Interpersonal Therapy: How It Works, Cost, & What to Expect

What Is Interpersonal Psychotherapy?

Interpersonal therapy is a type of psychotherapy that works on the premise that there is a significant connection between psychological trauma and interpersonal distress. Social factors such as relationships and romantic connections can impact someone’s ability to cope with stress and distressing events. The focus of treatment during interpersonal therapy is resolving symptoms and improving overall functioning and social support.²

In general, interpersonal therapy can be less stigmatizing for clients because they are not blamed for their symptoms or diagnosis. It is all seen as a product of their relationships, circumstances, or a break in significant relational attachments or social roles.³ The relationship between therapist and client is especially significant due to the level of trust and openness required for honest dialogue.³

Derived from psychodynamic theory, interpersonal therapy can be a great fit for people who are more curious about psychodynamic interventions. There is a basic assumption that in order to move forward, one must address past relationships and experiences.

The Origins of Interpersonal Therapy

Interpersonal therapy was created in the 1970s by Gerald Klerman, Myrna Weissman, and Eugene Paykel as a result of researching the effectiveness of combining medication with psychotherapy as a treatment for depression. The initial studies of interpersonal therapy focused on the same approach of combining medications with psychotherapy where the therapist played a very active role. Today, it is thought of as being a “high contact” therapy method as it is very structured and sessions are conducted on a weekly basis.²

What’s the Therapist’s Role in IPT?

In interpersonal therapy, the therapist plays a very active role in treatment instead of being non-directive and simply listening. During the process, there are opportunities to receive feedback and discuss what is going well and what is challenging in the client’s interpersonal relationships. Like most forms of psychotherapy, interpersonal therapy is offered both online as well as in person.

What Is Interpersonal Therapy Used to Treat?

Interpersonal therapy has been shown effective for treating mood disorders, including major depressive disorder, dysthymia, and bipolar disorder. It’s also used as an intervention for post-traumatic stress syndrome, social anxiety, and eating disorders.¹ Additionally, interpersonal therapy has positive results as a treatment for various substance abuse disorders. Multiple studies show that it can be effective when used in conjunction with prescription medication.²

You are most likely a good candidate for interpersonal therapy if you are encountering a stressful life event like the death of a loved one, relationship conflict, recent life transition, or social isolation.⁴ It’s important to remember that not every treatment modality is effective with everyone, so don’t be afraid to tell your therapist if you feel the focus of therapy isn’t meeting your needs.

Interpersonal Therapy Works for Every Age

Research studies have shown that interpersonal therapy is useful for individuals of all ages, ranging from adolescents to older adults. It can also be conducted in a group setting with children, adolescents, and adults. This is because the focus of therapy is on stressful life events and helping clients to improve connections with social supports.⁴

Types of IPT Therapy

There are three main therapeutic interventions that are based on the principles of IPT designed to treat specific mental health concerns with differences in structure and outcomes:

Dynamic Interpersonal Therapy

Dynamic interpersonal therapy is a highly structured psychodynamic approach that is delivered over the course of 16 weeks, with one session per week. This mentalization-based treatment aims to reduce symptoms of depression specifically, and has been shown to be just as effective in CBT in treating depression.⁵ This approach is based on the premise that symptoms will improve when relationship problems in the client’s life are resolved. Dynamic interpersonal therapy places relationships at the core of a person’s wellbeing.

Metacognitive Interpersonal Therapy

Metacognitive interpersonal therapy (MIT) is an intervention designed for people with personality disorders that are characterized by emotional inhibition (holding back your feelings) and avoidance. It aims to help clients understand the basic social motives that drive human behavior so they can better understand their own thoughts, feelings, and behaviors, as well as those of the other people in their lives. One study showed MIT to be effective in reducing symptoms of depression and increasing emotional awareness.⁶

Interpersonal and Social Rhythms Therapy

Interpersonal and social rhythms therapy (IPSRT) is for people with bipolar disorder and aims to stabilize circadian rhythm disruptions that are characteristic of this mental health disorder. This add-on therapy helps clients to understand their daily routines and establish healthier, more consistent habits, particularly related to sleep. This intervention is based on the premise that the more stable a person’s daily rhythms are, the less impacted their mood will be by outside stressors that are a part of everyday life.⁷

How Does Interpersonal Psychotherapy Work?

Interpersonal therapy works in three phases: Formulation, middle, and graduation. Each phase can last three to five sessions depending on the severity of symptoms and the interpersonal distress the client is experiencing.¹

1. Formulation Phase

The first phase consists of assessing your mood as well as current life events. The therapist also gathers information on previous relationships, sources of social support, and your history. Additionally, there is a psychoeducational aspect of linking symptoms to circumstances and relationships, sometimes called an interpersonal inventory.

Typically, a plan is determined and the focus of sessions fits into one of the following categories of the interpersonal inventory:

• Complicated bereavement: In IPT, complicated grief is identified by a person’s depressive symptoms being associated with the loss of a loved one, and the person is struggling to come to terms with the loss.⁸
• Role transition: When a client is facing difficulty with changes in their current life circumstances, role transition is cited as the area of treatment focus.⁹
• Role dispute: In IPT, a role dispute is defined as a client and a significant person in their life having different expectations for their relationship.
• Interpersonal deficits: This area is selected as a treatment focus for IPT when there is no particular problem in the present, but instead a longstanding history of interpersonal issues.

2. Middle Phase

The second phase involves a variety of strategies used to address one of the four categories of distress. The therapist usually begins each session by asking you about recent life events. If you’ve seen improvement, the focus turns to how things have changed, and if relationships have been positively impacted. If there’s been no change or an increase in symptoms, your therapist will work with you to identify interpersonal challenges.

3. Graduation Phase

The end of interpersonal therapy is marked by focusing on your improved confidence and sense of independence. If there has not been a change, the lack of improvement is attributed to the therapy and not you as an individual. However, treatment is not considered a failure if you do not have a decrease in your symptoms. Often a client will transfer to another therapist and create a new treatment plan.²

Interpersonal Therapy Techniques

In interpersonal therapy, therapists play an active role and use a variety of directive and nondirective techniques, including guidance, education, reassurance, and behavioral approaches like role-playing. During interpersonal therapy sessions, the role of the therapist is to remain realistic and avoid being too educational or reactive.¹⁰

During the course of treatment, you may engage in role-play exercises in order to draw conclusions about the health of your relationships and identify the connection between your relationships and your symptoms. This technique also helps you adjust the way you relate to the world around you.

The focus is on helping you to acknowledge feelings that can be painful but possibly appropriate under the circumstances. You’ll be gently challenged to start intentionally developing and learning to label new emotions. Additionally, your therapist will bring attention to the logical implications of your emotions and encourage you to clarify.¹⁰

Benefits of Interpersonal Therapy

Interpersonal therapy has been shown to help clients improve relationships. One way it accomplishes this is by increasing a client’s interpersonal skills and helping them to feel more comfortable in social situations. It also aims to work through relationship issues in the client’s life, and to help the client connect the dysfunctional relationships with their depressive symptoms, ultimately improving the relationship and reducing the symptoms of depression. This process bolster’s the client’s self-esteem as they learn to communicate and handle interpersonal challenges successfully.

By encouraging healthier communication patterns and addressing relationship problems that contribute to the client’s depression, they often find symptom relief as their skills increase and problems are ameliorated. Some therapists might use IPT in conjunction with medication in treating depression.¹¹

Additionally, IPT can help clients through major life transitions, like the loss of a loved one, job loss, divorce, or a move. It can help clients work through unresolved grief in order to heal and move forward in life.

Is Interpersonal Therapy Effective?

There is overwhelming evidence that interpersonal therapy can be an effective intervention for mood disorders, and it is one of the most commonly used treatments for major depressive disorder, anxiety disorders, and bipolar disorder.¹² Its effectiveness for other mental health disorders is still being researched, although numerous studies have shown it can be effective in treating depression and decreasing the likelihood of relapse once symptoms have resolved.

Additionally, interpersonal therapy can be effective in family therapy when there is a family member with a diagnosis of depression, and as an intervention for eating disorders and some anxiety disorders.⁴ In a study conducted on individuals diagnosed with a personality disorder, interpersonal therapy was shown to decrease the severity of symptoms.¹³ In general, it highlights the link between relationships and mental health, which is highly relevant due to the fact that humans are social beings who benefit from connections with others.¹⁴

Limitations & Criticisms of IPT

Though IPT has many proven benefits, there are a few limitations to this therapeutic approach. First, it is a time-limited intervention, and some clients may require ongoing maintenance in order to avoid relapse of their symptoms, which IPT does not typically provide.

Second, though IPT may be a good fit for some people with mood disorders and other mental health concerns, it is focused on relationships and may not be the best fit for every person’s situation. IPT is not appropriate for people with psychosis, or who are actively suicidal.

Finally, IPT is focused on the present and is less likely to delve into past trauma, developmental history or other personal histories that could be contributing to the problem.

Can Interpersonal Group Therapy Work?

Group IPT may be used in treating mental health concerns like depression in a community setting, like community health centers, hospitals or nonprofit organizations. In group IPT, typically 6-10 members meet for 90 minutes for 8 weeks to learn more about the four problem areas. They then work together to connect depressive symptoms to the problems impacting their relationships, and ultimately find healthier strategies for dealing with these problems.

Group therapy facilitators should be licensed and trained in IPT, and group members should be referred by a physician or mental health professional. Group members should also undergo individual screening prior to the first group session, to ensure goodness of fit.¹⁵

How to Find an Interpersonal Therapist

A good place to start looking for an interpersonal therapist is the Interpersonal Therapy Institute or an online therapist directory where you can sort by specialty and location. One important thing to keep in mind is that most state laws require a therapist to be licensed in the state of your residence. So, if you’re moving soon or taking an extended trip, it may impact the relationship with your therapist.¹⁶

If you’d like to use your mental health insurance, you can call the member services number on the back of your insurance card and ask for a list of therapists in your network that are located close to you. This would also be a great time to ask any questions that you might have about your deductible and copay.

Key Questions to Ask an Interpersonal Therapist

If you are using your insurance for the therapy session, it’s a good idea to verify whether or not they are in network with your insurance. However, there are other questions to ask in order to assess whether a therapist is an appropriate fit. Many therapists even offer a free consultation where they welcome your questions about their background.¹⁷

Here are eight key questions to ask before starting interpersonal therapy:

1. What type of interventions do you use?
2. How often do you recommend clients attend sessions?
3. Can you explain your treatment style to me?
4. What is your ideal client to work with?
5. How familiar are you with interpersonal therapy?
6. What is important for me to know when working with you?
7. What’s your favorite part about being a therapist?
8. How do you help your clients deal with stressful life events?

Cost of Interpersonal Therapy

While there can be significant differences in the cost of therapy depending on your geographical region, expect to pay somewhere between $75 to $175 per session. It never hurts to ask about a reduced rate or sliding scale, as some therapists will give discounts to clients who are within a certain income bracket, or who are willing to pay upfront for several sessions at a time.

While not every therapist accepts insurance, many therapists are in network with health insurance companies. The rate you pay per session will be based on the specifics of your plan as well as the deductible. For the most accurate quote, contact your insurance carrier to confirm the amount of your co-pay and how many sessions they will cover.¹⁸

What to Expect at Your First Therapy Appointment

Every therapist conducts their first session differently, but you should expect to answer questions about yourself and share some of your stresses. Your therapist may also provide you with a standardized questionnaire about your symptoms. Using an interpersonal therapy approach, they will link a diagnosis to a current life event and take inventory of your close relationships, social supports, and behavioral patterns within relationships.¹

Your first therapy appointment may feel awkward as you get to know your therapist and they get to know you. There may be topics you don’t get to discuss, but you can delve deeper in subsequent sessions. If you have seen multiple therapists, are taking prescribed medication, or have recently been hospitalized psychiatrically, it’s important to bring this information to your therapist at the first session.

Remember that it’s completely acceptable to go at your own pace. Always let your therapist know if you’re feeling uncomfortable or would like a quick break. It’s typical in the first session to establish rapport and start identifying specific goals. Your therapist may also spend some time outlining their confidentiality policy.¹⁹