IPT Background Influences Adolf Meyer Swiss trained psychiatrist, practical pragmatic approach, move...

IPT Background Influences

Adolf Meyer

• Swiss trained psychiatrist, practical pragmatic approach, move away from abstraction.

• Famous for the psychobiological life history approach, developed the LIFE CHART father of modern life events research. LIFE SPAN APPROACH.

• Sets the scene for a genuine integration of the biological, the psychological and the social.

Background Influences

Harry Stack Sullivan

Founder of the Interpersonal School of Psychoanalysis. Emphasised importance of social and cultural context.

Use of basic language, emphasised the drive for

attachment, sceptical of too much emphasis on unconscious processes. Real experience more important.


Harry Stack Sullivan

Therapist should adopt the role of expert. As this would inspire confidence and motivate the patient to continue with therapy.

Sullivan saw the therapeutic relationship as a real relationship with some reciprocal elements. Not a blank screen.


• Sullivan’s view was that anxiety does not stem from the frustration of biological need but is introduced through interaction with the care giver.

• Early on the child learns what type of interaction produces a positive response as oppose to an anxiety producing response in close relating with a care giver.


• Sullivan used the term parataxic distortion to describe how new relational experiences will always repeat the relational patterns of the past.


Sullivan identified two competing needs a person has in interpersonal relationships through the life course:

1.The need for satisfaction2. The need for securityThe relative balance between these needs is a

key factor in determining emotional Health


John Bowlby

Founder of attachment theoryMove away from stage theories of

development, many recent developments regarding implications for therapy examining attachment patterns and their potential for change even in adult life.


• Attachment theory can be seen to bring Object relations, internal working models of relating into main stream psychology and research in psychotherapy .

• Attachment styles inform our understanding of relating through out life.

Principles of Attachment Theory

• Relationship is primary need

• Attachment is a biological drive

• Attachment is dyadic

Definition of Attachment

• “The propensity of human beings to make strong affectional bonds to particular others” throughout the life-cycle (Bowlby, 1977)

• “It is a primary motivational system with its own workings and interface with other motivational systems” (Bowlby, 1973)

The Role of Relationships

• “Not only young children.., but human beings of all ages are found to be at their happiest and to be able to deploy their talents to best advantage when they are confident that, standing behind them, there are one or more trusted persons who will come to their aid should difficulties arise.”(Bowlby, 1973:359)

Patterns of Attachment in Adults

• Secure

• Insecure Dismissing

• Insecure Preoccupied

• Unresolved

Adult Psychopathology in Secure Attachment

• Secure Attachment Associated With: Lower anxiety & hostility, greater ego resilience, greater ability to regulate affect through interpersonal relatedness; relationships are relatively unambivalent

• In therapy: Favourable outcomes (good response to brief interventions & strong therapeutic alliance); linked to ability to reflect on mental states of both others and self & metacognitive monitoring

Features of Secure Attachment

• Coherent, collaborative discourse

• Values attachment relationships

• Objective regarding relationships and events

• Description of attachment-related experiences is consistent, whether favourable or unfavourable

Adult Psychopathology in Insecure Attachment

• Insecure Attachment Associated with: more depression, anxiety, hostility, psychosomatic illness: less ego resilience, perceived levels of interpersonal support

• In therapy: initial anxiety in response to making changes leads to resistance. Work needs to address alterations in attentional, emotional & relational patterning. Use of the therapeutic relationship

Features of Insecure-Dismissing Attachment

– Dismissing of attachment–related experiences and relationships

– Normalising of early unsupportive relationships

– Description of attachment related experiences very brief

Features of Insecure-Preoccupied Attachment

• Not coherent discourse

• Preoccupied by or with past attachment relationships or experiences.

• Description of attachment experiences long, entangled

Features of Unresolved Attachment

During discussion of loss or abuse individual shows striking lapses in the monitoring of reason or discourse, eg that someone dead is alive

Adult Psychopathology in Insecure Attachment

• Insecure Attachment Associated with: more depression, anxiety, hostility, psychosomatic illness: less ego resilience, perceived levels of interpersonal support

• In therapy: initial anxiety in response to making changes leads to resistance. Work needs to address alterations in attentional, emotional & relational patterning. Use of the therapeutic relationship

Adult Psychopathology in Insecure (Unresolved) Attachment

• Unresolved attachment associated with: intense and unstable relationships, identity disturbance and other features of BPD

• In therapy: 16 session IPT unlikely to be effective because identity disturbance militates against short-term interventions. However there is a modification of IPT for BPD.

The Secure Base (SB) Phenomena

• Initially SB is care-giver to whom the child turns when distressed.

• Infants & young children experience SB behaviourally; at times of threat or illness infant turns to caregiver/s. Their protection ensures the child’s survival.

The Secure Base Phenomenain Adults

• In adulthood SB is internalised and experienced as a representation within the individual’s mind.

• Under stress individuals regulate affect by self-soothing (using the

representation) and/or make contact with attachment figures

• Psychological survival impossible without an SB. SB exists within both secure and insecure attachment style.

• The relationship with a therapist provides the opportunity for a new SB representation.

IPT and Neurological Change

• IPT emphasises importance of a positive therapeutic alliance and of interpersonal relationships. Positive and attuned interpersonal / therapeutic relationships enhance neural plasticity and learning.

• IPT encourages the expression of affect in the context of cognitive appraisal. Optimal levels of emotion and stress stimulate production of neuro-transmitters and neural growth hormones, enhancing learning and cortical reorganisation.


• There is also a third type of life event that is referred to in the literature:

• History graded events – these are events that a whole cohort or community experiences. Examples would be the Great Depression, World War 2, 9/ 11 , the current recession. Consider age of patient when event experienced and social context.


Two Main types of life events we are interested in.

• Normative or transition events that characterise the life course.

• Non Normative events that are usually unexpected are always stressful and upsetting they involve long tern threat to the individual.


• Social approach, especially the role of LIFE EVENTS and CHRONIC STRESSORS to cause and exacerbate mental health problems.

• See the work of George Brown and Tirrel Harris, Michael Rutter, Jean Paykel and many others important in 1970’s and 80’s

Research developments on the link between life events and illness are relevant to IPT.

• Severe events and chronic difficulties often precede the onset of depression.

• These stressors also impede recovery.

• Stressors are often interpersonal in nature.

• Events that disrupt key social roles are particularly important.

• A confiding relationship, particularly with a partner, reduces the vulnerability to depression when severe stressors occur.

• Lack of a confiding relationship with a partner is associated with an increase in the occurrence of the type of events that are known to precede depression.


• We can’t usually prevent stressors in the form of life events and chronic difficulties form occurring .

• Social support protects against stressors IPT aims to intervene by improving social support.


• Rutter demonstrated that a child’s relationship with others beside the Mother can also create attachment bonds and the disruption of these bonds can contribute to the onset of depression.

• This supports IPT’s focus on the importance of the wider network and relationships with close others in a broader sense.


• Rutter also demonstrated that forming positive, supportive relationships with peers and others at school and work can be protective particularly for those at risk as a result of early adversity . One way they can protect is to help the individual make positive choices and effectively plan important transitions such as co-habitation and marriage

Rutter also showed that: • Events are less important than the chronic stressors or difficulty to which they give rise. It is the lack of care or chronic discord that follows events such as the loss of a parent that is more likely to lead to later problems. Most of these chronic stressors concern poor social relationships in the individual’s immediate social network.



• The literature on the impact of social support on mental health is vast and complex but also very useful for IPT.

• IPT is all about understanding and using the client’s network and the potential for support within it to promote better mental health.


Robert Weiss, Scott Henderson , Cohen and Wills

• Understanding of the role of SOCIAL SUPPORT in mental health, especially its protective function in the face of adversity (conceptualised as life events and chronic difficulties.)

What can we take from the literature on social support? Social support needs to be assessed across a range of life domains that are important to the individual e.g. family, friends, work, other interests, neighbours, school/college, church etc. What these domains are will be influenced by the individual.

Types of social support are effected by wider social factors such as sex, class and culture.

Social support assessment needs to include both:• availability • adequacy.

•The perceived adequacy of support is a better predictor of mental health than availability.

•What type of network?

•There is some evidence that diffuse networks are more protective than dense networks.

• Reciprocity is important.

• Social support can be both negative and positive.

• Social support is influenced by personality. To what extent can individuals make use of the support that is offered?

SUPPORT FUNCTIONS

• EMOTIONAL SUPPORT Provides reassurance about a person’s worth. Linked to concept of unconditional positive regard. Synonymous with confiding. Usually provided by close relationships of long standing.

• INSTRUMENTAL SUPPORT The provision of direct assistance or practical help.

• SOCIAL COMPANIONSHIP Being in the company of known others while engaging in activities - often for pleasure or leisure.

• MOTIVATIONAL SUPPORT (Wills 1985) Consistently helps to maintain hope in chronically difficult circumstances. Helps to sustain a belief in a chosen course of action (plan).


A more recent article on the importance of social factors so topical in the 1980’s.• Entitled “Slings and arrows: Depression and Life

Events” Even in an age of genomics, neuro imaging and Prozac, our understanding of emotional disorders continues to involve the ups and downs of everyday experience. That’s what IPT’s about. (Oatley, 2007)

IPT Background Influences Adolf Meyer Swiss trained psychiatrist, practical pragmatic approach, move...

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