Full Content

Interpersonal Therapy

Interpersonal therapy (IPT) has offered a framework for practice that has a focus on current social and relationship arrangements underpinned by the theoretical influences of attachment theory.

Background

Developed principally through the research work of Gerald Klerman, Myrna Weissman and colleagues in the 1970’s (Law, 2014; Markowitz, 2008; Brakemeir & Frase, 2012). IPT “was initially developed as a time-limited and manualized psychotherapeutic approach for the treatment of major depression in outpatients” (Brakemeir & Frase, 2012:117). Although not considered to have a strong theoretical basis, IPT is strongly influenced by Bowlby’s attachment theory and poses that “depressive symptoms may be influenced strongly by the disruption of close personal attachments” (Moore et al, 2010).

Principles

The diagnosis is seen as a treatable medical condition, the medical model places the client in a position free from personal fault, experiencing a set of common symptoms that will respond to a planned and deliberate treatment regime (Markowitz, 2008). It is important to recognize that IPT is concentrated on the ‘here and now’, focusing on current and not previous relationship experiences as driving symptom presentation and therefore the foci of attention (de Mello  et al, 2004; Markowitz, 2008; Robertson, 1999).

The literature defines four clear areas of disrupted personal attachments:

  1. Interpersonal disputes.
  2. Role transitions
  3. Grief
  4. Interpersonal deficits.

(de Mello et al, 2004; Markowitz, 2008; Moore, et al; 2010 & Robertson, 1999).

Treatment

The history of treatment has identified three clear phases ranging between 12-16 sessions.

  1. Early – diagnostic evaluation and framework for treatment.
  2. Middle – treatment framed by particular interpersonal problem area.
  3. Termination – consolidation of gains. (de Mello et al, 2004; Robertson, 1999).

There is growing evidence of IPT being applied to a variety of settings and diagnostic groups that identify quite a variation to length of treatment within the practice of experienced clinicians (Moore et al, 2010).

Therapeutic relationship

Law states “the therapeutic relationship is of crucial importance in interpersonal therapy, but is rarely an explicit focus of discussion” (2011:28). Brakemeir & Frase, describe a structured therapeutic stance that emphases warmth, appropriate personal disclosure in role modelling and the avoidance of transference; “Overall, the therapist should stay in a complementary relationship formation, providing the opposite role to the patient’s behaviour” (2012:118). Robertson supports a structured approach where “the therapist remains warm and positions him or herself in a collaborative framework with strict adherence to the manual.” (1999:25).

Efficacy

“Over the past three decades the efficacy of the IPT approach has been confirmed … IPT efficaciously treats depression both as an independent treatment and in combination with pharmacotherapy … IPT deserves its place in treatment guidelines as one of the most empirically validated treatments for depression” (Brakemeir & Frase, 2012:120).

In agreement with this position, Markowitz (2008) has provided an excellent review of multiple studies covering IPT in treating both mood and non-mood diagnoses. Markowitz cites a lack of positive response in geriatric care, where clients are heavily drawn toward the impact of early life relationships; positive results in treating bulimia, but not so for anorexia nervosa; and poor results in limited trials working with clients with substance use. This review reports promising indications of strong support for the application of interpersonal counselling in the primary care setting (often within a few sessions), relationship work and via telephone support. Dennis & Hodnett (2007) cite IPT to be “equally promising” (p. 7) with CBT and psychodynamic therapy, in supporting clients with post partum depression with the compounding reluctance to take medication and continue breastfeeding.

Singer’s evidence based literature review (2006), noted an absence of established interventions to support youth with the comorbid disorders of suicidal behaviours, major depression and attention deficit; in 2009, Tze –Chun Tang et al citing IPT as “a newly developed treatment model” (p. 463), provided intensive IPT twice weekly over six weeks for secondary school students experiencing depression with risk of suicide, and parasuicide behaviour patterns. The study found, “This short-term treatment model is effective for depressed adolescents with suicide risk in the community setting.” (2009:469).

Reference list

Brakemeier, E-L., & Frase, L. (2012). Interpersonal Therapy (IPT) in major depressive disorder. In, Eur Arch Psychiatry Clin Neurosci, 262 (Suppl 2):S117-S121. DOI 10.1007/s00406-012-0357-0

de Mello, M. F., de Jesus Mari, J., Bacaltchuk, Verdeli, H., & Neugebauer. (2004). A systemic review of research findings on the efficacy of interpersonal therapy for depressive disorders. In, European Archive Psychiatry Clinical Neuroscience (2005) 255:27-82

Dennis, C-L., & Hodnett, E. D. (2007). Psycosocial and psychological interventions for treating postpartum depression. In, The Cochrane Library. Cochrane Depression, Anxiety and Neurosis Group. DOI. 10.1002/14651858.CD006116.pub2

Law, R. (2011). Interpersonal psychotherapy for depression. In, Advances in psychiatric treatment, Vol. 17:23-31. DOI, 10.1192/apt.bp.109.007641

Markowitz, J.D.(2008). Interpersonal Pychotherapy. In, R. Hales, et al (Eds.), The American Psychiatric Publishing Textbook of Psychiatry (5th ed.)American Psychiatric Publishing, Arlinington, Virginia

Moore, T.H.M., Hunot, V., Davies, P., Caldwell, DF., Jones, H., Lewis, G., & Churchill, R. (2010). Psychodynamic therapies versus treatment as usual for depression(Review). In, The Cochrane Library, 2010, Issue 9. pp. 1-15.

Robertson, Michael. (1999). Interpersonal Therapy: An introduction for clinicians. In Australasian Psychiatry, Volume 7, No 1, February 1999, pp. 25-27.

Singer, J.B. (2006). Making Stone Soup: Evidence – Based Practice for a Suicidal Youth With Comorbid Attention Deficit/Hyperactivity Disorder and Major Depressive Disorder. In, Brief Treatment and Crisis Intervention, 6:3, August, 2006:234-237

Tze-Chun Tang, Shaw – Hwa Jou, Chih – Hung Ko, Shih – Yin Huang & Cheng – Fang Yen (2009). Randomized study of scholl – based intensive interpersonal psychotherapy for depressed adolescents with suicidal risk and parasuicide behaviours. In, Psychiatry and Clinical Neurosciences 2009; 63:463 – 470.