Interpersonal Psychotherapy for Posttraumatic Stress Disorder

Middle Phase.
 The subsequent sessions dealt with affective attunement. The 
therapist began each session by asking how things had been since they last 
met. Chuck remained guarded, mostly relating dealings with his wife and kids 
and a lawn dispute that developed with his suburban neighbors over the place-
ment of a fence and a fruit tree. He reported feeling numb most of the time; 
the world seeming detached, unreal, and trivial. Yet periodically he would get 
frustrated and explode: his wife and children started to give him a wide berth, 
which made him feel unloved. The issue of the fence seemed trivial, and yet 
it was a critical boundary war that reminded him of military perimeters and 
seemed to raise a question of safety versus danger. He was considering hiring 
a lawyer to sue the neighbors.
 

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90 
I P T   F O R   P T S D
The therapist repeatedly asked in these situations: “So how do you feel when 
that happens?” Chuck initially answered that he didn’t feel anything, just 
numb. He didn’t know how he felt. On discussion, he began to acknowledge 
feeling a little something, maybe “upset.”
Chuck: So I wanted to be helpful with the kids, tried to get involved, 
and my wife Judy kind of froze me out, just went on without me. 
[Silence]
Therapist: So you wanted to help and it was like she didn’t notice, or 
didn’t want your help?
Chuck: I think she noticed, but she thinks I’m a menace, doesn’t trust 
me with the kids.
Therapist: Uh- uh. So what was that like for you?
Chuck: What do you mean? I’m used to it.
Therapist: Did you have a feeling when you tried to help and Judy 
ignored you?
Chuck: No. It’s okay
… 
. I guess maybe a little upset.
Therapist: Yeah?
Chuck: So yeah, maybe my wife got me a little upset when she looked 
at me that way. All I was trying to do was help.
Therapist: What kind of upset? What does it feel like?
Chuck: I don’t know. Nothing. A little rise in my chest, maybe.
Therapist: Huh. What do you call that feeling?
Chuck: Maybe, frustrated?
Therapist: Yes? Frustrated?
Chuck: Kind of annoyed.
After sitting with this feeling for a while— not rushing to the point, but letting 
Chuck tolerate the emotion, letting it sink in:
Therapist: So you were a little annoyed, angry at Judy ignoring you. 
Think it was reasonable to have that feeling?
Chuck: I don’t know. I don’t like getting angry.
Therapist: Look, it can be a problem if you express too much anger, 
but it’s helpful to know when you feel that way. Anger tells you when 
someone’s treated you badly, and feeling that way gives you a chance 
to understand the situation and respond. Again, was it reasonable for 
you to feel some anger in that situation?
Chuck: I guess a little. But it reminds me of when I got lethal mad 
in Iraq.

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Role Transitions 
91
Therapist: So, what’s that mean?
Chuck: I don’t want to get like that with her.
Therapist: You don’t want your anger to get out of control.
Chuck: Yes, sir.
Therapist: But feeling angry about her behavior is reasonable? If you 
could find a way to express it.
Chuck: I guess.
Having normalized the anger:
Therapist: So, if it’s a reasonable reaction and you don’t want to 
explode, what options do you have?
They then role- played scenarios, with the therapist taking Judy’s role. Chuck 
wanted to trust his wife— they’d once had what felt like a good relationship— 
and wanted her to trust him. On the other hand, things were not going well, and 
both feared his “exploding.” The role play allowed Chuck to practice saying what 
he wanted, and the tone in which he could say it. At first this came out crudely:
Chuck: “You don’t trust me as a parent. Fuck you.” [Silence]
Therapist: How did that sound?
Chuck: It’s how I feel.
Therapist: Good. How did it feel to say that?
Chuck: To the point. I guess good to get it off my chest. But also not 
good. She’d be hurt.
Therapist: Okay, well is there another way you could put it that might 
go over better with her?
Chuck: “You don’t trust me, and it makes me angry. I was just trying to 
help.” [Silence]
Therapist: “I’m sorry, I wasn’t trying to make you upset. I do 
trust you.”
Chuck: “No you don’t. You haven’t really given me a chance since I’ve 
gotten back.”
Therapist: “I’m sorry, it’s been hard for both of us. I appreciate your 
help, and you are their dad.”
Chuck: “Okay, then.” [Silence]
Therapist: How did that feel?
Chuck: Better.
Therapist: Good! Did you say what you wanted to say?
Chuck: Yeah, enough.

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92 
I P T   F O R   P T S D
Therapist: Was there something more you wanted to add?
Chuck: No, that was the point.
Therapist: Great! What about the way you said it: what did you feel 
about your tone of voice?
Chuck: Maybe not angry enough.
Therapist: Want to try it again?
They rehearsed some more.
Therapist: I agree that you’re getting there. I noticed that you pointed 
out that 
she made you feel angry
, that’s good communication. No way 
to misunderstand that.
Chuck: I guess.
Therapist: So, do you feel comfortable saying that to Judy? Because 
this kind of situation is likely to come up again.
Chuck: Think so.
Therapist: Great. I know you don’t like getting angry, but anger’s