Q & A

Q: So, is the term ‘interpersonal disputes’ or ‘role disputes?’

A:  I’ve always thought that the core of the disputes problem area was Klerman and Weissman’s concept of non-reciprocal role expectations. Framing a dispute in that way makes it so much easier and more specific for both the patient and the therapist.  It’s easier for the patient because it means that there’s not something FUNDMENTALLY wrong with me, with my partner in the dispute, or our relationship; it’s that we have different expectations of one another and they are not aligned.  When presented to the patient in that way, it seems approachable as a problem.  It’s easier for the therapist because one can typically get very specific information about what the patients expects of the other party to the dispute and pretty specific information about what the patient believes the other party’s expectations are. That kind of specific information is something one can really work with, in contrast to a more amorphous set of complaints about the relationship.  Clearly understanding those misaligned expectations is also very helpful in staging the dispute. ~ Ellen Frank


Q: Is IPT applicable in other cultures?

A: Yes, there is extensive experience in treating patients with a non-Western background and/or minoriy groups in Western countries. IPT seems to be equically effective for these patients. Often cultural adaptions have to be made . For example the way emotions are expressed (or not!) can differ greatly and the therapist must be sensitive to these differences from traditional Western views. For most patients the theory of IPT makes perfect sense: the way you feel is very much infuenced by the way you relate to the people around you. ~ Marc Blom


Q: Can all patients with depression be treated with IPT?

A: IPT works best in patients with a non-chronic form of depression.

Besides duration of the episode, the severity seems to matter most although research is somewhat conflicting in this area. Generally speaking patients with a depressive episode less than 12 months and with a mild to moderate severity will likely profit from IPT. ~ Marc Blom


Q: What is a common “beginner’s mistake” when learning IPT?

A: When starting a first IPT case, many therapists are so eager to “get it right” that they do not take the time to listen to their patient.  Beginning therapists sometimes focus too much on IPT procedures and not enough on their patient. Remember that IPT is an affect-focused psychotherapy.  Although it is very important to cover all the tasks required of IPT (the interpersonal inventory, giving the sick role, case formulation, etc.), it is also critically important to focus on feelings, pull for affect, and allow for silence.  Balance the IPT-specific factors and task with psychotherapy common factors (empathy, building rapport, instilling hope). ~ Holly Swartz


Q:  How is communication analysis used in IPT?

A:  When conducting communication analysis in IPT, the therapist asks the client to describe in detail, and reflect on a specific conversation associated with the arousal of affect.  It is used to help clients to develop an understanding of what is in their minds and the minds of others, and to appreciate how communication can have impacts on others in way that are unintended.  The therapist helps the client to reflect on both parties’ emotions, assumptions (of understanding or being understood), and expectations within a relationship, that underlie and arise from communications.  This naturally leads to the planning of future conversations in which a client can express themselves with greater clarity and empathy. ~ Paula Ravitz


Q: IPT is supposed to be an active therapy. How do I know when to intervene and when to wait and listen?

A: Good question. This is part of the art of psychotherapy, and it should be a question whether you’re doing IPT or any treatment. Letting the patient talk tends to deepen mood and elaborate details. Often if you say nothing, the patient will bring it up in the next minute or two herself. Meanwhile, if you intervene, you structure the treatment but may lose learning about wherever the patient was heading. Too many therapist interventions risk making the treatment emotionally shallow and overly structured, and detract from the patient’s sense of agency. On the other hand, IPT has a time limit and a structure, and you can’t just let things go on indefinitely. One answer is to follow the affect: if the patient is intellectualizing or going off topic, it’s time to intervene. Striking an optimal balance takes practice. ~ John Markowitz


Q: Any suggestions about how to use IPT to help treat mood disturbances in adult  children of alcoholics?

A: Thematically all of the focal areas are potentially useful: disputes if the relationship is current and conflictual (perhaps aiming to adjust expectations/achieve damage limitation and make more of stable alternative relationships), transitions if the person has ended contact with the parent(s) and is navigating through establishing new boundaries and refocusing on more adaptive support system, grief if the parent(s) died and sensitivities if the ramifications of dysregulated early experiences are widely evident across their own close adult relationships.   I would suggest trying not to be overly distracted by one feature of the clinical history and formulate the individual’s difficulties as you would with any other IPT cases. ~ Roslyn Law