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INSTITUTE FOR INTERPERSONAL PSYCHOTHERAPY Intensive 2 -Day Training Institute Dr. Ron Frey C. Psych. Consulting Clinical and Organizational Psychologist Cindy Goodman Stulberg, Dip.C.S.,C.Psych. Psychologist Info@ipt-institute.com www.interpersonalpsychotherapy.com

Faculty/Presenter Disclosure In compliance with the Conflict of Interest policies, we have no financial relationships and no in-kind support with the products or services described, reviewed, evaluated or compared in this presentation. There are no potential conflicts of interests and no disclosures. Finally, there are no circumstances of potential bias in this training program.

Overview of Interpersonal Psychotherapy • Gerald L. Klerman, M.D., Myrna Weissman, Ph.D. • The social context of mental health • Attachment and interpersonal theory • Influences of Adolf Meyer and Harry Stack Sullivan 
 • Depression research and how it shaped the IPT model

Development of IPT Drs. Klerman and Weissman, psychiatrist and psychologist, husband and wife developed IPT in the 1960’s. Research into e ffi cacy of SSRI’s for depression prompted them to ask about the e ffi cacy of psychotherapy. The concept of researching therapy was unheard of at that time. They sought to articulate what was being commonly delivered by clinicians as supportive psychotherapy for depression. From that point they also incorporated interpersonal theory of Adolf Meyer and Harry Stack Sullivan and research that demonstrated life events significantly impacting the development and sustaining impact on depression (eg. death of a loved one, loss of job, divorce, etc.) In the United States, third party insurers paying for therapy were limiting the number of sessions provided and were also wanting to see indicators of e ffi cacy. It was these factors that impacted the development of manualized therapy that could be taught, researched and discussed amongst clinicians. Video: the Harlow Experiments

“The field of psychiatry is the field of interpersonal relations, under any and all circumstances in which these relations exist…a personality can never be isolated from the complex of interpersonal relations in which the person lives and has his being.” Harry Stack Sullivan, Concepts of Modern Psychiatry Before the understanding of how the external world affected mental health, the emphasis was on intrapsychic functioning. Common thinking was there must be something wrong with you, inside your head, a more biologic, personal failing, illness, problem. There was a big shift from assuming one was “crazy” to understanding the impact of trauma, abuse, systemic factors, cultural norms, racism, patriarchy, poverty, financial factors, etc., etc. Factors that we take for granted now a days as impacting mental health functioning.

Original Intent of IPT “Our intent was not to develop a new psychotherapy but to describe what we believed was reasonable and current practice with depressed patients and might be considered for inclusion under the rubric of short-term supportive psychotherapy” Klerman & Weissman, 1993 Klerman and Weissman did not set out to develop a new therapy. Research was being done to evaluate the efficacy of SSRI’s. In addition, the question of evaluating the efficacy of psychotherapy was raised. Evaluating psychotherapy had not been done before. By creating a manual for therapy, it could be taught, researched, and discussed in a formalized manner.

Depression in Society (Government of Canada, 2020) • Depressions are among the most common mental disorders - and the most treatable 
 • Affects people of all ages, education, income levels, and cultures. 
 • About 11% of men and 16% of women in Canada will experience major depression in the course of their lives • Almost one in 8 adults (12.6%) identified symptoms that met the criteria for a mood disorder at some point during their lifetime, including 11.3% for depression and 2.6% for bipolar disorder 


Depression is a common illness worldwide, with more than 264 million people affected. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Close to 800 000 people die due to suicide every year. Suicide is a leading cause of death in 15-29-year-olds. Although there are known, effective treatments for mental disorders, between 76% and 85% of people in low- and middle-income countries receive no treatment for their disorder. Barriers to effective care include a lack of resources, lack of trained health- care providers and social stigma associated with mental disorders. Another barrier to effective care is inaccurate assessment. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants. Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself. There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa. Source, World Health Organization, 2020

DIAGNOSIS OF DEPRESSION DSM-V Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition. 1. Depressed most of the day, nearly every day as indicated by subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful) 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observation) 3. Significant weight loss when not dieting or weight gain (e.g., change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day 4. Insomnia or hypersomnia nearly every day 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 6. Fatigue or loss of energy nearly every day 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide (cont’d)

Symptoms of Depression (continued) \ The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The episode is not attributable to the physiological effects of a substance or to another medical condition. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. There has never been a manic episode or a hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.

DSM-V Criteria Changes DSM-V Criteria Changes DSM-V removed what was known as the bereavement exclusion for major depressive episodes. Rather a footnote assists clinicians to distinguish between normal grief and a major depressive episode. DSM-V added premenstrual dysphoric disorder (PMDD), a severe form of PMS which is characterized by strong emotional symptoms such as depression, anxiety, moodiness and irritability. “The Famous Five in ’29” - does a “Person” include a woman? 15