In plain words
Depression often begins or deepens around changes in relationships: a loss, a conflict, a new role. Interpersonal psychotherapy (IPT) is a time-limited treatment that links mood to those interpersonal events and helps people handle them differently.
Developed by Gerald Klerman, Myrna Weissman, and colleagues, IPT is structured into phases and focuses on one or two problem areas.1
Core ideas
Where this approach came from
Interpersonal psychotherapy (IPT) was developed in the 1970s by Gerald Klerman, an American psychiatrist, and Myrna Weissman, an American epidemiologist, with colleagues, for a research trial of treatments for depression. They needed a therapy that was focused, time-limited, and clear enough to teach and test. They drew on the interpersonal psychiatry of Harry Stack Sullivan and on attachment theory, both of which see close relationships as central to mental health.
The basic idea: mood and relationships affect each other
IPT starts from a simple observation: depression often begins or deepens around a change in relationships, such as a death, a conflict, a move, or a new role. And depression in turn makes relationships harder. IPT works on that two-way link. It doesn't claim relationships cause all depression. Biology, adversity, and circumstances matter too. But improving what is happening in relationships right now can help mood recover.
IPT uses a medical model: depression is described as a treatable illness, not a personal failing. The therapist may give the client the sick role, explicit permission to temporarily do less while recovering, in the way someone with the flu would, along with the responsibility to work on getting better.12
How treatment is structured
IPT usually lasts about 12 to 16 weekly sessions in three phases:
- Initial phase: reviewing symptoms, explaining the medical model, and completing the interpersonal inventory, a careful review of each important relationship, what support it gives, where the tensions are, and what each person expects. The therapist then shares an interpersonal formulation: a brief explanation linking the depression to one or two current relationship problems.
- Middle phase: working on the chosen problem area.
- Ending phase: reviewing progress, acknowledging feelings about ending, and planning for the future.
The four problem areas
IPT organizes the work around one or two of four problem areas:
- Grief: the death of someone important.
- Role dispute: a conflict with someone important about what each expects of the other.
- Role transition: a major life change, such as a move, a new job, retirement, illness, divorce, or becoming a parent.
- Interpersonal sensitivity (once called interpersonal deficits): long-standing loneliness or difficulty forming and keeping relationships, when none of the other three fits.
Grief
The grief focus is for difficulty adjusting after someone has died. The therapist helps the person talk about the relationship in all its complexity, good and bad, experience the feelings that come up, and gradually rebuild support and activity. Losing someone can also mean losing companionship, practical help, or a place in a social network, so those losses are explored too.
Role disputes
A role dispute is a conflict with someone important rooted in different expectations. One partner may see taking over a task as caring, while the other experiences it as a lack of trust. Disputes can be open arguments, or show up as withdrawal and repeated disappointment.
IPT considers what stage the dispute is in. In renegotiation, both are still actively trying to resolve it. At an impasse, communication has stalled. In dissolution, the relationship may be ending. The task differs for each: practicing a clearer request makes sense if negotiation is still possible, while weighing the consequences of separation serves a relationship that may be over. The aim isn't always reconciliation.14
Role transitions
A role transition is a life change that alters someone's responsibilities, identity, or relationships: graduating, migrating, becoming ill, becoming a parent, retiring. Even a wanted change can involve grief for the old role and the routines, recognition, and support that came with it.
Interpersonal sensitivity
When there's no clear recent loss, dispute, or transition, IPT may focus on long-standing isolation or difficulty connecting. The older term, interpersonal deficits, made it sound as if the person was defective, so many clinicians now prefer interpersonal sensitivity.
The work looks at specific recent interactions, including the one with the therapist, to find a small next step, such as following up after a pleasant encounter, and then looks at what made it hard. The therapist distinguishes limited opportunities from limited skills, considers exclusion, disability, money, and geography, and respects the person's own preferred kinds of connection.13
What the therapist actually does
- Communication analysis: going through a specific conversation in detail (what the person meant, what they said, what the other person heard, and what happened next) to find where it went wrong. Someone may mean to ask for help but only say "everything is exhausting," then hear advice as a refusal of care.
- Role-play: rehearsing a clearer request or boundary in session before trying it in real life.
- Decision analysis: helping the person list and weigh their options in a relationship problem.
- Encouraging feelings: helping the person notice and express emotions, such as hurt or anger, that carry information about what they need.
- Building support: helping the person find and use people who can help.14
How change happens
IPT proposes that improving what is happening in relationships reduces depression. Joshua Lipsitz and John Markowitz describe several possible pathways: more usable social support, less interpersonal stress, better processing of emotions, and stronger interpersonal skills. They present these as working hypotheses still being studied, not proven explanations for every person's improvement.512
Current developments
- Attachment-oriented IPT: Scott Stuart, a psychiatrist, and Michael Robertson give more weight to attachment and communication patterns and less to the medical model.
- Adolescents: Laura Mufson and colleagues adapted IPT for depressed teenagers (IPT-A), attending to growing independence, family, peers, and school.
- PTSD: Markowitz developed an IPT for PTSD that focuses on current relationships and numbed emotion rather than on retelling the trauma.
- Global reach: Weissman and Jennifer Mootz describe IPT adapted for groups and community health workers in many countries.
Meet the case
Reason for referral
Grace is a 58-year-old former elementary school teacher who took early retirement in June after 31 years in the classroom. In August she sold her house in Columbus and moved to a small apartment across town from her son, Michael, his wife, and their two young children. Her new primary care doctor refers her for therapy in November after Grace describes low mood, low energy, and long mornings in bed. Grace says she should be enjoying this time and can’t understand why she isn’t.
Presenting concerns
Most days Grace wakes early, then stays in bed until late morning because there is nothing she has to get up for. She has lost interest in reading and gardening, eats irregularly, and feels tired even when she has done little. She tells Michael she is “adjusting” and changes the subject to the grandchildren. Phone calls with her older sister, Ruth, often end with Ruth criticizing the move and saying Grace abandoned the family, and Grace feels worse for a day or two afterward.
In her words: “I should be grateful. I’m near my son, I’m retired, and I feel like I’ve disappeared.” She is warm, articulate, and quick to apologize, and she becomes visibly sad when she talks about her classroom and colleagues.
Background and history
Grace grew up in a close, opinionated family in Columbus and lived within a few miles of Ruth all her adult life. She divorced in her early forties and raised Michael largely on her own while teaching full time. She had one episode of depression after the divorce, treated with medication and short-term counseling, and recovered well. Teaching gave her structure, daily contact with colleagues and children, and a strong sense of being useful. The decision to retire and move felt sensible: her school was restructuring, Michael had asked her to be closer, and she wanted to know her grandchildren.
Current life and strengths
Grace lives alone and doesn’t yet know anyone in her new neighborhood. She sees Michael’s family about once a week, usually for Sunday dinner, and sometimes picks up the grandchildren from school. Ruth calls several times a week. A former colleague, Linda, has sent friendly messages that Grace hasn’t answered. She has noticed a library book group nearby but hasn’t gone.
Strengths include warmth, a long track record of building relationships with colleagues and families, organizational skill, humor, and her recovery from depression before. She knows how to be a good member of a community; she just hasn’t found a community yet.
Assessment
The therapist completes a depression assessment at the start and repeats a brief symptom measure every few sessions. Grace’s symptoms are in the moderate range: low mood most days, loss of interest, fatigue, poor appetite, early waking, and guilt about not feeling grateful. She denies thoughts of suicide or self-harm. Her doctor has started an antidepressant and is monitoring her response, and the therapist coordinates with the doctor with Grace’s consent. Thyroid and other basic tests were normal.
Working conceptualization
A conceptualization is a working explanation of the person’s difficulties and a plan for what therapy will focus on. The person and clinician review it together and change it as they learn more.
Interpersonal psychotherapy (IPT) treats depression as a medical illness that both affects and is affected by a person’s current relationships and social roles. It doesn’t claim relationships are the only cause. It looks for a current interpersonal problem area linked to when the depression began, and works on that.
Grace’s depression began within months of two big changes. That points to a role transition: she lost the role of teacher and colleague, along with its daily structure, contact, and sense of usefulness, and has not yet built a new role in a new place. A second possible problem area is a role dispute with Ruth, whose expectations (that Grace would stay close and visit often) clash with Grace’s choice to move. Ruth’s criticism adds strain, and Grace’s way of handling it (saying she’s fine, then exploding and hanging up) leaves her feeling worse.
Depression also shapes how Grace relates to people. She withdraws, doesn’t ask for support for fear of being a burden, and interprets setbacks as proof she made a selfish mistake. The working focus, agreed with Grace, is the role transition, with the dispute with Ruth addressed as part of it. The aim is to mourn what she lost, recognize what the new role could offer, build new sources of contact and meaning, and communicate more clearly with her family.
Goals and treatment plan
- Reduce depressive symptoms, tracked by regular measures
- Acknowledge what she lost when she left teaching and her hometown
- Build new routines and at least two sources of regular contact
- Ask Michael for a specific, modest kind of support
- Respond to Ruth in a way that protects the relationship and her own wellbeing
IPT is time-limited: 16 weekly sessions, in three phases. The first sessions cover assessment, an interpersonal inventory of important relationships, and an agreed focus. The middle sessions work on the role transition and specific conversations. The final sessions consolidate gains and plan for future difficulties. The therapist gives Grace the “sick role” explicitly, which acknowledges that depression limits what she can do right now, while encouraging small steps.
What would change the picture
The focus should change if symptoms worsen, if another interpersonal issue turns out to be more important, or if her medical care shows other contributors to her low energy. One good outing or an improved call with Ruth doesn’t mean recovery; symptoms and daily functioning are reviewed throughout.
The illustrated course of therapy
The story below follows five moments in this fictional course of therapy. Each scene names the interventions and shows the conversation and clinical reasoning. Session numbers show when events happen; they are not a schedule to copy.
How a clinician thinks
The interpersonal inventory reviews important relationships: who, how close, what is satisfying and not, what changed. It ends with an interpersonal formulation agreed with the patient.91
What this illustrates: The clinician connects Grace’s depression with changes in roles, contact, and support.
Lost contact with colleagues; few local friends; a sister who calls her ungrateful.
Map relationships.
Link onset to retirement and move.
Formulate: depression linked to role transition, with a possible dispute.
Agree on focus.1
Ageism, finances, or health changes in retirement may be part of the picture.
Examples of the core ideas
These moments from Grace’s therapy illustrate different concepts. One case across sessions follows the course of therapy in order.
What this illustrates: Grace mentions more than one relationship difficulty. The example shows why the clinician needs a shared focus.
Grace mentions both retirement and conflict with her sister.
In the room
Choose what you want to work on. Each intervention includes an explanation and three worked examples with Grace. Meet the case gives the background. These groups are options, not a treatment sequence.
Connect symptoms with an interpersonal situation
Map important relationships, connect the current difficulty with symptoms, and examine the relationship most relevant to the treatment focus.
Introduce a map of important relationships
Intervention
Introduce a map of important relationships
The interpersonal inventory is a structured conversation about important current relationships, recent changes, support, and difficulties. It is not simply a list of names or a lifetime personality assessment. Interpersonal psychotherapy, or IPT, uses the map to connect the timing and experience of symptoms with a current interpersonal problem area. Grace's retirement and move may represent a role transition, a change in social role that brings loss and adaptation demands. Her sister's criticism may involve a role dispute, disagreement about expectations. Those are hypotheses to assess, not labels assigned from one fact. Explaining the inventory's purpose helps Grace understand why relationships matter to a depression treatment. The therapist asks respectfully about closeness, conflict, and available support, while keeping symptom assessment and appropriate medical care in view.
What you do or say
- Explain how the inventory relates to symptoms and goals.
- Ask whom Grace sees or contacts regularly.
- Explore changes around symptom onset.
- Ask which relationships offer support and which feel difficult.
- Check missing relationships and practical context.
- Summarize a tentative map and invite correction.
One possible response: We’re seeing what changed around the depression and what support is available, not finding someone to blame.
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Grace is a 58-year-old recently retired teacher who moved closer to her son. At the first appointment she says she should be enjoying retirement but spends long mornings in bed. The therapist has begun assessing depression and asks about people she sees or speaks with now. Grace immediately worries that the counselor is looking for someone to blame. She names former colleagues, her son, and a sister who calls often, but says each relationship is different from before the move. Introducing the inventory can explain that they are mapping changes and support, not judging her family or asking for every private detail. Grace can decide what feels relevant and raise concerns about confidentiality. The map may reveal loneliness or conflict, but the clinician should not assume those explain all symptoms without assessment.
When to use it, and when not
Introduce the relationship inventory near the beginning: it is a shared review of important people, recent changes, and sources of support or strain. Explain why you are asking and let Grace choose the pace. Continue depression and safety assessment, coordinate medical care when needed, and do not require contact with an unsafe person.
What the clinician is tracking
Track current relationships, timing of changes, and Grace’s understanding of the inventory. Notice when questions feel intrusive or imply blame.
Three example exchanges
- Grace
- Why do you need to know about my family?
- Therapist
- We’re seeing what changed around the depression and what support is available, not finding someone to blame.
- Grace
- That makes more sense.
- Therapist
- We can begin with whoever feels most relevant.
The inventory is connected to treatment rather than presented as interrogation.
More examples
- Grace
- I used to see colleagues every day.
- Therapist
- That daily contact disappeared when you retired and moved.
- Grace
- Yes, more than I expected.
- Therapist
- Let’s include that loss in the map.
The therapist notices a role change beyond family conflict.
- Grace
- This feels like a questionnaire about everyone.
- Therapist
- I’ve moved too quickly. Which relationship would be useful to start with, and what would you prefer to leave for later?
- Grace
- My old colleagues first.
- Therapist
- Let’s begin there.
The therapist slows the relationship review and lets Grace choose to start with former colleagues, leaving other relationships for later.
Common slips
- Listing names without examining changes or support.
- Implying relationships are the sole cause of depression.
- Ignoring confidentiality concerns.
Connect symptoms to a current interpersonal situation
Intervention
Connect symptoms to a current interpersonal situation
Interpersonal framing offers a collaborative account of how symptoms relate to a current problem area. In IPT the common areas include grief, role disputes, role transitions, and persistent difficulty with social connection. Grace's retirement and relocation suggest a role transition: she has lost routine, familiar contacts, and part of an identity while adapting to a new life. A dispute with her sister may also matter. The therapist connects timing and experience without claiming relationships are the only cause of depression. The frame should reduce moral self-blame and guide concrete work. It remains provisional and includes assessment of biological, medical, and other contributors. A current focus is chosen together rather than forcing every story into the same category. The client can say the frame misses, and the clinician revises it.
What you do or say
- Summarize relevant symptom and relationship timing.
- Define the possible problem area plainly.
- Connect it to Grace’s stated goals.
- Retain other contributors and care needs.
- Ask Grace which parts of the explanation match her experience and which do not.
- Agree on a focus for now and review it as you learn more.
One possible response: You changed work, daily contact, and where you live at once. That’s a major role transition.
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Earlier in the illustrated case (Sessions 1–2: map the changed roles): The inventory becomes more than a name list: Grace describes how much contact and usefulness came from work. Her sister’s care and criticism both enter the map. The therapist checks confidentiality concerns and pace.
By Session 3 the inventory shows that Grace's daily contact with colleagues ended at retirement, the move changed her role in family routines, and conflict with her sister increased. Grace says she should be grateful to live near her son and concludes that depression proves she is ungrateful. The therapist can offer a different frame: several important roles changed quickly, and adaptation has been harder than expected. This does not imply the move was a mistake or that the sister caused the depression. Grace also has symptoms needing assessment and appropriate care. A tentative role-transition focus may connect her wish to feel useful with practical rebuilding of contact and routine. The clinician should check whether this account feels accurate and whether another current interpersonal issue deserves greater attention.
When to use it, and when not
Offer a possible link when the timing of symptoms and a loss, dispute, life change, or isolation suggests a useful treatment focus. Ask whether the connection fits Grace’s experience and explain that other contributors may also matter. Continue depression and safety assessment, coordinate medical care when needed, and do not require contact with an unsafe person.
What the clinician is tracking
Track symptom timing, losses, new demands, and the fit of the chosen problem area. Avoid turning a useful frame into a complete causal theory.
Three example exchanges
- Grace
- I should enjoy retirement.
- Therapist
- You changed work, daily contact, and where you live at once. That’s a major role transition.
- Grace
- It does feel like losing my place.
- Therapist
- We can work on grieving the old role and building the new one.
The frame offers direction without moral judgment.
More examples
- Grace
- My sister’s calls are the worst part now.
- Therapist
- Then the disagreement about the move may need attention alongside the transition.
- Grace
- Yes.
- Therapist
- Let’s agree what we focus on first.
The focus follows the client’s current needs.
- Grace
- You make it sound like retirement caused everything.
- Therapist
- That’s too simple. It’s one relevant context, and we still need to assess other contributors.
- Grace
- I’m glad you said that.
- Therapist
- We can keep the frame useful without treating it as complete.
The therapist acknowledges that retirement cannot explain everything and keeps assessment of other contributors to depression in the plan.
Common slips
- Claiming interpersonal context is the only cause.
- Choosing a problem area without collaboration.
- Using a category instead of explaining its meaning.
Explore one relationship in useful detail
Intervention
Explore one relationship in useful detail
The second inventory skill develops a specific relationship rather than remaining at the level of names and impressions. IPT asks what contact is like, what the person expects, what they receive, what they wish were different, and how feelings and symptoms interact with the relationship. Grace may say her sister is critical, but a concrete conversation can reveal expectations about closeness, obligation, and the move. The therapist does not decide which relative is right or infer a permanent character from one exchange. A useful account includes positive aspects and limits as well as conflict. Culture, practical constraints, and safety affect what change is feasible. The inventory supports selection of a current focus and potential sources of help. It is not a demand to disclose private history that has no relevance to the agreed treatment.
What you do or say
- Choose a relationship relevant to the symptom timeline.
- Ask about a recent interaction.
- Explore expectations and wishes on Grace’s side.
- Ask what the other person said or did, then discuss what Grace thinks it meant.
- Identify valued aspects and needed limits.
- Connect the information to the tentative focus.
One possible response: What happened in the most recent call?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
At Session 2 Grace describes her sister as judgmental and says every call leaves her feeling worse. When the therapist asks about a recent call, Grace mentions that her sister helped with the move and still sends photographs from family gatherings. The relationship includes care as well as criticism. Grace wanted support for the move; her sister expected more frequent visits and feels left behind. Those different expectations need exploration rather than a verdict that one is selfish. Grace's depressed mood may make calls harder to initiate, but that does not make the sister's hurtful comments imaginary. The clinician asks what Grace values, what she wants to preserve, and what boundaries she needs. It remains one relationship in a broader map, not the whole explanation for her depression.
When to use it, and when not
Explore one relationship after Grace identifies it as relevant to her current difficulties. Ask for recent examples and include both helpful and painful parts of the relationship. Continue depression and safety assessment, coordinate medical care when needed, and do not require contact with an unsafe person.
What the clinician is tracking
Track expectations, actual exchanges, support, strain, and symptom effects. Avoid choosing a side before understanding the relationship’s mixed qualities.
Three example exchanges
- Grace
- My sister is always critical.
- Therapist
- What happened in the most recent call?
- Grace
- She said I abandoned everyone.
- Therapist
- What did you say, and what did you wish you could say?
The question moves from a global label to a usable interaction.
More examples
- Grace
- She helped me move, then complained.
- Therapist
- There’s real help and a painful expectation attached to the move.
- Grace
- Exactly. I don’t want to lose her.
- Therapist
- We can examine what you want to keep and change.
The relationship is not reduced to a villain story.
- Grace
- You make her sound awful.
- Therapist
- I emphasized the criticism too much. What do you value in the relationship?
- Grace
- We’ve always supported each other.
- Therapist
- That needs a place in the formulation.
The clinician corrects a one-sided account.
Common slips
- Turning the inventory into a judgment of relatives.
- Ignoring positive contact because conflict is more dramatic.
- Treating guessed expectations as known facts.
Understand an exchange and make distress speakable
Clarify events, help the person communicate distress, and review a conversation closely enough to understand what happened.
Clarify the event before choosing a response
Intervention
Clarify the event before choosing a response
Clarification asks what a vague word or account means in a particular situation. “She was awful” or “I fell apart” may contain several different events, feelings, and actions. IPT needs enough detail to understand how a relationship and symptoms connect and what could change. The therapist asks about timing, actual words, intended meaning, and what followed, without cross-examining for a single correct version. Clarification also includes distinguishing what Grace knows from what she assumes. It should not invalidate the emotional reality of the event. A person can feel rejected even when another's intention is uncertain. Clearer detail supports communication analysis and a feasible next step. The clinician stops when further detail no longer serves the focus or when the pace becomes overwhelming.
What you do or say
- Identify the phrase that needs clarification.
- Ask what it meant in behavior and time.
- Assess changes in symptoms and any concerns about Grace's immediate safety.
- Ask Grace to recall what was said when the wording matters.
- Separate what happened from Grace's explanation of the other person's intentions.
- Reflect the feeling and summarize the clarified account.
One possible response: What did shutting down look like that afternoon?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Earlier in the illustrated case (Sessions 1–2: map the changed roles): The inventory becomes more than a name list: Grace describes how much contact and usefulness came from work. Her sister’s care and criticism both enter the map. The therapist checks confidentiality concerns and pace.
In Session 3 Grace says she “fell apart” after a call with her sister. The therapist could respond immediately with comfort or advice, but the phrase could mean crying, withdrawing for a day, missing meals, or something requiring urgent clinical attention. Grace says she turned off the phone, stayed in bed until late afternoon, and did not reply to her son. The clinician checks symptom and safety concerns appropriately, then asks what the sister actually said and what Grace understood it to mean. Grace heard “you abandoned us” as proof she had made a selfish decision. The sister's intention is not established by that meaning. Clarification can retain Grace's hurt while separating event, interpretation, and consequences, making later interpersonal work more precise and avoiding assumptions about the severity of “fell apart.”
When to use it, and when not
Clarify an account when it is unclear what happened, what Grace felt, or what she understood the event to mean. Ask gently and explain why the detail matters, so the question does not sound like disbelief. Continue depression and safety assessment, coordinate medical care when needed, and do not require contact with an unsafe person.
What the clinician is tracking
Track ambiguity in event, symptom, and meaning, including any need for assessment. Notice whether your clarification is supportive or sounds like disbelief.
Three example exchanges
- Grace
- I shut down.
- Therapist
- What did shutting down look like that afternoon?
- Grace
- I went to bed and ignored messages.
- Therapist
- That gives us a clearer picture.
Clarification identifies behavior without disputing feeling.
More examples
- Grace
- She said I abandoned them.
- Therapist
- Those were her words. What did they mean to you?
- Grace
- That I’m selfish.
- Therapist
- The sentence became a judgment about your whole decision.
The therapist distinguishes event and interpretation.
- Grace
- You sound like you don’t believe me.
- Therapist
- My questions came across that way. I believe it hurt; I’m trying to understand what happened and what support is needed.
- Grace
- Then slow down.
- Therapist
- I will.
The repair changes pace and validates the experience.
Common slips
- Questioning in a prosecutorial tone.
- Assuming a vague phrase proves or excludes danger.
- Collecting detail without a treatment purpose.
Help describe distress and ask for support
Intervention
Help describe distress and ask for support
This skill helps the person put distress and a support need into words that another person might understand. Depression can make reaching out difficult, and vague contact can leave others uncertain how to help. Grace may tell her son she is fine while hoping he notices that she is struggling. IPT examines that gap without blaming her for symptoms or assuming he can meet every need. The therapist helps distinguish description, feeling, and request: what has been happening, how it affects her, and what kind of support would be useful. The request should be specific, feasible, and safe. It is not a demand that another person provide treatment or rescue. Professional care and broader supports remain important, and the client can choose whom to approach and how much to disclose.
What you do or say
- Ask what Grace wants another person to understand.
- Help Grace describe her symptoms and how they affect daily life.
- Identify the support desired.
- Make the request specific and realistic.
- Consider safety, privacy, and alternatives.
- Rehearse wording and review her choice.
One possible response: How could you say that and name one helpful thing?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Earlier in the illustrated case (Session 3: clarify the painful call): Grace can describe wanting acknowledgment that the move was hard for her too. The therapist reflects that need and checks whether focusing on the dispute would be useful now. Other symptom contributors remain visible.
Grace says her son has not noticed how difficult mornings have become. When he asks how she is, she says she is adjusting and changes the topic to his children. She wants more contact but fears becoming a burden or implying that he should solve the depression. In Session 4 the therapist asks what she would want him to understand and what kind of help would actually fit. Grace identifies a wish for a regular short walk, not constant monitoring or advice. A clearer statement could describe low energy and isolation while making that modest request. The clinician should not assume her son is available or trustworthy simply because he is family. They consider the relationship, possible response, and other support options, while appropriate treatment and assessment continue.
When to use it, and when not
Use this when Grace wants someone to understand her distress or provide a particular kind of help. Agree what she wants to share and with whom; privacy and declining contact remain options. Continue depression and safety assessment, coordinate medical care when needed, and do not require contact with an unsafe person.
What the clinician is tracking
Track the difference between an unspoken wish and a feasible request. Notice shame, privacy, and whether the proposed recipient is appropriate and safe.
Three example exchanges
- Grace
- I want him to know I’m having a hard time.
- Therapist
- How could you say that and name one helpful thing?
- Grace
- I could ask for a weekly walk.
- Therapist
- That’s a clear, modest request.
The intervention makes support concrete.
More examples
- Grace
- I don’t want him to fix me.
- Therapist
- You can say you’re getting care and asking for company, not treatment.
- Grace
- That feels easier.
- Therapist
- Let’s find words that sound like you.
The request distinguishes social support from clinical care.
- Grace
- You keep saying I should tell my son everything.
- Therapist
- I overstepped. You choose what to share and with whom.
- Grace
- I’d rather begin with a friend.
- Therapist
- Let’s consider that relationship.
The therapist restores privacy and choice.
Common slips
- Assuming close family is always safe or available.
- Making a vague request that others cannot understand.
- Treating social support as a substitute for indicated care.
Replay a conversation closely enough to learn from it
Intervention
Replay a conversation closely enough to learn from it
Communication analysis reviews a specific interaction in detail: what happened before it, the actual words and tone, what each response meant to the client, and what followed. IPT uses this to identify misunderstandings, unexpressed needs, and possible alternatives. The therapist does not reconstruct the other person's mind with certainty or decide who won. Grace may intend to explain her move, while her sister hears a defense; Grace may then withdraw without expressing the wish to stay close. The analysis separates intention, wording, received meaning, feeling, and consequence. It remains manageable and connected to the chosen problem area. Not every conversation needs exhaustive analysis, and unsafe relationships may call for protection rather than better wording. The goal is useful learning and a feasible next action, not proving that the client communicated badly.
What you do or say
- Choose a relevant, bounded conversation.
- Ask what happened immediately before it.
- Ask Grace to recall the words and tone used in the conversation.
- Explore Grace’s intention and received meaning.
- Identify a possible mismatch or missing request.
- Discuss another way to respond and whether Grace wants contact with this person.
One possible response: What did you want her to understand at that moment?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Earlier in the illustrated case (Sessions 4–5: make a support request clearer): Grace makes a specific request; her son offers a different day. The therapist reinforces clarity and negotiation rather than judging success by immediate agreement. Grace begins evaluating her communication separately from another person’s response.
In Session 7 Grace describes a call in which her sister said she abandoned the family. Grace remembers answering, “You never understood me anyway,” then hanging up. She felt relief for several minutes and shame for the rest of the day. The therapist asks to replay a small part, beginning just before the accusation. Grace wanted her sister to acknowledge how difficult the move had been, but her response conveyed attack rather than that need. The clinician can examine the mismatch without deciding the sister's criticism was acceptable or making Grace responsible for the entire conflict. They also distinguish what the sister actually said from what Grace inferred. A close analysis may reveal one alternative response and whether further contact is appropriate, rather than becoming another exercise in self-blame.
When to use it, and when not
Review a recent conversation when Grace wants to understand where it went wrong. Reconstruct words, tone, intended meaning, and replies while staying uncertain about an absent person’s thoughts. Continue depression and safety assessment, coordinate medical care when needed, and do not require contact with an unsafe person.
What the clinician is tracking
Track intention, wording, tone, meaning, and consequences separately. Notice when analysis becomes blame or assumes knowledge of the absent person’s mind.
Three example exchanges
- Grace
- I told her she never understood me.
- Therapist
- What did you want her to understand at that moment?
- Grace
- That the move was hard for me too.
- Therapist
- Your intention and the sentence were different.
The analysis locates a communication gap without blame.
More examples
- Grace
- She wanted to punish me.
- Therapist
- That may be how it felt. What did she actually say, and what is still uncertain?
- Grace
- She said I abandoned them.
- Therapist
- We can examine those words without claiming her entire motive.
The therapist preserves emotional meaning and uncertainty.
- Grace
- You make it sound like I caused the whole fight.
- Therapist
- I focused too narrowly on your reply. Her accusation and the wider dispute matter too.
- Grace
- Yes.
- Therapist
- We’re looking for your options, not assigning all responsibility.
The therapist adds the sister’s accusation and the wider dispute to the review, so Grace’s reply is not treated as the whole cause of the fight.
Common slips
- Analyzing every word without a goal.
- Assuming the absent person’s intention.
- Making the client responsible for another person’s behavior.
Try a different interpersonal step
Consider alternative ways to communicate, recognize a useful attempt, build support, and review a feasible action.
Generate more than one way to communicate
Intervention
Generate more than one way to communicate
Generating communication options helps a client move beyond the feeling that there is only one possible response. IPT may compare a direct request, a boundary, a pause, written communication, or choosing not to engage, depending on the goal and relationship. Grace can want closeness with her sister and still decline insults about the move. The clinician elicits her ideas before adding options and considers likely effects, costs, and safety. A role-play can test wording in a modest fictional or clinically appropriate setting, but it does not predict the other person's actual response. The therapist avoids presenting an ideal script that the client must memorize. The best option is one Grace understands, can choose, and can realistically use. Sometimes practical support or reduced contact is more useful than another conversation.
What you do or say
- Clarify what Grace wants from the interaction.
- Invite her possible responses first.
- Add alternatives with permission.
- Compare fit, likely effects, and safety.
- If Grace wants to try an option, practice a short version with her.
- Leave room to decline contact or revise wording.
One possible response: Could there be a smaller boundary between those choices?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
After reviewing the call, Grace says she sees only two choices: accept her sister's criticism or stop speaking to her forever. The therapist asks whether there are intermediate options that fit what she wants to preserve. Grace considers naming the hurt, asking for a different topic, ending a call when insults begin, or writing a short message. Each has tradeoffs, and the clinician should not insist that direct confrontation is always healthier. Grace values the relationship but is also depressed and has limited energy for repeated arguments. A small rehearsal can help her hear which words sound like her. The purpose is to expand options and support choice, not teach her to manage the sister perfectly. The relationship's history and safety remain relevant to whether any contact is advisable.
When to use it, and when not
Generate options when Grace feels stuck between one difficult response and saying nothing. Compare the likely benefits, costs, and fit of each, including waiting or seeking support elsewhere. Continue depression and safety assessment, coordinate medical care when needed, and do not require contact with an unsafe person.
What the clinician is tracking
Track the goal, feasible options, and costs of each. Notice when your preferred communication style is being offered as the only mature choice.
Three example exchanges
- Grace
- I either take it or hang up forever.
- Therapist
- Could there be a smaller boundary between those choices?
- Grace
- I could say I’ll stop the call if insults continue.
- Therapist
- How would that sound in your words?
The therapist helps Grace find a boundary between tolerating insults and ending contact forever: she could end a call if the insults continue.
More examples
- Grace
- Writing might be easier.
- Therapist
- What would writing help, and what might it make harder?
- Grace
- I could think first, but tone might be misunderstood.
- Therapist
- Those tradeoffs can guide your choice.
Options are compared rather than ranked automatically.
- Grace
- That sentence sounds like you, not me.
- Therapist
- I supplied a script too quickly. What would you actually say?
- Grace
- Something shorter.
- Therapist
- Let’s work with your wording.
The therapist sets aside an unsuitable script and asks for the shorter words Grace would actually use.
Common slips
- Treating direct confrontation as universally best.
- Predicting another person’s response with certainty.
- Writing a script the client cannot own.
Recognize an effective communication step
Intervention
Recognize an effective communication step
Reinforcement of effective communication makes a useful action visible so the client can understand and repeat it. In IPT this often means identifying how a clear request, direct expression of feeling, or boundary changed an interaction. The therapist does not merely praise obedience or judge success by the other person's immediate agreement. Grace can communicate effectively even if her sister responds poorly. The skill examines what was specific, understandable, and aligned with her goals, as well as what needs adjustment. Acknowledging effort can support agency during depression, when setbacks easily become proof of personal failure. The response should be grounded in the actual exchange and separate the client's action from outcomes she cannot control. Communication remains shaped by power, context, and safety, not only by individual technique.
What you do or say
- Review the exact request or statement.
- Identify one effective feature.
- Explain why it helped the interaction.
- Identify what Grace can do and what depends on another person's response.
- Ask what Grace noticed and would keep.
- Identify one adjustment if needed.
One possible response: Your request was clear enough for him to negotiate a workable time.
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Grace returns after asking her son for a weekly walk. He could not manage the day she proposed, but offered another time. She begins by saying she did it wrong because the answer was not an immediate yes. The therapist asks what she actually said and how the exchange unfolded. Grace described her difficulty, made a specific request, and accepted a realistic alternative. Those are effective communication steps even though the original plan changed. The clinician can reinforce the clarity and negotiation without exaggerating the result or suggesting the depression is solved. Later, a clear boundary with her sister may be met with anger; that response would not automatically mean the boundary was ineffective. Grace needs a more nuanced way to evaluate her own actions and consider what to try next.
When to use it, and when not
Acknowledge a specific communication effort after Grace describes trying it. Discuss what she did and learned, even when the other person did not respond as hoped. Continue depression and safety assessment, coordinate medical care when needed, and do not require contact with an unsafe person.
What the clinician is tracking
Track the client’s observable communication and its fit with the goal. Separate a useful action from whether another person responds as hoped.
Three example exchanges
- Grace
- He offered Thursday instead.
- Therapist
- Your request was clear enough for him to negotiate a workable time.
- Grace
- I hadn’t seen it that way.
- Therapist
- What part of your wording would you keep?
Grace’s clear request allowed the other person to suggest Thursday. The therapist asks which words she would keep for another conversation.
More examples
- Grace
- My sister was angry anyway.
- Therapist
- Her anger doesn’t by itself mean your boundary was unclear. What did you say?
- Grace
- I said I wouldn’t discuss insults about the move.
- Therapist
- That was specific; now we can consider how to respond to her reaction.
The therapist separates communication from control of another person.
- Grace
- You sound like I got a good grade.
- Therapist
- I made it about my approval. I meant that your clear request helped a real conversation happen.
- Grace
- That’s more useful.
- Therapist
- What was your own assessment?
The therapist replaces praise that felt like grading with a discussion of what the request made possible, then asks Grace for her own assessment.
Common slips
- Praising compliance with the therapist’s script.
- Equating another person’s displeasure with failure.
- Ignoring structural power or relationship danger.
Build support beyond one difficult relationship
Intervention
Build support beyond one difficult relationship
Mobilizing social support identifies and strengthens relationships or community connections that can provide useful company, practical help, or belonging. In IPT the therapist considers support in relation to the current problem area and symptoms. Grace's retirement removed ordinary daily contact, so rebuilding connection may involve former colleagues, a local group, her son, or another appropriate resource. Support is not measured only by the number of people in a network. Reliability, fit, safety, accessibility, and the kind of help needed matter. Depression can make initiating contact difficult, so steps may need to be small and supported. The clinician should not imply that loneliness proves the client failed socially or that a new group replaces treatment. Barriers such as cost, mobility, transport, culture, and discrimination need concrete attention.
What you do or say
- Ask what kind of support Grace wants.
- Review existing and potential contacts.
- Assess reliability, safety, and accessibility.
- Choose a small client-owned step.
- Address practical barriers concretely.
- Review what happened and change the plan together if needed.
One possible response: Would replying feel useful, and what would you want to say?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Grace says her sister is the only person who calls regularly, which makes reducing painful calls feel like losing her last connection. The inventory also shows a former colleague who has sent messages, her son nearby, and a library group she noticed but has not attended. These are possibilities, not guaranteed support. Grace worries about being the oldest newcomer and has little energy on mornings when depression is worse. The therapist asks what kind of contact would be useful and what barriers need addressing. She chooses replying to the colleague and considering one afternoon event, rather than committing to several activities. The clinician can help plan those small steps while monitoring symptoms and appropriate care. The point is broadening options, not replacing one difficult relationship with a cheerful social prescription.
When to use it, and when not
Explore additional support when one relationship carries too much strain or Grace feels isolated. Begin with connections she wants and can access, taking symptoms, transport, money, and energy into account. Continue depression and safety assessment, coordinate medical care when needed, and do not require contact with an unsafe person.
What the clinician is tracking
Track quality and fit of support, access barriers, and symptom burden. Notice whether a proposed connection is genuinely wanted or merely expected.
Three example exchanges
- Grace
- A colleague texted last month.
- Therapist
- Would replying feel useful, and what would you want to say?
- Grace
- I could ask for a phone catch-up.
- Therapist
- That’s a small way to reconnect.
The step begins with a real relationship.
More examples
- Grace
- The group meets when mornings are hardest.
- Therapist
- Then that timing may not fit. What afternoon options exist?
- Grace
- The library has one.
- Therapist
- We can explore it without assuming you must attend.
Access and symptoms shape the plan.
- Grace
- You make it sound like joining a group will cure depression.
- Therapist
- I overstated it. Support may help, and treatment and assessment still matter.
- Grace
- I need that distinction.
- Therapist
- We’ll keep both in view.
The therapist corrects a false promise.
Common slips
- Counting contacts instead of assessing useful support.
- Ignoring access barriers and symptoms.
- Treating a social activity as a guaranteed cure.
Choose a small interpersonal action and review it
Intervention
Choose a small interpersonal action and review it
Motivating interpersonal action helps translate understanding into a chosen step that fits the client's goals and current capacity. In IPT this may mean a request, boundary, reconnection, or adaptation to a new role. The clinician explores obstacles and meaning rather than instructing Grace to be more active. Depression can impair energy, concentration, and hope; a realistic plan accounts for that instead of making action a character test. The step should be specific enough to review, with room to revise if it does not help. Rehearsal and problem-solving can increase feasibility, but the other person's response remains uncertain. Completing one action does not prove recovery, and not completing it does not prove unwillingness. Ongoing symptom assessment and appropriate care guide treatment alongside interpersonal learning.
What you do or say
- Explain how the next step relates to the problem you agreed to work on.
- Ask whether Grace wants to take it now.
- Explore emotional and practical barriers.
- Make the action small and specific.
- Plan how to interpret varied responses.
- Review learning and adapt care or support.
One possible response: What small contact would you choose this week?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Earlier in the illustrated case (Session 7: analyze and expand the options): They compare a brief statement, written contact, a topic boundary, and no further conversation that day. Grace tests wording that sounds like her and rejects the therapist’s longer script. The correction improves ownership.
Near Session 9 Grace has clearer words for the retirement transition and wants to reconnect with a colleague. She has drafted a message several times but worries that an unanswered text would confirm she no longer matters. The therapist explores that feared meaning and asks whether the planned step is still hers to choose. Grace decides on a short request for a call, with a plan to review what happens rather than send repeated messages. They consider a second support option so one person's availability does not carry the entire meaning of recovery. Her low-energy mornings remain clinically important and continue to be assessed. The action is a modest interpersonal experiment connected to her goal of rebuilding a role, not a test of whether she is trying hard enough.
When to use it, and when not
Plan a small step after Grace has chosen a relationship goal and wants to try something between meetings. Agree what she will do, what may get in the way, and how you will review it without treating completion as a test. Continue depression and safety assessment, coordinate medical care when needed, and do not require contact with an unsafe person.
What the clinician is tracking
Track ownership, feasibility, feared meaning, and symptoms affecting action. Review what the step taught rather than merely whether it was completed.
Three example exchanges
- Grace
- I’ll reconnect sometime.
- Therapist
- What small contact would you choose this week?
- Grace
- A text asking for a short call.
- Therapist
- When would sending it be manageable?
The plan becomes reviewable and realistic.
More examples
- Grace
- If she doesn’t reply, I’ll feel rejected.
- Therapist
- That feeling may arrive, and an unanswered message can have several meanings. How will you support yourself then?
- Grace
- I can discuss it here rather than send more texts.
- Therapist
- That gives the uncertainty a place.
The plan includes emotional consequences without promising a response.
- Grace
- You make it sound like I’m failing if I don’t send it.
- Therapist
- I’ve made action feel like a test. We need to understand the barrier and your choice, not grade you.
- Grace
- I need a smaller step.
- Therapist
- Let’s find one or pause the plan.
The therapist acknowledges making the action feel like a test and offers a smaller step or a pause, after asking what made it difficult.
Common slips
- Turning an action plan into a compliance test.
- Promising a positive response from someone else.
- Ignoring worsening symptoms because a task was agreed.
One case across sessions
Follow Grace through the sessions below. Return to the case background and treatment plan.
Sessions 1–2: map the changed roles
What happened
Grace describes low-energy mornings after retirement and relocation. The therapist assesses depression and begins an interpersonal inventory, explaining that it maps relationships and changes rather than finds someone to blame. Grace names lost colleague contact, her nearby son, and mixed support from her sister.
Interventions in this scene
- Introduce a map of important relationships
- Explore one relationship in useful detail
- Connect symptoms to a current interpersonal situation
- Grace
- I should be enjoying this.
- Therapist
- Several roles and daily contacts changed at once.
- Grace
- I didn’t expect to lose my place.
- Therapist
- Let’s understand what that place gave you and what support exists now.
What the clinician is thinking
A role transition involves loss and adaptation in a changed social role. It is a plausible current focus, not a complete cause of depression. The clinician distinguishes current interpersonal information from medical and other assessment needs.
How the clinician applies the intervention
The inventory becomes more than a name list: Grace describes how much contact and usefulness came from work. Her sister’s care and criticism both enter the map. The therapist checks confidentiality concerns and pace.
Where it goes next
Explore one relevant relationship in detail and agree a provisional focus. Continue symptom and risk assessment and appropriate treatment planning.
Session 3: clarify the painful call
Before this scene: Sessions 1–2 (map the changed roles).
What happened
Grace says she fell apart after her sister accused her of abandoning the family. Clarification shows that she stayed in bed and ignored messages. The clinician assesses the significance of that change and asks what was said, what Grace understood, and what followed.
Interventions in this scene
- Explore one relationship in useful detail
- Clarify the event before choosing a response
- Connect symptoms to a current interpersonal situation
- Replay a conversation closely enough to learn from it
- Grace
- She said I abandoned everyone.
- Therapist
- What did that sentence mean to you?
- Grace
- That I was selfish for moving.
- Therapist
- It became a judgment about your whole decision.
What the clinician is thinking
Clarification separates event, interpretation, feeling, and behavior without disputing the hurt. The therapist does not claim to know the sister’s complete intention. A role dispute, conflicting expectations about closeness and obligation, may matter alongside the retirement transition.
How the clinician applies the intervention
Grace can describe wanting acknowledgment that the move was hard for her too. The therapist reflects that need and checks whether focusing on the dispute would be useful now. Other symptom contributors remain visible.
Where it goes next
Review a small part of the communication closely, rather than rehearsing another call before understanding its purpose and whether contact is appropriate.
Sessions 4–5: make a support request clearer
Before this scene: Session 3 (clarify the painful call).
What happened
Grace wants her son to notice the depression but usually tells him she is fine. She fears asking will make him responsible for fixing her. The therapist helps distinguish describing distress from requesting one modest kind of company, while professional care remains separate.
Interventions in this scene
- Help describe distress and ask for support
- Recognize an effective communication step
- Build support beyond one difficult relationship
- Grace
- I don’t want him to rescue me.
- Therapist
- You can ask for company without asking for treatment.
- Grace
- A weekly walk would help.
- Therapist
- How would that request sound in your own words?
What the clinician is thinking
An unspoken wish can leave another person unable to know what is needed. IPT helps clarify symptoms, meaning, and a feasible request without blaming the client for depressed withdrawal. The recipient’s availability, safety, and limits must be considered.
How the clinician applies the intervention
Grace makes a specific request; her son offers a different day. The therapist reinforces clarity and negotiation rather than judging success by immediate agreement. Grace begins evaluating her communication separately from another person’s response.
Where it goes next
Review the contact and broaden support possibilities. Keep symptom changes and care needs in the picture rather than treating one useful walk as recovery.
Session 7: analyze and expand the options
Before this scene: Sessions 4–5 (make a support request clearer).
What happened
Grace recalls telling her sister that she never understood her, then hanging up. She wanted to express hurt but communicated attack. The therapist reviews the sequence without assigning Grace all responsibility and asks what she hopes to preserve in the relationship.
Interventions in this scene
- Recognize an effective communication step
- Replay a conversation closely enough to learn from it
- Generate more than one way to communicate
- Therapist
- What did you want her to understand?
- Grace
- That moving was hard for me too.
- Therapist
- What other way could you say that or set a limit?
- Grace
- I could name the hurt and stop the call if insults continue.
What the clinician is thinking
Communication analysis distinguishes intention, words, received meaning, and consequence. Generating options expands choice rather than prescribing direct confrontation. A boundary may be appropriate even if the other person dislikes it, and safety can make reduced contact preferable.
How the clinician applies the intervention
They compare a brief statement, written contact, a topic boundary, and no further conversation that day. Grace tests wording that sounds like her and rejects the therapist’s longer script. The correction improves ownership.
Where it goes next
Choose only a feasible, safe option and review what happens. Continue the role-transition work so one difficult relationship does not become the entire treatment.
Sessions 9–10: act without making it a test
Before this scene: Session 7 (analyze and expand the options).
What happened
Grace wants to reconnect with a former colleague but fears that no reply would prove she no longer matters. She has more language for the lost role and identifies an afternoon community option as a second possibility. Low-energy mornings still require attention and care.
Interventions in this scene
- Grace
- If she doesn’t reply, I’ll feel rejected.
- Therapist
- That feeling may arrive; the meaning of no reply may still be uncertain.
- Grace
- I can send one short request and discuss it here.
- Therapist
- That’s a chosen step we can learn from.
What the clinician is thinking
Mobilizing support considers quality, fit, and access rather than contact count. Interpersonal action links understanding to a modest goal while accounting for depression and uncertainty. Noncompletion would call for exploration and adaptation, not a verdict about motivation.
How the clinician applies the intervention
Grace chooses a short message and a review plan. The therapist helps separate her clear action from the colleague’s uncontrollable availability. They assess changes in symptoms and daily function rather than claiming a guaranteed outcome.
Where it goes next
Continue reviewing the focus, care needs, support, and eventual ending. The fictional sequence illustrates decisions and learning, not a universal session schedule.
Common mistakes and misconceptions
- IPT is not open-ended talk about relationships.
- It does not interpret transference.
- It is not only for depression, though it began there.
- The sick role is not an excuse; it reduces self-blame.
- Adaptations exist for adolescents, groups, and different cultures.
Evidence: the best current read
Meta-analysis supports IPT for depression, including acute treatment and prevention of relapse. Specific trials also examine adolescent and culturally adapted group formats. Comparisons and adaptations must be interpreted within their studied settings.101112
Source 10Review
Source 11Study
How to read this section
- Randomized trial: people are assigned by chance to different treatments, so differences in results are more likely due to the treatment.
- Meta-analysis: a study that combines the results of many trials. An umbrella review is a review of several reviews.
- Control condition: what a treatment is compared with, such as a waitlist, usual care, or another therapy. Beating a waitlist is a lower bar than matching another active treatment.
- Effect size (g or d): how big the difference between groups is. As a rough guide, about 0.2 is small, 0.5 medium, and 0.8 large.
- 95% CI (confidence interval): the range the true result probably falls in. If it crosses zero, the study can't rule out no difference.
- Equivalence or noninferiority: a formal test that one treatment is about as good as another, within a margin set in advance. It is stronger than simply finding no significant difference.
- Heterogeneity: how much results differ from study to study. High heterogeneity makes an average less trustworthy.
- Risk of bias and certainty (GRADE): ratings of how much the study design could have skewed results, and how much confidence the overall evidence deserves.
Across disorders: Effective for acute depression; comparable to other treatments.10
Cultural adaptation: Large effects in a cluster trial in rural Uganda.11
Adolescents: IPT-A outperformed usual care in school clinics.12
| Question and design | Finding | Limitation |
|---|---|---|
| Comparative efficacy of interpersonal psychotherapy and antidepressant medication for adult depression: a systematic review and individual participant data meta-analysis (opens in a new tab) How do IPT and antidepressant medication compare for adult depression? Systematic review and individual participant data meta-analysis. | See the paper for the pooled results. | Available participant data and included trial populations limit generalizationFull appraisalWho was studied: Adults in randomized depression trials contributing individual participant data. Treatment: Interpersonal psychotherapy. Compared with: Antidepressant medication. Outcomes measured: Depression outcomes. Follow-up: See the paper. |
| Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis (opens in a new tab) How effective is IPT across mental health problems? Meta-analysis. | Acute depression versus control g = 0.60 (0.45 to 0.75); versus other therapies g = 0.06 (n.s.); versus medication g = −0.13 (n.s.); combined beat IPT alone g = 0.24. Reduced relapse in maintenance. | Heterogeneity across disorders; fewer trials outside depression; one author is an IPT developer.Full appraisalWho was studied: 90 studies, 11,434 participants. Treatment: IPT. Compared with: Controls, other therapies, medication, combined treatment. Outcomes measured: Depression (acute, maintenance, prevention), anxiety, eating disorders. Follow-up: Maintenance and prevention studies included. |
| Is Exposure Necessary? A Randomized Clinical Trial of Interpersonal Psychotherapy for PTSD (opens in a new tab) Can an IPT adaptation treat PTSD without an exposure protocol? 14-week randomized controlled trial. | IPT met the trial’s prespecified noninferiority criterion against prolonged exposure on CAPS. Response proportions (63% IPT, 47% exposure, 38% relaxation) were not significantly different. IPT and exposure improved quality of life and social functioning more than relaxation; response percentages do not demonstrate IPT superiority. | A specialist trial with a defined population; does not establish universal suitability or justify unsupervised trauma work.Full appraisalWho was studied: One hundred ten unmedicated adults with chronic PTSD and CAPS scores above 50. Treatment: IPT for PTSD. Compared with: Prolonged exposure and relaxation therapy. Outcomes measured: PTSD, quality of life, and social functioning. Follow-up: End of fourteen-week treatment reported in the checked abstract; later follow-up not assessed here. |
| Interpersonal Psychotherapy: Past, Present and Future (opens in a new tab) How did IPT develop and spread? Narrative review. | See the paper for the pooled results. | Not a current systematic efficacy estimate; historical forecasts need comparison with subsequent work.Full appraisalWho was studied: No new empirical participant sample; conceptual or narrative discussion. Treatment: Interpersonal psychotherapy. Compared with: Not applicable: conceptual or narrative paper, not a new comparative treatment trial. Outcomes measured: Origins, adaptations, training, and research directions. Follow-up: No new prospective treatment-outcome follow-up. |
| A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents (opens in a new tab) Does school-clinic IPT-A improve adolescent depression relative to usual care? 16-week randomized effectiveness trial in5 NYC school clinics. | IPT-A n34;TAU n29. | Small setting-specific sample; not evidence for every youth condition or general relational skills.Full appraisalWho was studied: 63 adolescents;mean age15.1, predominantly female/Hispanic. Treatment: IPT-A delivered by clinic clinicians. Compared with: Treatment as usual. Outcomes measured: Greater symptom and functioning improvement in IPT-A. Follow-up: 16-week acute trial. |
| Interpersonal psychotherapy: principles and applications (opens in a new tab) What principles and applications define IPT? Narrative overview. | See the paper for the pooled results. | Older conceptual overview; later trials and current manuals are needed for contemporary evidence judgments.Full appraisalWho was studied: No new empirical participant sample; conceptual or narrative discussion. Treatment: Interpersonal psychotherapy. Compared with: Not applicable: conceptual or narrative paper, not a new comparative treatment trial. Outcomes measured: Treatment structure, problem areas, and applications. Follow-up: No new prospective treatment-outcome follow-up. |
Practice with a partner
Practice with fictional scenarios and take turns responding. Agree on a word either person can use to pause the exercise. Keep crisis scenarios and intensive personal exercises out of peer practice. These exercises support learning; they do not replace clinical supervision.
Choose an intervention below. Each rehearsal reminds you what it is, sets the scene, and offers three rounds with feedback.
Connect symptoms with an interpersonal situation
Introduce a map of important relationships
Intervention
Introduce a map of important relationships
The interpersonal inventory is a structured conversation about important current relationships, recent changes, support, and difficulties. It is not simply a list of names or a lifetime personality assessment. Interpersonal psychotherapy, or IPT, uses the map to connect the timing and experience of symptoms with a current interpersonal problem area. Grace's retirement and move may represent a role transition, a change in social role that brings loss and adaptation demands. Her sister's criticism may involve a role dispute, disagreement about expectations. Those are hypotheses to assess, not labels assigned from one fact. Explaining the inventory's purpose helps Grace understand why relationships matter to a depression treatment. The therapist asks respectfully about closeness, conflict, and available support, while keeping symptom assessment and appropriate medical care in view.
Read the full intervention and worked examples
What you do or say
- Explain how the inventory relates to symptoms and goals.
- Ask whom Grace sees or contacts regularly.
- Explore changes around symptom onset.
- Ask which relationships offer support and which feel difficult.
- Check missing relationships and practical context.
- Summarize a tentative map and invite correction.
One possible response: We’re seeing what changed around the depression and what support is available, not finding someone to blame.
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Case outline, treatment focus, and earlier sessions
Grace is a 58-year-old recently retired teacher who moved closer to her son. At the first appointment she says she should be enjoying retirement but spends long mornings in bed. The therapist has begun assessing depression and asks about people she sees or speaks with now. Grace immediately worries that the counselor is looking for someone to blame. She names former colleagues, her son, and a sister who calls often, but says each relationship is different from before the move. Introducing the inventory can explain that they are mapping changes and support, not judging her family or asking for every private detail. Grace can decide what feels relevant and raise concerns about confidentiality. The map may reveal loneliness or conflict, but the clinician should not assume those explain all symptoms without assessment.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Explain the purpose
Intervention: Introduce a map of important relationships
Opening line in this scene: Why do you need to know about my family?
See one possible exchange and why it helps
- Grace
- Why do you need to know about my family?
- Therapist
- We’re seeing what changed around the depression and what support is available, not finding someone to blame.
- Grace
- That makes more sense.
- Therapist
- We can begin with whoever feels most relevant.
The inventory is connected to treatment rather than presented as interrogation.
Include lost contact
Intervention: Introduce a map of important relationships
Opening line in this scene: I used to see colleagues every day.
See one possible exchange and why it helps
- Grace
- I used to see colleagues every day.
- Therapist
- That daily contact disappeared when you retired and moved.
- Grace
- Yes, more than I expected.
- Therapist
- Let’s include that loss in the map.
The therapist notices a role change beyond family conflict.
Repair intrusive pace
Intervention: Introduce a map of important relationships
Opening line in this scene: This feels like a questionnaire about everyone.
See one possible exchange and why it helps
- Grace
- This feels like a questionnaire about everyone.
- Therapist
- I’ve moved too quickly. Which relationship would be useful to start with, and what would you prefer to leave for later?
- Grace
- My old colleagues first.
- Therapist
- Let’s begin there.
The therapist slows the relationship review and lets Grace choose to start with former colleagues, leaving other relationships for later.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Introduce a map of important relationships? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track current relationships, timing of changes, and Grace’s understanding of the inventory. Notice when questions feel intrusive or imply blame.
- Try again with one change. Check this common slip: Listing names without examining changes or support.
Try this with a partner
Connect symptoms to a current interpersonal situation
Intervention
Connect symptoms to a current interpersonal situation
Interpersonal framing offers a collaborative account of how symptoms relate to a current problem area. In IPT the common areas include grief, role disputes, role transitions, and persistent difficulty with social connection. Grace's retirement and relocation suggest a role transition: she has lost routine, familiar contacts, and part of an identity while adapting to a new life. A dispute with her sister may also matter. The therapist connects timing and experience without claiming relationships are the only cause of depression. The frame should reduce moral self-blame and guide concrete work. It remains provisional and includes assessment of biological, medical, and other contributors. A current focus is chosen together rather than forcing every story into the same category. The client can say the frame misses, and the clinician revises it.
Read the full intervention and worked examples
What you do or say
- Summarize relevant symptom and relationship timing.
- Define the possible problem area plainly.
- Connect it to Grace’s stated goals.
- Retain other contributors and care needs.
- Ask Grace which parts of the explanation match her experience and which do not.
- Agree on a focus for now and review it as you learn more.
One possible response: You changed work, daily contact, and where you live at once. That’s a major role transition.
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Earlier in the illustrated case (Sessions 1–2: map the changed roles): The inventory becomes more than a name list: Grace describes how much contact and usefulness came from work. Her sister’s care and criticism both enter the map. The therapist checks confidentiality concerns and pace.
Case outline, treatment focus, and earlier sessions
By Session 3 the inventory shows that Grace's daily contact with colleagues ended at retirement, the move changed her role in family routines, and conflict with her sister increased. Grace says she should be grateful to live near her son and concludes that depression proves she is ungrateful. The therapist can offer a different frame: several important roles changed quickly, and adaptation has been harder than expected. This does not imply the move was a mistake or that the sister caused the depression. Grace also has symptoms needing assessment and appropriate care. A tentative role-transition focus may connect her wish to feel useful with practical rebuilding of contact and routine. The clinician should check whether this account feels accurate and whether another current interpersonal issue deserves greater attention.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Name the transition
Intervention: Connect symptoms to a current interpersonal situation
Opening line in this scene: I should enjoy retirement.
See one possible exchange and why it helps
- Grace
- I should enjoy retirement.
- Therapist
- You changed work, daily contact, and where you live at once. That’s a major role transition.
- Grace
- It does feel like losing my place.
- Therapist
- We can work on grieving the old role and building the new one.
The frame offers direction without moral judgment.
Keep the dispute visible
Intervention: Connect symptoms to a current interpersonal situation
Opening line in this scene: My sister’s calls are the worst part now.
See one possible exchange and why it helps
- Grace
- My sister’s calls are the worst part now.
- Therapist
- Then the disagreement about the move may need attention alongside the transition.
- Grace
- Yes.
- Therapist
- Let’s agree what we focus on first.
The focus follows the client’s current needs.
Repair a total explanation
Intervention: Connect symptoms to a current interpersonal situation
Opening line in this scene: You make it sound like retirement caused everything.
See one possible exchange and why it helps
- Grace
- You make it sound like retirement caused everything.
- Therapist
- That’s too simple. It’s one relevant context, and we still need to assess other contributors.
- Grace
- I’m glad you said that.
- Therapist
- We can keep the frame useful without treating it as complete.
The therapist acknowledges that retirement cannot explain everything and keeps assessment of other contributors to depression in the plan.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Connect symptoms to a current interpersonal situation? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track symptom timing, losses, new demands, and the fit of the chosen problem area. Avoid turning a useful frame into a complete causal theory.
- Try again with one change. Check this common slip: Claiming interpersonal context is the only cause.
Try this with a partner
Explore one relationship in useful detail
Intervention
Explore one relationship in useful detail
The second inventory skill develops a specific relationship rather than remaining at the level of names and impressions. IPT asks what contact is like, what the person expects, what they receive, what they wish were different, and how feelings and symptoms interact with the relationship. Grace may say her sister is critical, but a concrete conversation can reveal expectations about closeness, obligation, and the move. The therapist does not decide which relative is right or infer a permanent character from one exchange. A useful account includes positive aspects and limits as well as conflict. Culture, practical constraints, and safety affect what change is feasible. The inventory supports selection of a current focus and potential sources of help. It is not a demand to disclose private history that has no relevance to the agreed treatment.
Read the full intervention and worked examples
What you do or say
- Choose a relationship relevant to the symptom timeline.
- Ask about a recent interaction.
- Explore expectations and wishes on Grace’s side.
- Ask what the other person said or did, then discuss what Grace thinks it meant.
- Identify valued aspects and needed limits.
- Connect the information to the tentative focus.
One possible response: What happened in the most recent call?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Case outline, treatment focus, and earlier sessions
At Session 2 Grace describes her sister as judgmental and says every call leaves her feeling worse. When the therapist asks about a recent call, Grace mentions that her sister helped with the move and still sends photographs from family gatherings. The relationship includes care as well as criticism. Grace wanted support for the move; her sister expected more frequent visits and feels left behind. Those different expectations need exploration rather than a verdict that one is selfish. Grace's depressed mood may make calls harder to initiate, but that does not make the sister's hurtful comments imaginary. The clinician asks what Grace values, what she wants to preserve, and what boundaries she needs. It remains one relationship in a broader map, not the whole explanation for her depression.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Make the account concrete
Intervention: Explore one relationship in useful detail
Opening line in this scene: My sister is always critical.
See one possible exchange and why it helps
- Grace
- My sister is always critical.
- Therapist
- What happened in the most recent call?
- Grace
- She said I abandoned everyone.
- Therapist
- What did you say, and what did you wish you could say?
The question moves from a global label to a usable interaction.
Hold mixed qualities
Intervention: Explore one relationship in useful detail
Opening line in this scene: She helped me move, then complained.
See one possible exchange and why it helps
- Grace
- She helped me move, then complained.
- Therapist
- There’s real help and a painful expectation attached to the move.
- Grace
- Exactly. I don’t want to lose her.
- Therapist
- We can examine what you want to keep and change.
The relationship is not reduced to a villain story.
Repair taking sides
Intervention: Explore one relationship in useful detail
Opening line in this scene: You make her sound awful.
See one possible exchange and why it helps
- Grace
- You make her sound awful.
- Therapist
- I emphasized the criticism too much. What do you value in the relationship?
- Grace
- We’ve always supported each other.
- Therapist
- That needs a place in the formulation.
The clinician corrects a one-sided account.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Explore one relationship in useful detail? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track expectations, actual exchanges, support, strain, and symptom effects. Avoid choosing a side before understanding the relationship’s mixed qualities.
- Try again with one change. Check this common slip: Turning the inventory into a judgment of relatives.
Try this with a partner
Understand an exchange and make distress speakable
Clarify the event before choosing a response
Intervention
Clarify the event before choosing a response
Clarification asks what a vague word or account means in a particular situation. “She was awful” or “I fell apart” may contain several different events, feelings, and actions. IPT needs enough detail to understand how a relationship and symptoms connect and what could change. The therapist asks about timing, actual words, intended meaning, and what followed, without cross-examining for a single correct version. Clarification also includes distinguishing what Grace knows from what she assumes. It should not invalidate the emotional reality of the event. A person can feel rejected even when another's intention is uncertain. Clearer detail supports communication analysis and a feasible next step. The clinician stops when further detail no longer serves the focus or when the pace becomes overwhelming.
Read the full intervention and worked examples
What you do or say
- Identify the phrase that needs clarification.
- Ask what it meant in behavior and time.
- Assess changes in symptoms and any concerns about Grace's immediate safety.
- Ask Grace to recall what was said when the wording matters.
- Separate what happened from Grace's explanation of the other person's intentions.
- Reflect the feeling and summarize the clarified account.
One possible response: What did shutting down look like that afternoon?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Earlier in the illustrated case (Sessions 1–2: map the changed roles): The inventory becomes more than a name list: Grace describes how much contact and usefulness came from work. Her sister’s care and criticism both enter the map. The therapist checks confidentiality concerns and pace.
Case outline, treatment focus, and earlier sessions
In Session 3 Grace says she “fell apart” after a call with her sister. The therapist could respond immediately with comfort or advice, but the phrase could mean crying, withdrawing for a day, missing meals, or something requiring urgent clinical attention. Grace says she turned off the phone, stayed in bed until late afternoon, and did not reply to her son. The clinician checks symptom and safety concerns appropriately, then asks what the sister actually said and what Grace understood it to mean. Grace heard “you abandoned us” as proof she had made a selfish decision. The sister's intention is not established by that meaning. Clarification can retain Grace's hurt while separating event, interpretation, and consequences, making later interpersonal work more precise and avoiding assumptions about the severity of “fell apart.”
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Clarify an action
Intervention: Clarify the event before choosing a response
Opening line in this scene: I shut down.
See one possible exchange and why it helps
- Grace
- I shut down.
- Therapist
- What did shutting down look like that afternoon?
- Grace
- I went to bed and ignored messages.
- Therapist
- That gives us a clearer picture.
Clarification identifies behavior without disputing feeling.
Separate words and meaning
Intervention: Clarify the event before choosing a response
Opening line in this scene: She said I abandoned them.
See one possible exchange and why it helps
- Grace
- She said I abandoned them.
- Therapist
- Those were her words. What did they mean to you?
- Grace
- That I’m selfish.
- Therapist
- The sentence became a judgment about your whole decision.
The therapist distinguishes event and interpretation.
Repair skeptical questioning
Intervention: Clarify the event before choosing a response
Opening line in this scene: You sound like you don’t believe me.
See one possible exchange and why it helps
- Grace
- You sound like you don’t believe me.
- Therapist
- My questions came across that way. I believe it hurt; I’m trying to understand what happened and what support is needed.
- Grace
- Then slow down.
- Therapist
- I will.
The repair changes pace and validates the experience.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Clarify the event before choosing a response? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track ambiguity in event, symptom, and meaning, including any need for assessment. Notice whether your clarification is supportive or sounds like disbelief.
- Try again with one change. Check this common slip: Questioning in a prosecutorial tone.
Try this with a partner
Help describe distress and ask for support
Intervention
Help describe distress and ask for support
This skill helps the person put distress and a support need into words that another person might understand. Depression can make reaching out difficult, and vague contact can leave others uncertain how to help. Grace may tell her son she is fine while hoping he notices that she is struggling. IPT examines that gap without blaming her for symptoms or assuming he can meet every need. The therapist helps distinguish description, feeling, and request: what has been happening, how it affects her, and what kind of support would be useful. The request should be specific, feasible, and safe. It is not a demand that another person provide treatment or rescue. Professional care and broader supports remain important, and the client can choose whom to approach and how much to disclose.
Read the full intervention and worked examples
What you do or say
- Ask what Grace wants another person to understand.
- Help Grace describe her symptoms and how they affect daily life.
- Identify the support desired.
- Make the request specific and realistic.
- Consider safety, privacy, and alternatives.
- Rehearse wording and review her choice.
One possible response: How could you say that and name one helpful thing?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Earlier in the illustrated case (Session 3: clarify the painful call): Grace can describe wanting acknowledgment that the move was hard for her too. The therapist reflects that need and checks whether focusing on the dispute would be useful now. Other symptom contributors remain visible.
Case outline, treatment focus, and earlier sessions
Grace says her son has not noticed how difficult mornings have become. When he asks how she is, she says she is adjusting and changes the topic to his children. She wants more contact but fears becoming a burden or implying that he should solve the depression. In Session 4 the therapist asks what she would want him to understand and what kind of help would actually fit. Grace identifies a wish for a regular short walk, not constant monitoring or advice. A clearer statement could describe low energy and isolation while making that modest request. The clinician should not assume her son is available or trustworthy simply because he is family. They consider the relationship, possible response, and other support options, while appropriate treatment and assessment continue.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
State the need
Intervention: Help describe distress and ask for support
Opening line in this scene: I want him to know I’m having a hard time.
See one possible exchange and why it helps
- Grace
- I want him to know I’m having a hard time.
- Therapist
- How could you say that and name one helpful thing?
- Grace
- I could ask for a weekly walk.
- Therapist
- That’s a clear, modest request.
The intervention makes support concrete.
Avoid rescue expectations
Intervention: Help describe distress and ask for support
Opening line in this scene: I don’t want him to fix me.
See one possible exchange and why it helps
- Grace
- I don’t want him to fix me.
- Therapist
- You can say you’re getting care and asking for company, not treatment.
- Grace
- That feels easier.
- Therapist
- Let’s find words that sound like you.
The request distinguishes social support from clinical care.
Repair an imposed contact
Intervention: Help describe distress and ask for support
Opening line in this scene: You keep saying I should tell my son everything.
See one possible exchange and why it helps
- Grace
- You keep saying I should tell my son everything.
- Therapist
- I overstepped. You choose what to share and with whom.
- Grace
- I’d rather begin with a friend.
- Therapist
- Let’s consider that relationship.
The therapist restores privacy and choice.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Help describe distress and ask for support? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track the difference between an unspoken wish and a feasible request. Notice shame, privacy, and whether the proposed recipient is appropriate and safe.
- Try again with one change. Check this common slip: Assuming close family is always safe or available.
Try this with a partner
Replay a conversation closely enough to learn from it
Intervention
Replay a conversation closely enough to learn from it
Communication analysis reviews a specific interaction in detail: what happened before it, the actual words and tone, what each response meant to the client, and what followed. IPT uses this to identify misunderstandings, unexpressed needs, and possible alternatives. The therapist does not reconstruct the other person's mind with certainty or decide who won. Grace may intend to explain her move, while her sister hears a defense; Grace may then withdraw without expressing the wish to stay close. The analysis separates intention, wording, received meaning, feeling, and consequence. It remains manageable and connected to the chosen problem area. Not every conversation needs exhaustive analysis, and unsafe relationships may call for protection rather than better wording. The goal is useful learning and a feasible next action, not proving that the client communicated badly.
Read the full intervention and worked examples
What you do or say
- Choose a relevant, bounded conversation.
- Ask what happened immediately before it.
- Ask Grace to recall the words and tone used in the conversation.
- Explore Grace’s intention and received meaning.
- Identify a possible mismatch or missing request.
- Discuss another way to respond and whether Grace wants contact with this person.
One possible response: What did you want her to understand at that moment?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Earlier in the illustrated case (Sessions 4–5: make a support request clearer): Grace makes a specific request; her son offers a different day. The therapist reinforces clarity and negotiation rather than judging success by immediate agreement. Grace begins evaluating her communication separately from another person’s response.
Case outline, treatment focus, and earlier sessions
In Session 7 Grace describes a call in which her sister said she abandoned the family. Grace remembers answering, “You never understood me anyway,” then hanging up. She felt relief for several minutes and shame for the rest of the day. The therapist asks to replay a small part, beginning just before the accusation. Grace wanted her sister to acknowledge how difficult the move had been, but her response conveyed attack rather than that need. The clinician can examine the mismatch without deciding the sister's criticism was acceptable or making Grace responsible for the entire conflict. They also distinguish what the sister actually said from what Grace inferred. A close analysis may reveal one alternative response and whether further contact is appropriate, rather than becoming another exercise in self-blame.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Identify the wording
Intervention: Replay a conversation closely enough to learn from it
Opening line in this scene: I told her she never understood me.
See one possible exchange and why it helps
- Grace
- I told her she never understood me.
- Therapist
- What did you want her to understand at that moment?
- Grace
- That the move was hard for me too.
- Therapist
- Your intention and the sentence were different.
The analysis locates a communication gap without blame.
Separate inference
Intervention: Replay a conversation closely enough to learn from it
Opening line in this scene: She wanted to punish me.
See one possible exchange and why it helps
- Grace
- She wanted to punish me.
- Therapist
- That may be how it felt. What did she actually say, and what is still uncertain?
- Grace
- She said I abandoned them.
- Therapist
- We can examine those words without claiming her entire motive.
The therapist preserves emotional meaning and uncertainty.
Repair blaming analysis
Intervention: Replay a conversation closely enough to learn from it
Opening line in this scene: You make it sound like I caused the whole fight.
See one possible exchange and why it helps
- Grace
- You make it sound like I caused the whole fight.
- Therapist
- I focused too narrowly on your reply. Her accusation and the wider dispute matter too.
- Grace
- Yes.
- Therapist
- We’re looking for your options, not assigning all responsibility.
The therapist adds the sister’s accusation and the wider dispute to the review, so Grace’s reply is not treated as the whole cause of the fight.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Replay a conversation closely enough to learn from it? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track intention, wording, tone, meaning, and consequences separately. Notice when analysis becomes blame or assumes knowledge of the absent person’s mind.
- Try again with one change. Check this common slip: Analyzing every word without a goal.
Try this with a partner
Try a different interpersonal step
Generate more than one way to communicate
Intervention
Generate more than one way to communicate
Generating communication options helps a client move beyond the feeling that there is only one possible response. IPT may compare a direct request, a boundary, a pause, written communication, or choosing not to engage, depending on the goal and relationship. Grace can want closeness with her sister and still decline insults about the move. The clinician elicits her ideas before adding options and considers likely effects, costs, and safety. A role-play can test wording in a modest fictional or clinically appropriate setting, but it does not predict the other person's actual response. The therapist avoids presenting an ideal script that the client must memorize. The best option is one Grace understands, can choose, and can realistically use. Sometimes practical support or reduced contact is more useful than another conversation.
Read the full intervention and worked examples
What you do or say
- Clarify what Grace wants from the interaction.
- Invite her possible responses first.
- Add alternatives with permission.
- Compare fit, likely effects, and safety.
- If Grace wants to try an option, practice a short version with her.
- Leave room to decline contact or revise wording.
One possible response: Could there be a smaller boundary between those choices?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Case outline, treatment focus, and earlier sessions
After reviewing the call, Grace says she sees only two choices: accept her sister's criticism or stop speaking to her forever. The therapist asks whether there are intermediate options that fit what she wants to preserve. Grace considers naming the hurt, asking for a different topic, ending a call when insults begin, or writing a short message. Each has tradeoffs, and the clinician should not insist that direct confrontation is always healthier. Grace values the relationship but is also depressed and has limited energy for repeated arguments. A small rehearsal can help her hear which words sound like her. The purpose is to expand options and support choice, not teach her to manage the sister perfectly. The relationship's history and safety remain relevant to whether any contact is advisable.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Expand choices
Intervention: Generate more than one way to communicate
Opening line in this scene: I either take it or hang up forever.
See one possible exchange and why it helps
- Grace
- I either take it or hang up forever.
- Therapist
- Could there be a smaller boundary between those choices?
- Grace
- I could say I’ll stop the call if insults continue.
- Therapist
- How would that sound in your words?
The therapist helps Grace find a boundary between tolerating insults and ending contact forever: she could end a call if the insults continue.
Consider style and context
Intervention: Generate more than one way to communicate
Opening line in this scene: Writing might be easier.
See one possible exchange and why it helps
- Grace
- Writing might be easier.
- Therapist
- What would writing help, and what might it make harder?
- Grace
- I could think first, but tone might be misunderstood.
- Therapist
- Those tradeoffs can guide your choice.
Options are compared rather than ranked automatically.
Repair scripting
Intervention: Generate more than one way to communicate
Opening line in this scene: That sentence sounds like you, not me.
See one possible exchange and why it helps
- Grace
- That sentence sounds like you, not me.
- Therapist
- I supplied a script too quickly. What would you actually say?
- Grace
- Something shorter.
- Therapist
- Let’s work with your wording.
The therapist sets aside an unsuitable script and asks for the shorter words Grace would actually use.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Generate more than one way to communicate? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track the goal, feasible options, and costs of each. Notice when your preferred communication style is being offered as the only mature choice.
- Try again with one change. Check this common slip: Treating direct confrontation as universally best.
Try this with a partner
Recognize an effective communication step
Intervention
Recognize an effective communication step
Reinforcement of effective communication makes a useful action visible so the client can understand and repeat it. In IPT this often means identifying how a clear request, direct expression of feeling, or boundary changed an interaction. The therapist does not merely praise obedience or judge success by the other person's immediate agreement. Grace can communicate effectively even if her sister responds poorly. The skill examines what was specific, understandable, and aligned with her goals, as well as what needs adjustment. Acknowledging effort can support agency during depression, when setbacks easily become proof of personal failure. The response should be grounded in the actual exchange and separate the client's action from outcomes she cannot control. Communication remains shaped by power, context, and safety, not only by individual technique.
Read the full intervention and worked examples
What you do or say
- Review the exact request or statement.
- Identify one effective feature.
- Explain why it helped the interaction.
- Identify what Grace can do and what depends on another person's response.
- Ask what Grace noticed and would keep.
- Identify one adjustment if needed.
One possible response: Your request was clear enough for him to negotiate a workable time.
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Case outline, treatment focus, and earlier sessions
Grace returns after asking her son for a weekly walk. He could not manage the day she proposed, but offered another time. She begins by saying she did it wrong because the answer was not an immediate yes. The therapist asks what she actually said and how the exchange unfolded. Grace described her difficulty, made a specific request, and accepted a realistic alternative. Those are effective communication steps even though the original plan changed. The clinician can reinforce the clarity and negotiation without exaggerating the result or suggesting the depression is solved. Later, a clear boundary with her sister may be met with anger; that response would not automatically mean the boundary was ineffective. Grace needs a more nuanced way to evaluate her own actions and consider what to try next.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Recognize clarity
Intervention: Recognize an effective communication step
Opening line in this scene: He offered Thursday instead.
See one possible exchange and why it helps
- Grace
- He offered Thursday instead.
- Therapist
- Your request was clear enough for him to negotiate a workable time.
- Grace
- I hadn’t seen it that way.
- Therapist
- What part of your wording would you keep?
Grace’s clear request allowed the other person to suggest Thursday. The therapist asks which words she would keep for another conversation.
Allow an unwelcome response
Intervention: Recognize an effective communication step
Opening line in this scene: My sister was angry anyway.
See one possible exchange and why it helps
- Grace
- My sister was angry anyway.
- Therapist
- Her anger doesn’t by itself mean your boundary was unclear. What did you say?
- Grace
- I said I wouldn’t discuss insults about the move.
- Therapist
- That was specific; now we can consider how to respond to her reaction.
The therapist separates communication from control of another person.
Repair approval-based praise
Intervention: Recognize an effective communication step
Opening line in this scene: You sound like I got a good grade.
See one possible exchange and why it helps
- Grace
- You sound like I got a good grade.
- Therapist
- I made it about my approval. I meant that your clear request helped a real conversation happen.
- Grace
- That’s more useful.
- Therapist
- What was your own assessment?
The therapist replaces praise that felt like grading with a discussion of what the request made possible, then asks Grace for her own assessment.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Recognize an effective communication step? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track the client’s observable communication and its fit with the goal. Separate a useful action from whether another person responds as hoped.
- Try again with one change. Check this common slip: Praising compliance with the therapist’s script.
Try this with a partner
Build support beyond one difficult relationship
Intervention
Build support beyond one difficult relationship
Mobilizing social support identifies and strengthens relationships or community connections that can provide useful company, practical help, or belonging. In IPT the therapist considers support in relation to the current problem area and symptoms. Grace's retirement removed ordinary daily contact, so rebuilding connection may involve former colleagues, a local group, her son, or another appropriate resource. Support is not measured only by the number of people in a network. Reliability, fit, safety, accessibility, and the kind of help needed matter. Depression can make initiating contact difficult, so steps may need to be small and supported. The clinician should not imply that loneliness proves the client failed socially or that a new group replaces treatment. Barriers such as cost, mobility, transport, culture, and discrimination need concrete attention.
Read the full intervention and worked examples
What you do or say
- Ask what kind of support Grace wants.
- Review existing and potential contacts.
- Assess reliability, safety, and accessibility.
- Choose a small client-owned step.
- Address practical barriers concretely.
- Review what happened and change the plan together if needed.
One possible response: Would replying feel useful, and what would you want to say?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Case outline, treatment focus, and earlier sessions
Grace says her sister is the only person who calls regularly, which makes reducing painful calls feel like losing her last connection. The inventory also shows a former colleague who has sent messages, her son nearby, and a library group she noticed but has not attended. These are possibilities, not guaranteed support. Grace worries about being the oldest newcomer and has little energy on mornings when depression is worse. The therapist asks what kind of contact would be useful and what barriers need addressing. She chooses replying to the colleague and considering one afternoon event, rather than committing to several activities. The clinician can help plan those small steps while monitoring symptoms and appropriate care. The point is broadening options, not replacing one difficult relationship with a cheerful social prescription.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Use an existing contact
Intervention: Build support beyond one difficult relationship
Opening line in this scene: A colleague texted last month.
See one possible exchange and why it helps
- Grace
- A colleague texted last month.
- Therapist
- Would replying feel useful, and what would you want to say?
- Grace
- I could ask for a phone catch-up.
- Therapist
- That’s a small way to reconnect.
The step begins with a real relationship.
Address a barrier
Intervention: Build support beyond one difficult relationship
Opening line in this scene: The group meets when mornings are hardest.
See one possible exchange and why it helps
- Grace
- The group meets when mornings are hardest.
- Therapist
- Then that timing may not fit. What afternoon options exist?
- Grace
- The library has one.
- Therapist
- We can explore it without assuming you must attend.
Access and symptoms shape the plan.
Repair social prescription
Intervention: Build support beyond one difficult relationship
Opening line in this scene: You make it sound like joining a group will cure depression.
See one possible exchange and why it helps
- Grace
- You make it sound like joining a group will cure depression.
- Therapist
- I overstated it. Support may help, and treatment and assessment still matter.
- Grace
- I need that distinction.
- Therapist
- We’ll keep both in view.
The therapist corrects a false promise.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Build support beyond one difficult relationship? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track quality and fit of support, access barriers, and symptom burden. Notice whether a proposed connection is genuinely wanted or merely expected.
- Try again with one change. Check this common slip: Counting contacts instead of assessing useful support.
Try this with a partner
Choose a small interpersonal action and review it
Intervention
Choose a small interpersonal action and review it
Motivating interpersonal action helps translate understanding into a chosen step that fits the client's goals and current capacity. In IPT this may mean a request, boundary, reconnection, or adaptation to a new role. The clinician explores obstacles and meaning rather than instructing Grace to be more active. Depression can impair energy, concentration, and hope; a realistic plan accounts for that instead of making action a character test. The step should be specific enough to review, with room to revise if it does not help. Rehearsal and problem-solving can increase feasibility, but the other person's response remains uncertain. Completing one action does not prove recovery, and not completing it does not prove unwillingness. Ongoing symptom assessment and appropriate care guide treatment alongside interpersonal learning.
Read the full intervention and worked examples
What you do or say
- Explain how the next step relates to the problem you agreed to work on.
- Ask whether Grace wants to take it now.
- Explore emotional and practical barriers.
- Make the action small and specific.
- Plan how to interpret varied responses.
- Review learning and adapt care or support.
One possible response: What small contact would you choose this week?
Vignette: the intervention in context
Fictional case: Grace
Case background and conceptualization
Grace is a 58-year-old recently retired teacher. Her depression began after retirement and a move to be near her son. She also has tension with her sister.
Working conceptualization
Grace’s depression began around retirement and moving nearer her son. Familiar roles, routine, and support changed, and a dispute with her sister adds strain. IPT develops an agreed interpersonal focus: how a current role transition or relationship difficulty connects with mood. This is a treatment focus, not a claim that relationships are the only cause of depression.
Earlier in the illustrated case (Session 7: analyze and expand the options): They compare a brief statement, written contact, a topic boundary, and no further conversation that day. Grace tests wording that sounds like her and rejects the therapist’s longer script. The correction improves ownership.
Case outline, treatment focus, and earlier sessions
Near Session 9 Grace has clearer words for the retirement transition and wants to reconnect with a colleague. She has drafted a message several times but worries that an unanswered text would confirm she no longer matters. The therapist explores that feared meaning and asks whether the planned step is still hers to choose. Grace decides on a short request for a call, with a plan to review what happens rather than send repeated messages. They consider a second support option so one person's availability does not carry the entire meaning of recovery. Her low-energy mornings remain clinically important and continue to be assessed. The action is a modest interpersonal experiment connected to her goal of rebuilding a role, not a test of whether she is trying hard enough.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Make it specific
Intervention: Choose a small interpersonal action and review it
Opening line in this scene: I’ll reconnect sometime.
See one possible exchange and why it helps
- Grace
- I’ll reconnect sometime.
- Therapist
- What small contact would you choose this week?
- Grace
- A text asking for a short call.
- Therapist
- When would sending it be manageable?
The plan becomes reviewable and realistic.
Prepare for uncertainty
Intervention: Choose a small interpersonal action and review it
Opening line in this scene: If she doesn’t reply, I’ll feel rejected.
See one possible exchange and why it helps
- Grace
- If she doesn’t reply, I’ll feel rejected.
- Therapist
- That feeling may arrive, and an unanswered message can have several meanings. How will you support yourself then?
- Grace
- I can discuss it here rather than send more texts.
- Therapist
- That gives the uncertainty a place.
The plan includes emotional consequences without promising a response.
Repair pressure to act
Intervention: Choose a small interpersonal action and review it
Opening line in this scene: You make it sound like I’m failing if I don’t send it.
See one possible exchange and why it helps
- Grace
- You make it sound like I’m failing if I don’t send it.
- Therapist
- I’ve made action feel like a test. We need to understand the barrier and your choice, not grade you.
- Grace
- I need a smaller step.
- Therapist
- Let’s find one or pause the plan.
The therapist acknowledges making the action feel like a test and offers a smaller step or a pause, after asking what made it difficult.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Choose a small interpersonal action and review it? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track ownership, feasibility, feared meaning, and symptoms affecting action. Review what the step taught rather than merely whether it was completed.
- Try again with one change. Check this common slip: Turning an action plan into a compliance test.
Try this with a partner
Going deeper
Optional topics for when the core ideas feel familiar. Open any that interest you.
The field today
A map of selected published perspectives, the people developing them, and questions to compare as you read.
Schools of thought
The focused depression-treatment tradition
Weissman, Markowitz, and Klerman organize IPT around current interpersonal problem areas and a time-limited treatment agreement. Symptoms are connected with relational events without assuming that relationships are the sole cause. The focus makes the work more specific than general relationship counseling.1
Attachment- and communication-oriented teaching
Stuart and Robertson give attachment and communication an explicit organizing role in their clinical guide. Trainees can compare how different IPT teachers formulate the same interpersonal difficulty and negotiate treatment. These are differing emphases within IPT, not wholly unrelated therapies.6
Developmental, trauma, and global applications
Mufson and colleagues adapt IPT for adolescents; Markowitz develops PTSD applications; Weissman and Mootz bring together international work. Adaptation changes delivery, context, or focus while making it important to specify what remains central to IPT.783
People to know
Myrna M. Weissman. IPT development, teaching, and international dissemination.1
John C. Markowitz. Clinical IPT, adaptations, and PTSD work.8
Scott Stuart. Attachment- and communication-oriented IPT teaching.6
Michael Robertson. IPT clinical formulation and application.6
Laura H. Mufson. IPT for depressed adolescents.7
Jennifer J. Mootz. International IPT applications and dissemination.3
Kristen Pollack Dorta. Developmentally adapted interpersonal treatment.7
Live debates
These questions bring the different clinical priorities above into conversation.
A medical frame and a relational account
A medical framing can reduce blame and make symptoms discussable. Some clinicians and clients prefer language that places more emphasis on meaning and social conditions; the formulation needs to connect both without insisting on a single explanatory identity.16
Focus and flexibility
An agreed interpersonal focus gives limited sessions a direction. More flexible application accommodates complex or changing circumstances, but can lose coherence if every relationship issue becomes a new treatment target.16
Interpersonal change and symptom change
The model proposes pathways from relationship changes to relief of distress. Symptoms can also alter relationships, making direction and sequence important research questions rather than assumptions settled by the formulation.5
Dissemination and treatment identity
Wider delivery can make IPT available in new communities and services. Adaptation also requires supervision, locally meaningful language, and clarity about the treatment’s core tasks so that dissemination does not become a name attached to generic support.3
What institute trainees read
A reading route into these traditions. Individual institutes set their own syllabi.
The Guide to Interpersonal Psychotherapy: Updated and Expanded Edition
The developers’ guide to IPT, including adaptations.1
Interpersonal Psychotherapy: A Clinician’s Guide, 2nd ed.
Presents an attachment- and communication-oriented account of IPT practice and adaptation.6
Interpersonal Psychotherapy for Depressed Adolescents, 2nd ed.
A developmentally adapted clinical manual; current catalog format verified, edition publication year not inferred from reprint date.7
Interpersonal Psychotherapy for Posttraumatic Stress Disorder
Study a specialist IPT adaptation and its rationale; not a peer-practice trauma-processing manual.8
Casebook of Interpersonal Psychotherapy
Follow clinical reasoning across role transitions, disputes, diverse populations, and differing treatment formats.13
Interpersonal Psychotherapy: A Global Reach
A contemporary international guide to adaptations, training, implementation, and culturally varied practice.3
Read, watch, listen
Books
The Guide to Interpersonal Psychotherapy: Updated and Expanded Edition (opens in a new tab)
The developers’ guide to IPT, including adaptations.
Paid · Purchase or library. Source details
Interpersonal Psychotherapy: A Global Reach (opens in a new tab)
A contemporary international guide to adaptations, training, implementation, and culturally varied practice.
Paid · Purchase or library. Source details
Casebook of Interpersonal Psychotherapy (opens in a new tab)
Follow clinical reasoning across role transitions, disputes, diverse populations, and differing treatment formats.
Paid · Purchase or library. Source details
Podcasts
PsychEd Episode 42: Interpersonal Psychotherapy (IPT) with Dr. Paula Ravitz (opens in a new tab)
Explains IPT’s principles, phases and clinical choices.
Free. Source details
Interpersonal Psychotherapy (IPT) (opens in a new tab)
A concise introduction to IPT’s framework and applications.
Free. Source details
Cindy Stulberg on Relationships (opens in a new tab)
Discusses IPT concepts in everyday relationships and depression.
Free. Source details
Videos
Interpersonal Psychotherapy in Practice (opens in a new tab)
Observe how symptom history, inventory, and a negotiated problem area organize clinical work.
Paid · Purchase or library. Source details
Interpersonal Psychotherapy for Older Adults With Depression (opens in a new tab)
A population-specific demonstration relevant to role and support changes later in life.
Paid · Purchase or library. Source details
Interpersonal Psychotherapy: A Case of Postpartum Depression (opens in a new tab)
A case-based demonstration of IPT’s structure and empathic clinical stance.
Paid · Purchase or library. Source details
Articles
Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis (opens in a new tab)
Surveys IPT trials across mental health conditions and comparison treatments.
Journal or institutional access. Source details
Comparative efficacy of interpersonal psychotherapy and antidepressant medication for adult depression: a systematic review and individual participant data meta-analysis (opens in a new tab)
Uses participant-level data to compare IPT and antidepressant medication for adult depression.
Free. Source details
Interpersonal Psychotherapy: Past, Present and Future (opens in a new tab)
Traces IPT’s research origins, development and dissemination.
Free. Source details
Interpersonal psychotherapy: principles and applications (opens in a new tab)
Explains the structure, interpersonal focus and applications of IPT.
Free. Source details
Mechanisms of Change in Interpersonal Therapy (IPT) (opens in a new tab)
Examines proposed interpersonal pathways of change and questions for mechanism research.
Free. Source details
More from the training institutes and publishers
Sources
Three Sides is independently produced and is not affiliated with or endorsed by the authors or publishers listed here. These publications are supporting readings; the teaching scenes and partner rehearsals were written for Three Sides. Fictional dialogue and case progress are illustrations, not study results.
Show all 27 references
The Guide to Interpersonal Psychotherapy: Updated and Expanded Edition (opens in a new tab)
The developers’ guide to IPT, including adaptations.
Interpersonal Psychotherapy: Past, Present and Future (opens in a new tab)
Traces IPT’s research origins, development and dissemination.
Interpersonal Psychotherapy: A Global Reach (opens in a new tab)
A contemporary international guide to adaptations, training, implementation, and culturally varied practice.
Key IPT Strategies (opens in a new tab)
Official summary of interpersonal inventory, problem areas, communication analysis, options, and termination.
Mechanisms of Change in Interpersonal Therapy (IPT) (opens in a new tab)
Examines proposed interpersonal pathways of change and questions for mechanism research.
Interpersonal Psychotherapy: A Clinician’s Guide, 2nd ed. (opens in a new tab)
Presents an attachment- and communication-oriented account of IPT practice and adaptation.
Interpersonal Psychotherapy for Depressed Adolescents, 2nd ed. (opens in a new tab)
Second edition originally published in 2004; paperback reprint in 2011.
A developmentally adapted clinical manual; current catalog format verified, edition publication year not inferred from reprint date.
Interpersonal Psychotherapy for Posttraumatic Stress Disorder (opens in a new tab)
Study a specialist IPT adaptation and its rationale; not a peer-practice trauma-processing manual.
Deliberate Practice in Interpersonal Psychotherapy (opens in a new tab)
A skills-rehearsal book for IPT, with exercises for partners and guidance for trainers.
Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis (opens in a new tab)
Surveys IPT trials across mental health conditions and comparison treatments.
Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial (opens in a new tab)
A landmark trial of IPT adapted to local culture and delivered in groups by trained local leaders.
A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents (opens in a new tab)
IPT adapted for adolescents (IPT-A) outperformed usual care in school-based clinics.
Casebook of Interpersonal Psychotherapy (opens in a new tab)
Follow clinical reasoning across role transitions, disputes, diverse populations, and differing treatment formats.
PsychEd Episode 42: Interpersonal Psychotherapy (IPT) with Dr. Paula Ravitz (opens in a new tab)
Explains IPT’s principles, phases and clinical choices.
Interpersonal Psychotherapy (IPT) (opens in a new tab)
A concise introduction to IPT’s framework and applications.
Cindy Stulberg on Relationships (opens in a new tab)
Discusses IPT concepts in everyday relationships and depression.
Interpersonal Psychotherapy in Practice (opens in a new tab)
Observe how symptom history, inventory, and a negotiated problem area organize clinical work.
Interpersonal Psychotherapy for Older Adults With Depression (opens in a new tab)
A population-specific demonstration relevant to role and support changes later in life.
Interpersonal Psychotherapy: A Case of Postpartum Depression (opens in a new tab)
A case-based demonstration of IPT’s structure and empathic clinical stance.
Comparative efficacy of interpersonal psychotherapy and antidepressant medication for adult depression: a systematic review and individual participant data meta-analysis (opens in a new tab)
Uses participant-level data to compare IPT and antidepressant medication for adult depression.
Interpersonal psychotherapy: principles and applications (opens in a new tab)
Explains the structure, interpersonal focus and applications of IPT.
Deliberate Practice in IPT: official sample pages (opens in a new tab)
A free official extract that includes introductory material.
Brief overview of IPT (opens in a new tab)
A short overview by a developer of IPT.
Is Exposure Necessary? A Randomized Clinical Trial of Interpersonal Psychotherapy for PTSD (opens in a new tab)
A specialist adaptation trial; keep it separate from assumptions about ordinary depression treatment or peer rehearsal.
APA Books Webinar Library: Deliberate Practice in Interpersonal Psychotherapy (opens in a new tab)
The publisher’s verified IPT webinar listing; follow the named entry in the library. Recording not played.
University of Toronto: Learn IPT course (opens in a new tab)
Browse the official collection for additional talks, interviews and training resources.
IPT Institute training (opens in a new tab)
Browse the official collection for additional talks, interviews and training resources.