August 25, 2014
By Michael Craig Miller M.D.
Harvard Medical School
A woman consulted a colleague of mine recently after a painful divorce. The colleague thought she was depressed. The woman's friend had suggested looking for a clinician who had experience doing interpersonal therapy or IPT. She had heard of cognitive therapy, behavior therapy and psychoanalytic therapy. But she had never heard of this therapy.
IPT focuses specifically on problems that come up in relationships. When a marriage breaks up, rather than blaming the "ex," it may be more fruitful to understand where and why the relationship went wrong. This kind of review may help you make a better match the next time. And it may help you feel better about yourself.
Interpersonal therapy was originally developed to treat depression. It is now used to treat other mental health problems, such as postpartum depression, anxiety disorders and eating disorders. In three or four months of weekly meetings, the therapist will review the person's present relationships with family, friends, co-workers and neighbors. By focusing on interpersonal issues, the therapist hopes to work with a patient to relieve immediate symptoms and devise better ways to manage relationships in the future.
During therapy, the clinician asks the patient questions to help sort out and appreciate the sources of depression. They discuss what type of changes would make the patient feel better and set goals based on these changes.
Usually therapy focuses on one of four kinds of relationship problems, although the topic may shift as therapy progresses.
1. Changes in a person's social roles
One common topic is social role transitions — such as the divorce this woman had just gone through. But this category also includes other sources of stress, such as:
- Serious illness
- Job loss or retirement
- Significant family changes, such as marriage, the birth of a child, moving or a child leaving home.
These situations involve new demands, a loss of the comfort of routine, and sometimes separation from familiar people. People frequently have difficulty making the necessary changes and need help adjusting to new roles.
The therapist asks questions to help a person think about what has been lost and gained, appreciate the reality of the losses, and create interest in new opportunities.
To defeat depression, the therapist also helps the patient to develop self-confidence and to turn to friends and family for comfort. These sources of support should help the patient meet the demands of new roles.
2. Coping with loss and grief
Another topic of interpersonal therapy is grief related to loss, such as the death of a loved one. This is often a source of depressed mood. The therapist tries to help someone dealing with prolonged grief to move through the mourning process and find interest in life again.
The therapist helps the patient recall memories — both good and bad — about the person who is gone. They talk about events surrounding the loss. Loss can be difficult, especially when there are mixed feelings about the lost person.
The therapist may explore any regrets or resentment the patient has about the person. The patient is reassured that these feelings are common and not a reason to feel guilty. Then therapist and patient consider alternatives to dwelling on the loss.
3. Resolving conflict
Therapy may also explore conflicts in relationships. Many of us can feel frustrated and beaten down by ongoing disputes, usually with a relative or a romantic partner. Patient and therapist take a close look at the issues at stake. They examine unstated assumptions that keep the conflict going. And then they make a plan, including rules for avoiding constant useless arguments.
If there is no real communication and the relationship is dying, the therapist can help the patient make a break. Whatever plan they choose, patient and therapist may also explore similar experiences in the patient's previous relationships.
4. Lack of relationships
Some depressed people have difficulty making any personal connections at all. Their problem is not a change or crisis involving others, but the absence of significant events and relationships in their lives.
In this case, interpersonal therapists help the patient acknowledge past accomplishments and hopeful moments that the patient may have forgotten or disregarded.
The patient and therapist explore self-defeating behavior patterns. They discuss the patient's feelings about the therapist to identify possible parallels. Then the therapist tries to help the patient learn and practice new social skills. Sometimes this involves using methods borrowed from cognitive behavioral therapy and psychoanalytic therapy.
Interpersonal therapy is well studied. And it's a helpful tool to treat a variety of mental health issues. It's most useful when a person is going through a major life shift that causes painful symptoms, such as depression. The loss of a relationship can trigger depression. IPT is a reasonable way to come to terms with the loss and move on with greater optimism.
Michael Craig Miller, M.D. is the former editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 30 years.