Interpersonal Psychotherapy. A Guide To The Basics. (Stuart, 2006)

542 PSYCHIATRIC ANNALS 36:8 | AUGUST 2006

C M E

Interpersonal Psychotherapy: A Guide to the BasicsScott Stuart, MD

Interpersonal psychotherapy (IPT) is a time-limited, dynamically in-formed psychotherapy that aims to

alleviate patients’ suffering and improve their interpersonal functioning.1-4 IPT focuses specifi cally on interpersonal relationships, with the goal of helping patients to either improve their interper-sonal relationships or change their ex-pectations about them. In addition, IPT also aims to assist patients to improve their social support so they can better manage their current interpersonal dis-tress.

A number of elements characterize IPT. These can be categorized as the the-ories supporting IPT; the targets of IPT; the tactics of IPT; and the techniques of IPT. Although individual elements in each of these categories may be shared with other psychotherapeutic approach-es, it is their unique combination that de-fi nes IPT (Table, see page xxx).

INTERPERSONAL ORIENTATION OF IPT

IPT is based on the premise that in-terpersonal distress is connected to psy-chological symptoms. Thus, the targets of treatment are threefold: the relief of psychiatric symptoms; the confl icts, transitions, and loss experiences in the patient’s relationships; and the help the patient needs to better use his or her ex-tended social support network. IPT is therefore clearly distinct from treatments such as cognitive-behavior therapy (CBT)5 and psychoanalytically oriented psychotherapies. In contrast to CBT, in

which the primary focus is the patient’s internal cognitions, IPT focuses on the patient’s interpersonal communications with others. Although IPT may address cognitions, they are not primary targets. Similarly, CBT and other approaches may deal with interpersonal issues, but they are not the primary target.

In contrast to analytically oriented treatments, in which the focus is the con-tribution of early life experiences to psy-chological functioning, IPT focuses on helping the patient to improve his or her communication and social support in the present. By virtue of its time limit and its focus on “here-and-now” relationships, IPT is designed to resolve psychiatric symptoms and improve interpersonal functioning, rather than to change under-lying dynamic structures. The question that drives the IPT therapist’s interven-tions is: “How can this patient be helped to improve here-and-now interpersonal relationships and build a more effective social support network?”

THE THEORY SUPPORTING IPTIPT rests on a triad of theories. The

fi rst and most important is attachment theory. The second, communication theory, describes the ways in which patients’ maladaptive communication patterns may lead to diffi culty in their current interpersonal relationships. The third, social theory, is the basis for un-derstanding the interpersonal context in which patients interact with others.

Attachment theory describes the way in which individuals form, maintain, and

end relationships and is based on the premise that humans have an intrinsic drive to form interpersonal relationships with others.6-11 Simply put, attachment forms the basis for an enduring pat-tern of interpersonal behavior that leads an individual to seek care and reassur-ance in a characteristic way. As Bowlby stated, “The desire to be loved and cared for is an integral part of human nature throughout adult life as well as earlier, and the expression of such desires is to be expected in every grown-up, espe-cially in times of sickness or calamity.”8

Attachment theory hypothesizes that people experience distress when disrup-tions in their attachments with others occur. This is both because of the prob-lems within the specifi c relationship and because their social support network is not able to sustain them during the loss, confl ict, or transition. Insecurely at-tached people are more prone to become distressed during interpersonal confl icts, after the loss of a relationship, or follow-ing role transitions, both because they are less secure in their primary attach-ments and because they have poor social support networks.12-14 These problem ar-eas — interpersonal disputes, role transi-tions, and grief and loss — are addressed specifi cally in IPT.

Rather than attempting to change the patient’s fundamental attachment style, IPT focuses on the ways the patient communicates attachment needs and on how he or she can construct a more supportive social network. Taking the patient’s attachment style as a constant,

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IPT works in real-time relationships to help the patient communicate needs more effectively.

Communication theory can be un-derstood in IPT as describing the way in which individuals communicate their attachment needs to specifi c signifi cant others.15-20 Attachment theory is con-nected to the broad, or macro, social context, while communication theory informs individual relationships on a mi-cro level. Attachment is the template on which specifi c communication occurs.

According to Kiesler, interpersonal problems occur as a result of negative or nonsupportive responses from others that are elicited unintentionally by the patient.21 Maladaptive attachment styles are manifested on a micro level as specif-ic communications that elicit responses that do not meet the patient’s attachment needs effectively. In short, maladaptive attachment styles lead to inappropriate or inadequate interpersonal communica-tion, which prevents a person’s attach-ment needs from being met.22

Social theory emphasizes the role of interpersonal factors such as loss and poor or disrupted social support in maladaptive responses to life events and the genesis of depression and anxiety.23-

25 The social milieu in which a patient develops interpersonal relationships strongly infl uences his or her ability to cope with interpersonal stress. Further, it is the effect of the person’s current en-vironment that is crucial.23 In essence, social theory posits that poor social sup-port is a causal factor in the genesis of psychological distress.

The social theory that supports IPT stands in sharp contrast to psychoanalyt-ic theory and clearly differentiates IPT. Psychoanalysis rests on two fundamen-tal principles: psychic determinism, and the proposition that unconscious mental processes are a primary drive for con-scious thoughts and behaviors.26 In con-trast, the social theory supporting IPT invokes neither of these principles. The

fundamental basis of IPT is that current interpersonal stressors lead to psychopa-thology — there is no need to involve either unconscious processes or psychic determinism as causal factors in psycho-logical dysfunction.

In sum, IPT rests on three theoretical underpinnings: attachment theory, inter-personal theory, and social theory. All are used in the interpersonal conceptu-alization of the patient’s distress, as well as to direct the interventions used in IPT. An acute psychosocial stressor in a pa-tient with attachment vulnerabilities, in the context of insuffi cient social sup-port, forms the interpersonal triad which leads to the development of symptoms and psychological distress (Figure 1, see page xxx). IPT is designed to address this by helping patients to improve their interpersonal communication and to use their social support systems more fully.

THE TARGETS OF IPTIPT is based on a biopsychosocial

model of psychological functioning,27 which asserts that biological, psycholog-ical, and social factors coalesce within an individual to produce a unique diathesis and response to stress. When faced with a suffi cient interpersonal crisis, vulner-able people are likely to have psycho-logical diffi culties. The biopsychosocial model, therefore, frames psychological diffi culties as the response of a unique individual to a specifi c stressor, rather than as categorical illnesses. Instead of narrowly viewing psychological distress or psychiatric symptoms as a manifesta-tion of a medical illness, IPT conceptu-alizes the patient’s functioning in broad terms as a product of his or her tempera-ment, personality, and attachment style, based on a foundation of biological fac-tors such as genetics and physiological functioning, placed in the context of so-cial relationships and broad social sup-port (Figure 2, see page xxx). A patient with a biopsychosocial diathesis coupled with an acute interpersonal stressor in

the context of poor social support will be likely to experience psychological distress or psychiatric symptoms.

The biopsychosocial model is consis-tent with the theoretical basis for IPT, in which attachments in relationships and a person’s ability to communicate ef-fectively are linked with psychological functioning. In addition, the biopsycho-social model leads directly to the spe-cifi c techniques and interventions used in IPT. This includes the use of IPT in combination with psychotropic medica-tions when indicated. Treatment with IPT therefore targets the biological, psy-chological, and social determinants of the patient’s distress.

IPT TACTICSThe Interpersonal Inventory

The Interpersonal Inventory2 is a reg-ister of the patient’s key current relation-ships. It is a unique feature of IPT that structures the process of history gath-ering and formulation of interpersonal problem areas and provides a reference point for conducting IPT. The Interper-sonal Inventory typically is compiled during the fi rst two to three sessions of IPT, but it is best considered a “work in progress,” as most therapists and patients fi nd that their perspectives of relation-ships and the problems associated with them change during the course of IPT.

The Interpersonal Inventory focuses on the patient’s contemporary relation-ships, the history of the patient’s current interpersonal problems, and the infor-mation that is relevant to resolving the interpersonal problem (eg, the patient’s attachment and communication styles). The Interpersonal Inventory is a critical element of IPT that orients both patient and therapist to the interpersonal prob-lems that are to be addressed in therapy. These problems are further character-ized within one of the four interpersonal problem areas: interpersonal disputes, role transitions, grief and loss, and inter-personal sensitivities (or defi cits). The


use of the Interpersonal Inventory and the interpersonal problem areas are tac-tical methods in IPT of addressing the patient’s interpersonal distress.

Interpersonal Problem AreasInterpersonal Disputes. Interpersonal

disputes are simply confl icts between individuals that are causing distress. Determining the stage of a dispute is important in IPT in understanding the patient’s perception of the problem and expectations for the relationship. Inter-personal disputes are conceptualized in IPT in one of three stages:2

● Negotiation — ongoing attempts by both parties to bring about changes.

● Impasse — attempts at resolving the dispute have stalled.

● Dissolution — the relationship is be-yond repair.The IPT strategy with interpersonal

disputes is to help patients move away from the impasse stage, where by defi -nition the confl ict is unresolved. The therapist either helps the patient become more invested in the relationship, shift-ing the confl ict back to the negotiation

stage, or helps the patient recognize that he or she is less invested in the relation-ship, shifting the confl ict to the dissolu-tion stage. This can be done by paying particular attention to the patient’s style of communication and his or her expec-tations about the relationship (both of which are frequent contributors to the problem), as well as factors that main-tain the dispute.

Role Transitions. All interpersonal re-lationships occur in complex psychoso-cial contexts. When the context changes, as in a role transition, the relationship changes. In IPT, the process of change within relationships that occurs as a con-sequence of contextual changes within the patient’s life is conceptualized as a role transition.

Although some transitions, such as loss of health, may be seen as wholly negative by the patient, most change involves some good and bad elements. When working with a patient who is experiencing a role transition, the thera-pist focuses directly on the ambivalent feelings that the patient is experiencing while undergoing the transition, bring-ing the patient’s attention to both posi-tive and negative reactions to the change.

The therapist’s task is to help the patient recognize these ambivalent reactions and deal with them effectively. The strat-egy in dealing with role transitions is to help the patient mourn the loss of the old role and develop a more balanced view of both the old and new roles. Encour-aging the patient to develop new social supports in his or her new environment also is crucial.

Grief and Loss. Bowlby13 described three stages of loss, which he labeled as protest, despair, and detachment. In IPT, the goal is to help patients work through these phases and continue on through a resolution of their grief. The resolution involves helping patients to understand and articulate their grief and loss experi-ence more fully, and then to share their experiences with others. The latter is ab-solutely crucial in IPT. This process of connecting with others will engage so-cial support, diminish patients’ sense of isolation, and help patients develop new attachments.

While the working through of the loss intrapsychically is extremely help-ful and is a necessary part of IPT, it is the communication of the experience to others and the development of social

TABLE 1.

The Defi ning Elements of Interpersonal Therapy (IPT)

Theory Attachment, Interpersonal, and Social Theory

Targets Biopsychosocial: Psychiatric Symptoms, Interpersonal Relationships, Social

Support

Tactics Interpersonal Inventory

Interpersonal Problem Areas: Interpersonal Disputes, Role Transitions, Grief

and Loss, Interpersonal Sensitivity

Interpersonal Formulation

IPT Structure: Acute Time Limit; Maintenance Treatment

Nontransferential Focus of Interventions

Present Focus

Collaboration and Goal Consensus

Supportive and Directive Therapeutic Stance

Techniques Communication Analysis

Interpersonal Incidents

Use of Content and Process Affect

Role Playing

“Common” Techniques

1. Defi ne and describe interpersonal psychotherapy (IPT).

2. Review the theories supporting IPT.

3. Discuss the tactics and techniques unique to IPT.

Dr. Stuart is professor of psychiatry

and psychology, University of Iowa, and

co-director, Iowa Depression and Clinical

Research Center (IDCRC), Iowa City, IA.

Address reprint requests to: Scott Stu-

art, MD, University of Iowa, Department

of Psychiatry, 1-293 Medical Education

Building, Iowa City, Iowa 52242; or e-mail

[email protected].

This work was supported by Na-

tional Institute of Mental Health grants

MH59668 and MH072757. Dr. Stuart dis-

closed no relevant fi nancial relationships.

EDUCATIONAL OBJECTIVESC M E


Figure 1. The interpersonal triad.

Acute Interpersonal Crisis

Attachment and Biopsychosocial Vulnerability

Inadequate Social Support

DISTRESS

support surrounding the loss that charac-terizes IPT. In essence, once a grief issue is established as a focus of treatment, the therapist’s tasks are simply to facilitate the patient’s mourning process and to as-sist the patient to obtain increased social support.

In IPT, grief and loss can be con-ceptualized broadly. The problem area includes reactions to an actual death, as well as anticipatory grief of another’s, or of one’s own, death. Loss of physi-cal health or of relationships also can be considered grief and loss issues. As with the other problem areas, the tactic in IPT is to use the area to maintain the inter-personal focus of treatment.

Interpersonal Sensitivity/Defi cit. In-terpersonal sensitivity1 or defi cits2 may be used to describe a patient’s diffi culty in establishing and maintaining close interpersonal relationships. It is distinct from the other problem areas in IPT be-cause it usually describes a consistent style of attachment, rather than refer-ring to an acute interpersonal stressor. In many cases, interpersonal sensitivity can be understood as the baseline attach-ment style on which an acute stressor is imposed and can therefore be conceptu-alized as a complicating factor in any of the other three problem areas. In other words, patients with sensitivities may present for treatment not because of their longstanding relationship problems but because they are in the midst of an acute interpersonal crisis, such as a tran-sition, a dispute, or a major loss.

When interpersonal sensitivity is the patient’s presenting problem, the pa-tient’s longstanding sensitivities usually have left him or her with a paucity of so-cial relationships and a lack of interper-sonal connectivity. Intuitively, this kind of longstanding problem would seem to be less amenable to a time-limited treat-ment, but limited empirical research does suggest that IPT can be helpful for patients with interpersonal sensitivities such as social phobia.28,29 Clinical ex-

perience also suggests that such patients may respond well to IPT. The primary therapeu-tic goals when working with interpersonal sen-sitivities are to help the patient improve his or her social skills and to develop a social support system that more fully meets his or her attachment needs.

The Interpersonal FormulationThe Interpersonal Formulation1 syn-

thesizes information from the Interper-sonal Inventory and psychiatric history regarding a patient’s biological and psy-chological makeup, attachment style, personality, and social context, creating a plausible hypothesis explaining his or her psychological symptoms (Figure 3, see page xxx). In essence, the “formu-lation” is nothing more than a theoreti-cally grounded working understanding of the unique person with whom the clinician forms a relationship in therapy. Because the theoretical orientation of IPT is based on attachment, communica-tion, and social theory, the formulation is an approximate understanding of the patient’s experience from that perspec-tive. As such, it is a critical bridge be-tween a general theory of human behav-ior and the patient’s specifi c and unique problems.

The Interpersonal Formulation is a hypothesis that addresses several ques-tions: How did the patient come to be the way he or she is? What factors are maintaining the problem? What can be done about it? The formulation empha-sizes both the interpersonal factors in-volved in the origin and context of the problem, as well as how IPT will help the patient overcome his or her symp-toms. It is therefore a pivotal part of IPT, as the successful collaboration between patient and therapist to construct a valid formulation “sets the scene” for the con-

duct of treatment. The Interpersonal Formulation should

provide: ● A plausible hypothesis explaining the

patient’s problems and their onset, clinical manifestation, and course;

● A validation of the patient’s experi-ence and a way of understanding his or her problems;

● A mutually determined focus for in-tervention based on the four problem areas; and

● A plausible rationale for treatment with IPT and for the use of specifi c IPT techniques.

Time Limit for Acute Treatment with IPT

IPT is characterized by a time-limit-ed acute treatment phase, and a contract should be established with the patient to complete acute treatment after a specifi ed number of sessions. In general, a course of 10 to 20 sessions is used for the acute treatment of interpersonal problems, de-pression, or other major psychiatric ill-nesses. Clinical experience suggests that tapering sessions over time is generally a more effective way of using the treat-ment. For example, weekly therapy may be provided for 6 to 10 weeks, followed by a gradual increase in the time be-tween sessions as the patient improves, such that weekly sessions are followed by biweekly and monthly meetings.

Maintenance TreatmentAlthough acute treatment should be

time-limited, both empirical research


and clinical experience with IPT have demonstrated clearly that maintenance treatment, particularly for those pa-tients with recurrent disorders such as depression, should be provided for pa-tients in order to reduce relapse risk.30 A specifi c contract for the maintenance phase should be negotiated with the pa-tient.31 IPT should be conceptualized as a two-phase treatment, in which a more intense acute phase of treatment focuses on resolution of immediate symptoms, and a subsequent maintenance phase follows with the intent of preventing re-lapse and maintaining productive inter-personal functioning. There is no need

in IPT to “terminate” at the end of acute treatment, especially as it is not in the interest of most patients to do so.

IPT follows a “family practice” mod-el of care, in which short-term treatment for an acute problem or stressor is pro-vided. Once the interpersonal problem is resolved, the therapeutic relationship is not terminated; the therapist makes him or herself available to the patient should another crisis occur, at which time an-other time-limited course of acute treat-ment can be undertaken. In the interim, the therapist can provide “health mainte-nance” sessions periodically.

Nontransferential Focus of IPTIPT is characterized by the absence

of interventions that address the thera-peutic relationship directly. Although sharing this characteristic with CBT and several other solution-focused therapies, IPT clearly differs in this way from the dynamically oriented therapies.

Attachment theory and clinical expe-rience both support the fact that, given enough time, a patient will display be-havior towards his or her therapist that is refl ective of his or her attachment style.9,32 This is in essence the basis for transference. Thus, the therapist is in a unique position to experience and exam-ine the way in which a patient develops and maintains relationships, because the therapist is in a relationship in which he or she is the person on whom the attach-ment behaviors are imposed.

Transference and the display of at-tachment behavior in the therapeutic re-lationship are universal phenomena in all psychotherapy, including IPT. However, while in IPT the therapist’s experience of the patient–therapist relationship is used to provide information about the patient and his or her interpersonal world, the transference elements of this relation-ship are not addressed directly by the therapist as a part of the treatment. The use of the therapeutic relationship in IPT to understand the patient’s interpersonal functioning and to assess the patient’s attachment style is crucial. The use of the therapeutic relationship in IPT to formulate questions about the patient’s interpersonal relationships outside of therapy also is extraordinarily impor-tant. The use of transference to inform the therapist about potential points of resistance and potential problems in therapy is paramount.

However, the direct examination of the patient–therapist relationship is not encouraged in IPT because it changes the focus of treatment from more immediate work on the patient’s current social rela-tionships to an intense experience with,

Figure 2. The biopsychosocial stress-diathesis model of IPT.

Biopsychosocial DiathesesBiological FactorsGenetic Predisposition to Stress

Temperament

Psychological FactorsEarly Life Experiences

Attachment Style

Social FactorsCurrent Signifi ant Relationships

Current Social Support

Interpersonal Crisis

Interpersonal Dispute Interpersonal SensitivityGrief and LossRole Transition

Suprathreshold Intensity

Insuffi cient Social Support

Attachment Needs Unmet

Maladaptive Communicationof Attachment Needs

Interpersonal Problems and Psychiatric Symptoms

Subthreshold Intensity

Resolution

Suffi cient Social Support

Resolution


and analysis of, the relationship with the therapist. Addressing the patient–thera-pist relationship directly as a primary technique shifts the therapy from one that is oriented toward improvement in symptoms and immediate interpersonal functioning to a therapy that is oriented towards intrapsychic insight.

IPT therefore is structured in such a way that transference problems are less likely to develop. First and foremost, the patient is not explicitly encouraged to discuss the patient–therapist relation-ship. In addition, the IPT therapist gen-erally takes a supportive stance, rather than being neutral. The acute phase of therapy is time-limited, and the treat-ment is focused specifi cally on interper-sonal issues in the patient’s social rela-tionships.

In sum, the patient–therapist relation-ship, and particularly the information provided by the transference relation-ship, are extremely important in IPT but are not addressed directly in therapy. To do so detracts from the focus on symp-tom reduction and rapid improvement in interpersonal functioning that is the ba-sis of IPT, and also typically leads to a much longer course of treatment than is required for IPT. The goal in IPT is liter-ally to work with the patient to resolve his or her interpersonal distress quickly, before problematic transference devel-ops and becomes the focus of treatment.

IPT TECHNIQUESCommon Techniques

Warmth, empathy, genuineness, and unconditional positive regard, although not suffi cient for change in IPT, are all necessary for change in IPT. Sophisti-cated techniques have no effect if the pa-tient is not engaged in the therapy. With-out a productive alliance, the patient will simply discontinue therapy, an obstacle that no amount of technical expertise can overcome. The primary goal of the IPT therapist is therefore to understand the patient.

This is of particular importance in IPT because the therapy is time limited. It is incumbent on the therapist to quick-ly establish a therapeutic alliance. Thus in IPT, particular attention must be paid to all of the “nonspecifi c elements” of therapy — warmth, empathy, affective attunement, positive regard — that were described by Rogers33 as necessary to bring about psychotherapeutic change. It is crucial that IPT therapists be more than technicians; without establishing a productive therapeutic alliance, none of the IPT techniques and strategies will be effective.

Clarifi cation is one of the most fre-quently used techniques in IPT to devel-op such a positive alliance. Clarifi cation in IPT is in essence nothing more than listening, asking good questions so that the therapist can better understand the patient’s experience, asking very good questions so that the patient can better understand his or her own experience, and asking extraordinarily good ques-tions so that the patient is motivated to change his or her behavior.

Communication AnalysisCommunication analysis is simply a

structured method of investigating the hypothesis that the patient’s diffi culties are being caused, perpetuated, or exac-erbated by poor communication. The goals for communication analysis are to help the patient identify his or her com-munication patterns and recognize his or her contribution to the communication problem, and to motivate the patient to communicate more effectively.

To do this, the therapist works se-quentially with the patient through the following steps:● Collecting information about the pa-

tient’s interpersonal relationships and the communication that occurs within them.

● Developing hypotheses about the cause of the communication problem.

● Presenting the hypotheses to the pa-tient as feedback about his or her com-munication.

● Soliciting responses from the patient about the therapist’s critiques.

● Revising the hypotheses if needed.● Problem solving to develop new ways

Figure 3. The Interpersonal Foundation.

Biological FactorsGenetics

Substance Use

Medical Illnesses

Medical Treatments

Psychological FactorsAttachment Style

Temperament

Cognitive Style

Coping Mechanisms

Social FactorsIntimate Relationships

Social Support

Unique Individual

Interpersonal CrisesGrief and Loss

Interpersonal Disputes

Role Transitions

Interpersonal Sensitivity

Psychological Distress


of communicating.● Practicing new ways of communicat-

ing.

Interpersonal IncidentsInterpersonal incidents1 frequently

are used as a form of communication analysis. In essence, an interpersonal in-cident is a single episode in which com-munication occurs between the patient and a signifi cant other. An interpersonal incident is a description by the patient of a specifi c interaction with his or her at-tachment fi gures or social contacts — it is not a description of a general pattern of interaction. For example, if an identi-fi ed dispute is a confl ict between spous-es, the therapist might ask the patient to “describe the last time you and your spouse got into a fi ght,” or to “describe one of the more recent big fi ghts you had with your spouse.” The therapist then di-rects the patient to describe in detail the communication that occurred in the spe-cifi c incident, taking care to recreate the dialogue as accurately as possible. The patient should be directed to describe his or her affective responses, as well as both verbal and nonverbal responses, and to describe observations of his or her spouse’s nonverbal behavior.

In contrast to an approach that ques-tions the accuracy of the patient’s cog-nitions, the IPT therapist is interested in the way in which the patient communi-cates his or her attachment needs. IPT is directed at the patient’s communica-tions and is concerned with the ways in which the communication between the patient and his or her signifi cant other is maladaptive. In other words, rather than addressing internal processes, the IPT therapist is concerned with examining the interpersonal communication that is occurring in the relationship. The prem-ise under which an interpersonal inci-dent is analyzed is that the “problem” presented by the patient is the result of poor communication.

Use of Content and Process AffectRecognition and discussion of the

patient’s affective state is crucial in IPT. The more affectively engaged the pa-tient is in therapy, the more likely it is that change will occur. In IPT, the goals regarding affect are to help the patient recognize his or her immediate affect; facilitate the patient’s recognition of affect that may have been suppressed, or that the patient may fi nd painful to acknowledge; and assist the patient to communicate his or her affect more ef-fectively to others.

The most obvious technique that the therapist can use to reach these goals is to give direct feedback to the patient regarding the therapist’s perception of the patient’s affective state. A variation of this technique with particular rel-evance to IPT is based on the therapist’s observation of “process” and “content” affect.1 Process affect is the affect that the patient displays during the conduct of therapy; that is, the affect that the pa-tient displays in session with the thera-pist while discussing important issues. Content affect, on the other hand, is the affect that the patient reports having ex-perienced in the past, in interactions out-side of the therapeutic relationship.

When working with content and pro-cess affect, it is extremely important for the therapist to be aware of incongrui-ties in the patient’s presentation. In other words, when process and content affect are dissimilar, it signals the therapist that the topic under discussion should be explored further. It also signals that the therapist, when the patient is able to tol-erate the feedback, should point out the incongruity to the patient. This will as-sist the patient to become aware of emo-tions that he or she may be suppressing, or that he or she may be aware of but is fi nding diffi cult to acknowledge.

The recognition of incongruity be-tween content and process affect is ex-tremely important in IPT. Recognizing these discrepancies will help both pa-

tient and therapist understand the ways in which the patient is communicating, and will also draw the patient more into the therapeutic process.

Role PlayingRole playing is a technique in which

the patient and therapist create an in vi-tro interaction in therapy to reinforce behavioral change outside of therapy. While role playing, the patient’s com-munication style and his or her mode of affective interaction can be examined in detail. In addition, the patient often can gain a better understanding of the expe-rience of others involved in the patient’s social relationships. Role playing also allows more effective communications to be discussed, modeled, and practiced.

Role playing is not a mandatory in-tervention in IPT; it is best used with selected patients and with selected prob-lems. It tends to be most effective when the therapeutic relationship is such that the patient is feeling supported and can tolerate a degree of confrontation by the therapist.

SUMMARYIt is a Herculean task to condense the

hours of clinical experience, volumes of theoretical writings, and collections of treatment manuals into a coherent yet brief description of IPT. The issue is not complexity; in many ways, IPT is quite simple to understand, learn, and deliver. IPT speaks to the universal human con-dition: interpersonal relationships and the changes, confl icts, and losses that occur within them. It also speaks to our need to connect to and to be understood by others. The concepts are intuitive.

Instead, the diffi culties in describing IPT fully are a function of the unique na-ture of every patient and therapist. The power of the IPT rests on two nearly paradoxical factors. First, the clear theo-retical base, well-defi ned targets, and the tactical approach that fl ows from them in IPT lead to a solid structure on which


both therapist and patient can rely. On the other hand, IPT is also fl exible, so that it can be adapted to the unique indi-viduals that seek help, and to the human therapists that attempt to provide it. Both of these aspects of IPT are critical in un-derstanding the individuals with whom we work and facilitating change.

Consider IPT as a work of fi ne cu-linary art. Our patients’ fundamental needs to be nourished and cared for must be met. The basic recipe is clear, but it is the nuanced and peculiar skill of each chef that brings out the right fl avors for the unique patient who needs help that truly satisfi es.

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Addtional Resources on Interpersonal Therapy

Additional details regarding IPT can be found in Interpersonal Psychotherapy: A

Clinician’s Guide by Scott Stuart and Michael Robertson (Oxford Press US). The text in-

cludes information about the practical conduct of IPT, case examples, and a review

of the empirical data supporting IPT. A CD-ROM–based IPT training program includ-

ing didactic materials and standardized training videotapes is slated for publication in

2007. This program will serve as a template that users can modify for the needs of their

own training curricula.

More information on IPT training can be found on the website of the International

Society for Interpersonal Psychotherapy, http://www.interpersonalpsychotherapy.org.