Interpersonal Psychotherapy for Posttraumatic Stress Disorder

part of life: things are going to happen, people are going to annoy 
you the way they annoy everyone. When they do, it’s a kind of “trust 
moment”: if you tell someone that they’re bothering you, and why, one 
of two things can happen. Either they can apologize, and you can try 
to talk things out— in which case you’re establishing a kind of trust, 
building a safe space. Or they can ignore you and keep on bothering 
you, in which case I guess you can’t trust them. Telling them you’re 
angry allows them to respond, and it gets the anger off your chest 
so you don’t have to carry it around like a loaded weapon. That can 
feel really uncomfortable and contribute to your agitation. Also, 
sometimes people bother you without really meaning to, and if you 
don’t bring it up, they’re not going to know and will keep doing it.
Chuck: Makes sense.
During a role play, when Chuck threw in: “You don’t understand what I’ve 
been through!” the therapist responded, as Judy: “Well, I’d like to understand. 
You’ve never seemed to want to talk to me about it.” Chuck seemed briefly 
taken aback, and they role- played his talking to her more.
So therapy proceeded: focusing initially on normalizing negative emotions 
and helping the patient name them, to build an emotional vocabulary (“What 
kind of ‘upset’? What do you call that feeling?”). As Chuck developed that 
vocabulary, the focus shifted to verbalizing those feelings in interpersonal en-
counters, and using that emotional vocabulary to master situations. Week by 
week, “How have things been since we last met?” elicited tensions between the 
patient and his wife, kids, neighbors, and co- workers. Rather than exploding 

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Role Transitions 
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or retreating, Chuck began to try to talk his way through these encounters, 
and as he succeeded he began to see anger not as an enemy but an ally. He 
began to talk about having a pressure- relief valve through which he could blow 
off steam before the pressure built up.
By mid- treatment (week 7), Chuck’s CAPS score had fallen from 85 to 52, 
a considerable improvement that still left him in the moderately severe PTSD 
symptom range. Nonetheless, he recognized his progress and agreed with the 
score. (As an engineer, he appreciated having the metric.) By this time he had 
pulled back from his initial urges to wreck his neighbor’s yard or hire lawyers 
to sue. Things were still tense but markedly improved at work and home. The 
progress accelerated in the latter half of treatment.