Interpersonal Psychotherapy (IPT) for PTSD: A Case Study
Rafaeli, Alexandra Klein, Markowitz, John C., American Journal of Psychotherapy
Interpersonal Psychotherapy (IPT), a time-limited, evidence-based treatment, has shown efficacy in treating major depressive disorder and other psychiatric conditions. Interpersonal Psychotherapy focuses on the patient's current life events and social and interpersonal functioning for understanding and treating symptoms. This case report demonstrates the novel use of IPT as treatment for posttraumatic stress disorder (PTSD). Preliminary evidence suggests IPT may relieve PTSD symptoms without focusing on exposure to trauma reminders. Thus IPT may offer an alternative for patients who refuse (or do not respond to) exposure-based approaches. Interpersonal Psychotherapy focuses on two problem areas that specifically affect patients with PTSD: interpersonal difficulties and affect dysregulation. This case report describes a pilot participant from a study comparing 14 weekly sessions of IPT to treatment with two other psychotherapies. We describe the session-by-session IPT protocol, illustrating how to formulate the case, help the patient identify and address problematic affects and interpersonal functioning, and to monitor treatment response.
KEYWORDS: Posttraumatic stress disorder, interpersonal psychotherapy, affect dysregulation, interpersonal difficulties
Interpersonal Psychotherapy (LPT) is a time-limited, evidence-based treatment that focuses on patients' social and interpersonal functioning, affect, and current life events. It is efficacious in treating major depression, bulimia, and other conditions (Weissman et al., 2000). Developed by the late Gerald Klerman, M.D., and Myrna Weissman, Ph.D., LPT stems from the theoretical work of Harry Stack Sullivan and John Bowlby and from empirical research on the psychosocial aspects of depression. Sullivan (1953) viewed interactions with others as the most profound source of understanding one's emotions, while Bowlby (1969) considered strong bonds of affection with others the foundation for individual well being. These theorists guide IPT practitioners as they explore their patients' affective experiences through the lens of the social and the interpersonal.
Initial evidence suggests that IPT may also benefit patients with posttraumatic stress disorder ([PTSD]; Bleiberg & Markowitz, 2005; Campanini et al., 2010; Krupnick et al., 2008; Ray et al., 2010; Robertson et al., 2004; Robertson et al., 2007). There are at least two rationales for testing IPT for this population. First, LPT does not utilize exposure to trauma reminders. Although extensive evidence supports the efficacy of exposure-based therapies for PTSD (Grey, 2008), LPT offers an alternative to patients who may refuse exposure techniques or not respond to them. A recent review article suggested that highly traumatized patients who dissociate may fare better receiving affect-focused therapy than exposurebased therapy (Lanius et al., 2010). Second, LPT works by improving patients' interpersonal functioning and emotion regulation (Markowitz et al., 2006, 2009; Markowitz, 2010), which are commonly impaired in PTSD (APA, 2000) and therefore, important targets for change. Social support, which LPT helps patients to mobilize, has been shown to be a key factor in preventing and recovering from PTSD (Brewin et al., 2000; Ozer et al., 2003).
PTSD is a psychiatric illness triggered by traumatic events: experiencing a natural disaster, witnessing a death, suffering chronic abuse, or otherwise facing a threat to one's own life or physical integrity. Although most people (50% to 90%) encounter traumas during their lifetimes, only about 8% develop full PTSD (Kessler et al., 1995). Symptoms of PTSD are distressing and often significandy impair social and occupational functioning.
Many forms of psychotherapy have been employed to address PTSD. Those with the strongest evidence base are forms of cognitive behavioral therapy (CBT), which utilize controlled exposure to trauma reminders (Buder et. …