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How it works
IPT is based around the interpersonal triad which was initially designed to treat Major Depressive Disorder. An interpersonal problem is defined as “[an] interpersonal stressor that impedes social support, which, in the context of vulnerability factors (diathesis), precipitate and maintain symptoms” (Motl, 2018). These stressors in the realm of IPT can include grief and loss, interpersonal disputes, and role transitions. The Diathesis-Stress Model, as seen in Figures 1 and 2, explains that the process is triggered by an acute stressor, and the client’s ability to handle this is determined by their diathesis, which include biological factors (genetics), social factors (support) and psychological factors (like attachment style and communication style), which can all intensify the crisis (Stuart, 2008, p. 3). Social factors act as protective factors to help the client cope with the stressor
In the beginning, IPT was considered atheoretical and modeled techniques of person-centered therapy by Carl Rogers. Most psychologists simply thought it was a “good supportive therapy” (Stuart, 2008, p. 3). After it was proved to be successful, psychologists then built the structure. It is based on three pillars: attachment theory, communication theory, and social theory. The core of IPT surrounds Harry Stack Sullivan’s interpersonal theory, and stated that, “interpersonal relationships constituted a basic human need and that mental health depended on healthy, intimate connections with other people” (Sullivan, 1940). The next pillar, Attachment Theory was established by Mary Ainsworth and John Bowlby, who stated that, ‘‘The desire to be loved and cared for is an integral part of human nature throughout adult life as well as earlier, and the expression of such desires is to be expected in every grown-up, especially in times of sickness or calamity” (Bowlby, 1977, p. 428). Attachment Theory is based on the behavior of infants in reaction to “[the] perceived threat of losing the survival advantages that accompany being cared for and attended to by the primary caregiver(s).
How it works
Since the infants who engaged in these behaviors were more likely to survive, the instincts were naturally selected and reinforced over generations” (Akerman, 2018). The ideal attachment is secure attachment. This theory, in relation to IPT, says that when clients experience distress, they encounter disturbances in their relationships. Those who are insecurely attached are more likely to experience interpersonal conflict, role transitions, and losses due to their history of fear or rejection in past relationships and poor social networks (Stuart, 2008, p. 3). Social theory is based on attachment; when an individual is insecurely attached, they struggle to form relationships and will often have smaller social networks, which makes it harder for them to cope with stress. Communication Theory is also grounded in Attachment Theory, explaining that an individual’s communication of distress will depend on if they are securely or insecurely attached. Because of these two theories relying on Attachment style, being insecurely attached sets an individual up to lack social support and be unable to explain their distress. According to Stuart (2008, p. 4) based on the IPT model, all of this sets up a person to be vulnerable or unable to handle to an interpersonal crisis, such as a role transition, loss, or conflict (Lipsitz & Markowitz, 2013, p. 1138). If social support is lacking and they are unable to accurately communicate distress, clients may not seek help early on and drive away the few supporters they have by maladaptively seeking help (Stuart, 2008, p. 4). This leads to psychological distress, as seen in figure 2 (Lipsitz & Markowitz, 2013).
The focus of IPT is different from many other individual therapies. It looks to help the patient fix their interpersonal problem in relation to the context and relationship to the problem. This in turn helps enhance the client’s life situation and lessen psychological symptoms (Lipsitz & Markowitz, 2013, p. 1138). While IPT is a heavily integrative therapy that includes many common factors of psychology, including instilling hope and enhancing the expectation for change, it mainly relies on factors more specific to IPT. These are enhancing social support, decreasing interpersonal stress, processing emotions, and improving interpersonal skills. Researchers believe that processing and expressing emotions and improving interpersonal skills will facilitate the process of overcoming the stressor and in turn, decrease psychological symptoms (Lipsitz & Markowitz, 2013, 1139).. Even though the Diathesis-Stress Model is key to explaining IPT, the focus is not on changing biological or psychological factors, as there are only clinical and theoretical reasons to support that change. (Stuart, 2008, p. 4).
Social support has been found to have many positive influences on health behaviors, such as better nutrition, increase exercise, and better sleep, as well as on mental health including positive peer pressure and companionship. Since emotion dysregulation is a symptom of many psychological disorders, it is thought that social support will allow others to help regulate their emotions by holding them (Lipsitz & Markowitz, 2013, 1140). Therapists can do this until other social support is found (Motl, 2018). In regard to the four main interpersonal disputes, all have some loss of social support and lead to isolation.
The second mechanism of change is decreasing interpersonal stress. Interpersonal stressors provoke more distress and will interfere with the client’s social support and relationships. Therefore, the primary goal is to reduce their stress in relation to the context. For grief, the therapist will facilitate the grieving process and help them reconnect with other relationships. For role disputes, IPT is going to help facilitate expression of those emotions and decrease the stress in their relationships. For role transitions, IPT seeks to reduce stress by acknowledging the transition and processing the emotions surrounding it. Studies have shown that
The third mechanism is processing emotions. Learning to recognize and work through emotions is critical to overcoming and resolving interpersonal problems in IPT. Freud believed that catharsis was enough to be curative. Lipsitz and Burkowitz (2013) stated that by helping the client work through an interpersonal problem, the emotional processing will lead to increased social support and decreased stress and symptomology (p. 1142).
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