Interpersonal Psychotherapy for Posttraumatic Stress Disorder

particularly get a sense of recent and current relationships. Who are the 
important people in the patient’s life? In whom can he or she confide 
feelings, disappointments and upsets? (It’s worth mentioning to the 
patient that having confidants provides protection against symptoms.) 
How have relationships changed in the wake of the traumatic event?
Further, what patterns have existed in relationships in the past? How close has 
the individual ever been able to get to other people? How secure is the patient 
in attachments to others? Has he or she been able to express feelings directly to 
other people, including love, anger, and his or her needs? How do relationships 
start and end? What was the family situation like growing up? Friends? Dating?
The goals of the interpersonal inventory include:
 • 
Finding potential social supports
 whom the patient can mobilize even 
if he or she has not been using them. Whom is the patient closest to? 
How close? Social supports protect against symptoms and aid recovery. 
Research has found that being able to tell someone how you’re feeling 
and to share “dark secrets” may be crucial to the outcome of PTSD.
 • 
Finding potential role disputes
. Are there people in the patient’s life 
who are contributing to interpersonal conflict? Are there relationships 

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Initial Phase 
59
that the patient is having trouble negotiating? These could be a 
potential focus of the treatment.
 • 
Getting an overall sense of the patient’s interpersonal functioning.
 
Many patients with PTSD may have had difficulty in forming secure 
attachments in relationships even prior to the trauma they have 
suffered. Difficulty in forming such attachments may reflect earlier 
life traumas or difficult relationships, and may make it hard to 
mobilize social supports when needed after a recent trauma. Although 
the focus of IPT is on the present, it’s helpful to have a sense of the 
person’s background, starting with childhood and stretching to the 
present.
The interpersonal inventory is not a formal scale but a collection and weight-
ing of key relationships and patterns of relationships in the patient’s life, par-
ticularly the patient’s current life.
  C.  The interpersonal inventory and general history of present illness 
should yield the 
focal problem area
 on which treatment will center. 
This could be 
complicated bereavement
 (if the trauma is associated 
with violent death or murder), a 
role dispute
 (if the patient is engaged 
in a struggle with a significant other, such as an abusive spouse), 
or a 
role transition
 (having suffered a trauma and living with its 
consequences).
  D.  It will also be helpful to know something about 
prior treatment
 the 
patient has received: what the patient has found helpful or unhelpful, 
and what his or her feelings are about psychotherapy and about medi-
cation. If the patient has been in lengthy but unhelpful psychotherapy 
in the past, you can listen, ascertain what the patient found unhelpful, 
sympathize, and then explain that IPT is a different, brief, focused 
kind of treatment for medical problems like PTSD. Your job is to com-
municate therapeutic optimism and hope. Again, it’s good to invite 
dissent: if the patient doesn’t like something that’s occurring in the 
therapy, you welcome the patient’s bringing it up: such self- assertion 
is indeed a goal of the treatment. A past treatment relationship with 
an abusive therapist obviously requires careful discussion and the ex-
plicit setting of appropriate boundaries in the current treatment (see 
Chapter 11).
  E.  Having completed these tasks, you offer the patient a