Interpersonal Psychotherapy

This chapter introduces the basic principles, structure, and techniques of IPT: a brief treatment manual for the (tele-)clinician. IPT is a time-limited, affect- and life event–based psychotherapy that helps patients master a life crisis, often by mobilizing social support and learning to use feelings to understand and manage interpersonal encounters. The basic paradigm is that feelings and symptoms arise in an interpersonal context: feeling and situation are connected. The IPT framework includes making a diagnosis, taking an interpersonal inventory to explore the patient’s relationships and current life crises, giving patients the no-fault, medical model “sick role,” setting a time limit, and providing a formulation linking the patient’s diagnosis to a focal problem area on which the therapy will thereafter focus. The problem areas are grief (complicated bereavement following the death of a significant other), role dispute (a struggle with someone), or a role transition (any major life change). The chapter also stresses the importance of affect tolerance and building a treatment alliance and provides a Social Rhythm Metric and a Covid Behavioral Checklist.

Major Depression

Utilizing the elements described in the previous chapters, this one applies the IPT approach to patients with major depressive disorder in the setting of the Covid-19 pandemic. Major depression is a common sequela of disaster. Major depression is also the disorder for which IPT was first tested and has been most frequently evaluated, and for which it is considered a first line, practice guideline-recommended treatment. Four extended, detailed Covid-19 related case examples cover the three focal IPT problem areas of grief (complicated bereavement), role dispute, and role transition. These cases also underscore the importance of cultural issues in personalizing IPT to the treatment of individuals.

Life Crises

This chapter details the process of the IPT therapeutic treatment approach in the three focal problem areas: grief (complicated bereavement), role dispute, and role transition. (The potential fourth IPT problem area is unneeded in the setting of disaster.) Each involves a basic treatment paradigm spread across the three phases of treatment, including an opening question to determine recent affectively charged events; communication analysis, to help patients understand their feelings in a recent interpersonal situation; exploring options, to resolve interpersonal difficulties; and role play, to help patients practice those options. IPT assigns no homework but uses the time limit to press treatment forward. Although the three problem areas differ thematically, all involve solving an interpersonal crisis by interpersonal means.

Defining a combined constellation of complicated bereavement and PTSD and the psychosocial correlates associated with the pattern amongst refugees from West Papua

BackgroundRefugees are at risk of experiencing a combined constellation of complicated bereavement and posttraumatic stress disorder (PTSD) symptoms following exposure to complex traumas associated with personal threat and loss. Features of identity confusion are central to both complicated bereavement and PTSD and these characteristics may be particularly prominent amongst refugees from traditional cultures displaced from their homelands, families, and kinship groups. We investigate whether a combined pattern of complicated bereavement and PTSD can be identified amongst West Papuan refugees participating in an epidemiological survey (n = 486, response rate: 85.8%) in a remote town in Papua New Guinea.MethodsLatent class analysis was applied to derive subpopulations of refugees based on symptoms of complicated bereavement and PTSD. Associations were examined between classes and traumatic loss events, post-migration living difficulties (PMLDs), and psychosocial support systems.ResultsThe four classes identified comprised a complicated bereavement class (11%), a combined posttraumatic bereavement class (10%), a PTSD class (11%), and a low symptom class (67%). Symptoms of identity confusion were prominent in the posttraumatic bereavement class. Compared with the low symptom class, the combined posttraumatic bereavement class reported greater exposure to traumatic loss events (OR 2.43, 95% CI 1.11–5.34), PMLDs (OR 2.24, 95% CI 1.01–4.6), disruptions to interpersonal bonds and networks (OR 3.3, 95% CI 1.47–7.38), and erosion of roles and identities (OR 2.18, 95% CI 1.11–4.27).ConclusionsRefugees appear to manifest a combined pattern of complicated bereavement and PTSD symptoms in which identity confusion is a prominent feature. This response appears to reflect the combined impact of high levels of exposure to traumatic losses, PMLDs, and disruption of relevant psychosocial systems.

Interpersonal Psychotherapy for Older Adults

In clinical practice with older adults, depression is a common presenting problem and is usually interwoven with one or more life problems. These problems are often the focus of psychotherapy. Interpersonal Psychotherapy (IPT) is a highly researched and effective treatment for depression in adults and older adults. IPT is time-limited, and as an individual psychotherapy it is usually conducted over 16 sessions. IPT focuses on one or two of four interpersonally relevant problems that may be a cause or consequence of depression. These include: role transitions (life change), interpersonal role disputes (conflict with another person), grief (complicated bereavement), and interpersonal deficits (social isolation and loneliness). The four IPT problem areas reflect issues that are frequently seen in psychotherapy with depressed older people.

Grief

The symptoms of a normal grief reaction typically resolve over the course of a few months as the person processes the loss, thinking through remembered experiences with the deceased. This period of grief or mourning is a normal, useful, adaptive process. In contrast, in complicated grief, the person tries to contain her emotions, distancing herself from emotional life. This postponing and avoidance of grief is characteristic of complicated bereavement, a long-recognized form of major depression. This chapter discusses both normal and complicated grief and how grief is defined by the DSM-5 and how it presents as a problem area in IPT. The two goals of the therapist are to facilitate mourning (catharsis) and to reestablish interests and relationships that can to some degree substitute for the person and the relationship that have been lost. Case examples are included.

IPT for PTSD—Middle Phase

This chapter comprises a review of the middle sessions of IPT treatment for PTSD. This covers the interpersonal foci of grief (complicated bereavement), role disputes, and role transitions. It addresses techniques like affective attunement, eliciting, normalizing, validating, and helping patients verbalize feelings; eliciting a recent, affectively charged life event; exploring options; and role play. The key opening is a question: “How have things been since we last met?” Having identified a recent, affectively charged life event, the therapist uses an interrogatory triad to reconstruct it. Catchphrase: “Emotions are uncomfortable but not dangerous”—and indeed are even useful as social signals. The chapter also addresses thematic continuity of sessions and encouragement of taking social risks.