Interpersonal Therapy (IPT)

Interpersonal therapy (IPT) is a structured, short-term psychological treatment originally developed by Gerald Klerman and Myrna Weissman in the 1970s for the treatment of major depressive disorder. The IPT model is based on the assumption that interpersonal relationships strongly influence mood, and that difficulties in social or emotional relationships can trigger, exacerbate, or maintain a depressive episode.

Unlike cognitive or behavioral therapies, IPT does not primarily focus on the patient’s thoughts or behaviors, but rather on social interactions and interpersonal roles. The main goal is to help the patient understand and address current interpersonal difficulties that contribute to their distress, improving depressive symptoms by strengthening communication and relational skills.

Theoretical Model and Clinical Rationale

IPT is based on a medical model of depression, viewing the disorder as an episodic illness with environmental triggers, often interpersonal in nature. The treatment is focused on the present and assumes that improving the quality of relationships and managing social roles can significantly reduce depressive symptoms.

The main interpersonal factors that can contribute to depression, and which become the central focus of therapy, include:

• Unresolved grief: recent death of a significant person, blocked mourning process;
• Interpersonal disputes: major conflicts in family, romantic, or work settings;
• Role transitions: important life changes (e.g., retirement, parenthood, divorce);
• Interpersonal deficits: social isolation, difficulty initiating or maintaining meaningful relationships.

Each IPT course focuses on one or two of these themes, selected based on recent history and the current relational context. The aim is to enhance the patient’s adaptation to these issues by improving communication, negotiation, and the management of role changes or losses.

Treatment Structure

IPT typically involves 12–16 sessions, divided into three phases:

• Initial phase (sessions 1–3): diagnostic formulation based on the medical model, identification of the central interpersonal problem, and agreement on therapeutic goals.
• Middle phase (sessions 4–12): exploration of the selected interpersonal problem, application of specific techniques (e.g., role-playing, interaction analysis, assertive communication).
• Termination phase (sessions 13–16): consolidation of improvements, discussion of therapy closure, relapse prevention planning.

The therapy has a time-limited and focused approach, fosters patient empowerment, and uses a collaborative yet directive therapeutic relationship, with the therapist playing an active role in structuring and guiding the process.

Clinical Indications

Interpersonal therapy is indicated for the treatment of major depressive disorder of varying severity. It is especially effective in patients where recent relational factors are involved in the onset or maintenance of the depressive episode. It is also considered a first-line option for patients who:

• Have difficulty expressing emotions or communicating needs;
• Are facing significant life transitions (e.g., separation, retirement, bereavement);
• Experience chronic or acute interpersonal conflict;
• Live in social isolation or lack emotional support.

IPT is also effective in preventing relapse in recurrent depressive disorders, especially in patients with persistent dysfunctional interpersonal patterns. It has been successfully adapted for specific populations such as adolescents, older adults, and pregnant or postpartum women with depression.

Efficacy and Guidelines

Numerous clinical trials and meta-analyses confirm the efficacy of IPT in reducing depressive symptoms, with results comparable to CBT and pharmacotherapy in mild to moderate depression. It has proven particularly useful in outpatient and primary care settings.

According to NICE guidelines, IPT is recommended as a first-line psychological treatment for mild to moderate depression, and as an adjunctive option for more severe cases. The American Psychiatric Association and CANMAT also include it among validated therapies, both in the acute phase and for relapse prevention, with a high level of recommendation.

IPT appears to be most effective when patients recognize a link between their depressive state and recent relational events, and are open to working on social interactions. Clinical improvement is often accompanied by an increase in perceived support, enhanced assertiveness, and reduced isolation.

Final Considerations

Interpersonal therapy is a brief, structured, and evidence-based treatment that centers on the quality of relationships and adaptation to social changes as key factors in overcoming depression. Its effectiveness, flexibility, and applicability across life stages make it a valuable tool in both specialized clinical settings and outpatient care.

In a time when depressive suffering is often linked to dynamics of isolation, loneliness, or crises in emotional bonds, IPT provides a therapeutic space focused on restoring meaningful interpersonal connections and enhancing the ability to face change with greater balance and confidence.

Bibliography
1. Weissman MM et al. Interpersonal psychotherapy for depression. 2nd ed. New York: Basic Books; 2007.
2. Markowitz JC, Weissman MM. Interpersonal psychotherapy: past, present and future. Clin Psychol Psychother. 2004;11(6): 428–438.
3. Luty SE et al. Randomised controlled trial of interpersonal psychotherapy and cognitive-behavioural therapy for depression. Br J Psychiatry. 2007;190:496–502.
4. Cuijpers P et al. The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychol Med. 2010;40(2):211–223.
5. De Maat SM et al. Relative efficacy of psychotherapy and combined therapy for chronic depression: a meta-analysis. J Affect Disord. 2007;97(1):13–22.
6. Swartz HA et al. Interpersonal psychotherapy for depressed women with intimate partner violence: a pilot study. J Nerv Ment Dis. 2011;199(12):867–870.
7. National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. NICE guideline [NG222]. 2022.
8. American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. 2010.
9. Canadian Network for Mood and Anxiety Treatments (CANMAT). Clinical guidelines for the management of major depressive disorder in adults. Can J Psychiatry. 2016;61(9):510–523.
10. Klerman GL et al. Interpersonal psychotherapy of depression: A brief, focused, specific strategy. Am J Psychiatry. 1984;141(6):715–719.