What Are the Benefits of Interpersonal Therapy?

Interpersonal therapy is one of two major psychotherapies recommended for treating depression, the other being cognitive-behavioral therapy. While cognitive-behavioral therapy focuses on correcting distorted thought processes that influence behavior, interpersonal therapy focuses on a person's external environment. The theory and process of interpersonal therapy rely on resolving internal conflict that occurs when relationships with an important person are disrupted.

Unlike many other therapies, interpersonal therapy is highly structured and designed to be completed in a relatively short amount of time. Interpersonal therapy has years of research supporting its effectiveness in treating depression. More recent research has demonstrated that interpersonal therapy is valid for many other common mental health concerns.

The origins of interpersonal therapy

After nearly five years of development, interpersonal therapy (IPT) had its first successful randomized trial in 1974. IPT is rooted in psychologist Harry Stack Sullivan's interpersonal theory, a psychoanalytic theory of personality he developed in the early 20th century. Sullivan believed that interactions with significant others in a person's life positively influence their mental well-being. Today, "significant other" is commonly used to refer solely to romantic partners. In Sullivan's definition, a significant other is any individual who profoundly influences another person, including family members and friends.

Sullivan believed that the significant others in a person's life provided their sense of security, sense of self, and motivations for their behavior. Another psychologist and contemporary of Sullivan's, Adolf Meyer, expanded Sullivan's argument to distinguish between psychopathology due to internal conflicts and psychopathology due to disruptions in a person's support network.

IPT also benefitted greatly from John Bowlby's research into attachment theory. Attachment theory is a branch of psychology that was first concerned with the attachment between parent and child but was later expanded to conceptualize adult relationships as well. The principles of attachment theory describe the importance of secure attachment to significant others as a mechanism to prevent poor mental health.

Researchers in the 1960s knew and understood the work of Sullivan, Meyer, and Bowlby well. One researcher, psychiatrist Gerald Klerman, recognized how empirical evidence gathered in the early to mid-20th century could be applied to patients experiencing depression. At the time, depression was still poorly understood, and while medication and psychotherapy were both available, they were not as effective as modern options. Klerman's research group began to develop an interpersonal intervention for depression based on the following empirically supported facts:

• Social support networks protect against mental health concerns in general.
• Depression occurs in an interpersonal context and usually involves disrupted attachment with significant others.
• The death of a significant other, antagonistic relationships, life disruptions, and isolation increase the risk of depressive episodes.

• A present-focused mindset is necessary to improve social functioning.

Klerman understood that the above axioms outlined a particular strategy for helping his patients manage depression. He entrusted Myrna Weissman, then a recently graduated social worker, to develop the treatment protocol for what would eventually become IPT. Klerman and Weissman felt that the approach should be highly manualized, meaning a manual could be issued that contained step-by-step directions therapists could follow to administer IPT.

In 1974, Klerman, Weissman, and the rest of their research group published the first empirical evidence of IPT's effectiveness. In the initial study, the researchers compared the effectiveness of IPT against a commonly prescribed antidepressant at the time, amitriptyline. The results indicated that IPT could effectively reduce symptoms of depression.

Research into IPT has continued since the original 1974 study was published. Klerman and his colleagues were more researchers than popularizers, and dissemination of IPT in clinical settings was slow, further hampered by Klerman's death in 1992. Nevertheless, the 90s were a time of enormous growth for IPT as it was tested and modified to be effective for various mental health conditions and patient populations. 

Today, IPT is regularly practiced in clinical settings.

The interpersonal therapy process

IPT is a time-limited, manualized, and medicalized intervention. Time-limited means that the therapy is designed to be completed in a certain amount of time, usually 12 to 16 weeks. Manualized means the therapy is programmatic, and therapists who wish to apply it clinically can follow a treatment manual. Medicalized means that IPT follows the medical model.

The medical model is a conceptual framework to describe a patient's illness. In the context of IPT, depression is treated as if it were any other illness and not the patient's "fault," just as it is not the patient's fault if they develop bronchitis or asthma. IPT stresses that although patients are not responsible for their illness, they are in an excellent position to help themselves recover from it.

Because it is manualized, IPT follows a distinct process with three phases, beginning, middle, and end. The beginning and end phases last two to three sessions, and the middle phase lasts up to ten.

Beginning phase

The first phase of IPT is dedicated primarily to the interpersonal inventory. The interpersonal inventory is an extended psychosocial assessment designed to detect problems the patient has experienced with their significant others. The therapist reviews and questions the patient about important people in their life and the quality of their relationships.

As the patient and therapist converse, the therapist continues to seek to understand the patient's sources of social support, the nature of their trust-based relationships, their romantic attachments, and their interpersonal communication style.

At the conclusion of the beginning phase, the therapist will select one of four interpersonal problem areas for treatment:

• Grief or complicated bereavement. The death of a significant other.
• Role dispute. An unsatisfying interpersonal relationship is categorized by unmet role expectations between two parties.
• Role transition. Difficulty coping with changes in life circumstances is conceptualized in IPT as moving from one social role to another.
• Interpersonal deficits. A long-standing history of issues with interpersonal connections is chosen when no acute interpersonal event can be identified.

Once the interpersonal problem area is selected, the therapist will formulate the case with the patient and describe the next steps. In the middle phase, the client and therapist will work together to address the cause of the selected interpersonal problem.

Middle phase

The specifics of the middle phase are unique to each patient. The therapist might help the patient achieve appropriate mourning, peacefully resolve a struggle with a significant other, help the patient assume a new role, or help them decrease social isolation. The therapist will engage in other structured strategies, such as communication analysis and decision analysis.

Communication analysis is a process through which a therapist can help a patient understand and improve their interpersonal communication by examining what the patient intended to communicate compared to what was actually communicated. Decision analysis helps patients understand the options at their disposal for reducing the symptoms of their depression.

End phase

The end phase, or termination, is viewed as a graduation in IPT. The end phase is treated as a role transition away from therapy. The therapist helps the patient make plans to transition out of therapy and helps them mourn the loss of desired options that are no longer feasible. If the therapy has not been as effective as hoped, the therapist blames the therapy, preserving the "no-fault" attitude moving forward. Sometimes, the time-limited component of IPT may be dropped and continue as maintenance therapy.

Is interpersonal therapy only for depression?

While interpersonal therapy was originally designed to treat symptoms of depression, the years since its initial development have led to several evidence-based adaptations. A growing body of research suggests that IPT is effective for:

• Eating Disorders
• Bipolar Disorder
• Perinatal Depression
• PTSD
• Substance Abuse

Given the importance of social support for maintaining good mental health, interpersonal therapy will likely continue to demonstrate its effectiveness in other areas.

How can online therapy help?

Online therapy is an easy way to access the benefits of interpersonal therapy without leaving your home. You can talk to a therapist about your interpersonal relationships, dissect interpersonal problems, and find solutions without encountering traditional barriers to therapy, like traveling to an office or being restricted to nearby therapists. Online therapists use the same evidence-based treatment methods as traditional therapists. Teletherapy has received enormous research in recent years, and evidence indicates that psychotherapy delivered online is just as effective as if it were administered in person.