Interpersonal Psychotherapy (IPT) is a specific psychotherapy which requires only limited time. It was developed over a twenty year period, mainly for persons with major depressive disorder. Designed to be administered by experienced and trained mental health professionals, it can be used with or without medication. The procedures for treatment have been specified in a book used by your therapist as a guide (Klerman, et al., 1984). The idea behind IPT is that there are probably many causes of depression, including biological vulnerability, a recent stress or a loss. Whatever the “cause(s)”, depression usually occurs hi a social and interpersonal context. Some examples are:
• Your marriage breaks up
• You and your children have a dispute
• Your spouse becomes disinterested in you and the family and you think he/she is having an affair
• You lose your job or you think you will
• You move to a new neighborhood
• Your mother dies
• You are promoted
• You retire
In IPT, we take the position that understanding the social and interpersonal circumstances that led to the development of your depression (what was going on in your life when you became depressed) will help to unravel the reasons for your symptoms. It will be the first step in helping you to learn to develop new ways of dealing with people and situations so that you are less vulnerable.
This change occurs through open discussion with the therapist who has a point of view about depression and uses specific procedures, as we will describe, during the course of your treatment.
First the IPT therapist determines whether you have a depression, then proceeds to explore with you the associated interpersonal issues. This dialogue takes place over a set period of time.
IPT was developed in order to specify what we thought were helpful procedures used in psychotherapy for depressed patients who were being treated as 8 outpatients. We felt that by specifying these procedures more therapists might use them effectively. The patient would also be more informed about what to expect.
IPT has been tested in clinical treatment trials for depression where it has been compared to psychotropic medication, to placebo (sugar pills), to other specified brief psychotherapies and to no psychotherapy. It has also been tested in combination with medication. IPT has been tested as treatment for acute depression (with patients seen weekly for four months) and as a maintenance treatment to prevent new episodes of depression in recovered patients (seen weekly for eight months or monthly for three years). The results of these clinical trials, which use the same scientific format as studies testing new medications, were positive.
IPT is one of the psychotherapies recommended for the treatment of depression in the American Psychiatric Association Guidelines (Karasu et al., 1993) and in the Guidelines for Primary Care Physicians. Both of these guidelines were published in 1993. The complete reference is at the end of this chapter.
IPT was first developed for adult patients with major depression (the different types of depression are explained in Chapter 1). It has now been modified for: adolescents and the elderly with depression; persons with dysthymia or chronic depressions; patients with bipolar disorder (manic depression) or recurrent depression; depressed HIV positive patients; and patients with bulimia or with drug abuse. Modifications for patients with panic disorder and with personality disorders are underway. These modifications are at various stages of development and testing and have been summarized in a recent book by Klerman and Weissman (1993). For some of these modifications, it is too early to make claims of effectiveness. The best and most solid information relates to the effectiveness of IPT for patients with major depressive disorder, for whom this book is intended.
We do not believe that there is only one right treatment for depression. There are a range of medications and a range of psychotherapies and often these are used in combination. It is in the best interest of the depressed patient to have this variety available, but all treatments must undergo scientific testing before any claims are made. IPT, cognitive therapy, some behavior therapies and many antidepressant medications have undergone such testing.
Research has shown that IPT is helpful for depressed patients. It is an important alternative to medication for patients during some periods of their life, e.g., women during childbearing or nursing; the elderly and others who have difficulties with the side effects of medication; depressed patients about to undergo surgery; and patients who just don’t want to take medication. This is in no way to devalue the importance of medication as a treatment for depression, especially for patients who need rapid symptomatic relief; who are seriously symptomatic; and who have certain types of depression; for patients who are not helped by psychotherapy; or patients who just don’t want to talk about personal problems with a therapist. This broad view of treatment is part of the philosophy of IPT.
Mastering Depresion Through Interpersonal Psychotherapy, A Patient Workbook. By Myrna M. Weissman, Oxford University Press, 1995