Interpersonal Psychotherapy for Posttraumatic Stress Disorder

Figure  4. 1.
  Non- exposure adherence item.
Table  4. 1.
  Differences Between Exposure Therapies  
and IPT
Exposure- Based  Treatment IPT
Focus
Traumatic events
Narrative of trauma
Reminders of trauma
Current interpersonal 
relationships
Treatment principle
Exposure to trauma 
reminders;
Habituation diminishes  
fear
Interpersonal emotions; 
attachment, support
Goal
Reconstructing trauma 
history, habituation to 
trauma reminders
Improving and restoring 
emotional life and 
interpersonal functioning
Temporal focus
Largely on the time of the 
trauma(s), focusing on 
what happened
The present, focusing on 
interpersonal sequelae of 
having been traumatized
Discussion of trauma Extensive, throughout
Minimal, at outset
Message to patient
Face your fears, and they  
will go away
Your emotions can help you 
manage your relationships 
and decide whom you can 
trust; some people can 
provide helpful support
Homework
Yes, daily
None

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Adapting IPT for PTSD 
49
the former can easily tell you how they’re feeling, whereas the latter 
often report being numb, almost alexithymic (Markowitz et al., 2009). 
It is therefore crucial to help these patients (re)gain a connection with 
their emotions. Simply helping patients tolerate emotions that they 
perceive as dangerous represents a therapeutic gain. To further en-
courage patients to see that these seemingly dangerous feelings can 
guide social behavior adds another dimension to patients’ interper-
sonal skills and functioning. Thus we devote much of the early weeks 
of IPT for PTSD— sometimes as much as the first half of the 14- week 
treatment— to developing a working emotional vocabulary: What kind 
of “upset” does the patient feel? What do you call that feeling? Is that 
a reasonable response to the situation? What does it tell you about the  
situation? A goal of IPT for PTSD is to give patients comfort with  
the feelings they are desperately avoiding, particularly negative af-
fects like anger, sadness, and anxiety; and a chance to reflect on what 
they mean.
Thus although IPT is time- limited, and that time limit pressures the 
patient to move ahead in treatment and in life, toleration of affect is not 
a domain to rush through. As a therapist, you want to demonstrate and 
to have the patient experience that