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Interpersonal Psychotherapy
A Clinician’s Guide
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Interpersonal Psychotherapy
A Clinician’s Guide
Scott StuartMD
Associate Professor of Psychiatry and Psychology
at the University of Iowa, Iowa City, Iowa, USA
Michael RobertsonFRANZCP
Director of the Mayo Wesley Centre for Mental Health,
Taree, New South Wales, Australia
A member of the Hodder Headline Group
LONDON
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To Shana, Kaela, Ryson, Darra, and Logan – SS
To my family – MR
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Acknowledgments
We are indebted to many for their help with this project. We are particularly grateful to
Mike O’Hara and the staff of the Iowa Depression and Research Center. We thank
Bryanne Barnett for her assistance on some aspects of the discussion of Attachment
theory as well as Richard White, Jackie Curtis and Kay Wilhelm for their support and
helpful reviews of the ‘Problem Area’ chapters in particular. We would also like to thank
Georgina Bentliff and Serena Bureau of Arnold publishers for their advocacy and
patience over the life of the project.
Finally, we are grateful to our spouses Shana and Amanda, for their unfailing
support, encouragement and friendship through what has been a much larger under-
taking than any of us anticipated.
Scott Stuart
Iowa City, USA
Michael Roberson
Sydney, Australia
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Contents
Preface ix
SECTION 1 INTRODUCTION 1
1 Introduction 3
2 Theory and Clinical Applications 13
SECTION 2 INITIAL SESSIONS 35
3 The Structure of IPT 37
4 Assessment and Patient Selection 45
5 Negotiating the Treatment Contract 65
6 The Interpersonal Inventory 73
7 The Interpersonal Formulation 81
SECTION 3 IPT TECHNIQUES 93
Introduction 93
8 Clarification 95
9 Communication Analysis 101
10 Interpersonal Incidents 115
11 Use of Affect 125
12 Role Playing 131
13 Problem Solving 139
14 Homework 151
15 Use of the Therapeutic Relationship 159
SECTION 4 PROBLEM AREAS 165
16 Interpersonal Disputes 167
17 Role Transitions 183
18 Grief and Loss 195
19 Interpersonal Sensitivity 209
SECTION 5 CONCLUDING IPT 227
20 Concluding Acute Treatment and Maintenance 229
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viii Contents
SECTION 6 ADDITIONAL ASPECTS OF IPT 245
21 Psychodynamic Processes 247
22 Research in IPT 257
23 Integrated Case Example: Allan 281
APPENDICES 299
A Patient Information for IPT 301
B Interpersonal Inventory Form 303
C IPT Formulation Sheet 304
D The International Society of Interpersonal Psychotherapists 305
E Training and Certification in IPT 306
F Adapting IPT to a Research Setting 307
Index 309
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Preface
We present herein a guide to conducting Interpersonal Psychotherapy. Our use of the
term ‘guide’ is intended to convey that Interpersonal Psychotherapy is best conceptual-
ized as a treatment which is grounded in empirical research, theory, and clinical experi-
ence, and which should be applied using a healthy dose of clinical judgment. It is not a
treatment which is best delivered in formulaic fashion or by rote.
Our primary goal is to assist therapists in their endeavors with the unique individu-
als with whom they work, with the belief that Interpersonal Psychotherapy (IPT) is an
extremely useful framework for both clinicians and their patients to accomplish the
goals that they have mutually set forth. Our objective aim is to provide a guide to the
conduct of IPT, but our subjective aim is to help therapists better understand their
patients. This mirrors the goals of IPT – namely that therapists should aim to help their
patients alleviate their objective suffering, always keeping in mind the necessity of
subjectively understanding their individual patients, while helping their patients to
better understand themselves.
We are greatly indebted to the pioneering work of Gerald Klerman, Myrna
Weissman, and the other authors of the 1984 text, Interpersonal Psychotherapy of
Depression.1 Nearly all of the research that has been conducted regarding IPT has
been based on this manual, as have numerous adaptations of IPT which have been
developed for disorders other than depression.2,3 This research has had an important
impact on the field of psychotherapy as a whole, and the treatment of depression in
particular.
However, while IPT enjoys empirical support for its efficacy, there is no research to
date evaluating its effectivenessin typical clinical settings.aIn other words, IPT has been
empirically demonstrated to be of benefit when used:
∑ In an academic setting with therapists specifically devoted to its application.
∑ With subjects (as opposed to patients) who meet carefully selected diagnostic
criteria and who do not have comorbid diagnoses.
∑ With subjects who agree to be involved in a randomized clinical trial.
∑ With subjects who are not typically required to pay for their treatment.
∑ Following a tightly controlled protocol which dictates strict adherence to a manual.
ªThe same criticism can be made for all of the other psychotherapies – there are virtually no empirical data
available about the application of ‘manualized’ therapies in ‘real-world’ clinical settings.
