Interpersonal Psychotherapy for Posttraumatic Stress Disorder

the focus of treatment will be on interpersonal interactions 
in the patient’s daily life
 rather than on dreams, cognitions, homework, 
etc.; and rather than on the patient’s past trauma. You will be meeting 
 

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62 
I P T   F O R   P T S D
once a week, which is important to maintain momentum; and each 
week you’ll be asking about how the patient has been feeling, what has 
been happening in the patient’s life, and how those two aspects of the 
patient’s life interconnect.
  B.  You can explain that 
there is no homework in IPT
— you will not be 
giving the patient assignments. The goal of treatment will be to re-
solve the patient’s current interpersonal life crisis and thereby resolve 
the PTSD symptoms. Many patients may be relieved that you will 
not be asking them to do things they may not want to do. (Although 
there is no explicit homework, there is in fact the implicit task that 
the patient will need to resolve the interpersonal problem area by the 
end of the time- limited therapy. The patient can of course choose the 
pace at which to do this.) Despite not assigning homework, you will 
gently encourage the patient to take risks— not truly dangerous risks 
(about which patients with PTSD will surely be wary), but healthy 
endeavors that may feel emotionally risky— in order to help the pa-
tient make interpersonal changes necessary to resolve his or her 
symptoms.
For example: “This is actually a great time to risk changing certain 
behaviors that are getting in your way: If you try something out that 
goes well, you’re likely to feel better. If you try something new and it 
doesn’t work, that would be disappointing, but even then we could 
review what went wrong and learn from it. So I’m going to encourage 
you to ‘live dangerously.’ ”
 C. 
Give the patient the sick role
 (Parsons, 1951), excusing the patient from 
self- blame for symptoms of PTSD and what PTSD prevents him or her 
from doing. Encourage the patient to 
blame the illness
, or the current 
interpersonal situation, rather than him-  or herself. This is especially 
important with victims of childhood physical or sexual abuse, who 
often blame themselves rather than their attackers. Patients often feel 
crazy, damaged, and out of control. The very strength of the feelings 
they are attempting to suppress can contribute to that feeling. It can be 
reassuring to hear that PTSD is a serious but treatable illness, and that 
the sick role may only be temporary.
“Because you have PTSD— all the symptoms that we’ve gone over— 
you are not functioning at your best. It’s hard to do things when 
you’re anxious, having trouble concentrating, and on high alert. It’s 
hard to read other people’s behavior when you’re feeling numb and 
detached. It’s not your fault: like when you have the flu, you just have 
to adjust for symptoms that get in the way. Do the best you can, and 

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Initial Phase 
63
don’t blame yourself; blame the PTSD. As you get better, the PTSD 
symptoms should get in your way less and less.”
 D. 
Set a time limit
. The patient needs to know that treatment is not open- 
ended. The time limit pressures both the patient and you to move 
forward, and is probably an active ingredient in the treatment (see 
Chapter 3). Explain that there is now good evidence that 14 weekly ses-
sions of IPT often relieve the symptoms of PTSD. You will meet once 
a week, ideally at the same time (so that the patient has a regular, ex-
pectable schedule). By suggesting that things may improve in a matter 
of weeks, the time limit helpfully challenges the patient’s expectation 
that this chronic condition will continue indefinitely.
Although the time limit is a therapist- imposed fiction that you can always alter 
if you must, it’s important for you as a therapist to hold to it, to keep the pres-
sure on the patient for change. Don’t spread sessions out over multiple weeks 
if you can help it. Try to make up missed appointments in the same week 
to maintain continuity. If a patient misses multiple appointments, blame the 
PTSD rather than the patient, but continue counting down the weeks to ter-
mination, holding to the original contract, so that the time pressure does not 
weaken.
 E.