Interpersonal Therapy (IPT) in Action: A Clinical Example
Interpersonal therapy is a structured, time-limited psychotherapy that addresses depression and anxiety by focusing on current interpersonal relationships and communication patterns, typically delivered over 12-16 weekly sessions with specific phases targeting one of four problem areas: grief, role disputes, role transitions, or interpersonal deficits. 1
Core Framework and Structure
IPT operates on the principle that interpersonal problems either trigger or maintain depressive and anxiety symptoms, and resolving these difficulties through improved communication skills promotes symptom improvement 1, 2. Unlike CBT which targets cognitive distortions, IPT specifically focuses on the style and effectiveness of interpersonal interactions 1.
The therapy is administered weekly over 12 weeks for adolescents (IPT-A) or 12-16 weeks for adults, with frequent telephone contacts maintained with patients and parents often involved in treatment 1.
Three Distinct Treatment Phases
Initial Phase (Sessions 1-3)
The therapist conducts a comprehensive evaluation of symptoms, diagnosis, and history of interpersonal relationships, paying special attention to changes in relationships immediately prior to symptom onset 1.
The therapist educates the patient about depression/anxiety symptoms and places them within a framework of interpersonal distress, categorizing the problem into one of four areas:
- Grief/Loss: Reactions to death of a close person 1
- Interpersonal Role Disputes: Conflicts with significant others (spouse, family member, friend) 1
- Role Transitions: Life status changes such as grade/school changes, moving, relationship changes, retirement, parenthood, or chronic illness 1, 2
- Interpersonal Deficits: Lack of social skills leading to difficulty starting and sustaining relationships 1
Middle Phase (Sessions 4-10)
The therapist addresses the patient's specific interpersonal problems using concrete techniques including non-directive and directive exploration, clarification, encouragement of affect, and communication analysis 2. The treatment emphasizes options for change that had been precluded by depressive symptoms 1.
For adolescents specifically, IPT-A addresses separation from parents, conflicts with parental authority, development of close relationships with members of the opposite sex, initial experiences with death of relatives or friends, and peer pressures 1. Issues of adolescents in single-parent households are specifically addressed 1.
The therapist supports efforts to decrease pessimism and achieve new solutions to interpersonal dilemmas, encouraging more assertive and direct communication methods rather than passive-avoidant coping strategies 1.
Clinical Example: Role Transition
A 16-year-old presents with depression following a family move to a new city. In the initial phase, the therapist identifies this as a role transition problem area—the adolescent lost established friendships and struggles to form new relationships at their new school 1.
During the middle phase, the therapist helps the adolescent:
- Recognize how the move triggered depressive symptoms through loss of social support 1
- Identify communication patterns that may hinder forming new friendships 2
- Practice more assertive social engagement strategies 1
- Process grief over lost relationships while building new ones 1
Parents are involved in sessions to review progress and support the adolescent's efforts to establish new social connections 1.
In the termination phase, the therapist supports the adolescent's newly recognized independence in managing interpersonal concerns and helps them recognize early warning signs of future depressive symptoms 1.
Evidence for Efficacy
IPT demonstrates moderate-to-large effects for acute-phase depression (effect size g=0.60) with no significant difference compared to other therapies or pharmacotherapy 3. IPT has been found more effective than control therapy for depressed adolescents 1 and shows efficacy comparable to CBT for depression and anxiety disorders 3.
For adolescents with suicidal ideation, IPT was as effective as systemic family therapy and nondirective supportive therapy in reducing suicidal ideation during the 12-16 week treatment period 1.
Important Clinical Caveats
IPT requires patients to establish a therapeutic alliance and commit to informing the therapist about suicidal preoccupations, with agreement to access emergency services if necessary 1. The therapy was originally developed for non-psychotic, non-suicidal depressed individuals, though it can address suicidal behavior used as a method of communicating distress 1.
Patients with severe comorbid depression or anxiety disorders may require individualized approaches under mental health practitioner supervision before or during IPT 1. Some evidence suggests patients with IBS and mental health comorbidity respond less well to brain-gut behavioral therapies than to community-based psychotherapy, indicating that general psychological treatment may be needed before or alongside condition-specific IPT 1.
The therapeutic relationship is empathetic and encouraging of all patient progress, with evaluation of symptoms occurring at each session using both quantitative and qualitative measures 2.