Interpersonal Psychotherapy for Depression - University of Michigan ...

Interpersonal Psychotherapy for 

Depression 

Heather A. Flynn, PhD 

Associate Professor 

Director, Adult Psychotherapy Services 

Department of Psychiatry 

University of Michigan 

hflynn@umich.edu

Workshop Expectations 

• Literacy in IPT including exposure to 

demonstrations and practice 

• Decide whether IPT will be useful in 

your practice and if you‟d like to gain 

additional training 

• Learn about next step training 

opportunities 

• Will not be proficient in IPT

The Burden of Depression 

• Depressive and Bipolar Illnesses together lead the world in 

burden and disability (Murray and Lopez, 1996; WHO) 

 

 

 

 

 

Unipolar Depression responsible for 10.7% of ALL 

disability worldwide 

Unipolar Disorder 1st or 4th, depending upon measure 

Bipolar Disorder 6 th 

When combined, mood disorders are arguably the 

MOST disabling 

340 million worldwide, 18 million in USA

Widespread 

prevalence 

Early symptom 

onset 

Neurogenesis 

and brain 

changes 

Poor treatment 

adherence 

Burden of 


Under-diagnosis 

and treatment 

Genetic 

vulnerability and 

stress-genetic 

interactions 

Little 

recurrence 

prevention 

Recurrences, 

chronicity, 

loss of 

function

Life course - untreated 

Meets criteria for Major Depressive Disorder 

Ages: 

(Stressors designated by arrows) 

Child-Adolescent Adult Older

Severity 

Response, Remission, Recovery, Relapse, 

Recurrence & Chronicity 

adapted from Kupfer & Frank 2001 

Remission 

Recovery 

‘Normalcy’ 

Response 

Relapse 

Recurrence 

Symptoms 

X 

Incomplete 

recovery 

Syndrome 

Chronicity 

16 wks 12 mo 12 mo 

Treatment phases 

Acute Continuation Maintenance 

RX 

Time

Depression and 

mania are brain 

illnesses 

Brain imaging: Depression vs. Mania 

PET scan, depression 

PET scan, mania 

PET scan, depression 

Brain metabolism in depression and 

mania, same patient, different days 

Baxter, 1983

Percent of people diagnosed with depression 

Stress interacts with genotype in 

onset of depression 

50 

s/s Genotype 

l/l Genotype 

40 

30 

20 

10 

0 

0 1 2 3 4 

Number of Stressful Life Events Experienced

Treatment 

• Psychotherapies: e.g. CBT, IPT 

• Medications (Antidepressants) 

• Somatic Treatments: ECT, rTMS, VNS 

• Phototherapy 

• Lifestyle: sleep, exercise, diet

Psychotherapies and Antidepressant Medications 

Appear to Work in Different Brain Areas 

(Goldapple…Mayberg, AJP, 2004) 

CBT and IPT 

 

 

Cortical “Top- 

Down” 

Brody et al, 

ArchGenPsy 

2001 

Antidepressants 

 

Subcortical 

“Bottom-Up” 

COMBINED???? 

 

No 

neuroimaging 

studies 

CBT 

Paroxetine

Summary of Psychotherapy Research 

• Psychotherapy across a range of theoretical and 

treatment type domains is effective (effect sizes of .68 

and .85) 

• With some exceptions, psychotherapy is a good or better 

than psychotropic meds for all but most severely 

disturbed patients 

• Outcomes are substantial across multiple outcome 

domains (symptoms, multiple role functioning) 

• Psychotherapy is relatively efficient and cost effective 

• Outcomes of psychotherapy are likely to be maintained 

over time, even after withdrawal (vs meds)

Evidence-Based Psychotherapy 

• “EBP integrates all scientific evidence and clinical 

information that is used to guide and improve 

psychotherapy processes, interventions, therapeutic 

relationships, and outcomes” (Goodheart, Kazdin, Sternberg, p. 3) 

• More basically…how we ask and answer the question of 

whether, how, when, why and by whom psychotherapy 

improves patient outcomes and public health 

• Hundreds of psychotherapy research studies have been 

published and reviewed

Evidenced-Based Treatment 

Treatments that have been supported 

using accepted methods of science 

“An approach to treatment that is lifelong 

learning”

So…. 

Psychotherapy is effective, has a strong 

evidence base, and works at the 

neurobiological and environmental level

Why Psychotherapy for 

Depression? 

• Certain forms of psychotherapy (IPT, CBT) 

have been empirically demonstrated to be 

efficacious for the acute treatment of 

depression 

• Many individuals will not comply or adhere to 

anti-depressant medication therapy 

• 67% eventually discontinue meds due to side effects 

• non-response in 19-34% 

• partial response in 12-15%



• Depression is recurrent and is relapse is 

likely after medication discontinuation 

• Psychotherapy has been shown to alter 

stressors and an individual‟s responses to 

stress (relapse prevention) 

• Hopeless patients may get a sense of 

mastery 

• Builds new coping skills



• Alternatives to medication are needed: 

 

 

 

 

 

 

non-responders 

childbearing or nursing 

older adults / others taking multiple meds 

depressed patients about to undergo surgery 

individuals who will not take medication 

can be administered by non-prescribing 

personnel

Case example – Ms. R 

• 28 year old woman, at least 1 prior 

episode of depression (age 16) 

• Gave birth to second child 6 months ago 

• Moved; partner recently changed job 

• depressed, losing interest in work, 

increased conflicts with partner / irritability, 

feeling guilty and badly about parenting 

• Thoughts of something terrible happening 

to her baby; wants to “run away”

Basic Tenets of IPT 

• Treatment selection should consider a wide 

range of options, not simply the therapists 

preference 

• Hundreds of therapies (450+) have been 

described, but only a few have been 

empirically tested (IPT, CBT) for specific 

disorders 

• IPT is not a causal explanation for 

depression, but a pragmatic treatment 

(empirically based)

IPT Defined 

• IPT is a pluralistic approach; 

a “focused, time limited psychotherapy that 

emphasizes the link between mood and the 

current interpersonal relations of the depressed 

patient while recognizing the roles of genetic, 

biochemical, developmental, and personality 

factors in the causation of and vulnerability to 

depression” 

(Weissman, Markowitz, Klerman, 2000, p.4)

Basic Characteristics of IPT 

• Helps patients to “change rather than to 

simply understand and accept current life 

situation” – a focus on what is not working in 

a persons life and how to make it work for 

him/her. 

• IPT intervenes with symptom formation, 

social adjustment and interpersonal 

relationships…works predominately on 

current problems on a conscious and preconscious 

level.

Specific Characteristics of IPT 

• Time limited – LT therapy may reinforce 

avoidance behaviors 

• Focused, no open ended 

• Current, not past interpersonal relationships – 

surrounding depressive episode 

• Interpersonal, not intrapsychic 

• Interpersonal, not cognitive behavioral 

• Personality is recognized, but not a focus. 

Personality may affect 1) outcome of tx, 2) 

patient-therapist relationship, 3) recurrent 

interpersonal problems

Goals of IPT 

• Remission of current depression 

• Improved interpersonal capacity 

• Tools to cope with future problems 

• Insight into needs (of self/others) & 

choices 

• Plan to detect & seek tx for future MDE

I. Initial Phase 

II. 

III. 

IPT Overview 

Assessment and identification of Focus 

Area 

Middle Phase 

Maintain focus on problem area; elicitation 

of affect and behavior change 

Termination Phase 

Consolidate Gains; Relapse Prevention

4 Interpersonal Problem Areas 

1) Complicated Grief 

2) Interpersonal Role Conflict / Dispute 

3) Interpersonal Role Transition 

4) “Interpersonal sensitivity” / 

“Interpersonal Deficits”

IPT Compared to other 

Psychotherapeutic Approaches 

Similarities with CBT: 

 

 

 

 

 

 

 

specifically developed for depression 

have been empirically tested and found to be 

efficacious 

Similar techniques that may be “Key Ingredients” 

of therapy: 

gain sense of mastery 

combat social isolation 

restore a sense of social belonging 

finding meaning

IPT Compared to other 

Psychotherapeutic Approaches 

• Major Differences involve: 

• 1) Focus on interpersonal communications vs internal cognitions 

per se 

• 2) specific techniques: distorted thinking used only in relation to 

interpersonal issues 

• Specific difference from psychoanalytic therapies: 

• role of unconscious may be recognized by the therapist, but not 

emphasized 

• focus on here and now 

• since focus is on changing aspects of a persons life that 

contributes to depression, the past is not a major focus 

 

Personality and defense mechanisms are a given and used to 

improve communications vs a focus of change

IPT and CBT 

• CBT – larger evidence base (especially 

for well defined Axis I disorders) 

• CBT training to standard requires more 

time and is more difficult 

• CBT more widely disseminated

Role of the therapist 

• Therapist is a patient advocate, not neutral: 

UPR, foster positive expectations from therapy 

• The therapeutic relationship is not a 

manifestation of transference: the relationship is 

REALISTIC in that the therapist should be seen 

as supportive of improvement, understanding; 

reactions should be discussed in terms of 

relating to other interpersonal relationships 

• The therapist is active, not passive: maintain 

focus on goals; active role depends on stage of 

therapy 

• The relationship is not a friendship

Use of the Patient-Therapist relationship 

in IPT 

• To assess pts attachment style 

• Formulate questions about the person‟s 

interpersonal relationship and 

functioning outside of therapy 

• Information about potential forms of 

resistance / potential problems in 

therapy 

• To plan for termination 

• To predict the likely outcome of therapy

Assessment Phase: 

1-2 sessions preceding the therapy 

• In addition to diagnostic assessment: 

• Note Risk Factors: Family History Mood 

Disorder, Early Loss (

Indications for Combining Rx 

& Psychotherapy 

• Acute & uncontrolled suicidal acts or 

plans (consider hospitalization) 

• Genetic loading (family history suicide, 

bipolarity) 

• More severe, recurrent depression 

• Co-morbid Borderline, Histrionic, 

OCPD 

• Need for speedy symptom relief

Indications for Adjunctive Rx 

• Recurrent Depression 

• Marked vegetative signs 

• Extreme or uncontrolled mood 

• Anhedonia, loss of libido 

• Significant wt loss 

• terminal insomnia 

• Post-partum onset

Psychotherapy and Medications in 

the Acute Phase Treatment of Unipolar 

Depression (AHCPR - meta-analysis) 

60% 

50% 

40% 

30% 

20% 

10% 

Dynamic 

IPT 

CT 

BT 

Medications 

Placebos 

0%

Psychotherapy RCT‟s have 

generally not included: 

• Adjustment disorder 

• Dysthymia 

• Mood and Anxiety NOS 

• Symptoms of Axis I d/o of minimum 

duration

Meta-analyses of IPT (de Mello et al., 

2005) 

• Based on 23 strictly selected RCT‟s 

• Overall, IPT was superior to placebo 

• Similar to medication therapy 

• IPT produced overall fewer drop-outs 

than medication treatment (13% vs 

23%) 

• Slightly superior to CBT (3 studies; 

56% remission vs 47%)

The Ingredients of 

Therapeutic Efficacy 

• “Common factors contribute a great deal to 

positive outcome therefore, crucial for 

therapists to intentionally incorporate them.” 

• Provide support, establish therapeutic 

alliance, in which learning and then 

action/application can emerge 

• Positive Expectancy 

• Warmth & Attention/Caring & genuine 

curiosity 

• Understanding / Empathy (Bergin & Garfield 1994)

Primary Theoretical Underpinnings of IPT 

1) Attachment Theory – Bowlby 

Biologically based, instinctual drive to form 

relationships with others; describes the 

ways in which people form, maintain, end 

relationships and ways in which they 

develop problems with them 

Difficulty results from disrupted attachments 

with others: specific loss or inadequacy of 

social support network due to a conflict, loss 

or transition

2) Communication Theory - Kielser 

The ways in which non-functional 

communication patterns lead to difficulty in 

current relationships 

3 dimensions: Affiliation (positive feelings), 

Dominance (in charge), Inclusion 

(importance) 

Problems occur when people unintentionally 

elicit negative responses from others 

accompanied by lack of insight

3) Social Theory – Henderson 

Stress in current social relationships 

(social support network) is an 

independent causative factor for 

psychological distress 

Interventions that affect current social 

relationships will lead to improved 

interpersonal functioning

Functions of Attachment- Davies 

• Sense of security 

• Regulation of affect 

• Promoting expression of feeling and 

communication 

• Base for exploration

Attachment and IPT 

• Attachment - a person‟s “working 

model” / expectations of relationships 

and individual interactions 

• Set‟s the stage (“background music”) 

for day-to-day as well as global 

relationship perceptions and behaviors 

• Perturbations in relationship, either real 

or perceived contribute to mood and 

anxiety

Attachment and IPT 

• Relationship functioning becomes selffulfilling 

prophesy (interactional behaviors) 

• One goal of IPT is to help the person bring 

about more reinforcing / rewarding 

interpersonal interactions and experiences 

(consistent with Behavior activation)

Patients generally more likely to respond 

to short term psychotherapy 

• Motivated for therapy – expectancy of 

effectiveness 

• Capacity for insight / ego strength / 

psychological mindedness 

• Less chronic / severe course of illness 

• Ability to form a therapeutic relationship 

• History of response to psychotherapy

Selective Pt Variables for IPT for 


• Life Events: Recent, focused dispute with significant 

other, social or communication problems, recent role 

transition or life change, abnormal grief reaction 

• Relatively secure attachment style – Low attachment 

avoidance (McBride et al., 2006) 

• The ability to relate a coherent narrative with the 

ability to relate specific dialogue between parties 

• A specific interpersonal focus for distress 

• Modest to moderate need for direction and guidance 

• Available support network (responsiveness to 

environmental manipulation)

Specific patient characteristics 

matched to therapy type 

• Better social functioning and well being 

scores predicted positive treatment 

outcome for IPT 

• Patients reporting fewer depressogenic 

cognitions responded more positively to 

CBT and meds 

• Perfectionism and self-criticism 

predicted worse response to 

psychotherapy overall. 

(Sotsky et al., 1991; Marshall et al., 2008; Blatt et al., 1998)

I. Initial Phase 

II. 

III. 

IPT Overview 

Assessment and identification of Focus 

Area 

Middle Phase 

Maintain focus on problem area; elicitation 

of affect and behavior change 

Termination Phase 

Consolidate Gains; Relapse Prevention

The Initial Phase 

4 main tasks: 

1) Diagnose the depression 

2) Complete the Interpersonal Inventory and relate 

the depression to the interpersonal context 

3) Identify major interpersonal problem areas 

4) Explain IPT approach and make a treatment 

contract


• Key Issues: 

Education of the patient about depression, 

including reassurance and guidance, creates 

a sense the problems are being ―worked on‖ 

right away 

Review of symptoms – reassures the patient 

that they fit a pattern that is anticipated and 

understood (by therapist); helps pt 

understand that they are part of a patterned, 

time-limited, treatable illness.


• Key Issues: 

Patient’s perceptions of symptoms should be 

elicited without challenge or disagreement 

Need for medication – severity and recurrent 

pattern; the medical model of IPT makes it 

easily compatible with med tx; present 

treatment options and pertinent information 

about options

Tasks of Intermediate IPT 

Sessions 

• Focus discussion to topics relevant to 

problem area - link mood to IP events, 

clarify wishes (expectations) and 

options, communication analysis, 

decision analysis, behavioral activation 

• Stay „on focus‟ 

• Attend to affect and therapeutic 

relationship 

• Address resistance IF interfering with tx

• What are best Interpersonal focus 

areas and why 

• What are possible interpersonal / 

communication patterns that would be 

targets of intervernion 

• Spokesperson – summarize issues and 

challenges

Grief 

• For IPT, Grief requires the actual death of a 

loved one; differs from “normal” grief which 

typically resolves in 2-4 months and is not 

considered to be a psychiatric disorder 

• “Abnormal” grief = inadequate grieving can 

lead to depression, either following a loss or 

sometime later when reminded of the loss by 

current events (usually another loss) 

• Delayed Grief 

Distorted Grief

Grief - Complicated Bereavement 

• Ambivalence 

• Multiple Losses 

• Inadequate grief in bereavement period 

• Avoidance behavior about the death 

• Anniversary reactions 

• Fear of illness that caused the death 

• Hx of preserving environment of loved one 

• Absence of supports during bereavement 

(Weissman et al 2000)

Grief 

• Complicated grief may not always be 

obvious and requires careful questioning 

about loved ones who have died (e.g. 

circumstances of death and emotional and 

behavioral reactions to it) 

• Often, the person feels badly about him / 

herself, and idealizes the lost person; Goal 

is to clearer, more complex, realistic 

perception of the relationship. Help person 

to avoid fixating on the death itself, but more 

on the complexities of the relationship.

Grief 

• Two goals for depression that centers on Grief: 

• 1 – facilitate delayed mourning process 

• 2 – help reestablish interests and 

relationships that may substitute for what 

has been lost 

• Often, when a person is grieving, the therapist 

will serve as missing social network used to 

explore feelings etc. 

Emphasis on “quiet” allowance of expression of 

emotion

IPT Strategies - Grief 

• Recall sequence of events before, 

during and after the death 

• Reconstruct the lost one 

• Reconstruct the lost relationship 

• Explore associated feelings/regrets 

• Help pt to bring into focus memories of 

the loast person and emotions related 

the experiences with the lost person 

(Weissman 2000)

IPT - Grief 

• Goals: Facilitate mourning process & help 

patient to reestablish interest & relationships 

to substitute for what has been lost 

• Strategies: Review depressive symptoms & 

relate onset to death;reconstruct relationship 

with deceased; describe sequence & 

consequences of events prior, during & after 

death; explore associated feelings; consider 

ways to become involved with others. 

(Weissman 2000)

Interpersonal Role Disputes 

• Defined within IPT as ―a situation in which that 

patient and at least one significant other have 

non—reciprocal expectations about a 

relationship‖; These become the focus of 

therapy if they appear to be important in the 

onset and perpetuation of the depression 

• Identification of a role dispute often involves 

careful assessment of current important 

relationships; listen as much for what is omitted 

as what is said about relationships: insufficient 

or over-idealized descriptions provide clues


• Non-reciprocal expectations about 

relationship with significant other(s) 

• Communication problems 

• Differences that may or may not be 

reconcilable 

• Focus IF important in onset and 

perpetuation of the depression 

(Weissman 2000)


• General goals in working on role disputes: 

• 1 – identify the dispute 

• 2 – make choices about a plan of action 

• 3 – modify non-adaptive communication 

patterns and / or re-assess expectations for a 

satisfactory resolution 

• * Therapist has no investment in a particular 

outcome – must be driven by the patient 

• Helping patients to understand the nature of the 

dispute (expectations etc) may take the entire 

course of therapy

Staging the Dispute 

• Impasse - discussion stopped/low level 

resentment/the “silent treatment” 

• Renegotiation - awareness of differences & 

active efforts to bring about change/arguing 

• Dissolution - irretrievably disrupted/ 

considering ending the relationship 

(Weissman, Markowitz& Klerman)

IPT Goals - Role Disputes 

• Outcome: 

changed expectations and behavior 

of pt +/or other; 

OR accept that which cannot 

change; 

OR dissolution 

(Weissman 2000)


• Other strategies: 

Look for parallels in other relationships 

Help patient to recognize complex, mixed 

feelings about the situation and devise 

strategies for managing them (e.g. 

assertiveness) 

Patient should get to the point of directly 

expressing needs to the other person 

Use of role playing

Social Role Transitions 

• Normative progression through life 

cycle 

• Biological - adolescence, childbirth, end 

of childbearing potential, aging, medical 

illness 

• Social - entering college, leaving home, 

marriage, divorce, job promotion or 

loss, retirement

Interpersonal Role Transitions 

• Depression often occurs as a result of 

difficulty dealing with a life change; persons 

with depression are more likely to experience 

a role change as a loss – again, the goal is to 

bring about a more complex, well rounded, 

realistic perception of the change 

Examples: marriage, divorce, job change, moving, 

leaving home, new responsibilities, retirement, 

changing roles in important relationships, 

graduation etc. Most are associated with 

progression to another part of the life cycle


• Changes are not inherently good or bad, but 

have advantages and disadvantages 

associated with them 

• In depression associated with role 

transitions, the person feels hopeless to 

cope with the change, but often knows he / 

she “needs to make it


• Difficulty coping with the change is 

associated with: 

1 – loss of familiar social supports 

2 – management of accompanying 

emotions (sadness, fear, anger) 

3 – demands for new social skills / 

attachments 

4 – diminished self-esteem


• 4 tasks associated with managing Role Transitions: 

1 - Giving up the old role – this resembles facilitation of grief 

2 - Encouraging expression of affect – elicit feelings 

3 - Developing new social skills: 

Help the patient realistically assess assets and skills needed to 

manage the transition, looking for over and underestimation of 

skills; helpful to have the person imagine the worst thing that 

can happen around the new transition 

Difficulty developing new social skills may involve incorrect, or 

stereotyped assumptions about the role; i.e. marriage 

4 – Establishing Social Supports – carefully review 

opportunities available in the new role for getting involved 

with others

Enhance Social Supports 

• Need to form both new & familiar types 

of relationship with new people 

• Review opportunities for 

connection/involvement with others 

• Encourage behavioral activation 

“Whom do you know? Who can help you? 

Are there people you want to get to 

know?” 

(Weissman 2000)

Interpersonal Sensitivity 

(Weissman 2000) 

• Hx of social impoverishment, 

inadequate or unsustaining IP relations 

• Chronic social isolation & loneliness 

• Increased severity of distress 

• Role out Dysthymic Disorder & Social 

Phobia & not related to recent transition 

• ? Of cause & effect - does chronic 

depression arrest development (McCullough 

2000)

Interpersonal Deficits (sensitivity) 


• Hx of social impoverishment, 

inadequate or unsustaining IP relations 

• Chronic social isolation & loneliness 

• Increased severity of distress 

• Role out Dysthymic Disorder & Social 

Phobia & not related to recent transition 

• ? Of cause & effect - does chronic 

depression arrest development (McCullough 

2000) 

focus of last resort in IPT

Goals & Strategies - Deficits 


• Reduce social isolation 

• Increase social contact: quality and 

quantity 

• Encourage development of new 

relationships 

• Focus on past relationships including 

negative and positive aspects 

• Explore repetitive or parallel problems 

in these relationships

IPT - Deficits 

• “You can talk openly about your difficulties, 

hopes & fears here. This shows that you are 

capable of an intimate friendships. But we‟re 

not friends or family. Let‟s focus on the 

importance of your life outside of the therapy. 

Who can you talk to among your friends or 

family the way you are talking to me? How 

can we help you connect or overcome fear of 

being open? Whom do you have to help in 

your life? How can you approach them? Who 

have you been about to confide in?” 

(Weissman 2000)

Interpersonal Strategies and 

Techniques for Facilitating Change 

• Use discrepancies between effective & 

ineffective IP responses to identify 

maladaptive elements 

• Communication analysis to guide more 

effective communication 

• Decision analysis to reveal alternatives and 

consider consequences of potential choices 

• Modify role relationship models 

• Role playing (Beitman 1999; Weissman 2000)

Communication Analysis 

• Detailed account of conversation or 

argument with significant other with 

feelings and intentions 

• Help pts recognize unpleasant feelings 

• Assist with direct expression & 

strategize ways to cope when 

overwhelmed 

• Encourage assertion with appropriate 

expression of anger (Weissman 2000)

Decision Analysis 

• ? What has pt already tried 

• Help pt recognize broadening range of 

options and insist action held off until each 

option explored 

• “what would you want to happen in this IP 

situation? What solution to this would make 

you happiest? What alternatives do you feel 

you have now? Why don‟t we try to consider 

all the choices you have?” 

• Explore consequences, advantages & 

disadvantages of each line of behavior

Termination of Treatment in IPT 

• Specifically discuss termination at least 

2-3 sessions before ending 

• Termination Tasks: 

• Giving up a relationship 

Establishing sense of competence to deal 

with future problem autonomously

Termination Phase - IPT 

• Feelings of sadness are inevitable and 

should be expected as important part of the 

process of termination that provides 

therapeutic opportunity to work through 

• Need to differentiate normal sadness with 

endings from clinical major depression 

• Loss begets loss: Other ending/separation 

might emerge in the material 

• Opportunity for a „good bye‟ 

(Weissman 2000; Luborsky 1984)

Tasks of Termination 

• Explicitly discuss end of treatment 

• Ask/elicit reactions to end of treatment; 

patient‟s may not not volunteer or have been 

aware of associated feelings 

• Normalize sadness, apprehension, anger 

with endings 

• Emphasize patient‟s autonomous 

competence; Attend to patient‟s successes 

• Acknowledge alternative supports

Self-efficacy 

• Patient‟s may attribute gains to therapist 

effects and worry that they will not be 

maintained after therapy ends 

• Important to highlight beginnings of new 

coping, new behaviors and facilitate their 

taking credit in order to enhance their sense 

of self-efficacy/competence 

• In final 4 session, systematically call 

attention to patient‟s successes & supports

Final Sessions 

• Reflect, review, give & receive 

feedback 

• Discuss future needs, potential areas of 

future difficulty with contingency plans 

• Credit gains, social risks taken to date 

& development of social skills even in 

midst of depression 

• Wish them well; genuine feedback on 

the process

Maintenance Phase IPT 

• IPT appears to prevent recurrence after 

recovery 

• 2 Large Pittsburgh Studies 

1) 128 Outpatients with a history of 2 or 

more past episodes of MDD 

Acute phase treatment consisted of a 

combination of IPT and high dose 

imipramine (>200 mg / day)

Pittsburgh Maintenance Study: Cont: 

Responders maintained on high dose med, 

while IPT was tapered to monthly sessions 

for 4 months 

Then, randomly assigned to a) ongoing high 

dose of meds, b) med + monthly IPT, c) 

monthly IPT alone, d) monthly IPT + 

placebo, e) placebo + clinical management

Pitt maintenance study: 

Results: 

• Meds alone: 80% recovered after 3 years 

• Placebo: less than 20% survived 3 years 

• Monthly IPT less efficacious than meds 

and did little to enhance its effects 

• IPT superior to placebo 

• Low does IPT vs high dose meds 

• IPT worse for patients with reduced delta 

sleep; better for those high on adherence 

to IPT regimen

IPT Maintenance Dose Study 

(Frank et al., 2007) 

• 233 Women with recurrent MDD who achieved 

remission with either IPT alone or IPT + SSRI 

• Randomly assigned to weekly, twice / mo, or 

monthly IPT maintenance for 2 year follow up 

• 25% recurrence among those better with IPT acute 

phase alone, 36% among those who required SSRI 

then drug discontinuation 

• No maintenance sub-group differences 

• Overall, monthly IPT maintenance is successful 

among those who achieve acute phase remission 

with IPT alone, but not as effective for those who 

required the addition of acute phase SSRI.

Neuroimaging Studies 

Martin et al – 28 MDD randomly assigned to 

IPT vs venlafaxine 

• SPECT imaging pre and post treatment 

• Right posterior cingulate blood flow increased in IPT 

group post tx 

• Both groups improved in clinical outcomes 

Brody et al – PET in 24 MDD tx with IPT or 

paroxetine 

• Pt with depression had regional brain metabolic 

abnormalities at baseline changed in the direction of 

normalization post-tx in both groups

Other IPT adaptations receiving 

empirical support 

• Dysthymia – John Markowitz 

• Adolescent Depression – Laura Mufson 

• Elderly Depression 

• Eating disorders 

• PTSD 

• Interpersonal and Social Rhythm 

Therapy – Bipolar disorder

Psychotherapy Process Research 

• Formal monitoring of patient progress has a significant 

impact on client who show a poor response to treatment 

• Standardized feedback about patient progress can work 

well to Step up or down treatment intensity based on 

patient progress (Lambert, 2007) 

• Studies show therapists at all levels are not always alert 

to signs of treatment non-response (Yalom & Liebserman; 

Meyer & Schulte, 2002; Lambert et al., 2003) 

• Consultation improves performance at all levels, 

especially regarding treatment challenges

So…. 

• Evidence based psychotherapy is 

effective for most, and impact on 

clinical and functioning outcomes are 

enduring 

• Therapist experience and competency 

in the model link to clinical outcomes 

• Therapists are not accurate at 

appraising their proficiency in several 

domains of psychotherapy

How Do U.S. Clinicians Learn and Adopt 

New Treatment Methods? 

Pritchard, Wolfe, Waldron & Miller, ATQ, 1997 

6% 

4% 

14% 

20% 

29% 

Experience 

Workshops 

Books 

Classes 

Supervision 

Research 

27%

Conclusions from MI training study Study 

• Proficiency in MI is not substantially increased 

by reading the MI book and viewing MI 

videotapes 

• Proficiency in MI is modestly increased by a 2- 

day clinical MI training workshop 

• Proficiency in MI is substantially increased by a 

2-day clinical training followed by either or both: 

Personal performance feedback from actual 

practice 

Individual telephone coaching sessions

Community Practitioner Training Study 

Conclusions - MI 

MI skills can be trained and used at a 

high level when using 

 

 

 

recorded sessions 

interview coding 

clinical supervision

IPT Training Standards 

Level A: Basic Training in IPT 

Participation in an IPT Institute certified 

training course lasting one day or more.

Level B: Clinical Certification in IPT 

PREREQUISITES: 

• Completion of a two day Basic Training in IPT Course (Level A). 

• Familiarity with the IPT manuals. 

• Successful completion of written IPT knowledge test. 

• Professional clinical training in mental health treatment. 

THERAPY SUPERVISION: 

• Supervision by a certified IPT Institute supervisor for two complete 

IPT cases. 

• Supervision must be provided in individual or group formats. 

• Supervision must be based on audio or videotaped recordings of 

sessions. 

• Supervision must be based on a minimum of one hour of 

supervision per two hours of therapy 

contact. 

• IPT treatment must meet Level B certification standards for 

adherence and quality.

Level C: Research Level/Clinical 

Expert Certification in IPT 


• Completion of Level A and B certification. 

• Professional clinical training in mental health treatment. 

• Completion of a professional research training program. 


• Completion of three IPT cases with a certified IPT Institute 

supervisor. 

• Supervision must be provided in individual or group formats. 


sessions. 



contact. 

• IPT treatment must meet level C certification standards for 

adherence and quality.

Level D: IPT Supervisor/Trainer 

Certification 


• Completion of Level A, B, and C certification. 

• Completion of an IPT Institute certified IPT 

Supervisors‟ Workshop. 

• Completion of professional clinical training in 

mental health treatment. 


• Completion of five IPT cases with a certified 

IPT Institute supervisor. 

• Supervision must be provided in individual or 

group formats.


sessions. 



contact. 

• IPT treatment must meet research certification standards for 

adherence and quality. 

TEACHING AND SUPERVISION: 

• Co-facilitation of a Level A training seminar in IPT at an 

acceptable level of quality and 

adherence. 

• IPT teaching and training materials must be reviewed in person or 

with videotape review. 

• Supervision of an IPT trainee case at an acceptable level of 

quality and adherence. 

• Supervision of IPT must be reviewed in person or with audiotape 

review and phone or web 

conference supervision.

Michigan Depression Center 

• Established local training models in 

IPT, CBT and Motivational Interviewing 

• Will be initiating training in IPT and 

CBT for community clinicians statewide 

with the opportunity for ongoing 

supervision

Resources 

• www.academyofct.org 

• www.interpersonalpsychotherapy.org 

• National Working group on Evidence- 

Based Health Care – 

www.evidencebasedhealthcare.org 

• National Association of State Mental 

Health Program Directors Research 

Institute www.nri-inc.org 

• http://www.depressioncenter.org/

Indications for long-term or 

alternative treatments 

• Deficits cases: often have co-morbid P.D. 

• Recurrent Depression: consider 

maintenance treatment to prevent relapse 

• Non-responders who are still acutely 

depressed 

• Manual suggests either: 

 

 

Referral elsewhere 

New & different contract with change in focus and 

techniques with same therapist

New Developments 

• IPT for Eating Disorders 

• Dr. Sue Luty (Christchurch, New Zealand) 

• Dr. Fairburn (Oxford University) 

• IPT for Perinatal Depression 

• Dr. O‟Hara and Dr. Stuart (Univ. of Iowa) 

• IPT for Social Anxiety 

• Dr. Josh Lipsitz (Columbia University, NY) 

• IPT for Dysthymia 

 

Dr. John Markowitz (Cornell University, NY)

New Developments 

• IPT for Adolescence 

• Dr. Laura Mufson (Columbia University, 

NY) 

• IPT for Groups 

• Dr. Denise Wilfley (Yale University) 

• IPT for Bipolar Disorder 

• Dr. Ellen Frank (Univ.of Pittsburgh) 

• IPT for PTSD

Adolescent Depression 

Laura Mufson, Ph.D. 

Adaptation 

• treatment of unipolar adolescent depression 

• Developmental issues addressed: 

• Separation from parents 

• Development of romantic interpersonal 

relationships 

• Initial experiences with death 

• Peer pressures 

• Family is involved as needed 

• Treatment manual modified to reflect issues 

pertaining to adolescents

Adolescent IPT (cont‟d) 

Core components 

• explanation of medical model of illness 

• Psychoeducation 

• Interpersonal Inventory 

• Modify communication patterns 

• Interpersonal problem solving 

• Active parental involvement

IPT-A: Indicators for treatment 

• Grief reactions 

• Parent-child conflict 

• Peer conflict due to poor social problem 

solving skills and social deficits 

• Reaction to life transitions 

• Identified social precipitant 

• Mild and moderate MDD

Thank you !

Interpersonal Psychotherapy for Depression - University of Michigan ...

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