What type of interpersonal therapy focuses on the effect of one's interpersonal relationships on their mood, particularly for adults and adolescents with a history of mood disorders such as depression and anxiety?

Interpersonal Psychotherapy (IPT)

Interpersonal Psychotherapy (IPT) is the type of therapy that focuses specifically on how one's interpersonal relationships affect mood, targeting the style and effectiveness of current interpersonal interactions rather than cognitive distortions or thought patterns. 1

Core Distinguishing Features of IPT

IPT uniquely concentrates on the quality and patterns of interpersonal relationships in the immediate social context, examining how patients interact with others rather than what they think. 1 This distinguishes it fundamentally from cognitive-behavioral therapy (CBT), which addresses distortions of thinking that may provoke maladaptive behavior. 2

The therapy operates on the principle that interpersonal problems may cause or exacerbate depression, and depression in turn may worsen interpersonal problems. 2 IPT frames psychiatric symptoms within interpersonal distress, viewing depression as arising from disrupted social support and increased interpersonal stress. 1

The Four Interpersonal Problem Areas

IPT categorizes all interpersonal difficulties into exactly four structured domains: 1

• Grief/loss: Reactions to the death of a close and important person 2
• Interpersonal role disputes: Conflicts with significant others such as a spouse or family member 2
• Role transitions: Changes in life status, such as change of grade or school, moving, retirement, parenthood, or chronic illness 2, 1
• Interpersonal deficits: Lack of social skills that lead to problems starting and sustaining interpersonal relationships 2

Therapeutic Techniques and Mechanisms

IPT uses communication analysis as its primary tool, examining how patients express needs, negotiate conflicts, and maintain relationships. 1 The therapist employs non-directive and directive exploration, clarification, and encouragement of affect to help patients correlate their relational states with their mood. 1

The treatment emphasizes improving interpersonal problem-solving skills and modifying communication patterns to reduce depressive symptoms. 2 Frequent telephone contacts are maintained with patients between sessions. 2, 1

Treatment Structure and Timeline

IPT is administered over 12 to 16 weeks in the original adult format, with weekly sessions. 2 For adolescents (IPT-A), treatment is delivered weekly over 12 weeks. 2

The therapy progresses through three distinct phases:

• Initial phase: Evaluation of symptoms, diagnosis, and history of interpersonal relationships, with special attention to changes in relationships immediately prior to symptom onset 2
• Middle phase: Addresses the patient's specific interpersonal problems, supporting efforts to decrease pessimism and achieve new solutions to interpersonal dilemmas 2
• Termination phase: Supports newly achieved independence in managing interpersonal concerns and helps recognize and diminish effects of future depressive symptoms 2

Evidence Base and Clinical Applications

The American Academy of Child and Adolescent Psychiatry recognizes IPT as more effective than control therapy for depressed adolescents with interpersonal problems. 1 IPT has demonstrated moderate-to-large effects for acute-phase depression compared with control groups (effect size g=0.60), with no significant difference from other therapies or pharmacotherapy. 3

For adolescents specifically, IPT-A addresses developmentally specific interpersonal issues including separation from parents, conflicts with parental authority, peer pressures, first experiences with death, and development of romantic relationships. 1

Important Clinical Caveats

IPT was originally developed for nonpsychotic, nonsuicidal depressed patients. 1 Its effectiveness with actively suicidal adolescents depends on the patient's ability to establish a therapeutic alliance and commit to informing the therapist about suicidal preoccupations and intent. 2, 1

However, IPT is useful for addressing adolescents' use of suicidal behavior as a method of communicating anger, distress, or resolving conflict, provided the patient can commit to going to an emergency service if necessary. 2

Parents and caregivers are often involved in IPT-A sessions during specific phases of therapy to review progress and address family dynamics. 2