What is interpersonal psychotherapy, and can it be used for grief?

Psychotherapy refers to a form of treatment where conversation with a health care provider (HCP) is used to address mental health conditions. In situations where grieving a loved one or friend can result in depression, one of the most effective forms of psychotherapy is known as interpersonal psychotherapy (IPT).

IPT is a structured and time-sensitive treatment course that focuses on a person’s primary social support network, seeking to resolve any problems stemming from it in order to improve depressive symptoms. It was discovered by accident in the 1970s in a study assessing the benefit of antidepressant medications relative to psychotherapies.

The universal goal of IPT is symptom remission and improving a patient's primary social support unit. The therapist typically asks questions to learn and help patients compartmentalize their current social support systems and recent life events. Typically, interpersonal problems can fall into four categories – unresolved grief (like the loss of loved ones), life transitions (like changes in career or marital status), disagreements/disputes (like with a loved one), and interpersonal deficits (like with unfulfilling relationships). Understanding these problems, the elicited emotions stemming from these problems, and emotional expressions derived from these problems is key in treatment prognosis.

IPT is currently used to treat a range of psychiatric conditions including depression, bipolar disorder, eating disorders, substance abuse, and anxiety. IPT can be adapted to patients of any age range (from adolescence to old age), and there are no currently no known downsides associated with this treatment. The sole requirement for being considered for IPT treatment is that the patient must have enough motivation and interest to undergo treatment for its duration (typically six to 20 weeks), and must have awareness and understanding of the interpersonal relationships in their lives.

IPT largely relies on two theories of psychology: attachment, and interpersonal psychoanalysis. Attachment theory states that humans are motivated from birth to form meaningful bonds with others that form the basis of identity, security, and support. Disruptions in these relationships—for example, the death of a loved one—can impact a person’s wellbeing.

Interpersonal psychoanalysis asserts that there is a profound association between a person’s psychosocial stressors and depression. Although this connection may not be direct, improvement in one’s relationships correlates to an improvement in depressive symptoms and vice versa.

There are three stages associated with an IPT course: Assessment Phase, Addressing Phase, and Termination Phase. The Assessment Phase typically comprises the first three to four sessions of IPT. During this phase, the therapist focuses on forming a bond with the patient and setting goals of care.

The Addressing Phase forms the bulk of meetings during IPT and generally ranges from four to 14 weeks. During these meetings, the therapist and patient focus on resolving interpersonal problems. By examining all problems, forming strategies, and practicing new patterns to resolve these psychosocial issues, the expectation is that the mood symptoms will similarly improve. The therapist is there to help formulate these strategies and listen supportively. The patient has a responsibility to learn and implement these patterns outside of the therapy setting.

The Termination Phase comprises the final two to three sessions of IPT. During this phase, the HCP and the patient review the entire course of therapy. They evaluate the effectiveness of developed strategies, treatment gains, and future treatment needs. Potential problems or insecurities associated with the ending of IPT are also addressed. While IPT is technically time-sensitive, patients can schedule maintenance sessions for as long as necessary to provide updates, seek adjustments if necessary, and prevent relapse.

While hundreds of studies have noted the benefits of IPT, ultimately, treatment response is never guaranteed. There are several factors that may contribute to this. The less severe the patient’s depression, the better the outcomes of IPT. Co-morbid conditions, such as anxiety, can correlate to poor treatment outcomes. Finally, a patient’s pre-existing psychosocial baseline can determine IPT’s effectiveness. For example, for people who never had a strong social support system or had attachment issues that stemmed from birth, the outcomes of IPT tend to be worse.

Overall, while IPT is a powerful tool that HCPs can recommend for people experiencing depression stemming from grief, it is just one of the therapies. The most effective treatment protocols use a combination of psychiatric medications and IPT. Consulting your HCP early and routinely can help positively influence treatment success.

— Nikhil Anbarasan