Core Components

Interpersonal psychotherapy (IPT) is a time-limited psychological intervention, originally developed for the treatment of depression, but subsequently adapted for the treatment of other mental health disorders (e.g. eating disorders). This attachment-based intervention is present centred and focuses on addressing ‘here and now’ interpersonal problems areas (e.g. grief or complicated bereavement, role dispute, role transition and interpersonal deficits) for the purpose of helping patients achieve enhanced interpersonal functioning, increased social support and symptom remission. IPT has four key features that help achieve its treatment goals. These include:

1. Focus on interpersonal relationships and social support: IPT recognises the contribution of interpersonal distress to the emergence and maintenance of psychological distress and mental health disorders. It therefore helps patients communicate better within relationships or alter their demands or expectances from relationships. It also helps patients to strengthen their social network so that they can mobilize social support in times of interpersonal distress.
2. Based on biopsychosocial/cultural/ spiritual model of psychological functioning: IPT conceptualises patient functioning in the context of five factors, i.e. biological factors (e.g. genetics and physiology); social factors (e.g. social relationships and support); psychological factors (e.g. disposition and attachment style); cultural factors; and spiritual factors. These five factors align with the theoretical foundation of IPT which recognises attachment and effective communication as being intrinsically linked to psychological functioning.
3. Short-term in its acute phase: In the acute phase, IPT is a brief intervention that is typically delivered over 12-16 sessions, depending of complexity of patient’s condition, followed by longer maintenance therapy, also dependent on complexity of patient’s condition. The short-term approach of IPT prevents transference from being the focus of therapy, as transference issues detract from IPT’s focus on patient’s relationships outside of therapy. The time-limited nature of the acute phase therefore affords therapists enough time to address interpersonal issues, social support, and patient’s formation of attachment relationships outside of therapy.
4. A non-transferential approach: IPT’s key focus is on relationships that are outside of the patient-therapist relationship. Transference, which ensues in the course of therapy, provides the therapist with key information about patient’s distorted perception in relationships or attachment style. This enables the therapist infer on patient’s interpersonal functioning outside of therapy, recognise potential problems that could be encountered in therapy, predict the possible outcomes of therapy, and work out a good conclusion for therapy. Discussion of the patient-therapist relationship is not the focus of IPT, as the focus lies on interpersonal relationships outside of therapy.

IPT sessions are typically delivered weekly, with each session lasting about 45-50 minutes. These sessions are delivered in three phases:

1. Initial phase: Delivered over sessions 1-4 and consists of; i) Evaluation phase- To diagnose the disorder and comorbidity, and to conduct comprehensive review of relationships; ii) Case formulation phase- To define target diagnosis and link diagnosis to current interpersonal problem (i.e. interpersonal inventory); iii) Agreement on a treatment plan
2. Middle phase: Delivered over sessions 5-12 and aims to resolve the interpersonal problem
3. Final phase: Delivered over sessions 13-16 and aims to bring a good conclusion to the treatment

In the perinatal context, IPT addresses interpersonal problem areas (e.g. low social support, changes to social circumstances, role transition, and partner/ spouse conflicts) that are linked to distress and symptoms of mental health disorders in the perinatal period. Delivery of IPT during this period aims to enhance coping skills, promote resolution of partner/ spouse conflicts, and expand social networks. These can translate to reduced symptomatology and improved interpersonal functioning.   

Fidelity

NICE recommends that interventions in the perinatal period should be delivered by competent practitioner(s) with ongoing supervision. The intervention(s) should be delivered as per validated manual, and that stipulated content and structure are adhered to in order to ensure consistency in delivery of intervention. The use of competence frameworks developed from the treatment manual should also be considered. Treatment adherence and practitioner competence should be monitored and evaluated using appropriate measures, e.g. via recording of treatment sessions and auditing of recorded sessions.

IPT adherence and quality scale is a validated scale used by IPT supervisors and therapists for clinical supervision, as a guide to conducting IPT, and as a measure of adherence to treatment. Higher scores on the scale correlate with better psychological outcomes.

Modifiable Components

IPT is available as Family Based Interpersonal Psychotherapy (FB-IPT) for depressed preadolescents, and Interpersonal psychotherapy for depressed adolescents (IPT-A).  IPT is an individualised intervention, but has been evaluated as a group and couples intervention. In addition to face-to-face delivery (in clinic, medical and community settings), IPT has been delivered via telephone. It is typically delivered over 12-16 sessions, however, an 8-session brief format has been evaluated. This brief format has been delivered to socio-economically disadvantaged and racially diverse women. IPT has also been modified into Interpersonal Counselling (IPC), a scripted intervention for subsyndromal depression and anxiety symptoms, delivered by non-mental health nurses. IPT resources are available in English and have been translated into several languages including German, Italian, Spanish, Japanese, Korean, Mandarin, Dutch, French, Turkish and Portuguese.