Interpersonal Psychotherapy (IPT) for Eating Disorders

IPT is a time limited, collaborative, and empirically validated therapy used to treat mood disorders and eating disorders. It focuses on the way that common life events that include:

• Loss 
• Change
• Conflict in relationships

Relationships difficulties are viewed as contributing to mental health difficulties (such as eating disorder symptoms), which in turn contribute to relationship difficulties. Essentially it sees the eating disorder (ED) as primarily a coping strategy for dealing with relationship difficulties, loneliness, loss, stress of change etc.

The goal of IPT is to reduce ED symptoms by improving social functioning. It uses skills and strategies to help clients to:

• Repair or build supports
• Improve communication
• Resolve relationship difficulties
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The Development of Interpersonal Psychotherapy

Interpersonal Psychotherapy was first published in 1984 and is based on three theories:

1. Adolf Meyer’s 1957 theory that behaviours associated with mental illness can be viewed as coping strategies for difficulties with relationships
2. Harry Stack Sullivan’s 1953 theory that peoples coping strategies tend to be long-term patterns that manifest significant relationships
3. John Bowlby’s 1982 theory that early attachment plays an important role on subsequent relationships and mental health

Interpersonal Psychotherapy Perspective on Eating Disorders and Mood Disorders

IPT proposes: 

• That the development and maintenance of eating disorders and mood disorders occurs in a social context
• Both the maintenance of the ED and the response to treatment are influenced by the relationships between the individual and their significant others
• The eating difficulties/mood disorder can be shifted by identifying and altering relationship difficulties

IPT views self-harm, suicidaility, alcohol and drug dependence, all through the same lense - a coping strategy that both results from relationship difficulties and contributes to relationship difficulties. 

In contrast to Cognitive Behaviour Therapy (CBT), it is not trying to create change through challenging distressing thoughts and shifting symptomatic behaviours, but through improving the quality of significant relationships.

IPT categories life difficulties in to four problem areas in relationships:

1. Role Transitions - changes that occur moving from one social role to the next eg. moving from high school to university
2. Role Disputes - situations in which an individual and at least one significant other have nonreciprocal expectations about the relationship eg. an adolescent child developing identity separate to that of their parents, increasing their autonomy, and becoming body aware
3. Grief - loss of a loved one or loss of something else significant eg. going from able-bodied to disabled, or developing a chronic illness (and therefore going through a role transition)
4. Interpersonal Deficits - social isolation, chronically unfulfillning relationships, difficulties forming meaningful relationships, or difficulties having sustained long-lasting relationships
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Interpersonal Psychotherapy Structure

IPT is a structured, manualised treatment that has three phases.

1. Initial/assessment phase
2. Intermediate phase
3. Conclusion and maintenance phase

Phase one includes:

• Assessment and diagnosis
• Psychoeducation around the eating disorder
• Acknowledgment that eating disorders are a sickness and are serious - they are not the client’s fault and take alot of work and effort to change
• Work on the client-therapist relationship
• Developing the interpersonal inventory (see below)
• Establish problem area
• Therapist discusses with the client the importance of engagement and reassures them recovery is possible

The Interpersonal Inventory can occur over multiple sessions and is a key ingredient in IPT. It is a timeline of events (both positive and negative) and in particular is interested in looking at times when the eating disorder symptoms were better or worse, and what was happening socially/relationally for the client at that time. 

In a nutshell, it explores the connection between interpersonal difficulties, trauma, and stressful life events, with the onset and maintenance of the eating disorder.

Phase two takes up the majority of the sessions, and is a practical, goal oriented phase, where each week the therapist discusses with the client how skilful and satisfied they feel in their significant relationships and social groups.

Rather than focusing on eating disorder symptoms, the focus is heavily on social and relational satisfaction, and how this exacerbates or minimises ED symptoms. 

Phase two will often include:

• Goal setting
• Identifying dissatisfaction in relationships
• Skills to make and maintain friendships
• Skills to improve relationships
• Skills to cope with or reduce loneliness
• Work around accepting and tolerating difficult emotions
• Identifying ways in which ED symptoms are connected to interpersonal difficulties 

During phase two the client is expected and encouraged to actively work on goals between sessions.

In phase three the therapist and client review the course of treatment, identify treatment gains, and future treatment needs. The next steps may be:

• Finishing therapy
• Maintenance treatment at reduced frequency
• Moving to a new treatment model 

The IPT perspective is that if the ED symptoms haven’t significantly reduced, the treatment is to blame and not the client. The therapist may recommend alternative therapies, or may also identify interpersonal issues that have not been adequately addressed.

Strengths and Limitations

Strengths

• Time-limited
• If IPT works as intended, then it can result in better relationships and improved social skills. This improves the clients quality of life in ways other than just reducing their ED symptoms 
• It is evidence based
• Is less complex than other therapies. IPT doesn’t involve trying to change thought patterns or distorted thinking – like cognitive behavioural therapy attempts to do. Instead, IPT adopts a less complex approach, and focuses on changing relationship patterns. For many people, this can be the driver behind their mental health problems
• Is an approved treatment for Bulimia Nervosa (BN) and Binge Eating Disorder (BED) under Medicare’s Eating Disorder Plan (EDP)

Limitations 

• IPT is purely focused on the present-day. While discussions about past relationship struggles will take place, the focus is very much on the “here and now”. While this won’t matter for some people, this is generally not a good for individuals with trauma
• It requires active commitment. In order for IPT to truly work, a person needs to actively commit to the therapy, and be ready to put into practice what they learn. The problem is, that when someone is feeling very low, it can be difficult to commit to something like this.
• It is not suited to severe and complex presentations, and tends to be more helpful for mild to moderate symptoms
• The shorter timeline tends to not be a good fit for individuals with chronic conditions
• It not an approved treatment for Anorexia Nervosa (AN) or Otherwise Specified Feeding and Eating Disorder (OSFED) under Medicare’s EDP