Interpersonal Psychotherapy for Posttraumatic Stress Disorder

Do not encourage exposure to traumatic reminders.
 As already noted, 
exposure is not the focus or mechanism of IPT. Part of our interest 
is to show that IPT can treat PTSD without requiring the exposure 
exercises common to other validated PTSD therapies. If the patient 
decides to confront reminders of trauma on his or her own, that’s fine, 
but you should not prompt the patient to do so. The focus of IPT is on 
interpersonal interactions in the present.
 2. 
Do not assign homework.
 The other therapies will be doing this. The 
only homework of IPT is to resolve the interpersonal focus (e.g., role 
transition) in the course of the 14 weeks of treatment. Not providing 
specific homework assignments week to week has an advantage. If you 
assign no specific homework, the patient cannot fail to complete it, an 
outcome that would worsen the prognosis of behavioral therapies.
  3. You should obviously not encourage the patient to do progres-
sive muscle relaxation or breathing exercises, as the relaxation 
therapists will.
  4.  Do not engage in psychodynamic interventions such as dream or 
transference interpretation. Again, if the patient offers you a dream 
during a session, you can help the patient explore its manifest inter-
personal content— but focus on the interpersonal interactions and 
emotions and then bring the treatment around to current waking 
events.

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Practical Issues 
141
  5.  When you have succeeded in eliciting a strong negative affect from a 
patient, do not rush to do anything. Sit with it, let the patient sit with 
it, and give the patient the therapeutic opportunity to 
reflect
: to tol-
erate and understand the emotion.
When in doubt, discuss what you can and can’t do with your supervisor.

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13
Training in IPT for PTSD
How much training does one need in order to conduct IPT adherently and 
competently? What constitutes “certification” in IPT? These two questions 
have been points of controversy over the forty year history of this treatment 
(Weissman et al., 2007; Markowitz & Weissman, 2012). Some early training re-
search indicated that already experienced psychotherapists could adapt well to 
using IPT to treat patients following a single supervised pilot case (Rounsaville 
et al., 1986, 1988). In my experience, this has been true for some therapists. 
Other therapists benefit from at least a second supervised, successfully con-
ducted case, which may also provide experience in working in a different 
problem area (e.g., grief vs. role dispute) or with a different target diagnosis.
Adherence to IPT can be determined by assessment of taped sessions 
(Hollon et al., 1984; Markowitz et al., 2000). Researchers have historically de-
termined competence based on adherence and clinical supervision. Standards 
for training currently vary by country. Some countries have their own IPT 
societies and have set up requirements for training. The most developed train-
ing guidelines come from the United Kingdom (http:// www.iptuk.net/ ). In 
the United States, where therapists receive certification by professional degree 
(M.D., Ph.D., L.C.S.W., R.N.) rather than by psychotherapy, there is no such 
thing as formal certification in IPT; and this holds true in much of the rest 
of the world. The International Society for Interpersonal Psychotherapy (list-
serv:  isipt- [e-mail]) provides information about IPT around 
the world, including posting announcements of training courses, but it specif-
ically eschews any claim to certifying therapists in IPT.
My recommendations for training in IPT for PTSD are as follows:
 1. 
General clinical experience.
 If you want to treat PTSD, it helps to have 
had some experience in working with patients who have the disorder. 
You will do a better job treating patients in IPT if you feel familiar 
with the target disorder. It’s hard to learn two domains at once. An 
 
 

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Training in IPT for PTSD 
143
important common factor of therapy (Frank, 1971)  is 
therapeutic 
poise
: the ability to remain composed when a patient reveals something 
painful or alarming (Greenacre, 1957; Markowitz & Milrod, 2011) or 
acts in an upsetting way in a session. If you stay reasonable and calm 
and react appropriately, the patient is likely to feel reassured. You will 
be more likely to maintain that pose if you have familiarity with PTSD.
Most therapists do not learn IPT as a first therapy, but come to it having first 
received training in psychodynamic psychotherapy or Cognitive Behavioral 
Therapy.
 2. 
General competence in IPT.
 Perhaps it’s my prejudice based on the way 
I learned IPT, but I feel it makes sense to start at the beginning: to first 
use IPT where it was first used, and remains most used— as a treat-
ment for major depressive disorder. Thus I recommend that therapists 
first treat a depression case, then branch out. Leaving aside the thorny 
question of certification, the general approach to training is threefold 
(Weissman et al., 2007):
 a. 
Read a manual
: For general IPT, I recommend Weissman et al., 
2000, or Weissman et al., 2007. If you have come this far in this 
book, you will have already read an IPT manual. The manual 
provides initial orientation to the treatment, then serves as a 
protocol and reference guide as you actually conduct treatments.
 b. 
Attend a workshop
: IPT experts offer courses in various 
settings, ranging from freestanding workshops to professional 
organizational meetings such as the American Psychiatric 
Association Annual Meeting. The International Society for 
Interpersonal Psychotherapy holds biennial meetings with various 
training workshops. A one-  or two- day course, in conjunction 
with having read a manual, often helps orient therapists and 
organize their thinking about the treatment. Such workshops 
often include videotapes of patient sessions or role plays among