INTERPERSONAL
PSYCHOTHERAPY
Interpersonal Psychotherapy Institute
Scott Stuart, MD
www.iptinstitute.com
Copyright IPT Institute 2012
Interpersonal Psychotherapy Institute
www.IPTInstitute.com
Copyright: Scott Stuart, M.D.
INTERPERSONAL
PSYCHOTHERAPY
Interpersonal Psychotherapy:
Training Goals
Scott Stuart, M.D.
IPT Institute
Iowa Depression & Clinical Research Center
Women’s Wellness & Counseling Service
University of Iowa
1

Understand the IPT model

Familiarity with IPT techniques

Ability to conduct IPT

Understand additional IPT training
2
IPT Community-Based Training
1) Completion of a two-day Level A IPT Course
Interpersonal
Psychotherapy
2) Completion of at least 10 biweekly hour-long group consultation calls
3) Completion of two IPT portfolios
a) Case Report
b) Interpersonal Inventory
c) Interpersonal Formulation and Summary
d) Self-Evaluation Form (based on the IPT Quality and Adherence Measure)
e) Patient Outcome Measures- PHQ-9 and GAD-7 every 4 sessions
f) An audio or videotape of one session
Theoretical Framework
4) Completion of a one-day IPT Booster Course
5) Recommend Advanced IPT Training every 3 years
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4
What is Interpersonal Psychotherapy?

IPT: Symptom Formation
Interpersonally Based
 Interpersonal Disputes
 Role
Transitions
and Loss
 Grief

Time- Limited
 Family

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Practice Model
Non-Transferential Interventions
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What is Interpersonal Psychotherapy?
Attachment Theory
 Manual
 Relationships
based
 Empirically supported
 Targets of treatment:
relief
 improved interpersonal functioning
 increased social support
matter
 Attachment
is a biological drive
 Attachment
support is sought in crisis
 symptom
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8
Attachment Theory
 “Working
Attachment Theory
 Attachment
Models” of attachment
 Model
of others
 Model
of self
 Flexible
attachments are critical
 Providing

help to others
Develops social support
 Asking
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is dyadic
for help from others- graciousness
10
Model of Self
Self-Competent
Not Self-Competent
Secure
Preoccupied
Dependable
Model of Others
Not Dependable
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Dismissing
Model of Self
Secure
Fear of
Abandonment
(preoccupied)
Model of Others
Fearful
Fear of
Vulnerability
Fear of Loss
Of Control
(dismissive)
(fearful)
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Attachment Theory

Model of Self
Therapist Self-Competent
Attachment persists within relationships
Secure
Dependable
 Attachment


persists across relationships
explains transference in IPT
Preoccupied
Model of Others
Not Dependable
Attachment tends to persist,
but is NOT fixed
Not Self-Competent
Dismissing
Fearful
Development of therapeutic alliance
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Model of Self
Therapist Self-Competent
Secure
Dependable
Attachment Theory
Not Self-Competent
Preoccupied
 Those
with less secure attachments are
more vulnerable to crises because:
1) They have poor social support
2) They have difficulty asking for help graciously
Model of Others
Not Dependable
Dismissing
Fearful
 Biopsychosocial/Cultural/Spiritual Model
Corrective therapeutic experience
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Interpersonal Triad
IPT Summary
Acute Interpersonal Crisis

Distress results from:

DISTRESS

Attachment and
Biopsychosocial/
Cultural/Spiritual
Vulnerabilities
and Strengths


IPT focuses on:
symptom relief
 improved interpersonal functioning
 increased social support

Inadequate Social Support
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An acute crisis
Biopsychosocial, cultural and spiritual factors
Inadequate social support
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IPT: Evidence of Efficacy
Interpersonal Psychotherapy
 Does
IPT work?
 For
what type of distress?
 For which patients?
Evidence of Efficacy
 How
should the data inform clinical
practice?
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IPT-Empirical Research
IPT- Empirical Research
NIMH Treatment of Depression Study
Initial Studies: Acute Treatment of Depression

IPT equivalent to Amitriptyline

IPT + Amitriptyline superior to either alone
 combination
 combination
Acute Depression
N = 256
t = 16 weeks
treatment more acceptable
treatment better tolerated
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Imipramine
(Placebo)
IPT
CBT
4
IPT-Empirical Research
IPT-Empirical Research
NIMH Treatment of Depression Study
NIMH Treatment of Depression Study

IPT superior to placebo
IPT = Imipramine for mild to moderate depression

IPT slightly better than CBT for severe depression

No preventive effects for IPT, CBT, or Imipramine
at 6, 12, or 18 months

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Clinical
Management

43% entering IPT achieved remission

55% who completed IPT achieved remission

23% terminated prematurely from IPT


Premature terminators more severely depressed at intake
33% achieving remission relapsed within 18 months
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IPT-Empirical Research
IPT-Empirical Research
Maintenance Therapy with IPT
Maintenance Therapy with IPT
**
N = 230
**
*
*
N = 157
N = 128
Mean 3 Year Survival (weeks)
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IPT-Empirical Research
IPT-Empirical Research
Maintenance Therapy with IPT: II
Maintenance Therapy with IPT: II



233 female subjects
112 remitted (48%) – with IPT alone
58 additional remitted (25%) – with IPT + SSRI
N = 233

Remission:
IPT alone = 112
IPT + SSRI = 58
Total = 170


N = 131
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
19/74 remitting with IPT alone had a recurrence
13/26 needing IPT + SSRI to remit had a recurrence
**
IPT alone mean survival = 84 weeks
IPT + SSRI mean survival = 54 weeks
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IPT-Empirical Research
IPT-Empirical Research
Maintenance Therapy with IPT: II
11

No differences between IPT frequencies

Bi-Weekly IPT had best compliance

Patients “vote with their feet”
Maintenance Therapy with IPT: II

Maintenance treatment = Acute treatment

Frequency of maintenance does not affect recurrence


Doesn’t matter for the study group, but DOES matter a
great deal for individuals!
Use Clinical Judgment
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IPT-Empirical Research
IPT for Postpartum Depression:
Beck Depression Inventory
Postpartum Depression
 120
DSM-IV Postpartum Major Depression
 DSM-IV major depression
 Women recruited from the community
 Randomly assigned to:
**
**
**
 12
sessions of IPT
 Waiting list control
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IPT-Empirical Research
Diverse Populations
IPT for Postpartum Depression:
Hamilton Rating Scale for Depression

Older Adults

**

Adolescents

**
**
(Mufson et al, 2004)

Low income populations

Ethnic diversity



(Grote et al., 2009; Krupnick et al., 2008)
(Mufson et al., 1999; Spinelli et al., 2013)
International populations

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(Reynolds et al, 1999, 2004; Miller 2009)
(Bolton et al, 2007; Gao, Chan, & Sun, 2012)
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IPT-Empirical Research
Types of Distress





Additional Applications
Depression


IPT-Empirical Research
Antenatal & Postpartum (O’Hara & Stuart, 2000; Stuart 1997, 2012)
Dysthymia (Markowitz et al, 2005)


Somatization Disorder (Stuart & Noyes, 2005, Stuart 2006, 2014)
PTSD (Markowitz et al 2015; Meffert et al. 2011; Robertson et al., 2007)
Bipolar Disorders (Frank et al, 2005)
Eating Dysregulation (Agras et al., 2000; Fairburn et al, 1998, 2015, Hibbert et al,
Antenatal Depression

Somatization Disorder


Anxiety (Lipsitz et al, 1999; Stangier et al., 2012)
(Stuart, 1997; Stuart, 2006; Stuart and Koleva 2014)
(Stuart & Noyes, 2005; Stuart et al 2008; Stuart 2014)
Maintenance Treatment

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(O’Hara & Stuart, 2000; Stuart, 2012; Stuart et al in press)


2012)

Postpartum Depression
(O’Hara et al 2010)
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IPT Delivery Modalities
 Individual
 Group
Therapist Training
 Quality
(Stuart & Robertson, 2012)
IPT and Adherence improves outcome
 Experienced
therapists can deliver high
quality adherent IPT with 2 supervised cases
(Wilfley et al., 2000)
 COMMUNITY-BASED
 Couples
TRAINING
and families
(Brandon et al., 2012; Miller & Reynolds, 2007)
 Ongoing
supervision predicts use and adherence
(Schultz and Stuart 2013, 2015)
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IPT-Empirical Research
Meta-Analysis (Cuijpers 2008)

53 studies comparing 7 treatments for depression:









CBT
Supportive
Behavioral Activation
Psychodynamic
Problem Solving Therapy
Social Skills Training
IPT
IPT-Empirical Research

38 RCTs of IPT for depression (Ciujpers et al. 2011)
 Large to moderate effect for IPT
 Evidence for combination treatment
 No evidence of greater efficacy than other psychotherapies

52 RCTs comparing 9 active treatments for depression in
children and adolescents (Zhou et al. 2015)
 Post-treatment: IPT and CBT significantly more efficacious
 IPT superior in long-term follow-up
 IPT and PST significantly more acceptable (fewer
discontinuations)
IPT more efficacious (d = .20)
Remission rate with IPT increases from .45 to .55
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IPT: Evidence of Efficacy

Does IPT work?
For distress transdiagnostically
 For non-psychotic patients with stable attachment styles


How should the evidence inform clinical practice?
IPT as one tool in your toolbox
Adapt treatment length and frequency
 Provide maintenance treatment



“Flexibility with fidelity”
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Psychotherapy involves a creative
tension between
Interpersonal Psychotherapy
Listening Well
and
Providing Structure
IPT Structure
which allows for meaning to be
developed and understood
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IPT Structure
Assessment/ Initial Phase
1-3 Sessions
Middle Phase
4-12 Sessions
Conclusion of Acute Treatment
Maintenance Treatment
Therapy should be tailored
to fit the patient
rather than forcing the
patient into a rigidly
structured therapy
1-4 Sessions
As agreed
Based on relapse risk
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IPT: Overview of Structure
 “Form

IPT: Overview of Structure
follows Function”

The Structure and Tactics of IPT are flexible and
are based on IPT Theory and Targets
 Modify
IPT focuses on 3 Problem Areas:
 Modify
IPT structure based on Complexity
IPT structure based on Social Support
 Grief
 Modify
IPT structure based on Attachment Style
 Interpersonal
and Loss
Disputes
 Empathy
 Directiveness
 Role
 Intensity
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Transitions
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IPT: Overview of Structure
IPT: Overview of Structure
Collaboration
 IPT
Therapeutic Stance
 Active
 Supportive
 Directive
 Model Graciousness
 Minimizing Transference
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The therapist is not doing IPT
TO the patient, but instead is
doing IPT WITH the patient.
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IPT: Assessment
IPT Structure
Assessment/ Initial Phase
 Patient
Selection
 Treatment Selection
 Evaluate
1-3 Sessions
Complete Psychiatric Evaluation
Interpersonal Inventory
Interpersonal Formulation and Summary
4-12 Sessions
Middle Phase
Interpersonal Problem Areas
Social Support
Maintenance Treatment
 interpersonal
relationships
 attachment style
 narrative
 general suitability
1-4 Sessions
Conclusion of Acute Treatment
As agreed
Based on relapse risk
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IPT: Overview of Structure
Assessment/ Initial Sessions
IPT: Evaluation of Attachment
 Patient’s
 Direct
Description

Inquiry; Interpersonal Inventory
 Complete
an Interpersonal Inventory
 Develop an Interpersonal Formulation
 Information
from Others
 Therapeutic Relationship
 Probes
 Biopsychosocial/Cultural/Spiritual Model
(empathy, directives)
 Narrative
 Diagnoses
Quality
 Develop
 Stories
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Conduct a General Psychiatric Assessment
 The
and IPT Problem Areas
an Interpersonal Summary
Summary is the Treatment Plan
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IPT: Interpersonal Inventory
 Overview
of Social Network
 Evaluate
 interpersonal
problems
 communication
 narrative
 attachment style
 general suitability
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IPT: Interpersonal Inventory: Key Questions
IPT Tools: Principles

 Who
are the 7-8 people I would need to
know to understand you well?
Collaborative

Out of head and onto paper

Open discussion
15
 Who
are the important people in your life?
 How would you describe your social
support?
 Who do you go to for support?
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IPT: Interpersonal Inventory
Key Questions
 Who
IPT: Interpersonal Inventory
Key Questions for Each Relationship
is on your team?
 Who

is on the bench? Other team? Coach?

 Who
do you depend on?
 Who is inside your head at the moment?
 Who is taking up your mental energy?
 Who has loved you well and how have they
done it?
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





How often do you see this person?
What do you like about the relationship?
What don’t you like about the relationship?
What has changed in the relationship?
How would you like the relationship to be different?
What kind of support do you get from this person?
How do you support them?
How would you describe an argument?
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IPT: Interpersonal Inventory
Key Questions for Each Relationship








How often do you see this person?
What do you like about the relationship?
What don’t you like about the relationship?
What has changed in the relationship?
How would you like the relationship to be different?
What kind of support do you get from this person?
How do you support them?
How would you describe an argument?
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IPT: Overview of Structure
Intermediate Sessions
Identify Interpersonal Problem
 Exploration and Clarification of
Perceptions, Expectations
 Brainstorm and Problem Solve
 Implement Proposed Solution
 Monitor and Revise
 Practice
IPT: Overview of Structure
Intermediate Sessions
 Formulation/Summary:

 Maintain the
Listen
Direct
21
Focus on IPT Problem Areas
 Attend
to the Patient’s Affect
 Attend
to the Therapeutic Alliance
22
IPT Structure
IPT: Overview of Structure
Conclusion of Acute Treatment
 Anticipate
Assessment/ Initial Phase
Complete Psychiatric Evaluation
Interpersonal Inventory
Interpersonal Formulation and Summary
Future Problems
Middle Phase
 Conclude
Acute Therapeutic Relationship
 Schedule
Maintenance Treatment
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1-3 Sessions
4-12 Sessions
Interpersonal Problem Areas
Social Support
Conclusion of Acute Treatment
Maintenance Treatment
1-4 Sessions
As agreed
Based on relapse risk
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IPT Formulation & Summary
Interpersonal Psychotherapy
Biopsychosocial/Cultural/Spiritual
 Strength Based
 Works in Progress
 Summary is Collaborative!!

Interpersonal Formulation
Interpersonal Summary
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2
IPT Structure
IPT Formulation & Summary

Formulation: Technical

Summary: Personally meaningful




Assessment/ Initial Phase
Interpersonal Problem Areas
Social Support
Both are structured
Both explain problems and causes
Both Lead to interventions for IPT targets


1-4 Sessions
Conclusion of Acute Treatment
Maintenance Treatment
Reducing distress
Resolving Interpersonal Problems
Increasing social support
3
As agreed
Based on relapse risk
4
Biological Factors
Age
Genetics
Gender
Substance Use
Medical Illnesses
Medical Treatments
Sexual Orientation
Diet, Exercise
Cultural Factors
Tradition
Family
Acculturation
Assimilation
Generational Status
IPT Formulation
Social Factors
Intimate Relationships
Social Support
Employment
Education
Health Care System
Primary Language
Means of Communication
Psychological Factors
Attachment
Personality
Temperament
Defense Mechanisms
Trauma History
Gender Identity
Stigma
Biological Factors
38 years old
Female
3 month old baby
Breastfeeding
Infertility
Previous depression
(responded to SSRI)
Family Hx of depression
Social Factors
Married
Husband supportive
Husband with Multiple
Sclerosis
Parents supportive
Dispute with sister
Was employed, now at home
full-time
Highly educated
Psychological Factors
Securely Attached
(with some dismissive features)
Self-Reliant
High expectations of self
Self-critical
Intellectualization and
Humor as defenses
Perfectionism
Distressed Individual
Distressed Individual
Acute Interpersonal Crises
Interpersonal Dispute
Role Transition
Grief and Loss
Spiritual Factors
Tradition
Social Support
Meaning
Cultural Factors
Family Important
Achievement Valued
Traditional gender roles
in family of origin
Values natural childbirth
and breastfeeding
Diagnoses and Treatment Plan
IPT Targets
Interpersonal Functioning
Social Support
Distress
5
4-12 Sessions
Middle Phase
Summary is the treatment plan

1-3 Sessions
Complete Psychiatric Evaluation
Interpersonal Inventory
Interpersonal Formulation and Summary
Acute Interpersonal Crises
Interpersonal Dispute- sister
Role Transition- postpartum
Grief and Loss- infertility
Spiritual Factors
Raised as Christian
No spiritual community
Meaning in caring for others
Diagnoses: Postpartum Depression (recurrent, moderate)
Treatment Plan: IPT (consider medication if needed)
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Biology
Psychology
IPT Summary
Social
Reason for
distress #1
Goals:
1)
2)
3)
Reason for
distress #2
Patient
Culture
Reason for
distress #3
Spiritual
Specific
STRENGTHS
Specific Goals
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IPT Summary
Tired,
no sleep,
breastfeeding
Change in
friends,
feel alone
Cancer
I’m bored
and stuck
Partner
tries to
problem
solve
Fear of
Death
Fear of Pain
Goals:
1) Get help from partner
2) Feel less isolated
NO HELP
from
partner
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Reason for
distress #4
STRENGTHS
Problem Solver
Humor
Coming to treatment
Love my children
IPT Summary
Goals:
1) Cope better with cancer
2) Feel less isolated
STRENGTHS
Problem Solver
Competent
Humor
Isolation
Loneliness
Conflict
with family
about
treatment
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2
Biological Factors
Age
Genetics
Gender
Substance Use
Medical Illnesses
Medical Treatments
Sexual Orientation
Diet, Exercise
Cultural Factors
Tradition
Family
Acculturation
Assimilation
Generational Status
IPT Formulation
Social Factors
Intimate Relationships
Social Support
Employment
Education
Health Care System
Primary Language
Means of Communication
Distressed Individual
Acute Interpersonal Crises
Interpersonal Dispute
Role Transition
Grief and Loss
Diagnoses and Treatment Plan
IPT Targets
Interpersonal Functioning
Social Support
Distress
Psychological Factors
Attachment
Personality
Temperament
Defense Mechanisms
Trauma History
Gender Identity
Stigma
Spiritual Factors
Tradition
Social Support
Meaning
IPT Summary
Goals:
1)
2)
3)
STRENGTHS
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IPT Structure
Assessment/ Initial Phase
Complete Psychiatric Evaluation
Interpersonal Inventory
Interpersonal Formulation and Summary
Interpersonal Psychotherapy
Middle Phase
1-3 Sessions
4-12 Sessions
Interpersonal Problem Areas
Social Support
Role Transitions
Conclusion of Acute Treatment
Maintenance Treatment
1
1-4 Sessions
As agreed
Based on relapse risk
2
Assessment/Initial Phase
IPT: Role Transitions
Interpersonal Inventory
Interpersonal Summary

Role Transition
Grief and Loss
Dispute


Timeline

Dispute Graph


3
Identify Interpersonal Problem
Exploration and Clarification of
Perceptions, Expectations
Brainstorm and Problem Solve
Implement Proposed Solution
Monitor and Revise
Practice
Directives
4
IPT: Role Transition Issues
IPT: Role Transitions

Life-Cycle Transitions


Adaptation to change

Adolescence, Childbirth, Menopause,
Decline of Physical Capacity


Social Transitions

5
Listening
Well

School, Marriage, Divorce, Moving,
Coming Out, Employment, Unemployment,
Retirement, Emigration, Dislocation,
Returning from Deployment
New attachments
New social supports
Realistic expectations of self and others
Ambivalence about change


Elicitation of Affect
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IPT: Role Transitions
Strategies

IPT: Role Transitions
Goals of Treatment
Evaluation of the transition




some changes are negative


Development of new social support


“graciousness training”
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facilitate loss of old role

Development of realistic view
Grudging acceptance

Adaptation to the new role
Expression of Affect
Acquisition of new skills
Development of new social supports
How do these actually apply to therapy?
8
Timeline Goals

Help patient organize and tell their story
To you
 To others


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IPT: Role Transitions:
Role Transition Tactics



Before the change, I was…
Increases social support


Questions for patients
Organize the story
Practice telling the story in therapy
Tell the story to others

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Engage social support
Now, I am…
Describes, clarifies, conveys emotion
Instill hope
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IPT: Role Transitions:
IPT: Role Transitions:
Questions for patients
Questions for patients
When I think of myself now…
What do you aspire to?
To really understand me during
this transition, you need to
know…
Where does the arrow go?
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IPT Tools: Principles

Collaborative
What did you do?

Out of head and onto paper
What kind of support do you need?
From whom?
How can you get it?

Open discussion
What was that like?
How did it feel?
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IPT Transitions: Take Home Points

Help organize a complex story

Build ability to tell the story


practice
Engage others – who else can
the patient share the story
with?
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IPT Structure
Assessment/ Initial Phase
Interpersonal Psychotherapy
Complete Psychiatric Evaluation
Interpersonal Inventory
Interpersonal Formulation and Summary
Middle Phase
4-12 Sessions
Interpersonal Problem Areas
Social Support
Interpersonal Disputes
Conclusion of Acute Treatment
Maintenance Treatment
1
1-3 Sessions
1-4 Sessions
As agreed
Based on relapse risk
2
Assessment/Initial Phase
Psychiatric Evaluation
Interpersonal Inventory
Interpersonal Summary
IPT: Interpersonal Disputes
Identify Interpersonal Problem
 Exploration and Clarification of
Perceptions, Expectations
 Brainstorm and Problem Solve
 Implement Proposed Solution
 Monitor and Revise
 Practice

Role Transition
Grief and Loss
Timeline
Dispute
Dispute Ladders
3
Directives
4
IPT: Interpersonal Disputes


IPT- Interpersonal Disputes
Goals of Treatment
Exploration and Clarification

Expectations vs. Wishes
 Reassess
Expectations
 Modify Communication
 Communicate Interpersonal/
Attachment Needs More Graciously
 Act with Integrity
 Learn- Don’t Repeat the Same Mistake
Brainstorm and Problem Solve


5
Listening
Well
What is realistic?
What can be done with integrity?

Implement Proposed Solution

Practice
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IPT- Interpersonal Disputes
Strategies
IPT- Interpersonal Disputes
Goals of Treatment
 Examine
Parallels in Other Relationships
 Role Playing
 Conjoint Sessions
 Model

Reassess Expectations in the Relationship
 Modify Communication Patterns
 Communicate Interpersonal/ Attachment
Needs More Graciously
 Act with Integrity
Direct Communication
 “push
down” through therapy
7
How do these apply to therapy?
8
Interpersonal Disputes: Goals
 Help
patient communicate better
 Therapist identifies
patterns of communication
aware of patterns
 Patient learns to communicate more clearly
Interpersonal Psychotherapy
 Patient becomes
Interpersonal Theory
 Resolve
interpersonal problems
 Engage social support
 Reduce distress
9
10
IPT: Interpersonal Theory

Attachment is an enduring pattern of
interpersonal interactions: Forest

Relationship: the cumulative result of
reciprocal communication

Interpersonal communications reflect
attachment style: Trees

Communication MUST occur in relationships

Communication occurs on two levels:
 manifest content-- factual information
 process content-- information about the relationship

11
Interpersonal Communication
Interpersonal problems result from ineffective
or ambiguous communication
12
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Interpersonal Communication
Manifest and Process Content:
Examples

“Do you have children?”
 “How long have you been doing therapy?”
 “I didn’t do my homework assignment.”
 “I’m going to slash my wrists.”
In all relationships, three interpersonal
issues are negotiated:


“Take this medication and you will feel better.”
13

Affiliation (love / hate)

Status

Inclusion (degree of importance)
(dominance / submission)
14
Dominance
Dominance
Antisocial
Compulsive
Caregiver
Hostile
Hostile
Friendly
Friendly
Asocial
Submission
Submission
15
16
Interpersonal Communication
Dominance
Dismissive
Secure
Hostile
Fearful

Ineffective Communication
 Verbal and non-verbal communication
elicits or provokes negative or rejecting
responses

Characteristics:
 Inflexible attachment style
 Rigid interpersonal communication
 Lack of insight
Friendly
Preoccupied
Submission
17
Dependent
18
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Interpersonal Communication: Theory
Dominance
Dominance
Ultimate
Response
Hostile
Hostile
Antisocial/
Dismissive
Friendly
Friendly
Initial
Response
Submission
Submission
19
20
Dominance
Initial
Response:
Benevolence
Natural
Response:
Rejection
Hostile
Friendly
Ultimate
Response
Passive-Aggression
Dependent/
Preoccupied
Submission
21
Patient: “How many years have you been practicing
psychotherapy?”
Therapist: “About 2 years. What leads you to ask?”
Patient: “Just curious… so where did you train?
Was it a good program?”
Therapist: “Yes, it was a good program.
You seem to be very interested in my background.”
Patient: “Not really, I just need to make sure that you know what
you’re doing, and you look kind of young and inexperienced.”
22
Interpersonal Communication
Interpersonal Communication: Reality

Angry
Positive affiliation is high at baseline
Dominant
Assured
(most people are nice)

Friendly
Hostile
High affiliation elicits high affiliation
(friendly advice elicits gracious acceptance)

Hostility provokes hostility
PassiveAggressive
(aggression elicits aggression in response)
23
Trusting
Submissive
24
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Dominant
Dominant
Angry
TRAIT
I’m angry at you.
STATE
What is that like for you?
Hostile
Hostile
Friendly
Why do you always answer my
questions with a question?
PassiveAggressive
What leads you to ask that?
PassiveAggressive Submissive
Submissive
25
26
Interpersonal Communication: Summary
Dominant
Angry
Interpersonal Theory: Motivations
Assured

Friendly
Hostile
PassiveAggressive
More than one motivation may be present
 Motivations may conflict
 Motivations are often unclear to the patient

Trusting
Submissive
27

As a result: Communication is ineffective
28
Interpersonal Theory: Motivations
 Motivations
 Others
must be inferred by others
may infer incorrectly
Communication Questions





 Others
 As
29
Motivations drive specific communication
have their own motivations
a result: Communication is ineffective


What patterns do you see in your relationships?
What kinds of things do you have difficulty talking about?
What is it like for you to express anger to others? Sadness? Joy?
How do you respond when others are critical or angry with you?
How do you communicate your needs to others?
When you’re stressed, how do you tell others you need help?
How do others respond when you ask for help?
 What
is it like for you to ask for help?
30
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Improving Communication
I can ask for help more effectively by...
I
tend to ask for help by…
 When I ask for help others tend to
respond by...
 When others don‘t respond to me when
I ask for help I feel...
I
1)
2)
3)
4)
5)
can ask for help more effectively by...
31
Asking graciously
Asking for something realistic
Explaining what I need
Explaining why I need it
Asking someone who can do it
32
Interpersonal Triad
IPT: Therapist’s Tasks
1) Identify the ineffective patterns of communication
Acute Interpersonal Crisis
 Interpersonal Incidents
2) Help patient become aware of interpersonal patterns
 Communication Analysis
3) Help patient communicate more clearly

DISTRESS
Problem Solving, Role Playing
4) Create an inclusive therapeutic relationship

33
Communication
Attachment and
Biopsychosocial/
Cultural/Spiritual
Vulnerability
Communication
Inadequate Social Support
Therapeutic Feedback
34
Interpersonal Dispute Graph
How bad is it?
How important is the relationship?
35
36
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38
Interpersonal Dispute Ladders
IPT: Interpersonal Disputes
 Where
would you mark the dispute?
 How would you describe the dispute?
 How has it changed over time? Has it
always been this way?
 Where would the other person mark it?
How bad is it?
How important is the
relationship?
39
 Where
40
IPT: Interpersonal Disputes

How well does the other person understand?
How well do you understand the other person?

What is realistic?


41
would you like the marks to be?
I can communicate more effectively by...
1)
2)
Expectations vs. wishes

How can you communicate more effectively?

Do your choices foster integrity and graciousness?
3)
4)
5)
Asking graciously
Asking for something realistic
Explaining what I need
Explaining why I need it
Asking someone who can do it
42
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IPT Tools: Principles

Collaborative

Out of head and onto paper
Dispute Graph Goals
 Help
patient organize and tell their story
 To
you
 To others
 Resolve

43
interpersonal problems
 Increase social support
 Reduce distress
Open discussion
44
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IPT Techniques: General Principles

The Primary Goal is to Understand the Patient
 Balance
Interpersonal Psychotherapy
Therapeutic Techniques
1
listening and structure

All Interventions Should Be Therapeutic

All Interventions Should Enhance the
Therapeutic Alliance
2
IPT Techniques:
Encouragement of Affect
IPT Techniques

Spectrum of Directives

Therapist should be attuned to the patient’s affect
Goals:



Least Directive
Hmmm…
Content vs. Process Affect
“what were you feeling at the time?”
vs.
“what are you feeling as you’re talking now?”
Most Directive
I wonder if…
Here’s some homework
3
Recognition and attunement with affect
Use affect to facilitate change and better communication
4
IPT: Therapist’s Tasks
IPT Techniques:
Encouragement of Affect
Content Affect
1) Identify the maladaptive patterns of communication
 Interpersonal Incidents
2) Help patient become aware of interpersonal patterns
Process Affect
History
Present
“What were you feeling
at the time?”
“What are you feeling
now?”
 Communication Analysis
3) Help patient communicate more clearly

Problem Solving, Role Playing
4) Create an inclusive therapeutic relationship
 Therapeutic Feedback
5
6
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IPT Techniques: Interpersonal Incidents
IPT Techniques: Interpersonal Incidents

Interpersonal Incidents-- point-by-point detailed



Example:
“How did you ask your partner for help?”
“How did you start the conversation?”
“What exactly did you say?”
“Then what did he do?”
“How did you respond?”
“How did that make you feel?”
7
General
Statement
Content
C
A
Affect
D
B
8
IPT Techniques: Interpersonal Incidents
IPT Techniques: Interpersonal Incidents
“tell me about the last time...”
“what were you feeling at the time...”
Specific
Episode
Description of
Interaction
Conflict over
childcare
General
Statement
My partner
Never helps
Specific
Episode
Description of
Interaction
Conflict over
childcare
Affect
Angry
Sad
Hopeless
Frustration
Anger
Hopelessness
Affect
9
General
Statement
My partner
Never helps
Frustration
Anger
Hopelessness
10
IPT Techniques: Interpersonal Incidents
Communication Analysis
Specific
Episode
Description of
Interaction
Conflict over
childcare
Affect
Misunderstood
11
Specific
Episode
descriptions of interactions
Require direct inquiry- structure
Helpful in identifying patterns of communication
IPT Techniques: Communication Analysis
Assists the patient to identify
ineffective communication
 Identifies ambiguous, indirect,
non-verbal communication
 People often assume that:

General
Statement
My partner
Never helps
Frustration
Anger
Hopelessness



They have communicated clearly
They have understood clearly
They are being supportive
12
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I can ask for help more effectively by...
IPT Techniques: Communication Analysis

General Principles:
 The
patient should be encouraged to “put
everything into words”
1)
2)
3)
 The
patient should be encouraged to
communicate graciously
 Therapist should
4)
5)
always communicate graciously
13
14
IPT Techniques: Interpersonal Incidents
IPT Techniques: Problem Solving
Introducing the Possibility of Change
Specific
Episode
Description of
Interaction
Conflict over
childcare
Affect
Misunderstood
General
Statement
Identify Interpersonal Problem
 Exploration and Clarification of
Perceptions, Expectations
 Brainstorm and Problem Solve
 Implement Proposed Solution
 Monitor and Revise
 Practice

My partner
may help
Hopefulness
15
Listen
Direct
16
IPT Techniques: Role Playing
17
Asking graciously
Asking for something realistic
Explaining what I need
Explaining why I need it
Asking someone who can do it

Goals:
 Assist the patient to develop new perspective
 Assist the patient to practice communication

Helpful with Interpersonal Disputes

Have the patient play significant other first
IPT Techniques: Summary
Balance listening and structure
 Balance openness and directiveness
 Techniques:

 Use
of Affect
 Interpersonal Incidents
 Communication Analysis
 Problem Solving
 Role Playing
18
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“Grief is the interest owed
on the debt of attachment”
Interpersonal Psychotherapy
Grief and Loss
Irvin Yalom
1
2
IPT Structure
Assessment/ Initial Phase
Complete Psychiatric Evaluation
Interpersonal Inventory
Interpersonal Formulation and Summary
Middle Phase
Assessment/Initial Phase
Psychiatric Evaluation
Interpersonal Inventory
Interpersonal Summary
1-3 Sessions
4-12 Sessions
Role Transition
Interpersonal Problem Areas
Social Support
Conclusion of Acute Treatment
Maintenance Treatment
Dispute
1-4 Sessions
As agreed
Based on relapse risk
3
Timeline
Dispute Graph
4
IPT: Grief and Loss
Identify Interpersonal Problem
 Exploration and Clarification of
Perceptions, Expectations
 Brainstorm and Problem Solve
 Implement Proposed Solution
 Monitor and Revise
 Practice
IPT: Grief and Loss


5
Grief and Loss
Listening
Well
What is Grief and Loss?


Directives
Patient driven
“Pathological” Grief vs.
Experience of Grief and Loss
6
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IPT: Grief and Loss
Goals of Treatment
IPT: Grief and Loss
“Delayed Grief Reaction” vs.



Grief experienced in a new context



Context Matters

Life crises lead to new perspectives on loss
7
“Facilitate Mourning Process”
“Catharsis”
“Facilitate Acceptance”
“Normalize Loss”
What do these terms really mean?
8
IPT: Grief and Loss
 Facilitate Mourning Process
Creating a safe relationship in which to grieve
 Being with
 Asking the questions no one else does
 Clarification of experience- “what was that like?”
 Containment
Extension of experience to social supports
 Reduce Isolation
 Meet attachment needs for support


9
10
IPT: Grief and Loss
Grieving Well

Having a culturally and spiritually
relevant way of experiencing and
giving meaning to loss in a
socially supportive context
Opening Discussion




Graciously Closing Discussion


11
What was the loss like for you?
What emotions are connected to the loss?
What is it like to talk about the loss?
What are you doing now?
What kind of support would be helpful to you?
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Grief and Loss Goals
 Help
What was that like?
 To
you
 To others
How did it feel?
What did you do?
 Communicate
needs for support graciously
 Increase social support
 Reduce distress
What kind of support do you need?
From whom?
How can you get it?
13
patient organize and tell their story
14
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Psychotherapy Dose-Response
Interpersonal Psychotherapy
Improvement
Conclusion of Acute Treatment
&
Maintenance Therapy
Final Response rate ~ 85%
Attendance
26
8
1
2
IPT Structure
Assessment/ Initial Phase
1-3 Sessions
Middle Phase
4-12 Sessions
Conclusion of Acute Treatment
Maintenance Treatment
IPT: Conclusion of Acute Treatment
General Principles
 Acute
IPT should be Time-Limited
 “Family Practice” model of therapy
1-4 Sessions
 Maintenance
As agreed
Based on relapse risk
3
treatment must be explicit
4
IPT: Conclusion of Acute Treatment
Strategies
IPT: Conclusion of Acute Treatment
Goals
 Explicit
 Conclude
Therapy Well
 Facilitate Independent Functioning
 Enhance the Patient’s Competence
 Attachment
5
Number of sessions
Discussion of Acute Conclusion
 Attachment
to the therapist SHOULD happen
if the therapy is done well
 Therapists can be open about their own
feelings
 Plan when to return to treatment if needed
needs met outside of therapy
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IPT: Conclusion of Acute Treatment
Strategies
 Genuinely
and Positively Reinforce the
Patient’s Gains
 Review Patient’s Feedback
 Anticipate
Future Problems
 Agree on Future Treatment
7
8
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IPT Training and Certification: Goals
Interpersonal Psychotherapy
Training
Supervision
Certification
1

Help people be virtuoso therapists

Disseminate IPT as far as possible
 Encourage

all levels of training
Two training tracks
 Community-Based
IPT Training & Certification
 IPT Research Training & Certification
2
Community-Based IPT Certification
Community-Based IPT Certification

Completion of TWO IPT portfolios:
Case report of the completed IPT case
Self-evaluation form
 Interpersonal Inventory
 Interpersonal Summary and Formulation
 Patient Outcomes- PHQ-9 and GAD-7 every 4 weeks
 Audio or video tape of one session from each case


Completion of two day Level A course

Completion of at least 10 of 12 biweekly hourlong IPT group consultation calls



3
4
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IPT: Research Certification

Level A- Basic Training in IPT

Level B- Clinical Training in IPT

Level C- Clinical Certification in IPT
2
2
2
day interactive training
Training Opportunities:
supervised cases or Community Training
IPT for Groups
Perinatal IPT
IPT for Couples
IPT for Grief and Loss
IPT Supervisor Training
more supervised cases
Level D- Certified IPT Supervisor
 Level E- Certified IPT Trainer

5
Completion of a one day Booster IPT course
Recommend IPT Advanced training every 3 years
6
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Interpersonal Psychotherapy
Institute
IPT ADHERENCE AND QUALITY SCALE
INTERPERSONAL PSYCHOTHERAPY INSTITUTE
Copyright 2014 Interpersonal Psychotherapy Institute
1
IPT ADHERENCE AND QUALITY SCALE
Interpersonal Psychotherapy
Institute
INTERPERSONAL PSYCHOTHERAPY INSTITUTE
THERAPIST NAME:
SUPERVISOR NAME:
SESSION #:
DATE:
ALL SESSIONS
GENERAL RATINGS (RATE FOR ALL SESSIONS)
Low
Therapist’s
Therapist’s
Therapist’s
Therapist’s
warmth)
Therapist’s
Therapist’s
Therapist’s
Therapist’s
Therapist’s
QUALITY
High
skill in developing a therapeutic alliance with the patient
skill in structuring and organizing the session
skill in connecting this session to previous sessions
interpersonal skill (e.g., graciousness, compassion, empathy, genuineness,
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
skill in attending to the patient’s affect
use of non-specific therapy skills (e.g., clarification, reflection, validation)
confidence and self-assurance
skill in providing reassurance
ability to instill hope
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
5
5
5
5
5
IPT SPECIFIC RATINGS (RATE FOR ALL SESSIONS)
QUALITY
Not Done Low
Therapist maintained a consistent IPT theoretical orientation
Therapist maintained an IPT therapeutic stance (e.g. open, curious, personally
accessible)
Therapist collaborated with the patient
Therapist solicited and was responsive to the patient’s feedback
Therapist adapted to the patient’s attachment style
Therapist modeled good communication skills
Therapist was transparent about goals and conduct of IPT
The IPT Formulation was used to guide the session
Therapist explained the Formulation and Summary and their relevance to current
problems
Psychiatric symptoms/distress were addressed in interpersonal context
Specific Interpersonal Problem Areas were addressed
Specific interpersonal relationships were addressed
Therapist linked any past interpersonal experiences discussed to current
interpersonal context
Ways to develop better social support were addressed
Opportunities for change were noted
Strategies for change were developed collaboratively
High
1
1
2
2
3
3
4
4
5
5
1
1
1
1
1
1
1
2
2
2
2
2
2
2
3
3
3
3
3
3
3
4
4
4
4
4
4
4
5
5
5
5
5
5
5
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
OVERALL RATINGS (RATE FOR ALL SESSIONS)
Low
General Therapy Skills
IPT Specific Skills
Overall Rating for this session
Copyright 2015 Interpersonal Psychotherapy Institute
1
1
1
2
QUALITY
2
2
2
3
3
3
High
4
4
4
5
5
5
INITIAL SESSIONS
GENERAL IPT TACTICS- INITIAL SESSIONS (RATE ONLY FOR INITIAL SESSIONS)
Not Done Low
General psychiatric evaluation was conducted
Therapeutic alliance was fostered and enhanced
Interpersonal Inventory was collaboratively developed and used to generate
hypothesis about problem areas and social support
Interpersonal Formulation and Interpersonal Summary were
collaboratively developed as a way of understanding the patient’s distress
Specific Interpersonal Problem Areas were identified as targets for the middle
phase
Specific treatment goals were collaboratively identified
General psychoeducation about psychiatric illness/distress was presented
Psychoeducation about IPT and interpersonal framework was presented
The patient’s role as an active participant in the recovery process was discussed
Treatment Agreement for structure of therapy was developed collaboratively
(e.g., session frequency, number of sessions etc.)
QUALITY
High
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
1
2
3
4
5
1
2
3
4
5
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
5
5
5
5
5
MIDDLE SESSIONS
GENERAL IPT TACTICS- MIDDLE SESSIONS (RATE ONLY FOR MIDDLE SESSIONS)
QUALITY
Not Done Low
An Agenda for the session was collaboratively developed
Interpersonal Summary and Goals were reviewed and used to direct
treatment
Interpersonal Problem Area(s) were clearly identified for the session
Interpersonal tasks from earlier sessions were reviewed
Symptoms/distress were reviewed and discussed in an interpersonal context
Therapist linked any past interpersonal experiences discussed to current
interpersonal context
Ways to develop better social support were addressed
Opportunities for change were noted
Strategies for change were developed collaboratively
High
1
1
2
2
3
3
4
4
5
5
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
MIDDLE SESSIONS
IPT TACTICS- ROLE TRANSITIONS (RATE ONLY FOR MIDDLE SESSIONS- ROLE TRANSITIONS)
QUALITY
A clear focus on Role Transitions was maintained and followed
Understanding/conceptualization of Role Transition was based on the
Interpersonal Summary/Formulation
IPT Timeline was developed and/or discussed
Details of the Role Transition were discussed
Emotions associated with the transition were identified and explored
Needs met in previous role were identified and discussed
Ways the patient can develop and/or resume relationships and social support
were explored
Patient was encouraged to share experience of transition with others
Interpersonal communication was discussed
Interpersonal changes the patient intends to make were discussed
Copyright 2015 Interpersonal Psychotherapy Institute
3
Not Done Low
1 2
1 2
High
3
3
4
4
5
5
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
1
2
3
4
5
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
MIDDLE SESSIONS
IPT TACTICS- INTERPERSONAL DISPUTES (RATE ONLY FOR MIDDLE SESSIONS- ROLE TRANSITIONS)
QUALITY
A clear focus on Interpersonal Disputes was maintained and followed
Understanding/conceptualization of Interpersonal Dispute was based on the
Interpersonal Summary/Formulation
IPT Dispute Graph was developed and/or discussed
Details of the Interpersonal Dispute were discussed
Emotions associated with the dispute were identified and explored
Ways the patient can develop and/or resume relationships and social support
were explored
Interpersonal communication was discussed
Patterns in relationships were explored
Patient’s expectations of others were explored
Satisfying and unsatisfying aspects of the relationship were explored
Interpersonal changes the patient intends to make were discussed
Not Done Low
1 2
1 2
High
3
3
4
4
5
5
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
5
5
5
5
5
IPT TACTICS- GRIEF AND LOSS (RATE ONLY FOR MIDDLE SESSIONS- GRIEF AND LOSS)
QUALITY
Low
Not Done
A clear focus on Grief and Loss was maintained and followed
Understanding/conceptualization of Grief and Loss is based on the
Interpersonal Summary/Formulation
The therapist was emotionally present for the patient
Details of the loss were discussed
Emotions associated with the loss were identified and explored
Needs met in lost relationship are identified and discussed
Ways the patient can develop and/or resume relationships and social support
were explored
Patient was encouraged to share experience of loss with others
Interpersonal communication was discussed
Interpersonal changes the patient intends to make were discussed
High
1
1
2
2
3
3
4
4
5
5
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
1
2
3
4
5
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
CONCLUDING SESSIONS
GENERAL IPT TACTICS- CONCLUDING SESSIONS (RATE ONLY FOR CONCLUDING SESSIONS)
QUALITY
Not Done Low
An Agenda for the session was collaboratively developed
Interpersonal Summary/Formulation and Goals were reviewed and used to
direct treatment
Continuity with previous sessions was established
Conclusion of treatment was explicitly discussed
Treatment and progress in therapy was reviewed
Warning signs of recurrence were identified and discussed
An Agreement for Maintenance Treatment was collaboratively developed
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High
1
1
2
2
3
3
4
4
5
5
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
5
5
5
5
5
IPT TECHNIQUES
IPT TECHNIQUES- ALL SESSIONS (RATE FOR ALL SESSIONS)
USED
SHOULD HAVE
QUALITY
BEEN USED
YES
NO
YES
NO
Low
High
IPT SPECIFIC TECHNIQUES
Patient’s communications were discussed
Communication Analysis was conducted
An Interpersonal Incident was developed to understand
communication
Content and Process Affect were discussed
Implicit and non-verbal communication was discussed
Role Playing was conducted
Clarification—“what was that like for you?” questions—
were used
The patient was helped to articulate his/her experience
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
1
2
3
4
5
1
2
3
4
5
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
GENERAL TECHNIQUES
Directive Techniques (e.g., Limit Setting, Education,
Direct Advice, Assignment of Homework) were used
Therapist gave explicit advice and guidance
Therapist gave relevant self-disclosure
Therapist used humor
NON-IPT TECHNIQUES
Other theoretical models/techniques were integrated
STRATEGICALLY within the IPT framework
Specific models/techniques used were:
NON-IPT TECHNIQUES
Other theoretical models/techniques were used
INAPPROPRIATELY within the IPT framework
Specific models/techniques used were:
SUMMARY AND COMMENTS:
Copyright 2015 Interpersonal Psychotherapy Institute
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IPT ADHERENCE AND QUALITY SCALE
INSTRUCTIONS
The IPT Adherence and Quality Scale is designed for use by both supervisors and clinicians. It can be used both
for clinical supervision and as a measure of IPT adherence and quality in research settings.
IPT is most effective when it is delivered in a manner which is BOTH adherent and of high quality. Though there
is overlap between these constructs, they are different. For example, an intervention or technique which is
adherent can be delivered in a way which is poor in quality. This measure is designed to capture both adherence
and quality.
The measure is also designed to record whether particular techniques should (or should not) have been used in a
particular session. For instance, Communication Analysis, an important IPT specific technique, may not have
been used in the session, but should have been used in order to maximize the quality and effectiveness of the
session. As another example, a specific directive techniques such as the assignment of homework may actually
have been used in the session, but should not have been since the patient was not yet able to complete them or to
accept the directive to do homework. The scale allows raters to note not only if techniques were used, but if they
should have been.
The measure strongly emphasizes specific IPT tools such as the Interpersonal Inventory, the Interpersonal
Formulation and Summary, the Interpersonal Timeline, and the Conflict Graph. Use of these tools are specifically
noted in the instrument.
Non-IPT techniques can also be noted on the instrument. Rather than proscribing specific techniques, these
should be rated based on how well the therapist integrated them within an IPT framework. For instance, use of
motivational interviewing techniques in the service of developing better social support (an explicit goal of IPT)
can be extremely useful in an IPT session. Similarly, the use of behavioral activation techniques in the service of
engaging in social activities (an explicit goal of IPT) can be extremely useful in an IPT session. In contrast, a
psychodynamic technique, such as explicit discussion of transference, may, if not well-integrated into the IPT
framework, actually be detrimental to outcome as it distracts from the IPT focus on relationships outside of
therapy. Raters can note both the non-IPT techniques used as well as how well they were integrated into the IPT
framework.
Specific Instructions:
1) ALL SESSIONS- rate for every session
a. General Ratings
Rate each item for every session using the 1-5 quality scale.
b. IPT Specific Ratings
Each of these items describes a therapeutic tactic or technique that SHOULD occur in every IPT
session. First, note those that were not done in the session. Then rate each remaining item for
every session using the 1-5 quality scale.
c. Overall Ratings
Rate each item for every session
2) INITIAL SESSIONS- rate only for sessions in the Initial Phase of IPT
a. General IPT Tactics- Initial Session
Each of these items describes a therapeutic tactic or technique that SHOULD occur in every IPT
session. First, note those that were not done in the session. Then rate each remaining item for
every session using the 1-5 quality scale.
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3) MIDDLE SESSIONS- rate only for sessions in the Middle Phase of IPT
a. General IPT Tactics- Middle Sessions
Each of these items describes a therapeutic tactic or technique that SHOULD occur in every IPT
session of the Middle Phase. First, note those that were not done in the session. Then rate each
remaining item for every session using the 1-5 quality scale.
b. IPT Tactics- Role Transitions
Each of these items describes a therapeutic tactic or technique that is relevant to the specific
Problem Area being discussed in the therapy. One or more Problem Areas may be addressed in a
single session, in which case each Problem Area section should be rated. Some of the items noted
may not be necessary for a particular session—for instance, the patient may not yet be at a point,
early in the Middle Phase, when he or she is ready to begin making interpersonal changes. These
may be marked as N/A (not applicable) for that specific session. Some of the tactics, such as
maintaining a clear focus on the role transition being discussed, should occur in every session and
therefore should be rated for each session.
c. IPT Tactics- Interpersonal Disputes
Each of these items describes a therapeutic tactic or technique that is relevant to the specific
Problem Area being discussed in the therapy. One or more Problem Areas may be addressed in a
single session, in which case each Problem Area section should be rated. Some of the items noted
may not be necessary for a particular session—for instance, the patient may not yet be at a point,
early in the Middle Phase, when he or she is ready to begin making interpersonal changes. These
may be marked as N/A (not applicable) for that specific session. Some of the tactics, such as
maintaining a clear focus on the interpersonal dispute being discussed, should occur in every
session and therefore should be rated for each session.
d. IPT Tactics- Grief and Loss
Each of these items describes a therapeutic tactic or technique that is relevant to the specific
Problem Area being discussed in the therapy. One or more Problem Areas may be addressed in a
single session, in which case each Problem Area section should be rated. Some of the items noted
may not be necessary for a particular session—for instance, the patient may not yet be at a point,
early in the Middle Phase, when he or she is ready to begin making interpersonal changes. These
may be marked as N/A (not applicable) for that specific session. Some of the tactics, such as
maintaining a clear focus on the loss being discussed, should occur in every session and therefore
should be rated for each session.
4) CONCLUDING SESSIONS- rate only for sessions in the Conclusion Phase of IPT
a. General IPT Tactics- Concluding Sessions
Each of these items describes a therapeutic tactic or technique that SHOULD occur in every IPT
session of the concluding phase. First, note those that were not done in the session. Then rate each
remaining item for every session using the 1-5 quality scale.
Copyright 2015 Interpersonal Psychotherapy Institute
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