IPT for Depression

Presentation by Angela Claffey, Colin Goodwin, Jon

Fledzinskas, and
History and Overview of IPT - Iuri’s Section
- Interpersonal psychotherapy (IPT) is a short-term, attachment based
psychotherapy which aims to improve interpersonal functioning thus alleviate
patient’s sufferings. The main goal is interpersonal change (to improve social
functioning) and symptomatic recovery (to reduce depressive symptoms).

- Developed in the 1970’s by Klerman and colleagues in the context of research to

treat major depression.

- Empirical evidence and based on the biological model of disease - “medical

psychotherapy”, but does not assign a “sick role” to the patient.
The 4 tenets of IPT
1 - Focuses specifically on interpersonal relationships and social support as
points of intervention (interpersonal distress is intimately connected with
psychiatric symptoms and psychological distress generally).

2 - Based on a Biopsychosocial/Cultural/Spiritual model of psychological

functioning (Integrative model where the general functioning and psychopathology
are considered as the result of the interaction between different areas)
The 4 tenets of IPT
3 - IPT is short-term in the Acute Phase of Treatment (Lasts from 4 to 20
sessions, but acknowledges the need for recurring treatments)

4 - The interventions used in IPT typically do not directly address the patient–
therapist relationship as it develops in therapy (Although transference (Freud),
parataxic distortions (Sullivan) and imposition of working models (Bowlby) are
taken into consideration, these are not the focus of the intervention for the
psychotherapist which is more supportive than neutral)
The evidence for IPT
M van Hees et al (2013) conducted a systematic review of literature in order to
answer the following question:

“Is individual interpersonal psychotherapy more preferable in comparison with

other standardized forms of treatment for treating adult outpatients with a primary
diagnosis of major depressive disorder?”

Results: The differences between treatment effects are very small and often they
are not significant. Psychotherapeutic treatments such as IPT and CBT, and/or
pharmacotherapy are recommended as first-line treatments for depressed adult
outpatients, without favoring one of them, although the individual preferences of
patients should be taken into consideration in choosing a treatment.
Structure of IPT
IPT is divided into four phases: the Assessment/Initial Phase, the Intermediate
Phase, the Conclusion of Acute Treatment Phase, and Maintenance Treatment

Assessment/Initial - Is the patient a good fit?

● Seek to understand communication and attachment styles
● Highlight presenting concerns
● This phase seeks to construct an Interpersonal Inventory and develop an Interpersonal Formulation
(a detailed hypothesis)
● A flexible treatment agreement is constructed, with acute session numbers being negotiable

Middle (Intermediate) Phase

● Client and therapist work collaboratively to help client formulate solutions to specific interpersonal
problems. This is done usually through improvement of communication skills or modifying
expectations about a relationship conflict.
● Key part of this phase is implementation and practice (help client be persistent)
Structure of IPT continued

Conclusion of Acute Treatment

● A mutually negotiated ending of the intensive time-limited part of IPT
Review client’s progress in resolving interpersonal problems and plan for future problems that may
arise
● A more seamless transition to the next phase with minimal distress to the client is possible with
tapering of session frequency

Maintenance Treatment
● Client’s risk for relapse and clinician’s judgment determine frequency of maintenance sessions (ie:
low risk = once every 6 months; high risk = once a month).
● Progress is continuously monitored, while termination is never mandated nor is it suggested.
Assessment in IPT
Establishing the diagnosis and interpersonal activation
● Standardized depression measures (PHQ-9)
● Social functioning (Work and Social Adjustment Scale).
● Clarifying diagnosis and time line.
● Treatment target.
● Issues relevant to current episode; here and now approach
● Mobilize personal resources with positive presentation
Relating depression to the interpersonal context
● Detailed review of relationship network
● Nature and function of current significant relationships
● Active evaluation of current relationships and contribution to the depressive experience
● Evaluate social resources
● Diagram of client’s network
Assessment in IPT
Identification of an interpersonal focus
● Prioritize one area to work on
● Assisted in evaluating the impact of their interpersonal difficulties on depression
Formulation and contract setting
● Identifies a specific area for specific attention
● Formulation made explicit and negotiated to be meaningful to the client
● Interpersonal difficulties linked to onset and maintenance of depression
● Specific treatment goals
IPT Techniques - Angie’s Section
Clarification- “asking questions that help the therapist gain insight into the patient’s
experiences, help the patient can understand his own experience better, motivate
patient to change his behavior” (107).

Communication Analysis- “investigation of the hypothesis that the patient’s

difficulties are being caused perpetuated or exacerbated communication. Identifies
patient’s communication patterns and problem solve to develop new methods for
communication” (114).

Problem Solving- Brainstorming with client to generate solutions for the problem
communication. Implementation one of the chosen solutions. Feedback about new
problems that occurred are followed by continuous brainstorming of solutions that
are implemented (139)
IPT Techniques
Use of Affect- “Drawing attention to the patient’s affect, understanding it better, helping the patient use it
graciously communicate more effectively. Help client describe affect and emotions. Assist client to communicate
her affect more effectively to others” (152)

Role Playing- Role playing is best used to model and practice past or future interactions between the patient and
his significant others. Role playing allows more effective communications to be discussed, demonstrated, and
practiced.it is best used with selected patients and with selected problems.

Homework- “Homework is nothing more than a task that the patient is expected to do in the interval between
sessions. The goal of homework assignments in IPT is to increase the likelihood that the patient will engage in
constructive communication change, that her symptoms will be decreased, and that her interpersonal functioning
will be improved “(168)
Role Play Example
Role Play Questions
What did you observe?