All about Interpersonal Therapy (IPT) for Depression and Relationships

Interpersonal psychotherapy, or interpersonal therapy, is a targeted short-term therapeutic approach that usually takes between 12 and 16 weeks. Sessions typically last 50 minutes and are scheduled weekly.

IPT is designed to help you manage acute mood symptoms and improve interpersonal skills.

This type of therapy is based on a medical model of depression. This means that clinical depression is viewed as a biological predisposition, and interpersonal challenges are thought of as triggers.

In this sense, IPT stresses that depression and other mood disorders are never your “fault.” Instead, it’s believed that you might have an inherited or biological tendency to experience these symptoms.

Stressful life events, like interpersonal conflict, may activate them.

But even though depression may have biological contributing factors, you can manage your symptoms if you focus on addressing the interpersonal challenges that activated this underlying biological condition.

Clinical trials have shown that, indeed, if you can effectively address an interpersonal problem, symptoms of depression and other mood disorders tend to diminish as well. This is the main focus of IPT.

What ages is IPT for?

Interpersonal psychotherapy can be a one-on-one experience as well as a group therapy. It has been widely adapted to meet the needs of all ages, from teens to older adults.

For teens ages 12 to 18 years old, IPT has been adapted to IPT-A (interpersonal psychotherapy-adolescents). Similar to the adult version, IPT-A also lasts about 12 to 16 sessions. It focuses on how relationship challenges are linked to the onset or maintenance of symptoms of depression and other mental health conditions.

For children under 12, IPT-A has been adapted to include more parental involvement in a model called FB-IPT (family-based interpersonal psychotherapy). There is some early evidence suggesting its effectiveness in treating children ages 7 to 12 years old.

The late psychiatrist Gerald L. Klerman, MD and his colleagues developed this therapy in 1969 when an 8-month trial study for patients with major depressive disorder (MDD) included the approach as one of the intervention options.

Klerman saw how interpersonal and social stress can worsen depression onset and relapse. This led him to believe that addressing the interpersonal aspects of depression could improve all of its symptoms.

After demonstrating success in clinical trials for many years, IPT was deemed an effective and user-friendly treatment for depression.

Interpersonal psychotherapy was originally developed as a treatment for depression only. In fact, it has proven to be an effective approach for MDD.

Interpersonal therapy techniques have also been adapted and used to treat symptoms of other mental health conditions, including:

• bulimia nervosa
• post-traumatic stress disorder (PTSD)
• bipolar disorder
• social anxiety
• postpartum depression

There’s inconclusive evidence on how well IPT works for persistent depressive disorder and substance use disorder.

During the first few sessions, your therapist will focus on reviewing the status and quality of your most significant relationships.

This includes:

• determining the sources of your social support
• attachment styles
• communication styles
• specific interpersonal challenges you may be facing at the moment or in the past

Based on this assessment, the therapist will propose one focus area for the rest of the sessions.

IPT focuses on four main interpersonal challenge areas that may lead to symptoms of depression. One of these areas is usually chosen to focus therapy on:

1. Grief or complicated bereavement is chosen if the onset of your symptoms is related to losing a loved one.
2. Role transitioning is selected if you are having a difficult time transitioning or adapting to changes in social roles. For example, new relationship status, new professional role, or going from being a student to being an employee.
3. Interpersonal role disputes are the focus if your symptoms are associated with conflicts in a relationship where roles are non-reciprocal or unsatisfactory.
4. Interpersonal deficits are the focus if the onset of your symptoms is not linked to a specific event, but instead you have experienced longstanding challenges in interpersonal relationships.

Besides identifying one problem area, IPT therapy also focuses on two important strategies:

• communication analysis
• decision analysis

Communication analysis aims to establish a link between how you communicate with others and your interpersonal challenges. It also focuses on improving your communication skills.

This includes your therapist playing a script as well as role-playing exercises.

Your IPT therapist might work with you on different aspects of communication, including:

• nonverbal language
• tone
• timing
• emotional charge

Decision analysis focuses on your needs and wants in your relationships and other scenarios. Your therapist may ask you about your ideal outcome scenarios in different situations, as well as how you’d like to resolve your current challenges if it were only up to you. The main goal is for you to identify and value your own needs and desires.

If this is difficult for you at first, your therapist may provide you with different solutions and have you discuss with them how you feel about each of those.

If you propose a solution that your therapist might find not feasible or realistic, they will help you process that challenge as well.

IPT is based on a structured plan and develops in three phases:

1. Beginning

It lasts one to three sessions and focuses on identifying the interpersonal challenge area to work on.

You may be asked to make a list of all your past and current significant relationships, and how you feel about them. Your therapist may also want to review your personal medical history and past therapy experiences.

Based on all of this, they will establish how the rest of the therapy will proceed.

2. Middle

Based on what your therapist found and formulated during the beginning phase, they will now focus on addressing the challenge area: grief, role transition, role dispute, or interpersonal deficits.

This phase will also focus on establishing and addressing the link between this challenging area and your mood symptoms.

The middle phase usually goes from session four to session 14.

During these sessions, your therapist and you might explore alternative ways to handle interpersonal challenges. You may also focus on identifying new, adaptive behaviors for managing similar scenarios in the future.

These middle sessions will also focus on communication and decision analysis.

Even though you won’t go home with homework, your therapist will encourage you to apply the newly found solutions in the real world.

You might review these new experiences in your next sessions and discuss how these strategies played out.

If the new strategy went well, your therapist would encourage you to keep practicing in other scenarios. If you feel it didn’t go well or you didn’t feel comfortable, you may brainstorm new ways to address these problems.

3. End

The final two or three sessions will focus on reviewing your progress. It might also include focusing on role transitioning related to the end of therapy.

You will likely review your past sessions and how you feel about the course of treatment. You and your therapist might also identify new areas you’d like to focus on in the future.

If you’re still experiencing symptoms, your therapist might propose follow-up sessions to address maintenance issues and relapse prevention.

The main goal of IPT is the improvement of your symptoms and your interpersonal relationships.

The idea is that by addressing your interpersonal challenges associated with how you feel right now, these mood symptoms will eventually subside.

In turn, as you feel better, your relationships and social support network will strengthen. This, in turn, will further improve your symptoms and prevent any relapses.

Cognitive behavioral therapy (CBT) and IPT are both considered treatments of choice for depression and other mood disorders.

The treatments are similar. They are both short-term and diagnosis-targeted.

While IPT views depression as a biological predisposition that is triggered by interpersonal challenges, CBT sees it as a result of maladaptive strategies reinforced by dysfunctional behaviors.

IPT focuses on addressing interpersonal challenges, while CBT focuses on identifying thought patterns that may negatively impact your behaviors, and therefore, your mood.

While IPT works with you on improving interpersonal skills and challenges, CBT helps you find new ways of thinking and behaving in different scenarios, not only interpersonal.

When it comes to treating depression symptoms, CBT and IPT seem to both be effective. However, CBT seems to be better at treating some cases of major depressive disorder as well as some anxiety disorders.

Interpersonal psychotherapy or IPT is based on a medical model of depression that views the condition as a biological predisposition that may be triggered by life stress and interpersonal challenges.

IPT focuses on identifying and addressing interpersonal challenge areas to improve mood symptoms.

If you are experiencing any symptoms of depression, and have faced past or current interpersonal challenges, IPT might be a treatment option for you.