What is Interpersonal Therapy?

This article provides an overview of Interpersonal Therapy (IPT), including its theoretical foundations, elements and structure, and clinical applications.

Related articles: What is Person Centred Therapy?, What is Dialectical Behaviour Therapy?, What is Solution Focused Therapy?, What is Acceptance and Commitment Therapy?

Interpersonal Therapy defined

Interpersonal Therapy, also known as Interpersonal Psychotherapy (IPT), has been defined as a time-limited, dynamically-informed psychotherapy which aims to alleviate clients’ suffering while improving their interpersonal functioning. It is concerned with the interpersonal context: the relational factors that predispose, precipitate, and perpetuate the client’s distress. It is widely, but not exclusively, used to treat mood disorders (such as depression). Rather than examine internal cognitions, as the other empirically-based intervention for mood disorders – Cognitive Behavioural Therapy – does, IPT focuses specifically on interpersonal relationships, with the goal of assisting clients to either improve their relationships or else change their expectations about them. Moreover, IPT helps clients to build up their social supports so that they can manage themselves better through times of interpersonal distress (Stuart, 2006; Robertson, Rushton, & Wurm, 2008).

The evolutionary path: How Interpersonal Therapy moved from control intervention to a therapy in its own right

Most psychotherapies begin with a theory and grow in prominence and popularity as the theory attracts followers and begins to show results. Interpersonal Therapy developed in the opposite direction, appearing on the scene first as a control treatment for studies examining the efficacy of antidepressant medications. Thus until recently nearly all practitioners of IPT were researchers (Markowitz & Weissman, 2004)! But let us take it from the beginning.

Psychopharmacological research circa 1970

From the early 1970s, American psychiatry became interested in evidence-based medicine, coming to worship at the feet of the RCT (randomised, controlled trial). Researchers and clinicians had observed that most genres of psychotherapy seemed to work (eventually) with depression; the field was simultaneously experiencing the advent of tricyclic antidepressant medications. Thus it was deemed necessary to test the efficacy of these medications against established psychological therapies (Robertson et al, 2008).

Factoring in another reality, researchers knew that many clients treated with the then-available antidepressants relapsed after the medication was withdrawn, but what was not clear was how long the psychopharmacologic treatment should continue in order to avoid relapse. Beyond that, although psychodynamic psychotherapy was generally prescribed for both acute and maintenance phases of depression, there was little data to demonstrate its efficacy in general; there was even less evidence addressing the role of psychotherapy in preventing relapse.

At this time behavioural treatments comprised the chief psychotherapy studies. Several large-scale psychodynamic studies had been published, but unfortunately they failed to meet then-current diagnostic criteria for depression; they also did not have standardised outcome measures. Moreover, they were limited in scope and sample size. The movement to generate standardised, manualised psychotherapeutic treatments gathered momentum; researchers and clinicians both desired treatments for depression which could be tested and reliably replicated, such as Beck’s CBT (International Society for Interpersonal Psychotherapy [isIPT], 2014).

The need for standardised, manualised, shorter psychotherapy

There was a problem, though. Sixteen weeks seemed about right to test whether the antidepressant was having an effect, but the typical psychodynamic psychotherapy that would be prescribed along with it would only be starting to gain traction during that time. Thus, with the goal of standardising what seemed to make up the components of good psychotherapy, Gerald Klerman, Myrna Weissman, and colleagues of Yale University came up with a briefer treatment which integrated what was believed to be the essence of medical psychotherapy. From these elements, they constructed a treatment program that would fit nicely within the confines of a treatment trial. 

With the additional observation that depression invariably affected not only the mood of the client, but also his or her communication and through that, relationships in social and work spheres – the marital, family, friend, work-based, and community interactions – it became clear that interpersonal relationships should be the focus of the new therapy. Thus IPT was born: a therapy based upon academic rather than clinical considerations (Robertson et al, 2008).

Interpersonal Therapy debuted in a large, multi-site study of medication and psychotherapy for the treatment of depression in mixed-age adults. The study, the United States National Institute of Mental Health (NIMH) Collaborative Research Program, was a seminal investigation because of its varied study sites, randomised-controlled clinical design, and large sample size (Elkin, Shea, Watkins et al, 1989). Researchers’ interest in IPT was piqued with the demonstrated efficacy of IPT in such an important study (Hinrichsen, 2008). The IPT treatment manual, Interpersonal Psychotherapy of Depression (Klerman, Weissman, Rounsaville, & Chevron, 1984) became the “bible” and chief training resource for IPT researchers and clinicians. In 1993, New Applications of Interpersonal Psychotherapy (Klerman & Weissman, 1993) was published. It described then-current research developments and pointed to new uses for IPT. The 1990’s were about expansion beyond IPT’s original focus on acute treatment of depression for younger and middle-aged adults to different age groups, presenting issues, formats, and specific clinical applications, as we will discuss in the research and applications section. In 2007 the “must-have” IPT book list expanded to include the Clinician’s Quick Guide to Interpersonal Psychotherapy; it is a concise statement of how to conduct IPT and supporting research (Weissman et al, 2007). The reader may also note in the research section that the study sites are no longer merely US- or British-based, with studies coming to being conducted in South Africa, Europe, New Zealand, and of course Australia. There is now an International Society for Interpersonal Psychotherapy (Hinrichsen, 2008). 

The theories that support Interpersonal Therapy

The fact that Interpersonal Therapy is not developed in the traditional manner of theory leading to practice does not mean that it does not have solid theoretical foundations. Specifically, IPT is supported by three theoretical pillars: attachment theory, communication theory, and social theory. The most important of the three is probably attachment theory.

Attachment theory

Proposed by John Bowlby, attachment theory describes the manner in which individuals form, maintain, and end relationships. Human beings, said Bowlby, have an innate tendency to seek attachments; the quest for them contributes not only to individual satisfaction, but to the survival of the species. Attachment forms the basis for the life-long patterns of interpersonal behaviour which lead an individual to seek care and reassurance in a particular way. Attachments lead to reciprocal, personal, social bonds with significant others, and because they generate experiences of warmth, nurturance, and protection, they also decrease the need for vigilance and rigid muscle tone (indicating hyper-alertness for defence).

Recognising the intense human emotions generated by attachments, Bowlby noted that the desire to be loved and cared for is integral to human nature. This, he claimed, is true not only throughout adult life, but much earlier as well. The expression of such desires is, in fact, so central to human growth, development, and happiness that attachment behaviours are to be expected in every adult, especially in times of sickness or calamity. Human beings of all ages are most happy, effective, and competent when they have the confidence that one or more trusted persons in their lives will be available for help in times of trouble.

Understandably, proponents of attachment theory recognise an individual’s vulnerability to depression if: (a) attachments do not develop early in life and/or (b) attachment bonds are disrupted, say through death, divorce, or abandonment. The distress associated with disruptions in attachments may be due to problems within the specific relationship, but is also heightened when an individual’s social support network is not able to sustain him or her during the loss, conflict, or transition. Insecurely attached individuals are more likely to become distressed than securely attached people during interpersonal conflicts, after the loss of a relationship, or following role transitions, both because they are less secure in their primary attachments and because they have poor social support networks. These problem areas for interpersonal relating – interpersonal disputes, grief/loss, and role transitions, along with the ongoing issue of what is called “interpersonal sensitivity” (a general deficit in interpersonal skills) – form the basis for determining the direction of the work in interpersonal therapy (Encyclopedia of Mental Disorders, 2014; Stuart, 2006; Linton, n.d.).

Interpersonal Therapy’s second pillar, communication theory, is about how individuals express their attachment needs.

Communication theory

While some psychotherapies may try to change an insecurely attached individual’s basic attachment style, Interpersonal Therapy works with that as a given. IPT focuses, rather, on the ways the client communicates attachment needs, and on how the person can build a more supportive social support network. Comparing these two foundational pillars of IPT, we could say that attachment theory is linked to the broad, or macro-context of a person. Communication theory, in its quest to describe how individuals communicate their attachment needs to significant others, informs individual relationships on a micro-level. “Attachment,” notes Stuart, “is the template on which specific communication occurs” (Stuart, 2006, p 544).

Like attachment theory, however, communication theory deals in aspects of interpersonal relationships that are below the level of conscious awareness, and thus sometimes difficult to identify. Kiesler explains that IPT clients often elicit negative or unsupportive responses from others unintentionally. This occurs because those who have maladaptive attachment styles engage in specific communications which bring forth responses that do not meet their attachment needs effectively. When the poorly-attached person then reacts to the non-need-meeting response, it often escalates tensions, deepening the cycle and preventing those needs ever being met (Kiesler, 1979).

Social theory

The final pillar of Interpersonal Therapy’s support foundation focuses on the role that interpersonal factors have in creating maladaptive responses to life events which then generate depression and/or anxiety. Factors such as loss or disrupted or poor social support create the social milieu in which a person develops interpersonal relationships, which in turn strongly influences how a person copes with interpersonal stress. Social theory emphasises that it is the current environment which is crucial. Thus poor social support is seen to be causal in the generating of psychological distress (Stuart, 2006).

We can hold up the sharp contrast between this supporting social theory of IPT and psychoanalytic theory. The latter is based on two chief interrelated principles: psychic determinism – the theory that all mental processes are not spontaneous but are determined by unconscious or pre-existing mental complexes – and the notion that unconscious mental processes are a primary driver of conscious thoughts and behaviours. The social theory of IPT involves neither of these, maintaining as fundamental the notion that it is current interpersonal stressors, not psychic determinism or unconscious processes, which create psychological dysfunction (Stuart, 2006).

Now, let us move on from theory to the remaining elements which characterise Interpersonal Therapy.

The defining elements and structure of Interpersonal Therapy

Proponents of Interpersonal Therapy are fond of stating that the defining elements of IPT are the theory (which we have just discussed), the targets, the tactics, and the techniques (isIPT, 2014; Stuart, 2006). We list the component parts of each below, and explain them in context as we progress through the typical phases of the IPT structure.

Theory	Attachment, communication, and social theory
Targets	Biopsychosocial: psychological symptoms, interpersonal relationships, social support
Tactics	Interpersonal inventory Interpersonal formulation Interpersonal problem areas: interpersonal disputes, role transitions, grief/loss, interpersonal sensitivity Collaboration and goal consensus (between therapist and client) IPT structure: acute time limit, but also maintenance treatments Non-transferential focus of interventions Present focus Supportive and directive therapeutic stance
Techniques	Communication analysis Interpersonal incidents Directive techniques Decision-analysis Role-playing Use of content and process affect “Common” techniques (clarification, summaries, and questions) The therapeutic relationship

(Table adapted from UCL, 2010; Stuart, 2006)

Because IPT is time-limited, the process of employing the above elements occurs within a relatively well-structured framework, consisting of five phases: assessment, initial sessions, middle sessions, termination (of acute treatment) sessions, and maintenance sessions.

The Interpersonal Therapy structure

Assessment

At the assessment phase, the therapist wants to know if the client is suitable for treatment with IPT. Non-specifically to IPT, there are questions as to suitability for any sort of psychological intervention. That is, we can ask whether the client has sufficient ego strength, whether the client is motivated for change, and how adequate the client is to undergo non-psychological treatments, such as medications (Robertson et al, 2008). Clients are likely to benefit from Interpersonal Therapy if they have:

• A relatively secure attachment style.
• The capacity to coherently discuss their interpersonal network and specific interpersonal interactions.
• A specific interpersonal focus for distress (as opposed to a more purely intrapsychic one).
• A solid social support system.
• A sense that the IPT intervention resonates with their view of their psychological distress (Stuart & Robertson, 2003).

Here at the assessment phase, the therapist can usefully employ psychoeducation, teaching the client about the nature of his/her condition (say, depression) and how it might be manifesting in his or her relationships. The condition needs to be accurately named so that the client can accept it. One way that IPT therapists foster acceptance is by legitimising for a period the “sick role” that the client has taken up. That is, IPT holds the understanding that a condition is not merely an illness, but also a social role that affects the behaviour and attitudes of the client and those around him or her. The client comes to see how the sick role has increasingly influenced his or her social interactions. The therapist walks a fine line with validating (albeit temporarily) the sick role, because there is the ever-present danger of fostering dependency. Thus, even in the assessment phase, the client is encouraged to work and socialise as much as possible (i.e., with an intervention such as, “You are depressed, it is a real condition – not just weakness on your part – but while we are working on it, you will need to stay active and not withdraw” (Linton, n.d.; Encyclopedia of Mental Disorders, 2014).

The assessment phase ends when therapist and client have contracted to go ahead with a specific number of sessions (generally between 12 and 16, though some estimates say between 10 and 20 or more), and to work on one (typically), or in some cases, more than one, interpersonal problem (Robertson et al, 2008; Stuart, 2006).

The initial sessions (through Session 3)

As we described earlier, IPT is both diagnostically targeted and interpersonally-focused. It is also present-focused. Thus the chief goal of the initial sessions is to generate a detailed hypothesis about why the client is having interpersonal difficulties, and to assess how supportive their social networks are in general; this is called an interpersonal formulation. Therapist and client arrive at it jointly via the development of an interpersonal inventory, or IPI.

The interpersonal inventory (a tactic) is a register of the client’s principal relationships. It is a unique aspect of IPT that the history gathered is put into a formulation of interpersonal problem areas and a focus suggested for the interpersonal therapy. The IPI generally is put together during the first three sessions, but is widely regarded as a “work in progress”: one that both therapist and client should feel free to revisit and revise as their perspectives on the client’s relationships – and resultant problems – deepen over the course of the therapy.

The IPI focuses on aspects such as the following:

• the client’s current relationships
• the history of the client’s current interpersonal problems
• the information that is relevant to resolving the client’s interpersonal problems (such as his/her communication and attachment styles)

It cannot be overstated how critical the IPI is in its ability to direct the attention of both client and therapist to the interpersonal problems that will need to be addressed in the sessions (Stuart, 2006; Markowitz & Weissman, 2004).

We offer an example of an interpersonal inventory in the box below. Andi, whom you met in the introductory paragraphs, had an IPI similar to the following one.

Interpersonal Inventory for Andi

Relational facts

• Daughter: Molly, 19
• Married at 18, divorced at 28 when Molly was 10
• Was the child of a violent relationship and abused in her marriage
• Series of emotionally unstable and/or violent partners over the last nine years
• Has no siblings; has almost no extended family – none living in the country
• Mother dead; felt close to neither parent and was afraid of violent father

Problems

• Depressed over inability to form and maintain an intimate relationship
• Desperately seeking a workable romantic partnership
• Works long hours and tries to be available to daughter, so has few friends or social networks – no one to talk to
• Does not know how to attract caring, stable partners
• Has issues with visibility, as being seen was risky in family of origin

Expectations and fears

• Expects to be able to create a functional relationship
• Fears further “selection errors” as all partners seem nice in the beginning
• Acknowledges giving to men, hoping/expecting that they will meet her needs
• Finds it difficult to communicate needs assertively
• Fears being without a partner long-term, so sets up a new relationship very soon after a breakup
• Believes she must give men what they want immediately or there will be bad consequences

The Biopsychosocial model: the framework and target for the diagnosis/context. The interpersonal formulation – to be generated as the ultimate goal for the end of the initial sessions – is based on the Biopsychosocial Model of psychological functioning. It recognises that biological, psychological, and social factors come together in a different manner within each individual to create a unique diathesis (vulnerability) and concomitant response to stress (related article: Rethinking Wellness: A Holistic Perspective on Health). Many people may be potentially vulnerable to psychological difficulties, but not discover this until they are triggered into the difficulties (becoming depressed, for example) when faced with an interpersonal crisis. Rather than diagnose categorical illnesses, therefore, the Biopsychosocial Model frames psychological difficulties as the response of a unique person to a unique stressor.

Thus IPT sees a client’s functioning in broader, more holistic terms: as a function of attachment style, personality, and temperament, resting on a foundation of biological factors, such as genetic makeup and physiological functioning. Both of these strands of influence must be placed in the context of social relationships and social support generally. Clearly, a client who already has a biopsychosocial diathesis and then goes on to experience a substantial personal stressor will probably be triggered into psychological distress or psychiatric symptoms.

We can conceptualise it as follows:

Biopsychosocial diatheses

(Adapted from Stuart, 2006)

We can see how this model is congruent with IPT’s theoretical foundations, as it shows how an individual’s attachment style in relationships and capacity for communication are connected to psychological wellbeing (or lack thereof!). The model is clear for clinicians responsible for formulating a treatment plan, as it is directly linked to the four areas of crisis in which IPT operates and it points the way to the specific interventions IPT therapists use, including psychotropic medication, such as antidepressants. In summary, the IPT clinician both views the client through the biopsychosocial model lens and targets the biological, psychological, and social factors implicated in the client’s distress (Stuart, 2006).

Targeting the diagnosis/setting the context (part of the target element). The initial phase also requires the therapist to identify the target diagnosis (let’s say it’s an MDD, or Major Depressive Disorder). In diagnosing major depression (in our example) the therapist typically employs measures to check severity, such as the Hamilton Depression Rating Scale or the Beck Depression Inventory (BDI). However, given the biopsychosocial model of IPT, it is also important to communicate to the client – if it didn’t happen during the assessment phase – that the problem is seen as an illness, not a defect , but acknowledging that there is a link between internal mood and outer events. In this regard, the therapist might make interventions such as:

• “As we’ve noted, you’re suffering from _____ (say, major depression), which is a medical illness; it is not your fault and it is a treatable condition.” This way of defining it has the effect of excusing the client from (typical) self-blame.
• “From what you’ve told me, your low mood and the upsetting things happening in your life are related; you feel low on energy, don’t enjoy things, and aren’t eating or sleeping well – and all this has been happening since the breakup with your partner, which has been hard for you to come to terms with.” (This makes a practical link, IPT-style, between the client’s mood and distressing life events which either precipitate or follow on from mood issues. It doesn’t pretend to understand the aetiology, or cause, of the client’s low mood; it only asserts the relationship between that and life events) (Markowitz & Weissman, 2004)
• “I suggest that we spend the next 12 weeks (or however many are deemed to be needed) working on helping you cope with the loss of this relationship from your life, and also examining patterns in your relating generally. There may also be other information – like how you communicate – which is relevant to what happens in your relationships.” (This sets the context for the work) (Markowitz & Weissman, 2004).

The interpersonal formulation. The final task of the initial phase, sometimes placed in the following, middle phase of the work, is to generate an interpersonal formulation choosing an interpersonal focus: that is, identifying which of the four main IPT problem areas (above) will be worked on. Information is synthesised from the interpersonal inventory and psychiatric history of the client, including his or her biological and psychological makeup, attachment style, personality, and social context. Therapist and client together generate a hypothesis to explain the client’s symptoms, which is a kind of working understanding of the unique person sitting in front of the therapist. Given IPT’s theoretical underpinnings (attachment, communication, and social theory), this hypothesis should reflect the client’s understanding of his/her own experience. It is an essential bridge between a general theory of how human beings behave and the particular problems faced by the specific client.

The interpersonal formulation, therefore, should include questions such as:

• How the client came to be the way s/he is
• The factors that are maintaining the problem
• What can be done about it

It looks into the rear view mirror to see the interpersonal factors involved in the origin and context of the problem, and also looks forward toward overcoming the problem, or at least alleviating the symptoms. Thus the interpersonal formulation not only proposes an explanation of the problem; it also validates the client’s experience and understanding, provides a jointly determined focus for intervention, and also serves as a credible rationale for the IPT treatment (Stuart, 2006; Robertson et al, 2008).

Collaboration and goal consensus between therapist and client (a tactic). In case you missed it, let us elaborate a major point again. While IPT therapy is directive (as opposed to, say, highly client-directed Rogerian therapy), it is nevertheless a collaborative effort between client and therapist. The therapist may propose a diagnosis, but the client must find that that diagnosis resonates with him or her. When clients genuinely accept and embrace the hypothesis about what they are experiencing, they become a potent partner in the healing process. When the focus for intervention is mutually determined, clients experience a more profound engagement (and compliance) with treatment efforts. 

In short, this tactic is highly interpersonal, just like the overall therapy in the context of which it takes place. As noted above, the four areas are interpersonal (role) disputes, role transitions, unresolved grief or loss, and interpersonal “sensitivities” (a.k.a. deficits) (Linton, n.d.; Encyclopedia of Mental Disorders, 2014). We review these areas within the middle phase section, as the middle phase is where working on them takes place. 

Middle phase (Sessions 4 – 13)

Because IPT is structure- and time-limited, typically one area is chosen to work through (the area most closely associated with the onset of the current symptoms), with re-contracting for others as necessary. Occasionally therapist and client will agree on a second area as a “back-up” focus for the sessions. While the assessment and initial phases were about preparation, laying the groundwork and setting the context, now in the middle phase the work begins in earnest. Always the coping strategies employed are tailored to the client’s unique needs; let us see what is involved in each.

Interpersonal problem area: role disputes. When the client and at least one other significant person have diffing expectations of their relationship, an interpersonal role dispute is occurring, although it may be so painful that the client does not spontaneously bring it up. Such disputes are worthy of therapeutic focus if/when they seem stalled or repetitious, or where the client sees little hope of improving things. Role disputes can include overtly hostile conflict (such as with domestic violence or verbal abuse), betrayals (such as infidelity or conflicting loyalties), disappointments (unmet expectations at work or school), and inhibited conflicts (such as when someone is angry at a partner’s illness or disability). Treatment goals for role disputes include:

1. Helping the client understand the nature of the dispute and “state of play” (that is: is the relationship at a stage of ongoing negotiation, are the partners stalled and at an impasse, or is it about dissolution, where the client needs to move on?)
2. Deciding on a plan of action, and
3. Beginning to modify communication of attachment needs, problem-solving styles, and relational patterns which have proved unworkable or are unsatisfying. Often clients need to re-assess their expectations of the relationship as well. 

While IPT therapy is said to be directive, the therapist does not direct the client to a particular solution, and certainly does not try to preserve obviously unworkable relationships (such as where the client is being subjected to violence or abuse) (Encyclopedia of Mental Disorders, 2014; Robertson et al, 2008).

Linton (n.d.) diagrams role disputes in this way:

(Linton, n.d.)

Interpersonal problem area: role transitions. Have you ever experienced a major life change –such as moving cities, changing career, or getting divorced – and realised that you felt “all at sea” for a while? Generally such life changes require new roles and individuals experiencing difficulty with the transition tend to experience depression and/or anxiety. Role transitions are varied, but chief examples include:

• Situational role transitions, such as job loss, promotion, graduation, or migration
• Relationship role transitions, including marriage, divorce, and step-parenthood
• Illness-related role transition: e.g., diagnosis of chronic illness and adaption to pain or physical limitations
• Post-event role transition, such as post-traumatic symptoms or refugee status.

It goes without saying that people diagnosed with MDD typically experience role changes as losses more than new opportunities. For example, in leaving home the focus may be on loss of parental or familial support rather than on the pleasure of greater independence. A woman having a baby may experience a loss of time and independence more than the opportunity to love and develop another being. In order to complete IPT therapy for role transitions, the client must give up the old role; express concomitant feelings of guilt, anger, and loss; take on new skills and attitudes to overcome the challenges of the new role; and create a new social network around the new role (Robertson et al, 2008; Encyclopedia of Mental Disorders, 2014).

Linton expresses this IPT problem area diagrammatically as follows:

(Linton, n.d.)

Interpersonal problem area: (unresolved) grief and/or loss. While psychotherapists sometimes state that the full grieving process requires five years (Hubbard, 1998), it is also true that with normal bereavement, the symptoms largely abate within two to four months. When individuals have suppressed, delayed, or distorted the expression of their grief, however, there may be non-emotional symptoms, often physical. When unresolved grief is determined to be the primary issue, the treatment goals are about facilitating the mourning process (related article, Assessing and Treating Prolonged Grief Disorder).

The basic IPT tasks of working with grief are:

1. Diagnosing grief as a problem area
2. Clarification of the circumstances of the loss
3. Linking the timing of the loss to the onset of symptoms
4. Helping the client accept painful affect associated with the loss
5. Helping the client communicate the loss to others
6. Recreating the relationship with the deceased
7. Helping the client utilise existing social supports and develop new attachments

The client is assisted to re-establish relationships and interests to begin filling the void left by the loss (Encyclopedia of Mental Disorders, 2014; Robertson et al, 2008).  

Linton’s diagram for this problem area looks like this:

Interpersonal problem area: interpersonal sensitivity (deficits). Some clients may not have learned how to form supportive, lasting relationships, especially as an adult. Such clients may act unassertively, afraid to express anger, and carrying a huge sense of inadequacy. If there is a history of unsupportive or inadequate relationships, the client is probably also experiencing social isolation and accompanying (severe) emotional disturbances which may sometimes manifest as psychiatric symptoms. The treatment goal in such cases is to reduce the client’s social isolation. IPT therapy for interpersonal deficits examines the client’s past relationships, the present relationship with the therapist, and ways to form new relationships.

In fact, it is in part through the relationship with the therapist that interpersonal sensitivity can manifest. It can also show up as clients who report having few friends, repeated relationship failures, or conflict with others. If the client’s behaviour during sessions is marked by passivity and/or hostility toward the therapist, that is another indication of interpersonal deficit. While such deficiencies are admittedly well-ingrained in clients, IPT can nevertheless intervene by assisting the client to resolve a current interpersonal stressor. A focus on problems in the here-and-now enables therapist and client to boil down the client’s interpersonal problems to a “digestible”, meaningful form. Thus, reducing clients’ isolation and expanding their social repertoire occurs via the following interventions:

• Optimising the client’s current relational functioning
• Helping the client establish new supportive relationships
• Resolving the client’s acute interpersonal stressor (the here-and-now problem) (Encyclopedia of Mental Disorders, 2014; Robertson et al, 2008).

Role deficits can be expressed in diagrams as follows:

(Adapted from Linton, n.d.)

The acute phase

An IPT therapist’s contract with a client is not a hazy, open-ended, “Gee, it would be good if s/he stayed in therapy for some time.” Rather, therapist and client contract to complete the treatment – meaning, the acute phase of the treatment – in a specific number of sessions: as we noted earlier in the course, typically between 12 and 16 sessions for presenting issues such as interpersonal problems, depression, or psychiatric illnesses, though estimates vary and some clients may do much more work.

One suggestion for clinicians just starting to work in IPT therapy is to taper the sessions over time in order to maximise the efficiency of the treatment. For instance, let’s say you contract as an IPT therapist to do 16 sessions with a depressed client. You might do weekly therapy for, say, 6 to 10 weeks, followed by a series of sessions spaced further and further apart. So as the client gets to feeling better there may be 4 to 6 sessions at fortnightly intervals, followed by several at the end that occur only every three to four weeks.

The maintenance phase

If you’ve ever sat on the other side of the therapy room – in the client’s chair – you may already have experienced the disappointment, or even angst, that can come with terminating therapy. For clients, then, it is good news that both empirical research and clinical experience with IPT have shown that maintenance treatment should be offered, especially in the case of conditions where relapse is common, such as depression and anxiety. This relapse-reducing phase is, again, not indefinite. A specific contract – separately or as part of the whole treatment program – should be negotiated with the client to cover not only the acute stage where immediate symptoms are resolved, but also a subsequent stage which has the express goal of preventing relapse and maintaining effective interpersonal interactions.

In Interpersonal Therapy, it is not in the interest of most clients to “terminate” as that term is understood in traditional psychotherapy. Instead, IPT follows a way of treating clients modelled on general practice, in which the client is seen more intensely in the acute phase of the illness, but still comes back for “check-ups” when symptoms have been resolved or are being well managed (meaning: when interpersonal problems are resolved). Thus, the therapeutic relationship is not terminated; the therapist makes him/herself available to the client in the event of further crises, at which time new contracts can be drawn up for acute work. IPT can be thought of as a two-phase treatment, with the first phase incorporating the first four steps of assessment, initial sessions, middle sessions, and termination sessions, with the second phase being solely the maintenance sessions (Stuart, 2006). 

Non-transferential focus of interventions. IPT does not directly address the therapeutic relationship. In this it is unique among psychodynamically-oriented psychotherapies, functioning more like other solution-focused therapies. It is not that transferences (which psychodynamic therapists address within the therapeutic relationship) do not develop in IPT. Both Bowlby, coming from a stance of attachment theory, and Harry Stack Sullivan, a clinician, acknowledge that, over time, a client will begin to show toward the therapist behaviours that reflect his or her attachment style, and it is these on which transferences are based (Bowlby, 1988; Sullivan, 1953). Thus, we can say that transferences do develop in this therapy. And the therapist is right there, being the person on whom the attachment/transference behaviours are imposed, so the therapist is in an unparalleled position to examine the way in which the client sets up and maintains relationships. In fact, it is not at all controversial to assert that transference and the display of attachment behaviour in the therapeutic relationship is a universal phenomenon, one seen in all psychotherapies. 

But it is what the therapist does with the transferential/attachment data gathered that makes IPT unique. It is used to provide information about the client and his or her interpersonal world. Understanding this and the client’s attachment style is essential. It is also paramount for the therapist to use burgeoning transferences to formulate questions about the client’s interpersonal relationships outside of session time. Third, transferences crucially inform the therapist about points of resistance and potential issues in the therapy. What the therapist doesn’t do with the insights and experience of the client’s transferences is to address it directly with the client as a primary focus on the client-therapist relationship. You may ask why. The reason is that it would change the focus of the work from an examination of the client’s current social relationships to an intense experience and analysis of the relationship with the therapist. To switch to this focus would be to change IPT from a therapy oriented toward symptoms and immediate interpersonal functioning to a therapy that is oriented toward intrapsychic insight.

The thinking person logically asks at this juncture, “Well, then, given that you’ve just stated that transference happens in all therapeutic relationships, how do you manage to keep the spotlight off the client-therapist relationship?” Good question. IPT is structured in such a way as to minimise the development of transference problems. For one thing, clients are not encouraged to bring up the question of the therapist-client relationship. Moreover, the role that the IPT therapist takes up vis-à-vis the client is one of supportiveness rather than neutrality (see section, “Supportive and directive therapeutic stance”, below). Third, IPT treatment is time-limited. As any normal-length psychodynamic therapist will agree, transferences take a long time to fully develop and massive time to work through, so even if there were a focus on transference it would not be able to be completely dealt with during the briefer period of IPT therapy. Finally, the treatment is focused specifically on interpersonal issues in the client’s social relationships.

In summary, while transferential information is supremely important in IPT, it is not addressed directly in this therapy where the goal is to help the client resolve his/her interpersonal distress quickly, before developing transferences become problematic and need to become the focus of treatment (Stuart, 2006). 

Present focus. The here-and-now focus of Interpersonal Therapy means that the therapist is active, using both directive and non-directive techniques. They offer the client:

• Information (as in psychoeducation about psychiatric conditions, a topic on which many people are hugely ignorant)
• Guidance (yes, therapists do lead occasionally, and it is ok)
• Reassurance (instilling hope is important in this therapy)
• Clarification (as part of the counselling microskills: interventions such as “What I think you said was…”)
• Communication skills education (more on this below, but it is about how clients say what they say)
• Behavioural techniques (as in “How about let’s try this…”)
• Management of the environment (“Let’s give the guns to your brother to keep”) (Linton, n.d.)

Supportive and directive therapeutic stance. The IPT therapist adopts a stance which is supportive, directive, and relaxed. If that combination is hard to imagine, think of the various roles that the therapist (and let’s say it’s a woman) takes up. She is the client’s ally. When the client (a man, let’s say) prepares to go off and engage an interpersonal task which is difficult for him, the therapist acts as cheerleader, encouraging the client to believe he can do it, and affirming that he has the requisite skills. When the client succeeds in an interpersonal task in his life, the therapist celebrates with him, acting as reinforcer of what he did right: employing the adaptive interpersonal skills that carried the day. When he tries and things don’t go according to plan, the therapist takes up the roles of commiserating with the client and being a co-analyst, as they jointly figure out what went wrong and brainstorm options for how it can go better next time. The therapist may also initiate a role play to allow the client to practice a given skill.

Notice two things here. First, the therapist does not have to be in the role of homework police, such as may occur in CBT. The limited time frame means that no formal homework is assigned, but the client knows that he has only the contracted number of sessions to solve his interpersonal problem, the focus of which provides an overall task – and the motivation to accomplish it. Second, observe that the treatment is centred on what happens outside of the sessions, in the client’s real-life environment, rather than on the therapy. In sessions, the therapist and the client jointly review the week’s events and – armed with a revised plan and/or new skills – the client steps forth to test them out. Thus the therapist maintains a supportive and also directive stance, while remaining relatively relaxed (Markowitz & Weissman, 2004).

Having looked into the theory, targets, and chief tactics of IPT, we now have a relatively fuller picture of the therapy: a time-limited, non-transferentially-oriented, present-focused, dynamically informed way of helping clients with interpersonal issues which sees them supported, yet sometimes directed. We can now colour in the remaining aspects of the IPT picture by examining the specific techniques by which it operates.

Working the middle sessions with the techniques

While the IPT therapist needs to be competent in interpersonal skills generally, there is also a specific list of techniques as we noted in the Defining Elements chart, consisting of:

• Communication analysis
• Interpersonal incidents
• Directive techniques
• Decision-analysis
• Role-playing
• Use of content and process affect
•  “Common” techniques (clarification, summaries, and questions)
• The therapeutic relationship

Communication analysis. This technique is of paramount importance, as disordered communication is thought to be a chief reason for causing, perpetuating, or exacerbating the client’s interpersonal problems. The general goals for this technique are to (1) help the client identify his or her communication patterns; (2) recognise his or her contributions to the communication problem; and (3) motivate and equip the client to communicate more effectively.

In particular, the therapist is attuned to potential ambiguous and indirect verbal and non-verbal communication that could be changed to more direct, less ambiguous communication. Thus with communication analysis the therapist is looking to observe whether the client:

• Is using ambiguous nonverbal rather than direct verbals?
• Is assuming that s/he has communicated when he or she has not?
• Is being purposely ambiguous verbally?
• Is being silent when communication is needed?

Recent and past incidents that were significant in some way to the client are explored in some detail in order to detect the particular utterances that show the communicative disorder and to explore alternative ways of communicating. The detail is needed to correct for the biased accounts by many clients with communicative deficits. They tend either to blame the other party for what went wrong, or in some cases, to put excessive blame on themselves. The therapist can gather the data both from instances of communication exchanges in session or alternatively from other sources, such as people closely involved with the client’s life.

To do this, the therapist works through the following steps, more or less in sequence:

1. Collecting information about the client’s relationships and the communication occurring within them
2. Developing hypotheses about the cause of the communicative problem
3. Presenting the hypotheses to the client as feedback
4. Soliciting responses from the client about the feedback
5. Revising the hypotheses as needed
6. Developing alternative ways of communicating in problem-solving sessions
7. Practicing those new ways of communicating (thus communication analysis often leads on to use of the role play technique)

Naturally, the therapist needs to be able to function as a role model for communication as well, so the skills the therapist is required to have within this technique can be summarised as the ability to:

• Engage the client in reporting and reflecting on recent, difficult exchanges with others
• Elicit detailed reconstructions of interpersonal incidents and the accompanying feelings, and link these to symptoms and implicit and explicit intentions
• Help the client focus on both verbal and non-verbal levels of the communicative exchange
• Help the client identify what s/he would have liked to say, had skill levels been higher
• Assist the client to identify the contradictory or non-reciprocal role expectations that maintain a difficult interpersonal exchange
• Aid the client in reflecting on how the other person might have experienced and understood the interaction
• Help the client to find alternative ways of communicating in order to be more effective and to be understood
• Respond empathically and with explicit acknowledgement when the client experiences the therapist as critical or blaming him or her for the identified problem (UCL Clinical Psychology, 2010; Linton, n.d.; Robertson et al, 2008; Stuart, 2006)

Interpersonal incidents. Sometimes used as a form of communication analysis, or perhaps regarded as a subset of it, interpersonal incidents nevertheless merit discussion as a technique in their own right in terms of the somewhat different therapeutic emphasis when utilising these as compared to communication analysis techniques. Similarly to the latter, the essence of interpersonal incidents as an IPT technique is that a single episode of communication between the client and a significant other is dissected, in this case for what can be learned about the client’s attachment style. The goal is not, as with communication analysis, to obtain a description of the client’s general interactional pattern.

Thus where CBT seeks to discover maladaptive thinking patterns as possibly shown in an interaction and communication analysis seeks to discover communication patterns, the analysis of a particular interpersonal incident is to find out how the client communicates his or her attachment needs. How, asks the therapist, might this communication show maladaptive attachment occurring in the relationship? To gather the needed data, the therapist may direct the client to describe in detail a significant interaction (let’s say, a fight between partners, or an incident in which the client was heavily criticised). The therapist helps the client to reconstruct the dialogue that occurred as accurately as possible, including his or her nonverbal and affective responses. The client is also directed to report observations, as far as possible, of the other person’s nonverbal behaviour. The basic assumption on which analysis of interpersonal incidents rests is that the interactional problem experienced by the client is so because of his or her deficient communication (Stuart, 2006).

Directive techniques. We have alluded to the directive stance that an IPT therapist takes at times in order to provide critical elements such as psychoeducation, guidance, reassurance, general information, and even advice. Two points need to be made here. First the therapist is not just bossing the client around! Directive techniques are used selectively. Second, part of the rationale for utilising such techniques is to foster confidence in the client that the therapist, indeed, has the capacity to help (UCL Clinical Psychology, 2010). So we can understand this group of techniques as akin to salt on a meal: it is necessary for the flavour, but only a dash is needed; use sparingly.

Decision analysis. Along with communication analysis skills, the therapist needs the ability to assess when decision analysis will be a useful intervention in support of the agreed therapy goals. The analytical skills here consist of three aspects, those of being able to help a client:

• Consider alternative courses of action in order to resolve a problem
• Evaluate the likely consequences of different potential courses of action
• Apply decision analysis for him/herself outside the therapy setting (UCL Clinical Psychology, 2010)

Some clients may need assistance to get to the idea that they need to choose: that is, that not choosing to take action in an interpersonal interaction is in itself a decision: one by default, yet it will have consequences just as if the choice had been actively made.

Role-playing. Some decisions and some types of utterances are highly challenging to make, especially for communicatively disordered clients. Such individuals need practice in order to be able to take the decision or move into the new role, which has new ways of communicating. Thus role-playing is a useful intervention to prepare clients for their new relational modes. With it, client and therapist create an in vitro interaction in session to reinforce behaviour occurring outside of therapy.

To utilise this technique demands of the therapist the ability to first assess when role-playing might be a useful intervention to support the client’s agreed aims and second, to be competent at helping clients explore their feelings and practice new ways of communicating with others. The more effective ways of communicating are discussed and modelled as well as practiced, so the client’s awareness of his/her mode of affective interaction gets examined in detail. And clients gain a better understanding of the experience others are having interacting with them. As useful as it is, however, role-playing is not a mandatory IPT technique. It is used with selective clients and selective presenting issues. Because it involves some confrontation by the therapist, it is best employed in the context of a trusting, supportive therapeutic relationship (UCL Clinical Psychology, 2010; Stuart, 2006).

Use of content and process affect. Emotion is often a central feature in significant communicative exchanges, yet those who experience communication deficits are often unaware of the emotion that they are expressing along with the words that they say. The purpose of this technique is to help clients express, understand, and manage affect; thus the therapist’s goals in using it are to:

1. Assist the client in recognising his or her immediate (in the room) affect
2. Aid the client in communicating affect more effectively to others
3. Facilitate the client’s recognition of affect which s/he may have suppressed or found too painful to acknowledge.

The title of this technique – content and process affect – leads us to consideration of a central aspect of using it. That is the crucial importance of distinguishing between process affect – that emotion which occurs during session, observable by the therapist, experienced by the client – and content affect: that which the client reports from past interactions in his/her life outside of therapy. 

In using this technique, the eagle-eyed therapist is on the lookout for one phenomenon in particular: that of incongruity. Does the client’s nonverbal behaviour match his or her words? Is s/he somehow relating a story or incident which was horrifying, but saying it with flat affect? When process and content affect are dissimilar, it signals to the therapist that that area should be explored further. It also means that, as soon as the client can tolerate the confrontation, the incongruity should be pointed out to him/her.

Upon receiving this feedback, clients have another avenue for becoming aware of emotions which they may be suppressing, or that they may be aware of but somehow cannot manage to express. When the therapist explores a range of feelings with them in session, clients learn how to safely express feelings outside of session in order to resolve disputes and enhance their social networks. The recognition of incongruity is hugely central to successfully utilising this technique. When incongruity is recognised, both therapist and client understand more about how the client is communicating, and the client is drawn more into the therapeutic process (Robertson et al, 2008; Linton, n.d.; Stuart, 2006).

“Common” techniques (clarification, summaries, and questions). There are two primary reasons why IPT therapists use the so-called “common” techniques, meaning the counselling microskills of: clarification, paraphrasing, reflecting, summarising, questioning, and the non-specific skills of extending Rogerian-style warmth, empathy, and unconditional positive regard. The first reason is so important that if the techniques are not employed early on in the therapeutic relationship, the second reason becomes null and void. The first reason is that the microskills, while not sufficient for change, are necessary for it to occur. It does not matter how brilliant the techniques are, nor for that matter, the therapist using them, if the client is not engaged in the therapy. This is especially important in IPT, where there is limited time. It is the therapist’s job to establish, as quickly as possible, a solid therapeutic alliance, or else none of the other techniques will work – or they will not have a chance to work because the client will leave the therapy!

The second reason to use the “common” techniques is that, apart from creating a productive therapist-client alliance, they help the client to grow in understanding of interpersonal communication skills. Clarification (really nothing more than good listening), for example:

• Helps clients to become more aware of what they characteristically feel and think in relation to others
• Allows the exploration of particular interpersonal hypotheses
• Calls attention to logical implications of what clients have said
• Highlights contradictions
• Points out extremes when a moderate approach is more appropriate

Exploratory techniques – those nondirective techniques in which therapists must also be well-versed – foster the client’s sense of competence and autonomy. These include open-ended questions/verbalisations, supportive acknowledgement and extension of productive topics, and the capacity to refrain from structuring parts of a session in order to allow the client to elaborate on what s/he is feeling.

Stuart observed that these common techniques, especially including clarification, are about asking good questions so that the therapist can better understand the client’s experience, asking very good questions so that the client can understand his or her own experience, and asking extraordinarily good questions so that the client is motivated to change his or her behaviour (UCL Clinical Psychology, 2010; Linton, n.d.; Stuart, 2006).

The therapeutic relationship. Finally among IPT techniques, we must name the use of the therapeutic relationship as a valid technique, in addition to being an element in the successful employment of other tools. As we have just noted with regard to the common techniques, the establishment of a productive therapeutic alliance is key. A basic principle of IPT is that all interventions should be therapeutic and strengthen the alliance. Several points are worth noting here. For one thing, IPT is structured, so the therapist is sometimes directive and active, but there is also a balance between activity and active listening. We have repeated in numerous contexts in this discussion how transferential reactions are addressed in terms of the client’s wider social network rather than the therapist-client relationship. Doing so leaves bandwidth to use the therapeutic relationship to attend to clients’ attachment needs, helping them to experience a successful relationship. By modelling adaptive communication patterns in session, the therapist is using the relationship to bring about therapeutic change. Most importantly, the therapeutic relationship provides a safe container in which change may occur.

Taking the above points into consideration, the therapist who would use the therapeutic relationship as a technique must demonstrate the following abilities:

• To identify and provide constructive feedback on recurring interpersonal patterns and communication challenges when these manifest in the therapeutic relationship
• To thereby link these patterns to those that occur with significant others
• To provide feedback to the client about how they may be coming across to others
• To help the client explore and attempt, within the therapeutic relationship, alternative ways of communicating
• To assess whether the therapeutic alliance is strong enough for exploration of the therapist-client interaction (Linton, n.d.; UCL-Clinical Psychology, 2010).

Applications of Interpersonal Therapy

As we have noted throughout this article, the “home base” of Interpersonal Therapy has been in the treatment of mood disorders, most notably depression – including peripartum depression, dysthymia, bipolar depression, depressed adolescents, and depressed medically ill patients (Markowitz & Weissman,  2004), but it has become increasingly popular in recent years with a widening variety of presenting issues and also special populations, including:

• Elderly clients, requiring similar but modified treatment to their younger cohorts, with shorter sessions and depressive symptoms being prominent. The elderly may require coaching to tolerate rather than resolve long-standing role disputes.
• Clients with HIV infection, who may require particular attention to deal with the psychosocial aspects of the disease: the stigma of it, accepting their homosexuality (if applicable), dealing with rejecting family members, and coping with the medical consequences of HIV infection.
• Adolescents, not just those who are depressed, but also those who are dealing primarily with developmental issues such as separation, developing authority and autonomy with respect to parents, peer pressure, developing new interpersonal relationships, and – possibly – adjusting to single-parent or blended families. Parents are usually brought in on some of the sessions to get a more comprehensive history, and the possibility of medication is discussed, as many do not believe it is helpful for this age group.
• Clients with eating disorders, where the focus is not on the symptoms, but rather on identifying the problem areas that have triggered the disorder over time. Many clients with bulimia, for example, have social anxiety, sensitivity to conflict and rejection, and challenges with managing negative emotions. By bringing to the surface underlying problems such as conflict avoidance and difficulties with role expectations, IPT helps bulimics to regulate the emotional states that maintain the bulimic behaviour. IPT can also help with anorexia nervosa, which research shows is connected to interpersonal and family dysfunction. Rather than concern itself with the origins of the condition, IPT works in the four areas (role disputes, role transition, grief/loss, and interpersonal sensitivity), which correspond to the core issues of anorexia.
• Clients with substance abuse disorders, who generally deal with the social and interpersonal consequences of drug use, and also want to stop or cut down on drug use. These form two typical IPT goals for this group. To achieve the goals, substance-abusing clients need to accept the need to stop, take steps to manage their impulsiveness, and acknowledge the social contexts for drug and alcohol abuse. Relapse is all part of the journey in IPT, so the therapist does not disapprove or look at the relapsed client as “failed”.
• Clients with anxiety disorders, such as Social Anxiety Disorder and PTSD. IPT has shown great promise in studies with these presenting issues, particularly because IPT does not work by virtue of exposure therapy, so clients unwilling to engage exposure techniques are happier with IPT than, say, CBT.
• Disorders with interpersonal pathologies, such as borderline personality disorder, primary insomnia, body dysmorphic disorder, and other disorders. Investigative exploration is ongoing for these and looks promising (Encyclopedia of Mental Disorders, 2014).

While CBT still gets the hands-down vote for most-studied, evidence-based psychotherapy, IPT nevertheless has bragging rights to increasing claims of demonstrated efficacy.

Interpersonal Therapy training and courses

This article was adapted from Mental Health Academy’s interpersonal therapy training course, The Basics of Interpersonal Therapy. The purpose of this 3-hour course is to provide a basic overview of interpersonal therapy, including its principles, techniques, clinical applications, and research findings.

Other interpersonal therapy training, including courses exploring interpersonal factors in mental health, wellbeing and treatment:

• Treating Postnatal Depression with Interpersonal Psychotherapy
• Social and Interpersonal Determinants of Suicide
• Psychopathology: A Primer for Clinicians
• The Role of Mattering in Personal, Organisational, and Community Wellbeing

Note: Mental Health Academy members can access 500+ CPD/OPD courses, including those listed above, for less than $1/day. If you are not currently a member, click here to learn more and join.

Key takeaways

• Interpersonal Therapy (IPT) is a time-limited psychotherapy that targets interpersonal relationships to alleviate clients’ distress, differing from therapies like Cognitive Behavioral Therapy (CBT) which focus on internal cognitions.
• Initially developed as a control intervention for mood disorders studies, IPT gained recognition through large-scale studies, such as the NIMH Collaborative Research Program, which demonstrated its efficacy in treating depression.
• Interpersonal Therapy is underpinned by attachment theory, communication theory, and social theory, emphasizing the role of interpersonal relationships in psychological distress.
• Interpersonal Therapy is structured into five phases: assessment, initial sessions, middle sessions, termination, and maintenance, ensuring a systematic approach to treatment.
• IPT employs various techniques, including communication analysis, role-playing, decision-analysis, and use of the therapeutic relationship, to improve clients’ interpersonal functioning.
• While primarily used for mood disorders, IPT has expanded to treat a range of issues, including anxiety disorders, eating disorders, substance abuse, and interpersonal pathologies, demonstrating its versatility and effectiveness across different populations.

References

• Bowlby, J. (1988). Developmental psychiatry comes of age. American Journal of Psychiatry; 1988, 145(1): 1-10.
• Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., et al. (1989). National Institute of Mental Health treatment of depression collaborative research program: General effectiveness of treatments. Archives of General Psychiatry; 1989, 46: 971–982.
• Encyclopedia of Mental Disorders. (2014). Interpersonal therapy. Encyclopedia of Mental Disorders: Advameg., Inc. Retrieved on 18 November, 2014, from: http://www.minddisorders.com/Flu-Inv/Interpersonal-therapy.html
• Hinrichsen, G.A. (2008). Interpersonal psychotherapy for late-life depression: current status and new applications. Journal of Rational-Emotive Cognitive-Behavioral Therapy; 2008, 26: 263–275. DOI 10.1007/s10942-008-0086-5.
• International Society for Interpersonal Psychotherapy. (2014). About IPT. International Society for Interpersonal Psychotherapy. Retrieved on 13 November, 2014, from: https://interpersonalpsychotherapy.org/ipt-basics/overview-of-ipt/
• Linton, J. (n.d.). Interpersonal therapy. Retrieved on 18 November, 2014. 
• Markowitz, J.C., Lipsitz, J., & Milrod, B.L. (2014). Critical review of outcome research on Interpersonal Therapy for anxiety disorders. Depression and Anxiety; Apr 2014, 31(4): 316-25.
• Markowitz, J.C. & Weissman, M.M. (2004). Interpersonal psychotherapy: Principles and applications. World Psychiatry; October 2004, 3(3): 136-139.
• Robertson, M. Rushton, P.J., Bartrum, D., & Ray, R. (2004). Group-based Interpersonal Psychotherapy for Posttraumatic Stress Disorder: Theoretical and clinical aspects. International Journal of Group Psychotherapy; 54(2),April 2004: 145-75.
• Robertson, M., Rushton, P., & Wurm, C. (2008). Interpersonal psychotherapy: An overview. Psychotherapy in Australia; May, 2008, 14(3): 46-54.
• Stuart, S. (2006). Interpersonal psychotherapy: A guide to the basics. Psychiatric Annals; August, 2006, 36(8): 542-550.
• Sullivan, H.S. (1953). The interpersonal theory of psychiatry. New York, NY: Norton.
• UCL Clinical Psychology. (2010). Specific IPT techniques. Retrieved on 17 November, 2014, from: https://www.ucl.ac.uk/pals/ucl-centre-outcomes-research-and-effectiveness  
• Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2007). Clinician’s quick guide to interpersonal psychotherapy. New York: Oxford University Press.