Interpersonal psychotherapy

Interpersonal psychotherapy (IPT) is a brief, present-focused psychotherapy that centers on resolving interpersonal problems and decreasing symptoms. It is a highly structured and time-limited approach that follows a manual and is intended to be completed within 12–16 weeks. IPT is based on the principle that relationships and life events impact mood and that the reverse is also true. It was developed by Gerald Klerman and Myrna Weissman for major depression in the 1970s and has since been adapted for other mental disorders. As an empirically validated psychological treatment for depressive disorders, IPT is recommended in treatment guidelines along with cognitive behavioral therapy (CBT) as a treatment of choice and is more effective when used in combination with psychiatric medications.

History

Originally named "high contact" therapy, IPT was first developed in 1969 at Yale University as part of a study designed by Gerald Klerman, Myrna Weissman and colleagues to test the efficacy of an antidepressant with and without psychotherapy as maintenance treatment of depression.

IPT was influenced by CBT as well as psychodynamic approaches. It takes its structure from CBT in that it is time-limited, employs homework, and structured interviews and assessment tools. The content of IPT's therapy was inspired by Harry Stack Sullivan's psychodynamic interpersonal theory. Unlike psychodynamic approaches, IPT does not include a personality theory or attempt to conceptualize or treat personality.

IPT has been studied in many research protocols since its development. It has been demonstrated to be an effective treatment for depression and has been modified to treat other psychiatric disorders such as substance use disorders and eating disorders. It has primarily been used as a short-term therapy completed in 12-16 weeks, but it has also been used as a maintenance therapy for patients with recurrent depression. Frank and colleagues demonstrated the efficacy of IPT as a maintenance treatment and delineated some contributing factors.

Applications

Interpersonal psychotherapy has been proven as an effective treatment for the following:

• Bipolar disorder
• Bulimia nervosa
• Post-partum depression
• Family therapy
• Major depressive disorder
• Cyclothymia

Adolescents

Although originally developed as an individual therapy for adults, IPT has been modified for use with adolescents and older adults.

IPT for children 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, including a client's relationship with his or her own self; 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 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.

Elderly

IPT has been used as a psychotherapy for depressed elderly, with its emphasis on addressing interpersonally relevant problems. IPT appears especially well suited to the life changes that many people experience in their later years.

Strengths and limitations

IPT is particularly accessible to patients who find dynamic approaches mystifying, or the ‘homework’ demands of Cognitive Behavioral Therapy (CBT) daunting. IPT has been specially modified for adolescents who may find CBT too much like school work, whereas IPT addresses relationships — a primary concern. IPT is abstemious in its use of technical jargon — a bonus for those who distrust ‘ psychobabble’. C.G. Fairburn, in a 1997 study, reported that both patients and therapists in his bulimia studies expressed a preference for IPT over CBT. This may have implications for compliance and therapist morale.

For general psychiatrists, a perceived limitation of IPT is it has not yet been modified for the management of psychoses ( although this limitation is true of many prominent psychotherapies). The CBT model requires such expertise for its use with this population that it would be considered risky for a trainee to attempt its use without expert training and support.

As with any face-to-face therapy, it is demanding of the individual in that effort must be made to attend pre-arranged dates for the therapy sessions. Whereas substantive effort may not be needed for 'homework' tasks, the therapy involves the reenactment of past negative feelings which, as well as creating a danger of emotional harm, often requires more effort than that required in CBT sessions.

Studies, such as the one conducted by Paley et al. (2008), have found little difference in the efficacy of CBT and IPT. A 1990 meta-analysis found that CBT was superior to a no-treatment control group; however, when compared to a placebo control group, there was no significant difference. If CBT and placebo therapies have similar effectiveness, and CBT and IPT have similar effectiveness, it is rational to presume that IPT and placebo therapies have similar effectiveness. Another 1996 study concluded after his experiment that both IPT and CBT showed a tendency for symptoms to recur, thus limiting the long term-effectiveness of these psychological therapies.

Any study showing the success of such therapies often fail to take into account poor attrition rates, which are very common among psychological therapies, as many patients drop out because they feel the therapy isn't working. Thus when an average is taken of the success of the therapy which includes the patients that dropped out, the therapy appears to be less effective than it actually is. If patients remain to complete the therapy, they are more likely to be benefit from it.