The interpersonal therapy (IPT) is a brief therapy developed in the late 70’s and operationalized by G. Klerman and his collaborators. IPT has been validated and recognized internationally as a treatment for depression. Although Bowlby’s attachment theory is one of the theoretical foundations of the IPT, it has been under-exploited in clinical practice. In an article published in Annales Medico-Psychologiques in 2015, and titled “Interpersonal Therapy based on Attachment Theory: From Kerman to Bowlby” the psychologists Mélanie Bay-Smadja et Hassan Rahiaoui assert that an insecure attachment style is a vulnerability factor for psychiatric disorders. They also offer a therapeutic approach based on the patient’s attachment needs. In practice, the therapy is structured over a period of 12 to 16 sessions and includes three main phases.
During the initial phase, the therapist identifies the depressive symptoms and makes up an interpersonal inventory, that is, a thorough review of the patient’s current and past relationships, in order to evaluate the way he/she expresses his/her attachment needs. Self-report measures can be used to assess the patients’ attachment style (for example, the Relationship scale questionnaire) and social network and support. The events associated with the depressive symptoms are also explored. This way, the therapist and patient together define a central interpersonal problem that will serve as the primary focus of the therapy.
The intermediate phase is the core of the therapy. It consists in actually resolving the interpersonal problem, which can fall into one of three categories. The first one is grief, that is, a bereavement reaction that follows the death of a loved one. The difficulty lies in the reestablishment of interpersonal ties. The second category is role transition, that is, a major and disturbing life change such as a disease, the birth of a child, or retirement. And the third category is role dispute, that is, an overt or covert conflict in an important relationship (a spouse, a parent, or one’s boss). During this phase, the patient reevaluates his expectations in terms of attachment, and learns how to improve his mode of communication.
The final phase involves a direct discussion with the patient, with a review of the improvements made over the therapy, the consolidation of the skills acquired and the anticipation of future problems.
The therapy lies on a certain number of technics, and the therapeutic relationship is one of them. During IPT, the therapist becomes a temporary “attachment figure”, who provides the secure base that enables change.
Exploration is another one. Its aim is to gather useful information in order to analyze the patient’s relational difficulties. It provides insight into the context in which depressive symptoms emerged, and enables to assess the patient’s attachment style, needs and expectations. During the intermediate phase, exploration is also used to encourage the patient to consider alternative ways to communicate his/her affects and attachment needs.
A third method is clarification. It consists in encouraging the patient to clarify his/her speech, especially in terms of the affects, expectations, needs and social roles involved in the problem under consideration. The objective of clarification is to help the patient gain further understanding of what can be dysfunctional in his or her relationships, and to accept change.
Finally, the fourth method, and the core of Rahiaoui and Bay-Smadja’s model, is called interpersonal emotion regulation. Its aim is to get the patient to express, understand and adjust his/her emotions according to the context. It can be accomplished through the therapeutic relationship (with the therapist being used a base for security) , psychoeducation (by explaining the patient that depression can be related to the way a person handles stressful situations), or the verbal expression, by the patient, of the thoughts and emotions triggered by the way he/she expresses his/her feelings. The objective here is to develop an « emotional language » that should ease the process of emotion regulation.
In addition to these methods, patients are encouraged to develop and strengthen their social networks. The therapeutic objective for patients with an anxious attachment style will be to learn how to solicit others in an appropriate way. For patients with an avoidant attachment style, it will be to create the desire for social support.