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Interpersonal therapy in the general practice setting

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 PEER REVIEWED FEATURE

Interpersonal
therapy
in the general
practice setting
KAY WILHELM AM, MB BS, MD, FRANZCP
ROBERT MAY MB BS

Interpersonal therapy is a useful tool for the How did interpersonal therapy (IPT) originate?
treatment of patients with depression and other Interpersonal therapy (IPT) was originally designed about 40 years
mental disorders. A shorter version is available for ago in a research setting as a time-limited psychotherapy, and its
effectiveness was compared with amitriptyline and ‘treatment as
GPs, which offers a more tailored intervention and
usual’ unstructured supportive psychotherapy. The two main
greater treatment options. investigators were Myrna Weissman, a social worker, and Gerald
Klerman, a psychiatrist. They proposed a brief interpersonally-­
KEY POINTS based treatment specific to each of four interpersonal domains
– grief, interpersonal dispute, roles ­transition and interpersonal
• Interpersonal therapy (IPT) has a strong evidence base for
the treatment of depression.
sensitivity – which, they hypo­thesised, precipitated and maintained
• IPT offers a short-term, unique approach that differs from
depressive episodes (Table 1).1 In the trial, the patients in the arms
cognitive behavioural therapy (CBT). receiving IPT or antidepressant medication showed similar rates
• Interpersonal counselling (IPC) is a shorter, manual-based of improvement, but the combination of IPT and antidepressant
version of IPT that is readily adapted to the general medication had the greatest impact on acute symptom improve-
practice setting. ment and delaying further episodes. Klerman and Weissman
• IPT and IPC formulate a patient’s mental illness in the went on to write the original textbook on IPT.2
context of their social environment. A multicentre trial in the USA was conducted to test the
• IPC can be delivered by GPs and practice staff with an efficacy of the antidepressant imipramine either with or without
interest in psychological therapy with the aid of available
psychotherapy as maintenance treatment for depression.3 The
manuals.
two short-term psychotherapies selected for the trial were
• IPT works well with the medical model and the use of
antidepressant medications and lends itself more
­cognitive behavioural therapy (CBT) and IPT. The patients in
adaptively to some patient circumstances than CBT. both psychotherapy arms showed similar rates of improvement,
• IPT has been expanded to a wide range of mental disorders although manifested in different ways. The imipramine plus
including anxiety, substance use and depression related CBT group improved in dealing with depressogenic cognitions
to medical illness. (thoughts) whereas the imipramine plus IPT group improved in
MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY

• An awareness of IPT and IPC allows a more tailored interpersonal function. The interest in IPT as an active treatment
© KATARZYNA BIALASIEWICZ/ISTOCKPHOTO.COM

intervention and greater treatment options for GPs and in its own right was further informed by a growing interest in
patients. attachment behaviour (an important theory underpinning IPT).

MedicineToday 2017; 18(8): 41-49 What is IPT?

IPT is a time-limited manual-based psychotherapy. It is based
Professor Wilhelm is a Consultant Psychiatrist, Consultation-Liaison Psychiatry on the premise that depression arises in an interpersonal context
Service, St Vincent’s Hospital, Sydney; Professor and Head of Psychiatry, University and that relationship problems (such as disrupted relationships
of Notre Dame, Sydney; and Conjoint Professor, School of Psychiatry, UNSW or expectations of those relationships) play a part in precipitating
Sydney. Dr May is a Psychiatry Registrar at St Vincent’s Hospital, Sydney, NSW. and maintaining depressive episodes.

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Interpersonal therapy continued

Therefore, the goals of IPT in relation • orientation to therapy with other standardised forms of treatment
to depression are to: • treatment in selected domain(s) – for adult outpatients with a primary diag-
• relieve depressive symptoms material can be shown to patients to nosis of major depressive disorder.5 The
• educate patients about the link help them select their preferred authors undertook a systematic review of
between their symptoms and events domains (Table 1) the eight identified randomised controlled
in their relationships • termination of therapy trials comparing individual sole IPT with
• improve skills in interpersonal areas • adding a maintenance phase, where other standardised treatments for adults
that may be contributing to or required. with major depression as the primary
exacerbating the depression. A recent review of studies involving IPT, diagnosis.
• The components of IPT are (see Box 1 CBT and anti­depressant medication inves- The findings were consistent with those
for more details):4 tigated how IPT performed in comparison from previous ­studies, in that they reported

TABLE 1. IDENTIFYING THE FOUR DOMAINS FOR INTERPERSONAL THERAPY1,2

Domain* Description Examples

Grief reaction Helping the patient mourn a loss, particularly a prolonged or Difficulty with grief after a death due to
unresolved response to a loss unresolved issues surrounding the loss

Interpersonal dispute Teaching conflict management skills. This may require: Longstanding bitterness due to
• renegotiation unresolved problems in a relationship;
• acceptance of an impasse both parties ‘stuck’, not able to talk
• recognition that the relationship has broken down about problems

Role transition Helping the patient learn how to navigate shifting roles; difficult Being retrenched, leaving home,
role transitions are either unexpected, unwelcome, untimely or developing a chronic or life-threatening
involve the need for considerable upheaval and change illness, recovering after a long illness

Loneliness, isolation, Improving the patient’s social skills; vulnerable styles include Longstanding difficulties making friends,
interpersonal sensitivity anxious worrying, anxious irritability, shyness, perfectionism, standing up for self, being taken
high personal standards, interpersonally sensitive to rejection seriously

* Domain or main stress area(s) associated with development and maintenance of a depressive episode.

1. COMPONENTS OF THE PHASES OF INTERPERSONAL THERAPY (IPT)

Orientation to therapy Treatment in the designated domain(s) • Anticipate future problems, consider
• Take a full patient history, including selected maintenance and relapse prevention
symptom review and diagnostic • Maintain the focus of treatment in the strategies
evaluation selected domain(s) • Establish contingencies for future
• Undertake an interpersonal inventory • Facilitate discussion of the problem, using treatment (which may include formal
(closeness circle; Figure 1) techniques appropriate to the domain booster sessions or another opportunity
to use IPC or IPT in the future, if the
• Educate about depression and • Attend to the patient’s affective state,
need arises)
symptom management including any need for antidepressants
• Assess the patient’s need for • Attend to the patient’s interpersonal Maintenance
medication relationships Identify and tackle resistance • Note the importance of recalling agreed
• Link symptoms to interpersonal context and other obstacles as they arise goals and new roles
(interpersonal formulation) • Discuss termination of IPT from the outset • Build in further formal booster sessions
• Work with the patient to identify the (a loss and role transition in itself)
• Maintain a social network
problem area(s)
Termination • Review relationships with healthcare
• Explain the rationale for IPT providers
• Wind up and acknowledge the ending as
• Explain the patient’s role in IPT, including a transition • Use cognitive behavioural therapy
discussion of the meaning of the ‘sick role’ approaches to identify relapse
• If interpersonal counselling (IPC) is
• Set a treatment contract performed by a GP, signal the return to cognitions and signs
‘business as usual’

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similar efficacy for IPT and CBT­, but (not in how someone appraises ­situations can Early research into CBT aimed at show-
surprisingly) CBT had more effect on cog- affect their mood and behaviour. The ing when its results were equal to or better
nitions and IPT on social function. The patient is encouraged to challenge these than antidepressant medication use. Indeed,
inclusion of antidepressant ­medi­cations appraisals and replace them with more a multicentre study used IPT as a different
made a difference in some studies but not helpful ones. It works best with people who form of psychotherapy to CBT to ensure
in others and varied by type; venlafaxine, can identify their thought processes and that any improvements in the CBT groups
imipramine and nortriptyline had more use a questioning approach to changing were due to the effect of psychotherapy in
effect than selective sero­tonin reuptake their unhelpful thinking styles. general.3 From the outset, studies into the
inhibitors. Barth and colleagues noted that Before of IPT have looked at the con-
IPT focusses on stressors in the patient’s effectiveness
the outcomes suggested that several kinds interpersonal context andFamily how they can tributions made by IPT and antidepressant
Friends
of treatments are effective or efficacious make changes in their relationships withJamiemedications together and separately. IPT
for patients with depression and recom- others, using the four domains (Table 1). works Mum well as a treatment on its own and
mended that patients can be given a treat- The patient is encouraged
Sarahto make changes works better in combination with antide-
ment that fits their personal preferences, in how they relate to their significant others pressant medicationsGrace than CBT. GPs may
and this in turn may may have a positive and social network. This can be simply Angelabe more comfortable ­prescribing an antide-
Andrew
Tamara
effect on the outcome.5 listed or undertaken by construction of a pressant and using the psychotherapy
closeness circle, which graphically repre- together. The importance of the ‘sick role’,
How does IPT compare with CBT? sents the patient’s interpersonal network as part of ‘the medi­c1al model’, is 2 consistent
3
Both IPT and CBT are intended to be time (Figures 1a and b). It can be useful to guide with this finding (Box 2).6
limited and instruction manuals are avail- the direction of therapy and can serve asGPa Jayant
able to provide guidance on the content reference for progress. It also recognises How has IPT evolved?
of sessions. that when people are depressed and anx- IPT has become a well-accepted and
Therapist
CBT identifies and addresses the cogni- ious, it is not always because they have empirically validated treatment for a
Trish
tions and behaviours that precipitate and ­dysfunctional thoughts (e.g. if dealing with ­variety of psychiatric disorders.6 Evidence
maintain depression. It implies that changes a serious illness). Professionals/ has supported its use for a variety of mood
Services Colleagues

After
Before
Emily
Family Jamie Friends Family Friends

Mum Adam
Mum
Sarah Jamie
Grace Grace Scott

Angela Tamara
Tamara Andrew Andrew
Sarah Angela

1 2 3 1 2 3
Jayant

GP Jayant
Trish
GP
Therapist
Trish
Professionals/ Therapist
Professionals/ Services Colleagues
Services Colleagues

After
Figure 1a and b. Closeness circle: an interpersonal inventory. The closeness circle is a graphical representation of the patient’s interpersonal
network. Interpersonal inventory before (a,Emily
top) and after (b, bottom) interpersonal therapy. See Case scenario 1 in Box 4 for an example of
how this tool can be implemented.
Family Friends
Adam
Mum
Jamie
Grace Scott MedicineToday ❙ AUGUST 2017, VOLUME 18, NUMBER 8 43
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Andrew
Interpersonal therapy continued

2. THE ‘SICK ROLE’ AS DEFINED IN 3. SOME FURTHER APPLICATIONS OF INTERPERSONAL THERAPY (IPT)7
THE MEDICAL MODEL6

The original IPT model for depression6 has been adapted for the following uses.
• The idea behind the ‘sick’ role’ is that
the patient is someone who needs Specific categories and contexts for Other disorders
care and has an illness (a treatable depression • Bipolar disorder (interpersonal and
condition), rather than being a • Peripartum and postpartum depression social rhythm therapy)
‘defective person’. • Dysthymia • Anxiety disorders
• This also draws on the doctor–patient
partnership as an opportunity to work • Recurrent depression • Post-traumatic stress disorder
collaboratively towards recovery. • Depression in adolescence • Substance abuse
• It empowers patients to decide and
• Depression in old age with mild • Disordered eating (i.e. anorexia,
‘take charge’ given the advice in their
cognitive impairment bulimia, prevention of obesity in
own biopsychosocial context.
• Depression in rural African settings adolescents)
• The idea of the ‘sick role’ as a
temporary state to give the patient • Depression in patients with HIV • Personality disorders
time and resources to work towards
• Depression in patients with breast cancer
their recovery from their condition/
illness is promoted by interpersonal • Depression in patients with a history of
therapy. low-level crime

disorders, anxiety disorders and eating with bodies such as the Interpersonal originally on depression, it has since been
disorders. IPT has the most evidence for Psychotherapy Institute in the USA used for several other conditions.7 Some
its treatment of patients with depression, (https://iptinstitute.com) providing of the adaptations are listed in Box 3.
second only to CBT.5 The use of IPT ­ongoing training and accreditation. CBT is the most commonly used psy-
has continued to expand internationally Although the focus of IPT was chotherapy for patients with depression,
but not everyone can relate to its highly
TABLE 2. AN EXAMPLE OF AN INTERPERSONAL APPROACH TO ROLE TRANSITION structured approach and it is not always
applicable. There are also specific popu-
The role I want to change to is to be a ‘competent self-manager’ of my life and my lations going through role transitions, such
diabetes
as those entering retirement or diagnosed
Advantages of changing to new role Disadvantages of changing to new role with terminal illness and others engaged
in interpersonal difficulties (either as dis-
• I will feel stronger • My family may not listen or appreciate
me changing putes or attachment issues) where an IPT
• I will have more control of my diabetes
• It means more is expected of me
approach lends itself more intuitively to
• I can tell my husband how I feel about
(I can not hide behind being helpless) the therapeutic process (Table 2). These
all the late nights working
• I will have to express my feelings are also cases where a CBT approach may
• Being stronger with my family will help
me lose weight • It may not work! be useful for some specific issues before
• It may help me get a better sense of
or after IPT. For example, it can be useful
direction in life in identifying cognitions present as part
• I will be achieving something of early relapse (relapse signature).
• I will set a good example for my kids
How can IPT be used in general
Advantages of NOT changing to new role Disadvantages of NOT changing to new role practice?
• I can stay with what I know • My relationships may suffer Having an idea of the process and domains
• No one expects much of me • Family and friends will get fed up and of interpersonal problems helps GPs
see me as a burden ­provide a framework for understanding
• My health will probably suffer problems and identifying patients who
• I will feel bad about myself would most likely benefit from an inter-
• This will reflect on my relationships
personal approach to psychotherapy (Table
3, Box 4 and Figure 2).2,8-12 This can be
• I will not be well enough to get a job
implemented by the GP themselves in the
• I will go on being depressed
form of interpersonal counselling (IPC)

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 TABLE 3. EXAMPLES OF INTERPERSONAL APPROACHES IN THE FOUR DOMAINS

Domain Some examples of questions pertinent to the domains*

Grief reaction • Can you tell me about … (the person who has died)?
• What happened? How did you feel at the time? And now?
• What are your own traditions of grieving?
Have you used these?
• How was your relationship with ...?
• How have you managed since the death? How has your life changed?
• Have you had the support you wanted or expected?
• Were there people you could count on when ... died?
• Later questions involve finding ways to remember the person and
finding new roles – this may involve questions about role transition

Interpersonal • How do you express your anger to others?

dispute • How are you getting on with ... (the person you have a dispute with)?
• Are you having difficulty communicating with ...?
• Have you found yourself unhappy, disappointed and/or angry?
• Are you happy with the way people treat you?
• Can you tell me about the dispute or disagreement?
• How well do you think people understand you?
• In your current dispute, what are the issues? How does it make you
feel?
• Some disputes involve arguments and disagreement: you may need
to find new ways of working things out (such as renegotiation)
• Some disputes are quiet: you feel misunderstood, unheard, but do not
talk about it, neither of you are communicating (at an impasse)
• Some relationships feel as though they are ending, that they are
beyond salvaging. Can you reconsider whether this is the situation?
If this is the best course, it is still best to ensure that there is as
little fallout as possible (dissolution)
• Communication analysis example: Can you describe a dispute? What
was said by you, by ...? What happened? What did you want to
happen?

Role • Have you experienced changes in your relationships, life, work or

transition health?
• How would you describe your old role and your new role?
• What are the positives and negatives in your old role? in your new
one?
• How were you before the change in role? How would you like to be?
• What can you do to make your new life better?
• Who is there to support you in making these changes?

Loneliness, • Can you describe any close relationships you have had?
isolation, • What problems do you have in your close relationships?
interpersonal • How frequently does this happen?
sensitivity • How do you approach people or get invited to social events or convey
interest to people you are talking to? Does this turn our as you would
like? If not, why not?
• Can we practice this with some role playing?

or by referral to nursing or allied health IPT works well with the medical model
professionals. Additionally, identification used in general practice and incorporates
of a specific interpersonal focus of distress education about ‘the sick role’ and sub­
should trigger the GP to consider a sequent recovery. Unlike CBT, the IPT
­provider trained in IPT as an alternative process is comfortable with concurrent
to CBT. prescription of medication, which may

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Interpersonal therapy continued

4. CASE SCENARIOS: IMPLEMENTING INTERPERSONAL COUNSELLING

Case 1 Case 2
Roy was a 37-year-old accountant who presented to his GP after the Margaret was a 54-year-old married woman with a 10-year history of
breakdown of his 12 year-long marriage with Angela, aged 34 years. type 2 diabetes. She lived with her two children (Alex, 22 years, and
He reported increasing arguments and frustration, with a ‘tense Sara, 20 years) and husband Rob, 56 years, who was working long
and loveless’ atmosphere at home. He worried how this might be hours. One of her three close friends had recently moved interstate.
affecting his children (Tamara, 14 years, and Jamie, 12 years). She had also been caring for her elderly mother who had recently
They had attended couples counselling with limited success, and been placed in a nursing home. She acknowledged that she was
Roy believed the situation had caused significant changes to his ‘too heavy’, drank ‘too much soft drink’, engaged in ‘comfort eating’,
mood and had affected his performance at work. smoked 10 cigarettes a day and ‘should do more exercise’. She had
He reported mood swings, problems controlling his anger and experienced intermittent episodes of depression and occasional
disturbed sleep. He asked the GP if he was depressed and for panic attacks.
advice about whether he should separate from his wife for the She had been seeing her GP because of tiredness and poor
sake of their children. glycaemic control. She stated that she had ‘lost her purpose in
Given the interpersonal nature of Roy’s problems, the GP life’.
considered interpersonal counselling and did the following. The GP decided to consider the possibility of IPC and did the
• Reviewed whether Roy had clinical depression, performed a following.
risk assessment and considered whether prescription of • In session 1, the GP reviewed whether Margaret had clinical
antidepressant medication would be useful. (The GP decided that depression. IPC principles and treatment domains (Table 1) were
Roy did not require antidepressant medication at this time). discussed, including the ‘sick role’, the impact of depression on
• The GP became familiar with the process of interpersonal her daily function, risk issues and whether an antidepressant
counselling.9,11,12 prescription was useful. Margaret was not keen to take
antidepressant medications at that point.
• In the initial IPC session, Roy chose ‘interpersonal dispute’ in the
context of his marriage. He agreed to construct an interpersonal • The GP and Margaret constructed an interpersonal formulation
inventory, here shown by a closeness circle (see Figure 1a). (see Figure 2). She was asked to think about her current roles
(as wife, mother, worker and poor organiser of her current health)
• In session 2, Roy discussed his current relationships. He divulged
and to identify people in her interpersonal network, illustrated
that the relationship first broke down four years ago, following his
with the closeness circle. Margaret chose ‘role transition’ as a
extramarital affair and subsequent withdrawal of intimacy by
focus for change and they decided that the transition would be
Angela. He identified that he and Angela were at an ‘impasse’,
from a role of ‘chronic, difficult patient’
meaning that their efforts to resolve the dispute had stalled;
with little control of life and diabetes to a role of ‘competent ­
however, neither party was actively attempting to end the
self-manager’ of her diabetes.
relationship. Further exploration revealed that Roy felt guilty for
his infidelity and the effects of this on Angela and the children. • The GP and Margaret considered ‘role transition’ (see Table 2)
from ‘poor self-manager of diabetes to ‘good self-manager’ as a
• In session 3, the GP asked Roy to consider: What are the issues
treatment focus.
in the dispute? How likely is change to occur? How do Roy and
Angela usually work on differences? Is there a pattern?9 • In session 2, the GP prescribed an antidepressant. They went
through Margaret’s closeness circle. She considered the pros and
• A communication analysis revealed that Roy expressed these
cons of staying ‘as she is’ and making changes. What would these
feelings ineffectively leading to further misunderstandings and
changes look like? What would life look like without any changes?
arguments. In session 3, problem-solving exercises were
Who in her closeness circle would be available to support her with
undertaken with to view to deciding if he wished to make changes
the changes?
or wanted to learn to live with an impasse in their marriage.
• In two further sessions, they discussed the impact of
• In session 4, with the aid of role play with the therapist, Roy
antidepressant medication on her mood and any side effects.
explored new ways of relating to Angela.
The GP supported her in discussing her new roles and how she
• In session 5, Roy reported that he had talked to Angela more related to her husband, children, mother and friends. This included
openly and they had agreed to remain married until their youngest Margaret deciding to involve two friends in an exercise program,
child was 16 years, and then reassess. They had decided to discussing changing the diet with family and reviewing her
collaborate better, utilise clearer communication to minimise relationship with her mother. (These sessions involved use of
misunderstandings and draw on their wider social circle for communication analysis and role play to encourage new
support. relationship styles).
• In session 6, Roy’s mood state had improved. The closeness circle • A ‘wrap up’ session reviewed the changes and it was suggested
was repeated and shown to have changed (see Figure 1b). The GP that each three months, the GP and Margaret would review her
and Roy ‘wrapped up’ and reflected on what had been learnt and progress and prevent relapse.
how to maintain improvement. The GP said Roy was welcome to
Note: Interpersonal counselling has a more structured approach than interpersonal
come back and discuss the situation if he felt that he wanted to do therapy and is designed to be conducted with minimal training (by using a series of
any further work on his relationships in the future. structured questions) and is suitable for use by GPs or practice nurses.

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Interpersonal therapy continued

Understanding your episode 5. RESOURCES FOR THOSE

INTERESTED IN TRYING AN
Predisposing factors Precipitants INTERPERSONAL APPROACH
Biological factors (e.g. life events leading to loss,
(e.g. genetic factors, medical illness, change, stress and illness)
• Black Dog Institute. Understanding
brain injury, medications, drugs, alcohol,
nicotine) Good friend moving your depressive episode. Sydney:
Black Dog Institute; 2017.
Overweight, type 2 diabetes Rob often home late Available online at: https://www.
Smoke 10/day, little exercise Kids less often around blackdoginstitute.org.au/docs/
Mother in nursing home default-source/psychological-toolkit/
Poor control of blood sugar 22-understanding-your-depressive-
episode.pdf?sfvrsn=2 (accessed
Personality factors July 2017).
(e.g. anxiety, worrying, low self-esteem,
• Black Dog Institute. Exercise handout
irritability, irritable style, perfectionism, Personal meaning of events
feeling trapped or helpless) 2: weekly exercise plan. Sydney:
Current predicaments
Black Dog Institute; 2017.
Put others first – neglect self I don't matter Available online at: https://www.
blackdoginstitute.org.au/docs/
Put off things for self I am feeling worthless
– is it worth it? default-source/psychological-
Not looking after health toolkit/2-exercisehandout1-
I have lost my way weeklyexerciseplan.pdf?sfvrsn=2
My family don't understand (accessed July 2017).
Interpersonal factors, domains
(e.g. disputes at work, with family, friends, • Law, R. Interpersonal therapy: the
recurring difficulties with relationships, model. Stafford, UK: NHS; 2010.
loneliness, isolation) Available online at: http://www.
sssft.nhs.uk/images/Psychological_
Haven't told Rob how I feel
Services/Interpersonal-
Children doing their own thing Psychotherpay-The-Model.pdf
DOMAIN = Role transition (accessed July 2017).
• Weissman MM, Markowitz JC,
Protective factors How episode is experienced Klerman GL. Clinician’s guide to
(e.g. social support, alliance with treating (i.e. symptoms, particularly early interpersonal psychotherapy.
clinicians, understanding of depression, in episode, these are important New York: Oxford University Press;
effective coping strategies) as goals for symptom relief, also 2007.
relapse signature) There is also a brief guide available,
Family support and love printed in the same year from the
Outcome Fatigue
Good circle of friends same publisher.
Forget medications • World Health Organization (WHO) and
Interesting p/t job
Irritable and teary Columbia University. Group
Love cooking
interpersonal therapy (IPT) for
depression. Geneva: WHO; 2016.
Available online at: http://apps.who.
Figure 2. An interpersonal formulation. int/iris/bitstream/10665/250219/
1/WHO-MSD-MER-16.4-eng.pdf
(accessed July 2017).
be an important aspect of therapy. GPs backgrounds are outside mental health.
The IPT group manual is published
can assist in commencing and titrating It is highly structured and provides scripts by the World Health Organization
medi­cations, medical interventions and to guide clinicians through the various (WHO). Although intended for groups,
lifestyle modifications alongside the ther- stages over three to six sessions, again it gives an idea of questions that can
apy (Box 1). focusing on the same four domains as IPT be used for IPC for individuals as well.
The WHO currently has a second
(Table 3). It can be implemented by GPs
version of an Interpersonal Counselling
What is interpersonal with relative ease after training with the for Primary Care handbook written
counselling? aid of supportive resources. It has been by Weissman and colleagues for
IPC is a simplified and manual-based used by GPs in some settings and is a good individual therapy nearing publication.
form of IPT.13 It was developed for use in way of learning about IPT. Resources for This will be available soon and will
be noted on the same website.
primary care for patients with depression those interested in trying an interpersonal
and is for healthcare professionals whose approach themselves or engaging practice

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 6. HOW TO FIND AN INTERPERSONAL
THERAPIST

Interpersonal psychiatrist
• Go to https://www.ranzcp.org
• Click ‘Find a psychiatrist’
• Enter suburb or town and choose
maximum distance away
• Choose primary problem and
population treated
• Click ‘Advanced search options’
• Choose ‘Psychotherapy –
Interpersonal’ under the ‘Treatment
and services’ option
• Click ‘Search’ for results
Interpersonal psychologist
• Go to https://www.psychology.org.au
• Click ‘Find a Psychologist’
• Select the mental health issue
• Select the location and radius
• Click ‘Find’
• Scroll down to panel on left called
‘Therapeutic approaches’
• Click IPT for results

nurses are given in Box 5. Details on find-

ing an interpersonal therapist are provided
in Box 6.

Conclusion
There is now a range of effective, manual-
based, short-term psychotherapies, which
provide GPs and their patients with choice.
The growing interest in IPT comes from
evidence showing it is as effective as CBT.
IPT can be used for a variety of psychiatric
disorders. It incorporates the ‘sick role’
and works well for patients who are med-
ically ill or require medication. GPs or
their practice nurses could undertake IPC
using a manual-based approach in its
current form, whereas formal training is
required for IPT.  MT

Acknowledgements
The authors would like to thank Dr Christopher Wurm
for comments on the final draft of this article.

References
A list of references is included in the online version of
this article (www.medicinetoday.com.au).

COMPETING INTERESTS: None.

MedicineToday ❙ AUGUST 2017, VOL 18, NO 8 49

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 MedicineToday 2017; 18(8): 41-49

Interpersonal therapy
in the general practice setting
KAY WILHELM AM, MB BS, MD, FRANZCP; ROBERT MAY MB BS

References
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The efficacy of drugs and psychotherapy in the treatment of acute depressive
episodes. Am J Psychiatry 1979; 136: 555-558.
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