Interpersonal Psychotherapy for Posttraumatic Stress Disorder

Clinician’s Quick Guide to Interpersonal Psychotherapy
 
(Weissman et al., 2007) for elaboration on themes discussed here.
The initial phase generally encompasses sessions 1– 3 out of 14 total acute- 
phase sessions. This first phase sets the stage for the remainder of treatment. 
It has several goals:
 1. 
Diagnosis,
 of both:
 a. 
PTSD, as the target diagnosis
, and any comorbidity; and
 b. 
the interpersonal context
 in which the patient lives with this 
disorder.
 2. 
Setting the framework for treatment
 3. 
Initial symptomatic relief
Although it may take as long as three sessions to complete this phase, the goal 
is to complete it as soon as possible. Depending upon your efficiency as a ther-
apist and the patient’s efficiency as an historian, it may sometimes be possible 
to complete the tasks of this phase sooner and to progress to the crucial middle 
phase. In any event, you do not want this organizing phase to extend longer 
than three sessions, because you and the patient need to work on the issues 
that will help resolve the patient’s life crisis and PTSD symptoms.
PHASE 1: DIAGNOSIS
Although in our research studies the patients had already been diagnosed by 
independent evaluators to ensure that they met study eligibility requirements, 
 
 
 

---

Initial Phase 
57
the therapist nonetheless reviewed PTSD symptoms (see Chapter 2) and the 
patient’s interpersonal history (Chapter  3). Again, you should use a PTSD 
rating instrument like the CAPS (Weathers et al., 2013a) or PCL (Weathers 
et al., 2013) to establish the diagnosis and symptomatic severity of PTSD.
Having diagnosed PTSD, 
use a medical model to label PTSD as a treat-
able illness that is not the patient’s fault.
 This begins psychoeducation about 
PTSD. You will also take an 
interpersonal inventory
 (Weissman et  al., 
2007) of the social supports, problematic relationships, and patterns of re-
lationships in the patient’s life, beginning in the past but concentrating on 
the present. For IPT- PTSD, this history will include a careful trauma history, 
looking for patterns of mistreatment, inability to effectively assert oneself 
or effectively express anger, difficulties with intimacy, anger dysregulation, 
etc. In taking the interpersonal inventory of the patient’s past and present 
relationships, assess the patient’s capacity for intimacy in relationships, capa-
bility for self- assertion and confrontation with others, and social risk- taking. 
If such functioning has clearly become impaired with the development of 
PTSD, that is worth underscoring. In taking a history, the therapist also as-
sesses current dangerousness (suicidal risk, potential for relapse into sub-
stance abuse). The goal will then be to link the two diagnoses— PTSD and its 
interpersonal context— in the IPT formulation that concludes this opening 
treatment phase.
Aspects of the early phase include:
 A. 
Taking a history of present illness, which will inevitably touch on the 
patient’s traumatic event.
 Your role as IPT therapist is to make it clear 
to the patient that, although you need to know what happened to the 
patient, this is the 
only
 time it is likely to come up in detail; the therapy 
will not consist of reconstructing and reliving it. Aspects of the trauma 
include the patient’s brief version of what happened: where he or she 
was, how risky he or she had thought the situation would be, how 
long it lasted, how the patient responded during the crisis, feelings the 
patient had at the time about the event; also when symptoms began, 
and which ones particularly bother the patient. Are there physical as 
well as psychic consequences to the trauma: traumatic brain injury 
(Stein et al., 2015) or other medical debility? You will also eventually 
want to ask about past traumas: Is this a patient who has repeatedly 
experienced overwhelmingly frightening events or brutalizations? 
Depending upon your treatment setting, some of this material may be 
available from the patient’s admission packet, but it is important to at 
least touch on this with the patient so that you have a shared under-
standing of what the patient has lived through.

---

58 
I P T   F O R   P T S D
Given the focus of IPT, you will also want to ask about how others around the 
patient reacted to the traumatic event and what support, if any, they provided. 
In this context, it is important to ask how much of the story the patient has re-
lated to others, seeking support; and how much the patient has kept to him-  or 
herself.
If a patient willingly discusses his or her traumatic history in a session, you 
can let the patient do so, but you should always bring the focus back to the 
effect this trauma may have had on their trusting or relating to other people. If 
the patient is uncomfortable discussing the trauma, acknowledge this as part 
of the PTSD syndrome and state that it is not necessary to review the trauma 
in detail. Still, you can continue, it would be helpful to have some general un-
derstanding of how other people may have hurt or upset the patient in order to 
appreciate how traumatic events and consequent PTSD symptoms may have 
affected the patient’s relationship to other people and social situations.
 B. 
Taking an interpersonal history
:  the 
interpersonal inventory
. In the 
same way that you want to understand the patient’s relationship to 
trauma, you also need to know how the patient interacts with other 
people. You can start with the present or the past, but cover both, and