Developments in Interpersonal Psychotherapy

Abstract

Background: Interpersonal psychotherapy (IPT), a time-limitedpsychotherapy, was developed in the 1970s as a treatmentfor outpatient adults with major depression. It since has grown in its range ofresearch applications and in its clinical accessibility. Method: Review ofrecent research and educational developments on IPT.Results: IPT has demonstrated efficacy in randomized controlled trials for major depression in various patient populations and in patients with bulimia. It showed no advantages in treating 2 substance abuse samples. Numerous further studies are underway. Growing numbers ofclinicians are learning IPT. Conclusions: At a time when both research developments and economic pressures are increasing interest in timelimited psychotherapies, IPT is expanding in both the research and clinical domains.(Can J Psychiatry 1999;44:556-561) Key Words: interpersonal psychotherapy, depression, randomized clinical trials, clinical trainingT his paper roughly follows the structure of an IPT treatment: beginning with history, offering an explanation of the framework ofthe treatment and its empirical basis, but focusing more on present and future options than on the past. HistoryIn the 1970s, psychodynamic psychotherapy was the predominant treatment in clinical practice among North American psychiatrists, but it had (then as now) little empirical validation as a treatment for depression. Beck and colleagues had begun testing cognitive-behavioural therapy (CBT) as an antidepressant treatment (1). It was in this context that Klerman, Weissman, and colleagues developed and tested a simple, time-limited psychotherapy as an alternative and adjunct to pharmacotherapy for major depression. This treatment, interpersonal psychotherapy (IPT) (2), has since expanded its indications through a series ofrandomized controlled clinical trials for different patient populations and diagnoses (3). Although IPT long remained solely a research treatment, in recent years growing numbers ofclinicians have begun to learn IPT, either in residency training programs or through continuing medical education. Still, it remains anomalous among Description of IPTIPT is time-limited (a predetermined 12-16 weekly sessions for acute treatment), diagnosis-targeted, pragmatic, and theoretically straightforward. It is based on interpersonal theory from the 1940s and 1950s (for example, 4) and on empirical research on interpersonal aspects of depression. IPT is based on a few core principles:1. Depression is a medical illness, a treatable illness, andnot the patient's fault. This framework shifts blame from the guilt-ridden patient onto the illness (and to some degree,onto the patient's interpersonal situation-see principle 2). The straightforward therapy based on these principles has demonstrated its utility in treating major depression and other disorders (3,5). There is a (noncausal) connectionIPI has 3 phases. In the first phase, the therapist works quickly to diagnose depression, to diagnose the interpersonal context in which the depressive episode ar...

A biopsychosocial model as a guide for psychoeducation and treatment of depression

“…Cognitive-behavioral models [Beck et al, 1979] emphasize the relationship between depression and automatic, negative thinking processes and dysfunctional patterns of information processing, and state that dysfunctional schemas, which are memory representations regarding the self and its relationships with others, increase one's vulnerability to depression. Interpersonal models [Coyne, 1976;Joiner, 2002;Klerman et al, 1984;Markowitz, 1999] relate several levels of social functioning to depression: (1) vulnerability as a result of interpersonal factors, (2) social skills and behavior of patients with depression, and (3) the effect of depression on social interactions and relations. Research into the association between depression and stressful or adverse life events corroborates the idea that serious losses, threatening occurrences, or difficulties in life play a major etiological role, particularly in initial depressive episodes [e.g., Brown, 1993;Brown and Harris, 1978;Brown et al, 1994;Jenaway and Paykel, 1997].…”

National Trends in the Use of Outpatient Psychotherapy

“…This change in the nature of psychotherapy may be related to growth in the number of private health plans that limit outpatient mental visits (42,43). It may also be a consequence of the resurgence of interest in cognitive behavior treatments (44,45) and of other evidence supporting time-limited psychotherapies (46).…”

Combined Treatment of Major Depression in Patients with Borderline Personality Disorder: A Comparison with Pharmacotherapy

“…Brief psychotherapies are commonly used as antidepressant therapy and have been studied by several authors (3)(4)(5)(6)(7)(8)(9). IPT ranks among models of psychotherapy that have been effective in treating depressive disorders (10)(11)(12)(13)(14)(15)(16)(17)(18). Accordingly, IPT has been recommended in the practice guidelines for depression and has been more widely used in clinical practice (1).…”