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Interpersonal Psychotherapy
for Posttraumatic Stress Disorder
1
Interpersonal Psychotherapy for
Posttraumatic Stress Disorder
J O H N C . M A R K O W I T Z
1
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© Oxford University Press 2017
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Library of Congress Cataloging- in- Publication Data
Names: Markowitz, John C., 1954- author.
Title: Interpersonal psychotherapy for posttraumatic stress disorder / John C. Markowitz.
Description: Oxford ; New York : Oxford University Press, [2017] |
Includes bibliographical references and index. | Description based on print version record
and CIP data provided by publisher; resource not viewed.
Identifiers: LCCN 2016019641 (print) | LCCN 2016018958 (ebook) |
ISBN 9780190465612 (ebook) | ISBN 9780190465599 (alk. paper)
Subjects: | MESH: Stress Disorders, Post-Traumatic—therapy | Psychotherapy—methods |
Interpersonal Relations | Stress Disorders, Post-Traumatic—psychology
Classification: LCC RC552.P67 (print) | LCC RC552.P67 (ebook) | NLM WM 172.5 |
DDC 616.85/21—dc23
LC record available at https://lccn.loc.gov/2016019641
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Printed by WebCom, Inc., Canada
CONTENTS
Acknowledgments
vii
Introduction
ix
1. Is Exposure Therapy Necessary to Treat PTSD?
1
2. The Target Diagnosis: PTSD
27
3. A Pocket Guide to IPT
36
4. Adapting IPT for PTSD
47
5. IPT for PTSD— Initial Phase
56
6. IPT for PTSD— Middle Phase
68
7. IPT for PTSD— Role Transitions
79
8. IPT for PTSD— Grief
99
9. IPT for PTSD— Role Disputes
106
10. IPT for PTSD— Termination Phase and Maintenance
125
11. Difficult Situations and Special Circumstances
130
12. Practical Issues
138
13. Training in IPT for PTSD
142
14. Conclusion: Where Do We Go from Here?
145
Appendix: Patient Handout for IPT- PTSD
147
References
151
About the Author
159
Index
161
ACKNOWLEDGMENTS
I would like to thank many people: Gerald L. Klerman, M.D., and Myrna
M. Weissman, Ph.D., who developed Interpersonal Psychotherapy and en-
couraged my researching this powerful treatment. Kathryn Bleiberg, Ph.D.,
who worked with me on the initial adaptation of IPT for PTSD at Cornell
Medical Center (and who contributes a case history to Chapter 7). Randall
Marshall, M.D., without whom the National Institute of Mental Health
would never have funded our randomized PTSD trial. The many members
of the Psychotherapies for Chronic PTSD treatment team at New York State
Psychiatric Institute/ Columbia University, without whom the research sup-
porting this book could never have been accomplished; in particular, Libby
Graf, Ph.D.; Hayley Pessin, Ph.D.; and Alexandra Klein Rafaeli, Psy.D., the
study IPT therapists who used an earlier version of this manual. Eva Petkova,
Ph.D., now at New York University School of Medicine, without whom the
grant would never have been funded or analyzed. My supportive, thought-
ful, and helpful colleagues at the Anxiety Disorders Clinic at New York State
Psychiatric Institute, where the study took place. The National Institute of
Mental Health, for funding the study (R01 MH079078). A string of mentors
and colleagues too long to recount. Barbara Milrod, M.D., for her tireless help,
informal editing, and support. Sarah Harrington, who championed the book
at Oxford in the face of some concerns by reviewers. And, of course, the pa-
tients who came to our study for treatment of PTSD, and who benefitted from
IPT and the other two study treatments, Prolonged Exposure and Relaxation
Therapy.
— John C. Markowitz, M.D.
INTRODUCTION
In the midst of life, tragedy strikes. Upsetting things occur in people’s lives,
and they have an emotional impact. Mostly we roll with the punches: we may
feel upset or worry for a few days; our sleep or appetite or concentration may
briefly suffer. But for the most part, we bounce back: people are resilient.
Although most individuals will experience some major trauma in the course
of their lives (Kessler et al., 1995; Breslau et al., 1998), most will not develop
serious psychiatric sequelae.
Some individuals have greater vulnerability to upset than others, based
upon their genetic makeup and early life experience— including early life
trauma. Some individuals experience greater life difficulties than others. Some
life events are sufficiently horrific that the American Psychiatric Association
(APA)
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