• Faith Teyber
• Edward Teyber

Someone recently asked me why they needed to know about the interpersonal process. There seemed to be a misunderstanding that the interpersonal process is only focused on building rapport, when stronger rapport is, in fact, a byproduct of the interpersonal process. If you have similar questions about how or why this framework could strengthen your practice, read on.

Interpersonal Process as a Framework

Appendix 2: Quality assessment form. North, Midland and East Programme for Information Technology. This chapter examines both theoretically and L empirically how market orientation as a cultural factor is related to the internationalization processes of SMEs. Of Molise, Italy Field experts take numerous approaches to modeling how culture influences groups in dealing with interpersonal conflict and its dynamics.

It is important to know that the interpersonal process is not a new theory or technique. Instead, it is a framework that can be integrated with any modality you want to use. You lay your favorite theory or technique upon this framework. This makes the interpersonal process not only versatile, but the cornerstone of any practice in which it’s used. Your modality can change based on individual needs, but the framework stays consistent.

Keep in mind that the interpersonal process comprises three core components: process dimension, corrective emotional experience, and client response specificity. Of these three, process dimension is what this article will focus on.

The Cognitive Domain: A Crucial Component of Process Dimension

Tyber and McCluer identify three domains that make up the process dimension: the cognitive domain, interpersonal domain, and familial/contextual domain. While interpersonal domain addresses how a person experiences attachment brokenness, and the familial/contextual domain is where this brokenness is reinforced, the cognitive domain is at the origin of an person’s attachment brokenness.

The cognitive domain addresses the practical application of much of the attachment research that has been done. Under the cognitive domain, we identify the origin of the attachment style a person had or has with their primary caregiver. As therapists, we seek to uncover how a person’s values and identity were established, how they developed coping mechanisms, their covert thought processes, their beliefs about themselves and the world, how their value of self-care was determined, and what they need to restore their identity.

Therapists use these subcategories of the cognitive domain to identify attachment brokenness that occurred in response to real life experiences. To understand the importance of healing attachment brokenness using the interpersonal process framework, let us first look at how we treat attachment brokenness in children.

The Experiential Approach in Action: Play Therapy, Theraplay, and the Neurodeck

Becoming a registered play therapist requires candidates to spend 15 hours in training that specifically address attachment and how to build, repair, and strengthen a child’s ability to attach to a primary caregiver. But what is the common theme between attachment play therapy, theraplay, and the Brain Booster Neurodeck? Simply put, the common thread in these three modalities is an experiential approach. Healthy attachment is developed through experience, not reframing.

As therapists, we seek to uncover how a person’s values and identity were established, how they developed coping mechanisms, their covert thought processes, their beliefs about themselves and the world, how their value of self-care was determined, and what they need to restore their identity.

Play Therapy

In play therapy, clinicians provide experiences that support healthy, safe touch through activities such as foil hand prints, lotion on hands or feet, holding hands during activities, or working together on a task. All these activities encourage safe touch and eye contact. Eye contact in particular is important for our limbic systems to communicate and bond, as we learn from clinicians such as Curt Thompson or Louis Cozolino. Communication between our limbic systems is nonverbal; hence, the importance of eye contact.

Theraplay

Theraplay is also quite experiential; in fact, it may be the most experiential of all the methods listed. Attachment brokenness is healed through re-experiencing the attachment-building interactions that were not provided (or were insufficiently provided) during the first years of life, such as eye contact made when a baby is fed and swaddled. In some cases, the child needs to be cuddled or rocked as they would have been as an infant, a process that is exceptionally experiential. It may also be that a traumatic event broke an initially secure attachment, in which case Theraplay is utilized to re-establish the previously secure attachment style.

The Neurodeck

The Neurodeck comprises activities that build the brain from the bottom up. It begins with activities that assist with sensory integration, utilizing many of the same type of activities used in other attachment play therapy techniques. These experiential approaches harness messy play and movement. For example, they may use the lotion activity mentioned above or swing a child in a blanket to mimic the rocking movements experienced in utero. As a clinician moves through the deck, the activities become increasingly relational. This is the attachment component of the Neurodeck approach.

While it is impractical to swing an adult in a blanket to provide experiential therapy, the interpersonal process provides relational experience to honestly, yet compassionately, bring awareness to a person’s interpersonal characteristics.

The deck specifically states that certain activities should be completed in a one-on-one context before they are used them in a group setting. The one-on-one context is important in establishing safety before engaging in group work. Attachment work is rooted in laying a foundation for understanding safe and unsafe characteristics in relationships through a one-on-one dynamic. This dynamic then informs the safety of other relationships, especially relationships in a group setting. Each phase in the protocol is experiential and progressive.

Addressing Attachment in Adults

It is evident how attachment work in children is achieved through experiential modalities. The same can be said for attachment work with adults. The cognitive domain mentioned above is at the root of an person’s attachment brokenness, while the interpersonal domain is where attachment brokenness is experienced, and the familial/contextual domain is where the brokenness is reinforced. Through our work as therapists, we provide an experiential repair for broken attachment that is evaluated through interpersonal skills. A person’s maladaptive interpersonal skills provide a wealth of information about what happened in the cognitive and familial domains, as well as crucial information for effective treatment planning.

While it is impractical to swing an adult in a blanket to provide experiential therapy, the interpersonal process provides relational experience to honestly, yet compassionately, bring awareness to a person’s interpersonal characteristics. Are they interacting in healthy ways that allow people to draw near to them and create a desire for others to be in a healthy relationship with them, or are they fracturing relationships unknowingly because they lack the awareness or skills to build healthy relationships? Sharing our experience of an person’s behaviors or words can help them develop self-awareness and contemplate whether they are communicating what they intend. This approach can also help with reality testing.

Strengths of Interpersonal Process

One strength of the interpersonal process framework is the way it helps build flexibility and other-focused awareness, which allows for healthy attachments and navigating unhealthy relationships more confidently and constructively. By highlighting awareness of how a person’s communication might be perceived by others, we broaden their understanding of themselves and of others. Maintaining a broader range of interpersonal understanding ideally increases a person’s window of tolerance in their relationships and creates a desire to repair a broken healthy attachment or confidently sever an unhealthy attachment. The individual becomes better equipped to advocate for positive change in their life through a strengthened commitment to repair healthy relationships or by valuing themselves enough to part ways with unhealthy relationships without behaving destructively.

The Effective Interpersonal Process Clinician

A provider who effectively uses interpersonal process reflects truths to people that help them feel heard and known so they may heal. Those on the receiving end of these truths may not always like what they hear. However, when they work with an empathic and skilled therapist, people can hear and understand their therapist’s reflections, even if they do not like what is said.

At the appropriate level of reflection, people learn to trust their therapist. Feeling known and understood improves rapport. In this context, rapport is equivalent to attachment. A grounded relationship with an effective interpersonal process therapist is emotionally supportive so people may engage in difficult, effective therapy that greatly improves treatment outcomes.

Reference:

Teyber, E., & McCluer, F. H. (2010). Interpersonal process in therapy: An integrative model (6th ed). Belmont, CA: Brooks/Cole.

© Copyright 2018 GoodTherapy.org. All rights reserved. Permission to publish granted by Jessica Volger MS, MAC, PLPC, therapist in O Fallon, Missouri

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery. It is an empirically supported treatment (EST) that follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks. IPT is based on the principle that relationships and life events impact mood and that the reverse is also true.^[1][2] It was developed by Gerald Klerman and Myrna Weissman for major depression in the 1970s and has since been adapted for other mental disorders.^[3] IPT is an empirically validated intervention for depressive disorders, and is more effective when used in combination with psychiatric medications. Along with cognitive behavioral therapy (CBT), IPT is recommended in treatment guidelines as a psychosocial treatment of choice,^[4][5] and IPT and CBT are the only psychosocial interventions in which psychiatry residents in the United States are mandated to be trained for professional practice.^[6]

• 3Clinical applications

History[edit]

Originally named 'high contact' therapy, IPT was first developed in 1969 at Yale University as part of a study designed by Gerald Klerman, Myrna Weissman and colleagues to test the efficacy of an antidepressant with and without psychotherapy as maintenance treatment of depression.^[7][8] IPT has been studied in many research protocols since its development.^[9][10] NIMH-TDCRP demonstrated the efficacy of IPT as a maintenance treatment and delineated some contributing factors.^[11]

Foundations[edit]

IPT was influenced by CBT as well as psychodynamic approaches. It takes its structure from CBT in that it is time-limited, employs homework, and structured interviews and assessment tools.^[12]

The content of IPT's therapy was inspired by Attachment theory and Harry Stack Sullivan's Interpersonal psychoanalysis. Social theory is also influenced in a lesser role to emphasis on qualitative impact of social support networks for recovery.^[13] Unlike psychodynamic approaches, IPT does not include a personality theory or attempt to conceptualize or treat personality but focuses on humanistic applications of interpersonal sensitivity.^[14][15]

• Attachment Theory, forms the basis for understanding patients’ relationship difficulties, attachment schema^[16] and optimal functioning when attachment needs are met.
• Interpersonal Theory, describes the ways in which patients’ maladaptive metacommunication patterns (Low to high Affiliation & Inclusion and dominant to submissive Status)^[17][18] lead to or evoke difficulty in their here-and-now interpersonal relationships.

The aim of IPT is to help the patient to improve interpersonal and intrapersonal communication skills within relationships and to develop social support network with realistic expectations to deal with the crises precipitated in distress and to weather 'interpersonal storms'.

Clinical applications[edit]

It has been demonstrated to be an effective treatment for depression and has been modified to treat other psychiatric disorders such as substance use disorders and eating disorders. It is incumbent upon the therapist in the treatment to quickly establish a therapeutic alliance with positive countertransference of warmth, empathy, affective attunement and positive regard for encouraging a positive transferential relationship, from which the patient is able to seek help from the therapist despite resistance. It is primarily used as a short-term therapy completed in 12–16 weeks, but it has also been used as a maintenance therapy for patients with recurrent depression.^[19]

Interpersonal psychotherapy has been found to be an effective treatment for the following:^[20]

• Major depressive disorder^[21][22]
• Cyclothymia^{[citation needed]}

Adolescents[edit]

Although originally developed as an individual therapy for adults, IPT has been modified for use with adolescents and older adults.^[20]

IPT for children is based on the premise that depression occurs in the context of an individual's relationships regardless of its origins in biology or genetics. More specifically, depression affects people's relationships and these relationships further affect our mood. The IPT model identifies four general areas in which a person may be having relationship difficulties:

Faith Teyber

1. grief after the loss of a loved one;
2. conflict in significant relationships, including a client's relationship with his or her own self;^[23]
3. difficulties adapting to changes in relationships or life circumstances; and
4. difficulties stemming from social isolation.^[20]

The IPT therapist helps identify areas in need of skill-building to improve the client's relationships and decrease the depressive symptoms. Over time, the client learns to link changes in mood to events occurring in his/her relationships, communicate feelings and expectations for the relationships, and problem-solve solutions to difficulties in the relationships.^[24]

IPT has been adapted for the treatment of depressed adolescents (IPT-A) to address developmental issues most common to teenagers such as separation from parents, development of romantic relationships, and initial experience with death of a relative or friend^[24] IPT-A helps the adolescent identify and develop more adaptive methods for dealing with the interpersonal issues associated with the onset or maintenance of their depression. IPT-A is typically a 12- to 16-week treatment. Although the treatment involves primarily individual sessions with the teenager, parents are asked to participate in a few sessions to receive education about depression, to address any relationship difficulties that may be occurring between the adolescent and his/her parents, and to help support the adolescent's treatment.^[25]

Elderly[edit]

IPT has been used as a psychotherapy for depressed elderly, with its emphasis on addressing interpersonally relevant problems. IPT appears especially well suited to the life changes that many people experience in their later years.^[26]

References[edit]

1. ^Markowitz, JC; Svartberg, M; Swartz, HA (1998). 'Is IPT time-limited psychodynamic psychotherapy?'. The Journal of Psychotherapy Practice and Research. 7 (3): 185–95. PMC3330506. PMID9631340.
2. ^'Interpersonal Therapy (IPT)'. Nightingale Hospital. Retrieved 26 April 2015.
3. ^Cuijpers, Pim; Donker, Tara; Weissman, Myrna M.; Ravitz, Paula; Cristea, Ioana A. (2016). 'Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis'. American Journal of Psychiatry. 173 (7): 680–7. doi:10.1176/appi.ajp.2015.15091141. PMID27032627.
4. ^Cuijpers, Pim; Geraedts, Anna S.; van Oppen, Patricia; Andersson, Gerhard; Markowitz, John C.; van Straten, Annemieke (2011). 'Interpersonal Psychotherapy for Depression: A Meta-Analysis'. American Journal of Psychiatry. 168 (6): 581–92. doi:10.1176/appi.ajp.2010.10101411. PMC3646065. PMID21362740.
5. ^Tsai, Alexander C.; Barth, Jürgen; Munder, Thomas; Gerger, Heike; Nüesch, Eveline; Trelle, Sven; Znoj, Hansjörg; Jüni, Peter; Cuijpers, Pim (2013). 'Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis'. PLoS Medicine. 10 (5): e1001454. doi:10.1371/journal.pmed.1001454. PMC3665892. PMID23723742.
6. ^Hollon, Steven D.; Beck, Aaron T. (2013). 'Cognitive and Cognitive-Behavioral Therapies'. In Lambert, Michael J. (ed.). Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (6th ed.). Hoboken, NJ: John Wiley & Sons. pp. 393–442. ISBN978-1-118-41868-0.
7. ^Weissman, Myrna M. (August 2006). 'A Brief History of Interpersonal Psychotherapy'. Psychiatric Annals. 36 (8).
8. ^Markowitz, John C.; Weissman, Myrna M. (2012). 'Interpersonal Psychotherapy: Past, Present and Future'. Clinical Psychology & Psychotherapy. 19 (2): 99–105. doi:10.1002/cpp.1774. PMC3427027. PMID22331561.
9. ^Klerman, Gerald L.; Dimascio, Alberto; Weissman, Myrna; Prusoff, Brigitte; Paykel, Eugene S. (1974). 'Treatment of Depression by Drugs and Psychotherapy'. American Journal of Psychiatry. 131 (2): 186–91. doi:10.1176/ajp.131.2.186. PMID4587807.
10. ^Weissman, MM; Prusoff, BA; Dimascio, A; Neu, C; Goklaney, M; Klerman, GL (1979). 'The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes'. The American Journal of Psychiatry. 136 (4B): 555–8. PMID371421.
11. ^Elkin, Irene (1989). 'National Institute of Mental Health Treatment of Depression Collaborative Research Program'. Archives of General Psychiatry. 46 (11): 971–83. doi:10.1001/archpsyc.1989.01810110013002. PMID2684085.
12. ^Weissman, MM; Markowitz, JC; Klerman, GL (2007). Clinician's quick guide to interpersonal psychotherapy. New York: Oxford University Press.^{[page needed]}
13. ^https://books.google.ca/books?id=emXzjtZmULEC^{[full citation needed][page needed]}
14. ^Hall, Judith A.; Andrzejewski, Susan A. (2009). 'Interpersonal Sensitivity'. Encyclopedia of Human Relationships. doi:10.4135/9781412958479.n291. ISBN9781412958462.
15. ^Prochaska (1984). Systems of Psychotherapy: A Transtheoretical Analysis.^{[page needed]}
16. ^Bartholomew, Kim; Horowitz, Leonard M. (1991). 'Attachment styles among young adults: A test of a four-category model'. Journal of Personality and Social Psychology. 61 (2): 226–44. doi:10.1037/0022-3514.61.2.226. PMID1920064.
17. ^Kiesler, Donald J.; Watkins, Lucy M. (1989). 'Interpersonal complementarity and the therapeutic alliance: A study of relationship in psychotherapy'. Psychotherapy. 26 (2): 183–94. doi:10.1037/h0085418.
18. ^Kiesler, DJ (1979). 'An interpersonal communication analysis of relationship in psychotherapy'. Psychiatry. 42 (4): 299–311. doi:10.1080/00332747.1979.11024034. PMID504511.
19. ^Cornes, CL; Frank, E (1994). 'Interpersonal psychotherapy for depression'. The Clinical Psychologist. 47 (3): 9–10.
20. ^ ^abcWeissman, Myrna M.; Markowitz, John C. (1998). 'An Overview of Interpersonal Psychotherapy'. In Markowitz, John C. (ed.). Interpersonal Psychotherapy. American Psychiatric Press. pp. 1–33. ISBN978-0-88048-836-5.
21. ^Joiner; et al. (2006). The interpersonal, cognitive, and social nature of depression. Mahwah, NJ: Lawrence Erlbaum Associates.^{[page needed]}
22. ^Zhou, Xinyu; Hetrick, Sarah E.; Cuijpers, Pim; Qin, Bin; Barth, Jürgen; Whittington, Craig J.; Cohen, David; Del Giovane, Cinzia; Liu, Yiyun; Michael, Kurt D.; Zhang, Yuqing; Weisz, John R.; Xie, Peng (2015). 'Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis'. World Psychiatry. 14 (2): 207–22. doi:10.1002/wps.20217. PMC4471978. PMID26043339.
23. ^'The Trauma Response'. StillPoint Counseling. Retrieved 13 December 2015.^{[unreliable medical source?]}
24. ^ ^abSwartz, Holly A. (1999). 'Interpersonal Psychotherapy'. In Hersen, Michel; Bellack, Alan S. (eds.). Handbook of Comparative Interventions for Adult Disorders. Wiley. pp. 139–55. ISBN978-0-471-16342-8.
25. ^Mufson, L. (1999). 'Efficacy of Interpersonal Psychotherapy for Depressed Adolescents'. Archives of General Psychiatry. 56 (6): 573–9. doi:10.1001/archpsyc.56.6.573. PMID10359475.
26. ^Hinrichsen, Gregory A. (1999). 'Treating older adults with interpersonal psychotherapy for depression'. Journal of Clinical Psychology. 55 (8): 949–60. doi:10.1002/(SICI)1097-4679(199908)55:8<949::AID-JCLP4>3.0.CO;2-S.

Sources[edit]

Edward Teyber

• Sullivan, Harry Stack (1968) [1953]. Interpersonal Theory of Psychiatry. W. W. Norton & Company. ISBN978-0-393-00138-9.