002 study comparing IPT therapy to Cognitive behavioral therapy approaches in treating depression found that external observers had difficulty differentiating the two approaches. The request of the study show that therapists using either CBT or IPT saw more gains from treatment the closer they adhered to an "ideal" CBT model. This conclusion casts doubt on the evidence supporting IPT as a stand-alone Evidence-based practice.External links
- http://www.abct.org/sccap/?m=sPublic&fa=pub_WhatIsInterpersonal What is IPT for Adolescents?