Interpersonal psychotherapy (IPT)

Interpersonal psychotherapy, or IPT, is a form of mental health treatment for patients with clinical depression. Working with a trained therapist, the patient learns to understand how relationships with others affect the symptoms of depression. The therapist helps the patient to identify key relationships that can influence depression and ways to minimize the effects. The patient is also taught how to form healthy, new relationships. This happens in a series of visits with the therapist over the course of three to five months. The overall goal of the therapy is to reduce the symptoms of depression and improve social relationships. Interpersonal psychotherapy is a relatively new form of treatment, and it is sometimes combined with other treatments such as the use of antidepressant medications.

Background

Depression, which is also known as major depressive disorder, is a medical condition in which the patient often feels sad or is unable to enjoy activities, even those that once brought great pleasure. It is a common condition that can become serious. A person is diagnosed with depression after two weeks of experiencing several of these symptoms:

• Sad mood
• Loss of interest in activities or inability to enjoy activities
• Sleep issues; either sleeping too much or not enough
• Fatigue and/or loss of energy
• Difficulty concentrating and impaired decision-making abilities
• Feelings of guilt, worthlessness, or contemplating death and suicide

Depression is different from the feelings of sadness that can occur after the death of a loved one or other significant loss. However, a loss can result in the onset of major depressive disorder. About one out of every fifteen adults experiences depression each year, and about one out of every six people will experience depression at least once in their lifetime. Depression is treatable, and about 80 to 90 percent of those who are treated will recover. Treatment takes several forms, including the use of antidepressant medications that help restore the balance of brain chemicals that cause depression for some people (pharmacological therapy); "talk therapy" with a trained therapist to help the patient learn coping skills (psychotherapy); and electroconvulsive therapy, a medical treatment sometimes used in cases that do not respond to other methods.

Interpersonal psychotherapy is a form of talk therapy that began as a clinical research experiment in New England in 1969. A team of research clinicians led by American psychiatrists Gerald L. Klerman and Myrna M. Weissman was conducting a controlled study of patients with major depressive disorder that tested the effectiveness of pharmacological treatments such as antidepressant medications. They added a form of psychotherapy in which the therapists helped the patients identify their symptoms and how the symptoms were affected by the patients' social and personal relationships. They also learned ways to behave in those relationships that either prevented or minimized the symptoms.

The approach to psychotherapy Klerman and his associates chose was considered a "high contact" approach, meaning that it involved regular sessions with the therapist. It also used a manual to guide the psychotherapist so that treatment was standardized from therapist to therapist and patient to patient. This was part of an overall trend in the 1960s and 1970s to create a uniform method of diagnosing, categorizing, and treating mental health conditions such as depression.

In addition to being one of the earliest forms of mental health treatments to become standardized, interpersonal psychotherapy defined depression as a medical condition for which the patient was not to blame at a time when many in the medical field believed that the depressive patient played a role in his or her condition. Interpersonal psychotherapy practitioners acted under the belief that while the condition was not the patient's fault, there were behaviors that could be adopted that would help minimize and possibly eliminate the symptoms of depression.

Overview

Interpersonal psychotherapy is based on the idea that dealing with interpersonal relationships is important because those relationships are affected by the symptoms of the patient's depression. For example, if one person in a couple is depressed and the other person is starting a new job that requires more time away from home, the depressed person may experience this as rejection and feel unimportant. The therapist might address this by helping the patient learn more effective communication skills and finding ways the couple can spend time together in a constructive way to minimize the feelings of rejection.

The therapist follows a specific protocol for the therapy sessions. This will include identifying the main relationships that the patient has and choosing a few to focus on that are most likely to produce results. The patient and therapist will work together to identify and develop coping behaviors for three different types of interpersonal issues that are problematic in depression: conflicts and disputes, role transitions and adaptations (changes in the patient's life that feel like losses because of the depression), and interpersonal deficits (too few or too unsatisfactory relationships).

Techniques that might be used by the therapist include active and empathetic listening to give the patient a safe outlet for expressing feelings and concerns, helping the patient to clarify and better understand feelings and concerns in an accurate way, role-playing to act through potentially problematic situations, and developing or improving communication skills. The therapist might also use a technique called encouragement of affect, in which the patient walks through negative or unpleasant feelings and thoughts in the safety of the therapist's office. This helps lessen the intensity when the patient experiences these feelings in actual events.

Another key factor in interpersonal psychotherapy is that it is limited in duration. The first few sessions for either individual or group therapy will be spent familiarizing the patient with the process. A session or two will be spent identifying key relationships to work on; the remainder of the sessions will be spent working on techniques for addressing those relationship issues in ways that minimize the patient's symptoms. From the onset, both patient and therapist know the course of treatment will include between twelve and sixteen weekly one-hour sessions; in some instances, therapy may last for twenty weeks.

Once the weekly sessions end, the patient will likely continue with monthly sessions to reinforce the skills learned during the intense short-term therapy. Managing the relationships so that they do not lead to a recurrence of the depression is the goal. Since its inception, interpersonal psychotherapy has been shown to be at least as effective as the use of antidepressants in treating mild to moderate depression in both adults and children.

Bibliography

"Interpersonal Therapy." Healthline, 4 Feb. 2021, www.healthline.com/health/depression/interpersonal-therapy#overview1. Accessed 2 Oct. 2024.

Markowitz, John C., and Myrna M. Weissman. "Interpersonal Psychotherapy: Past, Present and Future." Clinical Psychology and Psychotherapy, vol. 19, no. 2, Mar.–Apr. 2012, pp. 99–105.

Markowitz, John C., and Myrna M. Weissman. "Interpersonal Psychotherapy: Principles and Applications." World Psychiatry, vol. 3, no. 3, Oct. 2004, pp. 136–39.

Robertson, Michael, et al. "Interpersonal Psychotherapy: An Overview." Psychotherapy in Australia, vol. 14, no. 3, May 2008, img3.reoveme.com/m/3b3fee61308a2336.pdf. Accessed 2 Oct. 2024.

Saling, Joseph. "Interpersonal Therapy for Depression." WebMD, 28 Aug. 2022, www.webmd.com/depression/guide/interpersonal-therapy-for-depression#1. Accessed 2 Oct. 2024.

Van Hees, Madelon L. J. M., et al. "The Effectiveness of Individual Interpersonal Psychotherapy as a Treatment for Major Depressive Disorder in Adult Outpatients: A Systematic Review." BioMed Central Psychiatry, vol. 13, no. 22, 2013, doi.org/10.1186/1471-244X-13-22. Accessed 2 Oct. 2024.

"What Is Depression?" American Psychiatry Association, Apr. 2024, www.psychiatry.org/patients-families/depression/what-is-depression. Accessed 2 Oct. 2024.