Interpersonal Psychotherapy for Posttraumatic Stress Disorder

Termination.
 Early in session 10, the therapist noted that they would be 
finishing in four weeks: “We can talk about that if you’d like.” Chuck initially 
shrugged this off, but in session 11:
Chuck: You know, when I came here I thought I was a crazy person 
and you were going to treat me as a crazy person; I didn’t trust you at 
all. This has really changed my life, saved my life maybe, and while 
I don’t like the commute and can use the time, I’m going to miss this 
in some ways.
This was a striking measure of how far he’d come. At this point, Chuck and 
his wife were talking about feelings in a way both would have considered un-
imaginable a few months before. Tension in the house had dropped. Chuck 
felt he was being a pretty good husband and father, where he had felt himself 
a dangerous failure before entering treatment. Sex with Judy was better and 
felt more intimate than it ever had before. He felt the kids were looking up to 
their hero Dad rather than fearing him. His boss spontaneously complimented 
Chuck on how well he was handling the adjustment post- deployment.
Therapist: You were never crazy; you had PTSD, and you’ve really 
been brave in tackling it and making it better. As you said a while 
back, handling your strong emotions felt like defusing an IED, not 
easy; but you did it, and you’re using them in a very impressive way. 
You’ve been brave.
Chuck: Thanks, Doc.
He was much better: by the end of 14 weeks, his CAPS score had fallen to 23, 
a huge improvement. He no longer met 
DSM- IV
 criteria for PTSD. He wasn’t 
drinking, his depression had resolved, as had the paranoid personality dis-
order symptoms so prominent at the start of treatment. Chuck felt he had a 
new lease on life, and that he didn’t need further treatment at this point.
 

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94 
I P T   F O R   P T S D
Treatment concluded as scheduled, with the therapist asking Chuck to 
check in after six months, or before if needed. Chuck gruffly hugged his ther-
apist in departing. At six month follow- up, he reported feeling fine, had had a 
work promotion, and said things were “great” at home.
This is a dramatically positive story; not all cases go so smoothly. On the 
other hand, patients in extreme pain, once engaged, have great incentive to 
work on their problems. Although the therapist could conceivably have for-
mulated the treatment as either a role dispute (particularly at home) or a role 
transition, or even grief over his lost buddies, the global range of Chuck’s ad-
justment difficulties argued for focusing on this role transition. Note, too, how 
different the process of this IPT case was, in focusing on defining and normal-
izing affect and using it to win small interpersonal victories, from an exposure 
therapy that would have focused on past traumatic events in Fallujah.
CASE E X AMPLE 3 [ TRE ATED BY K ATHRYN 
BLEIBERG, PH.D.]
Deborah, a 32- year- old single white woman working in public relations with 
chronic PTSD and recurrent major depression, was referred by a trauma treat-
ment clinic where she had previously received Prolonged Exposure therapy. In 
her initial phone call, she stated that, although she liked the therapist who pro-
vided the exposure therapy, she disliked having to describe and listen to tapes 
of her past traumatic memories and was interested in a psychotherapy that 
focused on her current problems. Her PTSD symptoms were related to sexual 
abuse at least several times per week from ages 7– 8 by stepbrothers who were 
6– 7 years her senior. Her chief complaint: “I am having a lot of the symptoms 
I have had before, and I’m really depressed.”
On SCID and CAPS interviews, Deborah met 
DSM- IV
 criteria for chronic 
PTSD. On the SCID she also met criteria for recurrent major depression, 
but had no history of alcohol or substance abuse or dependence. She had no 
personality disorder by SCID- II evaluation. For two months prior to her e-
valuation, Deborah reported worsening of dissociative symptoms, difficulty 
falling asleep, nightmares, flashbacks, intense psychological and physical 
distress when exposed to reminders of her abuse, increased irritability, dif-
ficulty concentrating, hypervigilance, exaggerated startle response, and de-
pressed mood. She reported having experienced these symptoms in varying 
degrees since childhood and that they had intensified after visiting her family 
in Texas several months earlier. She reported also feeling unhappy at work, 
where her boss has been overly critical of her, and was in the process of look-
ing for a new job.
 
 

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Role Transitions 
95