Interpersonal Psychotherapy for Posttraumatic Stress Disorder

emotions, although powerful, are 
not dangerous.
 You can accomplish this task by pausing and silently 
and attentively sitting with the patient while he or she feels something 
and has a few moments to reflect upon it, survive it, and hopefully to 
recognize its pertinence to an interpersonal situation. Although you, 
too, may feel uncomfortable if the patient seems very angry or very 
sad, your job is to sit with it, encourage it; to show poise, and to show 
that you’re not afraid of the emotion. Changing the subject or rushing 
ahead conveys an avoidance of emotion that is precisely what you do 
not want to show. This is an important difference between an affect- fo-
cused therapy and some other treatment approaches.
Once the patient is in touch with his or her feelings, and the therapist has 
helped the patient normalize them, the next step is to utilize those feelings, 
often by verbalizing them, in addressing interpersonal encounters.
For many patients presenting with chronic PTSD, it is difficult to know 
whether they once had greater awareness of their feelings and then lost this 
after they developed PTSD and became numb. Alternatively, they may always 
have been relatively alexithymic— able to manage life without awareness of 
their feelings— until the weight of emotional response overwhelmed this 
adjustment. The first circumstance may be easier to address, as it simply re-
quires bringing a patient back to awareness rather than teaching an emotional 

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I P T   F O R   P T S D
understanding and vocabulary from scratch. From an IPT perspective, how-
ever, exactly how the patient became so out of touch with his or her feelings 
does not really matter. The critical points are that the patient is emotionally 
detached and numb, that PTSD has either caused or exacerbated this, and that 
understanding one’s feelings is essential in order to be able to decode inter-
personal interactions, to determine who in one’s environment is potentially 
trustworthy and a social support, and who is not.
 2. 
Focus on the interpersonal aftereffects of trauma.
 Exposure therapies 
focus on reconstructing the trauma the patient has experienced, and 
therefore on the past. IPT, however, acknowledges that the patient 
has experienced a severe trauma but (perhaps surprisingly) makes no 
attempt to reconstruct the traumatic event(s). In the initial session, 
the therapist briefly asks about what happened to the patient: “What 
was the trauma that provoked PTSD?” But having established that a 
trauma occurred, the focus is not on building a coherent narrative of 
the event, eliciting and helping the patient habituate to upsetting mo-
ments. The goal is simply to establish the trauma as antecedent to, and 
explanation for, PTSD symptoms. Indeed, the trauma receives no fur-
ther mention as such.
Instead, the IPT therapist focuses on the present, and on the 
interpersonal 
consequences of the trauma rather than the trauma itself
. What effect has the 
trauma had on the patient’s social relationships, use of social supports, and 
trust of other people? What havoc has the trauma wreaked on current re-
lationships, and where is the patient having difficulty in dealing with other 
people as a consequence of PTSD? Patients who do not want to relive their 
traumatic incidents do not have to; many have expressed relief on this account 
(Markowitz et al., 2015a).
Patients in IPT are told that they have PTSD, an anxiety disorder linked to 
the terrible trauma they have experienced. The therapist points out that this 
is not the patient’s fault, and that unfortunately many people are traumatized. 
IPT- PTSD then focuses on the interpersonal sequelae of PTSD.