Key IPT Strategies

Time Limit: IPT was originally conceptualized to be delivered as 12-16 weekly, 45-50 minute, individual sessions.  IPT has been tested in an even shorter, 8-session, brief format.  In clinical practice, the therapist can adjust the number of sessions to meet the needs of the patient and health care setting, but it is important to define from the outset a discrete time frame for the therapy.

Interpersonal Inventory: The inventory is an extended psychosocial assessment.  The therapist carefully reviews the important people in the patient’s life and the quality of those relationships.  The therapist seeks to understand the sources of social support, nature of confiding relationships, romantic attachments, interpersonal communication style, and relationship difficulties that may be a cause or consequence of the depressive episode.  The therapist uses information from the interpersonal inventory to select the interpersonal problem area.

Interpersonal Problem Areas: In IPT, the therapist selects one of four interpersonal problem areas as the focus for treatment.  The four IPT problem areas are:

  • Grief or Complicated Bereavement
  • Role Dispute
  • Role Transition
  • Interpersonal Deficits 

Grief is chosen as a problem area when the onset or maintenance of the depressive episode is associated with the death of a person close to the patient.

Role Dispute is chosen as a problem area when the onset or maintenance of the depressive episode is associated with an unsatisfying interpersonal relationship characterized by non-reciprocal role expectations between the two parties.

Role Transition is chosen as a problem area when the onset or maintenance of the depressive episode is associated with difficulty coping with changes in current life circumstances.  Role  transitions  may occur in many domains including employment, relationship status, physical health, living conditions, socioeconomic status, etc. The transition is conceptualized as moving from one social role to another social role (i.e., from a student to an employee, from military to civilian status, from single to married, etc.).

Interpersonal Deficits is chosen as a problem area when there is no clear acute interpersonal event associated with the onset or maintenance of the depressive episode and the individual describes a long standing history of impoverished or contentious interpersonal relationships. Although many patients seeking IPT treatment have deficits in interpersonal functioning, the interpersonal deficits category is reserved for cases where no other treatment focus is apparent.  Not surprisingly, patients with chronic impairment in social functioning who lack the life events on which IPT focuses fare worse in IPT.

Structured Treatment.  IPT has three phases: beginning, middle, and end. The initial phase can last up to three sessions.  During that time, the therapist has specific tasks (viz., obtain a psychiatric history and interpersonal inventory, offer a case formulation).  The middle phase is focused on resolving the chosen interpersonal problem area in order to improve mood symptoms.  The final phase focuses on termination or a “good goodbye.”

Communication Analysis: Communication analysis is used to enhance communication skills and thereby improve interpersonal functioning. In order to dissect in detail the communication between two individuals, the therapist asks for a “movie script” of an exchange between the patient and a significant other, including the setting, content, tone, non-verbal communication, and accompanying emotional experience. The therapist queries the patient about what was intended to be communicated as well as what she thinks was actually communicated.  The therapist may then use coaching or role play to help the patient improve her communication skills.

Exploration of Options and Decision Analysis: It is important to ask what the patient she wants in any given situation.  Depressed patients often neglect their own needs and desires because they lack energy, motivation, or interest, or feel doing so is “selfish.”  Thus, when faced with an interpersonal problem, the therapist asks the patient how she would like to resolve the issue.  Depressed patients may initially have difficulty generating options.  Therefore, therapists may have to be relatively active at first, helping patients generate a list of potential solutions. After generating options, the patient and therapist evaluate the alternatives to assess how realistic they are.  They discuss resources the patient needs to achieve the desired outcome and develop a plan to execute necessary changes. If the patient’s desire is not feasible, the therapist helps the patient mourn the loss of that potential outcome.

Termination: The final phase comprises the last 2-3 sessions of treatment.  IPT likens termination to a graduation: the patient has usually made meaningful gains, feels better, and is now ready for something different (i.e., a new treatment, maintenance treatment, no treatment). Thus termination is a role transition from acute therapy.  Therapist and patient review the course of treatment, identify treatment gains, and future treatment needs. If the depression has not fully remitted, the therapist blames the treatment rather than the patient and suggests alternative or adjunctive treatments that might address remaining symptoms. The therapist may also identify interpersonal issues that have not been adequately addressed in IPT, such as ongoing marital discord or job dissatisfaction, and perhaps recommend follow-up care for them.