Interpersonal Therapy (IPT) is a brief psychotherapy initially used to treat significant depression but, like many other therapies, has subsequently been adapted for other disorders. IPT's focus is the “interpersonal context” — that is, those factors arising from relationships or interactions with others that lead to and maintain an individual's distress.
IPT considers that symptoms (that would be defined as a disorder) are indicative of an illness that is not the patient's fault, and that those symptoms always arise from the interpersonal context. So anxiety results from difficulties in our everyday interactions with other people, and in turn that anxiety will also have a significant impact on the quality of interactions. Helping people to identify how they are feeling and behaving in relationships can enable them to relate more constructively, which will have the effect of alleviating their distress.
Combining theory on how people relate to others and understandings developed from research into the impact of stress, social support and illness on people, IPT sees factors peculiar to the individual and their personal contexts that are likely to both precipitate and maintain disorders as important.
Therapy is focused around an interpersonal conflict in someone's life — a current crisis or relationship problem that is affecting access to social support and increasing their interpersonal stress. By working alongside the person, IPT aims to achieve certain goals which include:
- Improving social support networks
- Reducing interpersonal stressors
- Enabling the processing of emotions
- Teaching better interpersonal skills.
The goal of this treatment, which is brief in duration, is to resolve the current life crisis, work on building social skills, communicate emotions more effectively, and enhance protective social supports.
IPT has a diathesis-stress theory of mental health disorders and combines two different theoretical frameworks. The first is relational theory, which holds that he quality of relationships or interactions are essential for good mental health. The second is the link between illness and stress and social support.
According to the diasthesis stress model, disorders arise from an interaction between nature and nurture: that is, a genetic or biological predisposition (diasthesis) is activated by life stressors. Neither one is sufficient alone to bring about a disorder but the combination of the two causes distress or disorder. In anxiety research there is considerable support for the reactivity or sensitivity of the stress response being heritable or at least to be seen in greater incidence in families. The tendency towards anxiety disorders seems to run in families as does the reaction to life events or psychological vulnerability: for such people life is full of threats and so they are perpetually in the fight-flight arousal mode.
How is IPT carried out?
IPT therapy focuses upon a key interpersonal issue in a person's life and the aim is to resolve this issue by changing the problem itself or altering the person's relationship to it. IPT doesn't regard the person as being in need of "fixing", but rather looks to the person to fix the problem themselves and in turn change their relationship to the problem. In order to address interpersonal problems, the person needs to process emotions arising from that context, and develop their interpersonal skills.
The three phases of IPT
- The initial phase covers defining the problem with a case formulation and conducting an analysis of relationships – past and present, linking the medical diagnosis to interpersonal problem areas, and agreeing a plan of treatment.
- The middle phase is focused upon resolving the interpersonal issues.
- The final phase involves review, consolidation and plans for managing future issues, alongside terminating the therapeutic relationship.
It is a collaborative process where person and therapist clarify the key interpersonal issue. Interpersonal problems are defined in one of four ways:
- Grief – this concerns bereavement and subsequent difficulties with resuming meaningful interpersonal connections in the absence of the loved one. People can find it hard to “carry on with life” after a significant loved one dies and this can mean their life and relationships are very much put on hold.
- Role transition– a key life change which unsettles, such as illness, retirement, or becoming a parent. Life changes can lead people to feel a sense of disequilibrium and loss of control and loss of important self-defining identity.
- Role dispute – a conflict in an important relationship such as with an employer, partner, parent or child. When people become entrenched in conflicts in relationships, this can be a significant cause of worry and stress.
- Deficits in interpersonal skills arising from social isolation. Sometimes people are so isolated that this is in itself a trigger for distress.
Why might IPT work for anxiety?
People who suffer from anxiety disorders may experience difficulties with confrontation, expressing emotion (especially anger), and communicating needs and wants. IPT can help people develop skills to navigate these crises, which can in turn prevent the anxiety from arising.
Because interpersonal problems play a role in nearly all mental illnesses, IPT can help patients with a wide range of issues. Research in support of its applicability to anxiety is fairly scanty and it's use probably even more so, given the current dominance of cognitive behavioral therapy (CBT). A fairly recent meta-analyses found support for IPT and indeed these studies showed no convincing evidence for CBT being more effective than IPT in treating anxiety disorders,suggesting there is no reason why it should not be used. Often the mode of therapy is down to personal choice – what feels like a good fit – and success ultimately determined by the quality of relationship with the therapist.