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Interpersonal Psychotherapy

INTERPERSONAL PSYCHOTHERAPY

Interpersonal psychotherapy (IPT) is a time-limited psychotherapy originally developed for the treatment of major depressive disorder (MDD). Since its development, it has also been used as a treatment for other psychiatric disorders. IPT focuses on interpersonal relationships because clinical observations and research have documented that depression can be triggered by problems in human relationships. Once people become depressed they may then also have additional problems in close relationshipsmost often with spousesbecause of the symptoms of MDD. Problems in close relationships, however, can make it much harder to recover from depression.

IPT was first developed as part of a large study of the effectiveness of psychotherapy and antidepressant medication for depression in adults. Because IPT was first used in a research study, it was important that research therapists conducted IPT in the same way. IPT was therefore manualized that is, the rationale, goals, and structure of the sessions were all outlined (Klerman, Weissman, Rounsaville, and Chevron, 1984; Weissman, Markowitz, and Klerman, 2000). The original manual still forms the foundation for conducting IPT with depressed people.

IPT is usually conducted over sixteen sessions, and there are three phases of treatment. In phase one (sessions one through three) the patient's symptoms are reviewed, a psychiatric diagnosis is given, and MDD is characterized as an illness. Patients are educated about depression and its treatment, and a determination is made as to whether the patient should be referred for antidepressant medication. Since seriously depressed people often blame themselves for their inability to complete daily responsibilities, they are counseled that this is common in MDD and that a temporary reduction in responsibilities may be best. Next the therapist reviews the patient's most important personal relationships to get a sense of the positive and negative aspects of them and what the patient might want to change in these relationships. The therapist then determines what the likely focus of the psychotherapy will be. IPT usually focuses on one or two of four interpersonal problem areas: role transition (a major life change), grief (problems in coming to terms with the death of a significant other), interpersonal dispute (conflict with a significant other), and social skills deficits (individuals who lack social skills to develop and maintain ongoing relationships with other people). At the end of phase one, the therapist summarizes the patient's concerns and outlines a treatment plan and goals for treatment. The patient is also reminded that IPT primarily focuses on current problems and concerns, in contrast to some psychotherapies in which early family issues are frequently discussed.

In phase two of IPT (sessions four through thirteen) the focus is on achieving the goals that were established in the problem area(s) selected for treatment. Overall goals and specific strategies to achieve those goals have been outlined in IPT for each of the four interpersonal problem areas. The patient continues to be educated about MDD, encouraged to think about and try out different options to achieve therapeutic goals, and, when needed, provided with support, guidance, and encouragement. Overall, the role of the therapist is as an active collaborator and facilitator.

In phase three of IPT (sessions fourteen through sixteen) there is an explicit discussion of the coming end of treatment, clarification of how the patient feels about this, and education that ending therapy can be difficult for some. There is also a review of the patient's progress, including any reduction in depressive symptoms and to what degree treatment goals have been met.

In younger adults, IPT has been found to be effective in the treatment of an episode of MDD, alone or in combination with antidepressant medication. It has also been found to be effective in longer-term studies of the usefulness of IPT and antidepressant medication to keep previously depressed people from having another episode of depression (see Frank and Spanier 1995).

Most people experience significant life changes at some point during old age. Health problems, the deaths of a spouse, siblings, or friends; retirement; adjustment to new social circumstances; and reduction of finances are some of the stressful circumstances older people confront. Most older adults successfully contend with these stresses and do not become depressed. A minority of older people do experience MDD and can benefit by psychotherapy and/or antidepressant medication. Given the interpersonally relevant changes of late life, IPT appears especially well-suited for depressed older adults.

A growing body of research indicates that IPT is useful in the treatment of depressive symptoms as well as MDD in older people. One study found IPT as useful as antidepressant medication in treating an episode of MDD (Schneider, Sloane, Staples, and Bender 1986). In another study, Charles Reynolds and his colleagues used IPT, antidepressant medication, and combinations of these treatments with older adults experiencing MDD who also had prior episodes of MDD. After successful initial treatment with IPT and antidepressant medication, older adults received one of several treatments or combinations of treatments and were followed for up to three years to determine which treatment(s) reduced the likelihood of a recurrence of MDD. Overall, it appeared that the combination of monthly IPT and antidepressant medication best reduced the likelihood of a recurrence of depression (see Reynolds, et al. 1999). In other research, a brief form of IPT reduced symptoms of depression in older people with medical problems (Mossey, Nott, Higgins, and Talerico, 1996).

Research studies and clinical reports indicate that IPT requires relatively little adaptation for older adults. The brief, problem-focused, collaborative nature of IPT is appealing to many elderly people. Role transition and interpersonal dispute are the most common interpersonal problems areas in IPT with older adults. Consistent with research studies, clinical reports indicate that 75 percent of older people with depression-related diagnoses treated with IPT alone or in combination with antidepressant medication evidence a significant reduction in depressive symptoms (see Hinrichsen 2000).

Further research is needed to examine the success of IPT in the treatment of late life depression. However, it appears that IPT is a promising psychotherapy, particularly for depressed older adults who are experiencing interpersonal problems.

Gregory A. Hinrichsen

See also Depression; Problem Solving Therapy; Stress and Coping.

BIBLIOGRAPHY

Frank, E., and Spanier, C. "Interpersonal Psychotherapy for Depression: Overview, Clinical Efficacy, and Future Directions." Clinical Psychology: Science and Practice 2 (1995): 349369.

Hinrichsen, G. A. "Interpersonal Psychotherapy for Treating Late Life Depression." In Innovations in Clinical Practice: A Sourcebook, vol. 18. Edited by L. Vandecreek and T. L. Jackson. Sarasota, Fla.: Professional Resource Press, 2000. Pages 2131.

Klerman, G. L.; Weissman, M. M.; Rounsaville, B. J.; and Chevron, E. S. Interpersonal Psychotherapy of Depression. New York: Basic Books, 1984.

Mossey, J. M.; Knott, K. A.; Higgen, M.; and Talerico, K. "Effectiveness of a Psychosocial Intervention, Interpersonal Counseling, for Subdysthymic Depression in Medically Ill Elderly." Journal of Gerontology: Medical Sciences 51A (1996): M172M178.

Reynold, C. F.; Frank, E.; Perel, J. M.; Imber, S. D.; Cornes, C.; Miller, M. D.; Mazumdar, S.; Houck, P. R.; Dew, M. A.; Stack, J. A.; Pollock, B. G.; and Kuper, D. J. "Nortriptyline and Interpersonal Psychotherapy as Maintenance Therapies for Recurrent Depression: A Randomized Controlled Trial in Patients Older than 59 Years." Journal of the American Medical Association 281 (1999): 3945.

Schneider, L. S.; Sloane, R. B.; Staples, F. R.; and Bender, M. "Pretreatment Orthostatic Hypotension as a Predictor of Response to Nortriptyline in Geriatric Depression." Journal of Clinical Psychopharmacology 6 (1986): 172176.

Weissman, M. M.; Markowitz, J. C.; and Klerman, G. L. Comprehensive Guide to Interpersonal Psychotherapy. New York: Basic Books, 2000.

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