Interpersonal Therapy (IPT): The Four Problem Areas
Interpersonal therapy, usually shortened to IPT, is a time-limited treatment for depression that works on the relationships around an episode rather than on the thoughts inside it. This guide covers the four problem areas Klerman and Weissman named, the interpersonal inventory that opens the work, the session structure, and what the trials show.
Reviewed byMichael Callans, MSWThe four problem areas
Grief
A death that has not been fully mourned, where avoiding the loss has kept the mood low. The work is to go through the mourning that was postponed and then rebuild interests and relationships around the gap. Not the same as ordinary bereavement, which does not need treatment.
Role disputes
An open fight or a long silence with someone over what each of you owes the other: a partner, a parent, a manager, an adult sibling. The work is to see the dispute clearly, decide whether to renegotiate it or accept an impasse, and change how you communicate inside it.
Role transitions
A change in who you are in the world: a job, a move, a divorce, a diagnosis, retirement, a new baby, leaving a long role behind. The work is to mourn what the old role gave you, name what the new one actually demands, and build the skills and contacts it needs.
Interpersonal deficits
Also called interpersonal sensitivity: a thin network, few close ties, and loneliness as the main complaint rather than a specific conflict. The slowest of the four to shift. The work is on initiating and sustaining contact, usually starting with one relationship that already half exists.
Fill in your interpersonal inventory
- List every person who matters to your week, good or bad: household, family, close friends, colleagues, anyone you see or avoid regularly. Aim for six to twelve names, not a full address book.
- Beside each name write how often you are actually in contact, and whether that is more or less than you want.
- For each one, write one sentence on what you get from the relationship and one on what you give. Where a column stays empty, note that too.
- Mark anything unsaid: a resentment, a request, a piece of news, an apology. One line each, in the plainest words you can manage.
- Note what changed in each relationship around the time your mood dropped. A loss, a new role, a fight, a drift, or nothing at all.
- Read the sheet back and circle the one relationship you would most want different in three months. Then match it to a problem area above: grief, dispute, transition, or thin network. That is your focus, and one is the right number.
Key terms in IPT
The three phases of a course
A standard course is 12 to 16 weekly sessions, and the shape is fixed enough that you can tell where you are in it. The opening phase, usually around three sessions, covers symptom history, an explanation of depression as a treatable condition, the interpersonal inventory, and an agreed formulation linking your mood to one problem area. The middle phase is the bulk of the course and stays on that focus, using communication analysis, decision analysis, role play and direct attention to feelings that keep getting managed rather than voiced. The closing phase, commonly the last two sessions, reviews what changed, treats the end of the therapy as its own transition, and makes a plan for a return of symptoms. The WHO group version compresses this into eight group sessions. Some brief individual protocols run to eight sessions as well, and the 12 to 16 figure is the classic form rather than a rule.
What an IPT therapist does in session
- Opens with how your mood has been since the last session, and links any change to what happened with people that week.
- Keeps the conversation on the agreed problem area rather than following whatever is loudest.
- Asks for one specific episode in detail rather than a general account: what was said, in what tone, what you felt, what you did not say.
- Treats suppressed feeling as useful material, and will slow down to let it arrive rather than moving to a solution.
- Rehearses the real conversation with you, then asks next week how it actually went.
- Watches the clock on the course as a whole, and will name out loud how many sessions are left.
What the evidence shows
IPT has one of the better evidence bases in psychotherapy. The reference point is the 2011 meta-analysis by Cuijpers and colleagues in the American Journal of Psychiatry: across 16 studies comparing IPT with a control condition, the pooled effect size was 0.63, corresponding to a number needed to treat of about three. Across ten studies comparing IPT with other psychological treatments, the difference was 0.04, which is to say none. The authors also found that adding IPT to medication did not clearly beat medication alone in the acute comparisons (effect size 0.16, not significant), while in the maintenance comparisons adding IPT to medication did reduce recurrence, and they concluded that IPT has earned its place in treatment guidelines. Two honest caveats. First, a treatment that matches cognitive behavioral therapy rather than beating it means the choice between them is about fit and availability, not about one being better. Second, most of the trial evidence is in depression; the adaptations to other conditions have thinner support and should be described that way.
What IPT is not
It is not couples therapy. The other person usually never comes, and nothing in the method requires them to change; the work is on what you do inside the relationship. It is not an exploration of early life either. History appears only where it explains a current pattern, and a therapist who spends the course in your past is not running IPT. It is not open-ended: the time limit is a working part of the treatment, and extending it indefinitely removes some of what makes it work. And it is not the first move when depression is severe enough to need medication or closer care, when the presenting problem is obsessive-compulsive disorder or psychosis, or when there is genuinely no interpersonal thread to pull. Fewer therapists are trained in it than in cognitive behavioral therapy, so ask about training directly: a full course, supervision, and which problem areas they work in most.
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About this tool
Interpersonal therapy, almost always called IPT, is a short, structured treatment for depression that works on what is happening between you and the people around you. It was built in the 1970s by the psychiatrist Gerald Klerman and the epidemiologist Myrna Weissman, initially as the defined psychotherapy arm of a drug trial, and set out as a manual in 1984 with Bruce Rounsaville and Eve Chevron. Its premise is narrow on purpose: whatever caused a depressive episode, the episode is happening in a web of relationships, and changing something in that web is a reliable way to lift mood.
The theory behind it borrows from three places. Adolf Meyer's psychobiology placed illness in a person's social setting rather than in the person alone. Harry Stack Sullivan argued that personality is formed and maintained in relationships, not inside one head. John Bowlby's attachment work supplied the mechanism by which the loss or disruption of a close bond destabilizes mood. IPT does not ask you to accept any of that as doctrine. The manual is deliberately atheoretical in session: a therapist works on the relationship in front of you without needing to agree about where the pattern originally came from.
An IPT therapist does something many treatments skip: name the depression as a medical condition that is treatable and not a character defect, and grant what Klerman and Weissman called the sick role, a temporary permission to be unwell while treatment runs. This is practical rather than sentimental. People in a depressive episode usually blame themselves for the slowdown, which adds a second problem on top of the first. Separating the person from the illness makes room for the actual work, which is on one specific interpersonal problem rather than on everything at once.
That work goes into one of four problem areas. Grief covers a death that has not been fully mourned, where the loss and the mood are tangled together. Interpersonal role disputes cover an open or silent conflict with someone over what each person owes the other: a partner, a parent, a manager. Role transitions cover a change in who you are in the world, including a new job, a divorce, a move, a diagnosis, retirement, or becoming a parent. Interpersonal deficits, often now called interpersonal sensitivity, cover a thin or absent network where loneliness is the main feature.
Read the diagram as text
A mood line runs across the top in neutral ink and dips in the middle. Below it one person is joined by four links to four other positions, one for each problem area: a link with a visible break and a dashed figure at the end, a link with two chevrons facing each other, a link crossing a dashed divider, and a thin dashed link to an empty dashed outline. The broken link is drawn in brand and carries a brand ring: it is the one the course of therapy takes as its focus. A dashed path rises from that ring toward the dip in the mood line and is crossed out, since the mood is not what gets argued with. On the phone canvas the four links stack and the crossed path leaves to the right.
One link, chosen out of four, carries the work
Conceptual route, not counts
The episode: Mood drops, and it drops inside a web of relationships rather than on its own
The interpersonal inventory: A systematic walk through the significant relationships, and what changed in them around the time the mood dropped
One problem area: Grief, an interpersonal role dispute, a role transition, or interpersonal sensitivity where the network is thin
The work on that link: Communication analysis of a specific exchange, decision analysis, rehearsal of a hard conversation
The mood itself: Treated as a medical condition and not a character defect, which is what the sick role is for, rather than as the thing to be argued with
Mood follows the relationship: The premise of the method: change something in the web and mood lifts with it
The episode → opens with → The interpersonal inventory
The interpersonal inventory → makes the focus obvious → One problem area
One problem area → goes to the people link → The work on that link
The episode → aimed at the mood alone, bypassing the link → The mood itself (error transition)
The work on that link → and then → Mood follows the relationship
The focus is chosen in the first few sessions using the interpersonal inventory, which is simply a systematic walk through your significant relationships, current and past. For each one, a therapist asks how often you see the person, what you give and get, what you want more or less of, what has gone unsaid, and how the relationship changed around the time your mood dropped. Done properly it takes most of two sessions and usually makes the focus obvious. The sheet lower down this page is our own simplified version of that interview, written so you can do a first pass alone.
IPT runs to a schedule. A standard course is 12 to 16 weekly sessions in three phases: an opening phase of roughly three sessions for history, psychoeducation and the inventory; a middle phase that works the chosen problem area; and two closing sessions that treat the ending of therapy as its own role transition and plan for what happens if symptoms return. Techniques inside sessions are concrete: communication analysis, where you reconstruct a specific exchange line by line to find where it went wrong; decision analysis, where you lay out options and consequences; role play to rehearse a hard conversation; and direct encouragement of feelings people have been suppressing to keep the peace.
The evidence is strong for depression. The 2011 meta-analysis by Pim Cuijpers and colleagues in the American Journal of Psychiatry pooled 16 studies comparing IPT with a control condition and found an effect size of 0.63, a number needed to treat of about three. Ten studies comparing IPT with other psychological treatments found no meaningful difference, an effect size of 0.04. The authors concluded that IPT deserves its place in treatment guidelines as one of the most empirically validated treatments for depression. In plain terms: it works, and it works about as well as the alternatives rather than better than them.
IPT also travels unusually well, which is part of why global mental health programs use it. In 2016 the World Health Organization, with Columbia University, published a field-trial manual for Group Interpersonal Therapy for depression: eight group sessions, written to be delivered by supervised facilitators without previous mental health training, as part of its series on low-intensity psychological interventions. The group version keeps the four problem areas and the time limit and drops most of the individual history taking. Adaptations of the individual version exist for perinatal depression, for persistent depressive disorder, for bulimia, and, as interpersonal and social rhythm therapy, for bipolar disorder.
Two things IPT is not. It is not couples or family therapy: the other person usually never attends, and the work is on what you do inside the relationship rather than on the relationship as a joint project. It is not an exploration of your early life either; history comes up only to explain a current pattern. It is a weaker fit when nothing interpersonal is identifiable, when the problem is obsessive-compulsive disorder or psychosis, or when symptoms are severe enough that medication or more intensive care comes first. Availability is the other practical limit: fewer therapists are trained in IPT than in cognitive behavioral therapy, so it is worth asking directly rather than assuming.
References
- Klerman GL, Weissman MM, Rounsaville BJ, Chevron ES. Interpersonal Psychotherapy of Depression. New York: Basic Books; 1984.
- Weissman MM, Markowitz JC, Klerman GL. The Guide to Interpersonal Psychotherapy. Updated and expanded ed. New York: Oxford University Press; 2018.
- Cuijpers P, Geraedts AS, van Oppen P, Andersson G, Markowitz JC, van Straten A. Interpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry. 2011;168(6):581-592. doi:10.1176/appi.ajp.2010.10101411
- Markowitz JC, Weissman MM. Interpersonal psychotherapy: past, present and future. Clin Psychol Psychother. 2012;19(2):99-105. doi:10.1002/cpp.1774
- World Health Organization, Columbia University. Group Interpersonal Therapy (IPT) for Depression. WHO generic field-trial version 1.0. Geneva: World Health Organization; 2016. https://www.who.int/publications/i/item/group-interpersonal-therapy-for-depression
Cite this source
Psychology.com. (2026, November 6). Interpersonal Therapy (IPT). Psychology.com. https://psychology.com/tools/interpersonal-therapy
Interpersonal Therapy (IPT) FAQ
What is interpersonal therapy?
Interpersonal therapy, or IPT, is a short structured treatment developed for depression that works on your relationships rather than on your thought patterns. A therapist first maps the people in your life, then picks one area to work in: unresolved grief, a conflict over what you and someone else owe each other, a change in your role in the world, or a network too thin to support you. A standard course runs 12 to 16 weekly sessions in three phases, and it ends on a planned date. The idea is that mood and relationships move together, so shifting one shifts the other.
What are the four problem areas in IPT?
Grief: a death that has not been fully mourned, where avoiding the loss has kept the mood down. Role disputes: an open argument or a long silence with someone about what each of you owes the other. Role transitions: a change in who you are, such as a new job, a divorce, a diagnosis, retirement or a new baby, where the old role has to be mourned and the new one learned. Interpersonal deficits, sometimes called interpersonal sensitivity: few close ties, with loneliness rather than conflict as the main complaint. A course works in one area, or at most two.
How long does interpersonal therapy take?
The classic course is 12 to 16 weekly sessions, split into three phases: roughly three sessions to take a history and build the interpersonal inventory, a middle phase working the chosen problem area, and two final sessions that review gains and plan for a return of symptoms. The end date is set early and the therapist refers to it out loud, because the time limit is considered part of how the treatment works. Shorter versions exist: the World Health Organization group manual runs to eight sessions, and brief individual protocols of around eight sessions have also been tested.
Is IPT as effective as CBT for depression?
On the available evidence, yes, roughly. The 2011 meta-analysis by Cuijpers and colleagues pooled ten studies that compared interpersonal therapy with other psychological treatments, most of them cognitive behavioral, and found an effect size of 0.04, meaning no meaningful difference. Against control conditions, across 16 studies, the effect size was 0.63, which translates to a number needed to treat of about three. So the honest answer is that both work and the choice between them is about fit and availability rather than superiority. IPT may appeal more if your depression is clearly tangled with a loss, a conflict, or a change in role.
What happens in an IPT session?
Sessions open with how your mood has been since the last one and what happened with people in between. The therapist keeps the conversation on the one agreed problem area and asks for specific episodes rather than summaries: what exactly was said, in what tone, what you felt, what you left out. From there the work is concrete. You might reconstruct a conversation to find where it went wrong, lay out the real options in a stalled decision, rehearse a hard conversation with the therapist playing the other part, or simply slow down enough to feel something that keeps getting managed away. Homework is usually a real conversation, not a worksheet.
Is interpersonal therapy the same as couples therapy?
No. In interpersonal therapy the other person usually never attends, and nothing in the method depends on them changing. The work is on what you do inside the relationship: what you ask for, what you avoid saying, how you handle a dispute, what you expect without stating it. Couples therapy treats the relationship itself as the client and needs both people in the room. The two can be complementary, and a therapist may suggest couples work alongside or after an IPT course if the dispute clearly needs both parties, but they are different treatments with different training behind them.
How do I find an IPT therapist?
Ask directly, because interpersonal therapy is less widely offered than cognitive behavioral therapy and some directories list it loosely. Useful questions: did you complete a full IPT training with supervision, how many courses have you run, and which problem areas do you work in most. National IPT societies maintain practitioner lists in several countries, and some health services offer it inside their depression pathways. Bringing a filled interpersonal inventory to a first appointment is a reasonable way to start the conversation, whichever therapy you end up with, since the same information is useful to almost any therapist.