What is interpersonal therapy?
Q. I got divorced a few months ago. Recently I was diagnosed with depression. A friend suggested I try interpersonal therapy. She thinks the problem is my relationship with my former husband. I'd never heard of this type of therapy. Could you tell me more about it?
A. Interpersonal psychotherapy is a form of therapy originally developed to treat depression, but it is now used to treat other mental health problems. In three or four months of weekly meetings, therapist and patient discuss the patient's present relationships with family, friends, co-workers, and neighbors. By focusing on interpersonal issues, the therapist hopes to relieve immediate symptoms and help the patient learn better ways to manage relationships in the future.
During therapy, the clinician asks questions meant to help the patient understand the source of the depression. Therapist and patient discuss what type of changes would make the patient feel better and set goals for treatment based on this analysis. Usually that means exploring one of four kinds of problems, although the topic may shift as therapy progresses.
One common topic is social role transitions — such as the divorce you've just gone through. But this category also encompasses other sources of stress such as serious illness, job loss or retirement, and 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. Patients may have difficulty making the necessary changes and need help adjusting to the new role.
The therapist asks questions to help the patient think about what has been lost and gained, to appreciate the reality of the losses, and to generate interest in the new opportunities. Therapists also try to defeat depression by helping patients cultivate the self-confidence and support from others that they need to meet the demands of the new role.
Another topic of interpersonal therapy is grief related to loss, such as the death of a loved one, that is often a source of depression. The therapist tries to help someone dealing with prolonged grief move through the mourning process and revive interest in life. Patient and therapist evoke memories of the lost person and discuss events surrounding the loss. They explore any regrets or resentment against 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.
Therapy may also explore interpersonal conflict. Some patients are demoralized by repetitive, frustrating disputes, usually with a relative or romantic partner. Patient and therapist analyze the issues at stake, examine unstated assumptions that perpetuate the conflict, and make a plan, including rules for avoiding constant useless arguments. If all real communication has ceased and the relationship is dying, the therapist can help the patient make a break. Whatever plan they choose, patient and therapist may also explore parallels in the patient's previous relationships.
A final focus is on interpersonal deficits. 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 pay special attention to past accomplishments and hopeful moments that the patient may have forgotten or disregarded. Patient and therapist explore repetitive self-defeating patterns, and discuss the patient's feelings about the therapist to identify possible parallels. Then the therapist tries to help the patient make what amounts to a social role transition by learning and practicing social skills, sometimes using methods borrowed from cognitive behavioral therapy.
Although originally developed for major depression, interpersonal therapy has since been adapted for other uses, including the treatment of postpartum depression, anxiety disorders, and eating disorders. It tends to be most helpful when a major life shift precipitates symptoms. Therefore, if depression follows divorce, where the roots of depression may be in that lost relationship, it is a reasonable treatment approach.
— Michael Craig Miller, M.D.
Editor in Chief, Harvard Mental Health Letter