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IPT builds social skills.
It should be evident why: the therapy focuses
almost entirely on recognition of affects in interpersonal situations;
validation of those affects; and helping the patient use the feelings,
often by verbalizing them, to improve interpersonal situations.
These principles have been borne out by multiple randomized clinical trials,
the gold standard in clinical outcome research.
Other important aspects of IPT include:
•
Mobilizing social support.
The perception that you are not alone, but
have people you can count on and turn to, makes a huge difference in
preventing or relieving a range of psychopathologies, including major
depression and PTSD (Markowitz et al., 2009). Being able to talk to
someone about one’s fears and concerns, rather than keeping them
in as a terrible secret, and receiving validation or support in return,
is a great relief. Thus a goal of IPT is to help patients to identify,
bolster, and use social supports. To do this, the therapist conducts
an
interpersonal inventory
(Weissman et al., 2007) during the initial,
history- taking sessions of IPT, to develop a sense not only of how the
patient relates to others, but of who those others are. Does the patient
have potential allies, even if depression or anxiety or PTSD mistrust
is inhibiting the patient from engaging with them? Who, conversely,
may be causing trouble in the patient’s environment (perhaps causing
a role dispute that might be the focus of treatment)? The members of
the interpersonal inventory often come into play in the treatment that
follows.
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I P T F O R P T S D
•
Setting a time limit.
Time pressure can work wonders. Although not
all disorders lend themselves to a time- limited approach, mood and
anxiety disorders certainly do. Telling a patient that he or she will end
treatment in a matter of weeks, probably feeling better, has several
therapeutic benefits. For patients who feel hopeless, it presents a
constructive paradox: How can my therapist really think I’ll get better
so fast, when I strongly doubt I’ll get better at all? Beyond that, the
time frame pressures both patient and therapist into action. This is a
powerful prod for depressed and anxious patients who feel passive,
helpless, and hopeless.
•
Deciding whether or not to prescribe medication.
Because of its
medical model, IPT is nicely compatible with pharmacotherapy.
Just as a patient with diabetes might receive both a behavioral
intervention (psychoeducation, diet, exercise, regular glucose
testing, etc.) and insulin, a patient with major depressive disorder
may benefit from both IPT and antidepressant medication. Not
all psychotherapies have such theoretical compatibility with
medication.
THER APEUTIC STANCE
The IPT therapist’s stance is encouraging, supportive, hopeful. This does not
mean projecting sugary sweetness, which can lead a patient to feel misun-
derstood and trivialize the patient’s suffering (Markowitz & Milrod, 2011).
Rather, the therapist acknowledges the patient’s suffering, helps the patient sit
with and tolerate rather than avoid painful affects, then helps the patient rec-
ognize the utility of feelings like anger, sadness, and anxiety. The patient is in
pain, but there is hope for interpersonal gains and symptomatic recovery. The
initial message is: You’re in pain
…
but there is hope.
The IPT therapist tries to function as a helpful coach, an expert in treating
the target disorder. The therapist encourages the patient to see his or her own
strengths, even if symptoms threaten to obscure them. Rather than feeding
the patient suggestions, the therapist asks, “What options do you have?” and,
if need be: “What you have tried before?” The therapist shifts undue blame for
situations from the patient to the depressive disorder, or to the interpersonal
environment, rather than siding with the patient’s depressive self- criticism.
The patient gets credit for accomplishments that occur during the treat-
ment: the therapist can make apparent that it is the patient who has tested out
a new interpersonal approach or made a life change, and that this active work
by the patient has produced therapeutic gains.
A Pocket Guide to IPT
43
IPT therapists apologize if they make mistakes or if the patient feels hurt by
an interchange. They do not generally self- disclose, but neither do they attempt
a neutral, impassive stance: they try to model decent interpersonal behavior.
PHASES OF IPT
Acute treatment is divided into three logical phases.
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