Interpersonal Psychotherapy for Posttraumatic Stress Disorder

support the patient’s adaptive 
interpersonal behaviors
. Congratulate the patient on successes. 
Cheerleading is okay so long as it’s not forced and saccharine.
 b.  If things have not gone well, 
sympathize; elicit the patient’s feelings
 
(don’t trivialize or dismiss the event). Then, acknowledging that 
things haven’t gone well, 
explore alternative interpersonal options
 
with the patient. When you have settled on a feasible alternative, 
try to 
role play
 this with the patient. Usually this means jumping 
into a role play, letting the patient play him-  or herself. Since 
patients may find role play artificial if you announce it as such, 
one useful way to slide into role play is to elicit the patient’s 
feelings, then ask whether they might express them to the other 
person. Or ask, “So in your own mind (in fantasy), how might 

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Middle Phase 
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you respond to that?” Before the patient realizes it, he or she is 
involved in role play.
 5. 
Thematic continuity
 makes therapy feel coherent. Don’t hammer home 
the idea of a complicated bereavement, role dispute, or role transition 
every few minutes (or even every session, necessarily). But reminding 
the patient, where appropriate, of how PTSD symptoms interfere with 
functioning, or of how the patient is maneuvering through a role dis-
pute or role transition, may help tie things together. Sometimes the 
therapist can do this neatly in summarizing a session at its end.
THEMATIC ISSUES
Typical themes of IPT for PTSD include the ideas that emphasize resilience:
“Reclaim your life!”
“You’ve been through something awful and unpredictable, but you can 
have some control over your environment.”
“You’re a survivor.”
(Primo Levi noted that his horrific experience at Auschwitz left him 
“more mature and stronger,” and was a “rite of passage” [Levi, 2003].)
Reviewing interpersonal situations, exploring the patient’s feelings and op-
tions for action in such situations, and testing out such options can help 
patients regain a sense of control over their interpersonal environments. 
Doing so allows an appropriate release of affect, gains in socialization, and 
a diminution of symptoms. As patients feel better, they may spontaneously 
attempt self- exposure, but this is not the focus of the treatment. The IPT 
therapist’s supportive, encouraging stance is that the patient’s past trauma is 
bad enough; it’s “
adding insult to injury
” that the past is interfering with the 
patient’s current ability to function in relationships and other interpersonal 
encounters.
In treating patients who report remote childhood traumas, situations where 
the patients truly had little control over their lives, it may be helpful to ac-
knowledge the pain of that situation but to point out: 
“That was then; this is 
now.”
 Now an adult, the patient has more control over interpersonal encoun-
ters and can handle them differently. This may be a helpful maneuver for redi-
recting a patient from the past to the present.
IPT treats PTSD by focusing on emotions and interpersonal circumstances, 
not by directly targeting the symptoms themselves. In recounting recent inter-
personal encounters, a patient may report flashbacks or other symptoms. If so, 
 

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I P T   F O R   P T S D
you can remind the patient that these are symptoms of PTSD that will likely 
fade as the patient regains control of his or her interpersonal situation. (This 
is what our research found [Markowitz et al., 2015].) It may be worth pointing 
out that such symptoms often appear not randomly, but in connection with a 
stressful current life circumstance: e.g., going to meet a friend when feeling 
uncertain or mistrustful. Mood and life events interact, on a small as well as 
on a larger, traumatic level. As a therapist, you want to maintain an interper-
sonal thematic focus (rather than, for example, bringing up biological, cog-
nitive, or other formulations of symptoms the patient may be experiencing).
The brief description above (elaborated upon in Weissman et al., 2007) should 
illustrate that IPT is a focused but not overly structured treatment. Its em-
phasis on feelings and social functioning explains why patients gain social 
skills in the course of IPT.
IPT therapists offer support, clarification, and realistic clinical optimism. 
They normalize the patient’s feelings in an interpersonal context, and (aided 
by the time limit) encourage the patient to tackle and solve practical problems 
in everyday encounters with people in the patient’s life. They take the role of 
a friendly ally, with a relatively relaxed and informal stance. They may offer 
occasional self- disclosure or advice when clinically warranted. They do 
not
 
interpret dreams (if the patient offers a dream, the therapist can briefly help 
the patient explore its manifest interpersonal content), interpret transference 
(Markowitz et al., 1998a), assign behavioral homework, or formally encourage 
exposure to trauma reminders.
In our treatment studies, we told IPT therapists: “