Interpersonal Therapy For Major Depression

Interpersonal Therapy (IPT) is a time-limited and structured therapeutic approach centered on improving mental health by addressing the impact of interpersonal relationships. It focuses on connections between a person’s psychological well-being and the quality of their interactions with others. Unlike some other forms of therapy, which may be ongoing, IPT typically involves a targeted intervention spanning a specific number of sessions to achieve therapeutic goals within a defined timeframe [1].

Interpersonal Therapy, or IPT, is an empirically validated, time-limited form of psychotherapy. It lasts between 12 and 16 sessions, which is the same basic time frame as Cognitive Behavioral Therapy. IPT is designed to treat depression and depressive symptoms. Unlike CBT, Interpersonal Therapy is not a behavior therapy, coming instead from more psychodynamic and social-learning traditions [1].

Erin L. George, MA-MFT, says, “An easy way to understand Interpersonal Therapy and the theories behind it is that this modality assumes that by solving life’s challenges—in this case, struggling relationships—a person is able to relieve many of their depressive systems. Instead of tackling the depression first, this type of therapy targets the interpersonal relationships that are causing sadness, frustration, and other symptoms of Major Depression.”

Instead of focusing on correcting dysfunctional thoughts, IPT focuses on understanding how personal relationships can cause someone to become depressed or experience worsening depressive symptoms. The IPT approach shifts blame from the (typically guilt-ridden) person onto the illness and, to some degree, the interpersonal situation [1]. This can be particularly helpful when used to examine systemic family or relationship dynamics, such as with at-risk families, parent and child relationships, or parents at odds about raising children. 

How IPT Works: A User-Friendly Guide

This therapeutic intervention explores how life events and interpersonal interactions can influence emotions. By addressing and improving relationships, IPT aims to improve mood and emotional well-being.

George says, “IPT therapy can also offer communication tools to help clients learn to express themselves better and maintain emotional regulation within the context of personal relationships. In the same way that CBT therapy helps clients learn new ways of thinking, IPT therapy can be useful in teaching people to communicate, set boundaries, and have and show empathy in their relationships.”

IPT and CBT are both effective therapies, but they differ in focus and technique. While CBT emphasizes the connection between thoughts, feelings, and behaviors to create behavioral change, IPT focuses on the patient’s interpersonal relationships and how they affect mental and emotional health. IPT explores how improving these relationships can alleviate emotional distress, making it distinct in its focus on the interpersonal context as a key factor in well-being. On the other hand, CBT tends to center on modifying cognitive processes and behaviors to bring about therapeutic change.

IPT Phases and Goals

Interpersonal therapy typically consists of three distinct phases, including:

• Initial or formulation phase: Includes assessment of interpersonal issues and moods, identification of problem areas in relationships, and goal-setting
• Middle phase: Includes exploring and working on relational issues, implementing strategies to enhance relationships, and monitoring progress
• End or termination phase: Includes reviewing progress and achievements, preparing for graduation, and discussing skills for maintaining process and preventing relapse

Initial or Formulation Phase

The initial phase of Interpersonal Therapy starts with the interpersonal inventory, which is a structured assessment tool that focuses on exploring current and past relationships. This comprehensive examination delves into significant life events, role transitions, grief, and interpersonal conflicts to identify patterns contributing to emotional distress. The interpersonal inventory serves as a foundation for setting treatment goals and establishing a therapeutic alliance by gaining insights into unique interpersonal dynamics. Establishing a therapeutic alliance means building trust between the therapist and client—something that is imperative for success with this type of therapy.

In the formulation phase, the therapist diagnoses depression and determines the interpersonal context in which the depressive episode arose by considering potential problem areas such as:

• Grief over a recent death or loss, such as the death of a loved one, the loss of a home or job, or dealing with a new disability
• Role transition, such as getting married or divorced, being promoted or demoted, being ill, moving to a new city, or becoming a parent.
• Interpersonal disputes, such as a struggle with a spouse or boss
• Interpersonal deficits, which aren’t caused by life changes but promote social withdrawal and impairments in social and communication skills—for example, never attending social functions for work

Based on the therapist’s conclusions, which are referred to as the “interpersonal formulation,” the therapist and client make an agreement regarding the cause of symptoms and the focus of subsequent treatment.

While in the formulation phase, the IPT therapist focuses on the client’s recent life events and mood. 

IPT also includes a psycho-educational component in which the therapist educates the client concerning the causes of depression, various treatment options, and the potential for improvements. This offers hope and can serve as a way of blaming the illness on depression itself instead of the person or their relationships alone. This slight blame shift, combined with hope, can help empower clients who feel hopeless, which is a common symptom of Major Depression.

In addition, the individual dealing with depression is often encouraged to adopt a “sick role,” which involves being excused from blame for missing activities because of symptoms. At the same time, the individual is expected to be compliant with the therapist’s recommendations and actively work to get better.

Middle Phase

The individual’s acceptance of the interpersonal formulation marks the beginning of the middle phase of IPT. The middle phase focuses on one or two of the four interpersonal problem areas. Each problem area requires a particular set of strategies to overcome. 

• The grief problem area requires catharsis (a release of pent-up emotion) over the loss and establishing new (or resuming old) activities to fill the void of that loss. 
• The interpersonal disputes problem area requires resolving the disagreement or, if resolution is not possible, ending the relationship and mourning its loss.
• The role transition problem area involves mourning the loss of an old role while recognizing the positive aspects of and gaining mastery over a new one.
• The interpersonal deficits problem area requires learning new social skills in order to build new relationships.

During this phase, many therapists also help clients identify natural supports in their lives so they can practice healthy relationships and identify what works in the relationships they have. If no such healthy relationships exist, mental health professionals will often help steer clients toward positive support groups where they can build a new network of supportive relationships.

Each IPT session begins with the question, “How have things been since we last met?” 

Exploring a recent event leads to a discussion of the focal problem area (grief or another identified primary issue). If the client has handled things well recently and is feeling better, the therapist highlights the connection between coping skills and mood and offers congratulations. 

On the other hand, if the client remains depressed, the therapist and individual explore interpersonal difficulties that have arisen and options for handling similar situations in the future. Role-playing alternative approaches help strengthen social skills for future situations.

Termination Phase

The termination phase of IPT, which occurs during the last few therapy sessions, is a “graduation” that reinforces a person’s sense of competence and independence. The IPT therapist points out the client’s achievements during treatment, reviews the nature of depression, and discusses the risk of recurrence. If a client has not improved, the therapist notes that the therapy has failed (rather than the client) and discusses alternative treatment options. People with recurrent depression who have responded to IPT may be offered continuation treatment in a new treatment contract.

What Does IPT Treat?

IPT was originally developed as a short-term treatment for depression, but it has since been used to treat many different mental health disorders, such as: [2]

• Bipolar disorder
• Eating disorders
• Dysthymia
• Posttraumatic stress disorder (PTSD)
• Borderline personality disorder (BPD)
• Anxiety disorder
• Social anxiety disorders
• Perinatal and postpartum depression
• Substance use disorders

IPT can also be helpful for specific issues or transitions people experience, such as divorce, remarriage, attachment issues, grief and loss, and relationship conflicts.

Evaluating IPT’s Effectiveness

IPT is most useful for people who are in the midst of recent conflicts with significant others or who have experienced difficulty adjusting to stressful life transitions. As with CBT, patients who are unable or unwilling to practice skills taught in therapy are not likely to gain significant symptom relief with IPT. Most therapists recommend that clients remain in ongoing maintenance therapy if possible. Maintenance IPT (IPT-M) is often used following the termination of the short-term phase of therapy. Recent research suggests that IPT-M may prevent future episodes of depression, particularly in women.

In clinical trials, both CBT and IPT have been found to be effective treatments for depression. There is no certain way to know upfront whether one form of therapy will be a better fit for you than the other. The available studies are too small and specific to recommend a specific type of person who would benefit best from one or another type of therapy. 

IPT has proven effective for depression as well as other psychiatric disorders. Many people find great results when they combine medication with IPT. Here is what the research says about the efficacy of IPT: [3],[4],[5],[6]

• A review of research revealed that IPT was as effective as CBT for treating Major Depression.
• Couples engaging in IPT have shown reduced depression and fewer relationship issues.
• IPT has also proven effective for addiction, anxiety disorders, and eating disorders.
• Research indicates that IPT can prevent the development of major depression as well as prevent depression relapses.
• One study revealed that IPT was effective in reducing depression and PTSD symptom severity in low-income women with PTSD.