Interpersonal Psychotherapy for Posttraumatic Stress Disorder

Contingencies.
 •  Make sure that the patient has a way to contact you in an 
emergency. You want to make yourself available to patients, 
within reason:
“If you’re feeling worse, please give me a call. I’d rather know what’s 
going on than not know.”
A statement like this communicates your interest, concern, and availability. 
In our experience, patients with PTSD tend to underuse rather than overuse 
this privilege.
 •  Try to let the patient know in advance if you will be away from the 
office on vacation, and what backup care will be available in that 
circumstance. Be prompt to sessions, providing an expectable, 
unalarming environment.
 •  If the patient cancels a session, or you have to miss a session, do your 
best to try to make up the session in the same week. Once- weekly 
sessions provide a thematic continuity and regular interpersonal 
contact that give the therapy a rhythm and momentum. It’s a good 

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64 
I P T   F O R   P T S D
interval for which the patient can answer the question, “How have 
things been since we last met?”
 •  You can give the patient an IPT- PTSD informational handout to help 
cement understanding of the PTSD diagnosis and of how therapy is 
likely to proceed. (See Appendix.)
 •  Ask the patient if these arrangements make sense and are agreeable. 
Encourage the patient to bring up anything else that’s bothering him 
or her.
PHASE 3: INITIAL SYMPTOMATIC RELIEF
Once you have diagnosed the patient’s disorder(s) and the interpersonal 
context of the PTSD, linked them in a formulation that the patient has ac-
cepted, and laid out the parameters of treatment, IPT enters its middle phase. 
Interestingly, just doing this diagnostic preparatory work tends to calm pa-
tients and to generate the beginnings of a treatment alliance. We have not 
repeated CAPS scores for PTSD patients after two or three sessions, but my 
bet would be that they slightly decrease. Patients don’t fully trust you, and 
they continue to suffer, but they derive some hope from experiencing the IPT 
therapist’s organized and collaborative approach, and they suffer a little less. 
Sometimes patients will report that a comment during the session has relieved 
them: “It really helped when you said that what happened to me wasn’t my 
fault and is treatable.” Providing a rational structure for treatment itself has 
benefit. This decrement in distress provides some momentum for the therapy 
to continue and build.
Other Aspects of Treatment
Like any effective treatment, IPT depends on the so- called 
common factors
 
shared across psychotherapies (Frank, 1971; Wampold, 2001; Barnicot et al., 
2014) (Table 5. 1). These factors help in establishing a strong 
therapeutic alli-
ance
, which has been shown to be crucial in the outcome of all treatments, 
including not only psychotherapy but pharmacotherapy as well (Krupnick et 
al., 1996). To build an alliance, you need to be a good and sympathetic listener, 
helping the patient feel understood. Let feelings, including painful feelings, 
build in sessions before intervening— don’t cut them off because they’re un-
comfortable, a maneuver that may further the patient’s view of negative affects 
as dangerous. Normalize feelings 
as
 feelings: emotions are reactions to inter-
personal encounters, and patients may appropriately feel angry if someone has 
 
 
 

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Initial Phase 
65
wronged them, sad if someone has disappointed them or is leaving, and happy 
if things go well. Underscore the feelings and link them to the patient’s situa-
tion. Try to be flexible about appointments, make up time if a patient comes late 
when possible. Be supportive, encouraging, understanding, nonjudgemental.
All of these common factors constitute aspects of good therapy, and IPT en-
courages using all of them fully. (Not all psychotherapies may use all common 
factors equally [Markowitz & Milrod, 2011].)
 •  For patients with PTSD, affective arousal is particularly important. 
Affective arousal makes sessions meaningful rather than dry and 
intellectualized; patients remember things that happen in emotional 
sessions, and they have the chance to experience powerful emotions as 
less “dangerous” than they have previously considered them to be.
 •  Focusing on specific, affectively charged current events is a great way 
to elicit feelings and the problems the patient is having. It keeps the 
therapy engaging, rather than letting it slide off into intellectualized 
abstractions.
 •  The IPT link between emotions and life events offers a framework that 
makes sense to patients, perhaps especially so in the extreme context 
of PTSD. The framework helps patients feel understood.
 •  Your expertise and poise as a therapist provides reassurance.
 •  The therapeutic procedure provides a workable, useful, and 
predictable method for understanding feelings and improving 
interpersonal functioning, two key areas of life functioning that again 
have particular import for patients with PTSD.
 •  IPT therapists provide optimism for improvement (based on 
empirical results).
 •  IPT provides success experiences— achievements of mastery for 
patients who feel weak, inadequate, overwhelmed, helpless, and