Klerman’s interpersonal therapy: what it is and how it works

Klerman’s interpersonal therapy is a therapeutic procedure that, although it was originally for depression, has been shown to be effective for several disorders.

Its approach is mainly interpersonal, focusing on patient relationships. Let’s take a closer look at how it improves people’s well-being and to what current it can be related.

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Klerman’s interpersonal therapy what is it?

Klerman’s interpersonal therapy is a brief treatment, originally designed to treat depression, which focuses on the psychosocial and interpersonal problems of the patient who demands treatment, taking aspects of the medical model. This therapy was developed in 1969 at Yale University by Gerald Klerman and Myrna Weissman, who were conducting a study on the efficacy of antidepressants in patients depending on whether or not they received psychological treatment in addition to pharmacological treatment.

Interpersonal therapy, as its name suggests, focuses on analyzing the relationships between the patient’s pathology and the psychosocial context he lives , that is, how he relates to other people. This treatment gives greater importance to how the patient lives the present instead of focusing on his past, although not ignoring him. It takes into account how the social environment acts as a support and recovery network for the patient.

As it is a therapy that is based on the medical model, adapting it in the field of clinical psychology, it can be combined with the psychopharmacological approach of disorders, especially major depression . It is also indicated for patients who have not received any treatment before.

Psychological approach

The approach behind this therapy is eclectic, that is, it is based on postulates of various currents , such as psychoanalysis, cognitive behavioral therapy and humanism, without being fully encompassed within any of them. It can also be said that being a pluralistic approach from which part is also applicable in countless socio-economic and cultural contexts.

It takes psychoanalytic aspects of Stack Sullivan’s interpersonal theory, in addition to aspects from Bowlby’s attachment theory, who was also a psychoanalyst. The theory of attachment allows us to understand the relational problems of the patient, taking into account his attachment style formed in childhood and how it affects him in his daily functioning.

Despite all these points, Klerman’s interpersonal therapy moves away from psychoanalytic personality theories, and does not intend to formulate any that relates the patient’s personality traits to his symptoms . Nor, and related to cognitive-behavioral therapy, does it intend to deal with negative thinking patterns, false attributions and cognitive distortions.

The purpose of Klerman’s interpersonal therapy is to improve the communication skills of the patient, both interpersonally and intrapersonally, and develop a social support network with realistic expectations of how they will deal with the distress they suffer. the patient.

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Approach to disorders

During the process, the therapist takes an active, hopeful and supportive role, but is not neutral . Disorders are addressed according to the following three levels.

  • symptom
  • Social and interpersonal relationships of the patient
  • Explicit conflicts

It should be said that this is mostly intended for those people who suffer from a depressive disorder more than any other type, although the adaptations made to Klerman’s interpersonal therapy allow this method to be adapted to other diagnostic labels.

In therapy they work with some cognitions of the patient, but not with the intention of extinguishing them completely. Nor is this aspect addressed in a structured way, that is, no detailed protocols or self-records are used as a ‘homework’ to do at home . Although some behavioral techniques can be added, such as systematic desensitization or exposure therapy, they are not used as a general rule.

As for the person’s life, Klerman’s interpersonal therapy focuses on four areas that may be behind their relational problems :

  • Duel after losing a loved one.
  • Conflicts in meaningful relationships, including relationships with oneself.
  • Difficulties to adapt to changes in life.
  • Difficulties to get out of social isolation.

Thus, once the main difficulties of the patient that are related to their psychological problems have been detected, it is possible to promote the development of social and communicative skills .

Duration and phases of treatment

As already mentioned, Klerman’s interpersonal therapy is a brief treatment, that is, it means that the therapeutic process is carried out in a small number of sessions . This type of treatment implies a high degree of structuring of the sessions, which are intended to be carried out on average between 12 and 16 weeks, and usually last around 40 to 50 minutes. These sessions are held individually.

Normally, therapy is developed following the following three phases.

1. Initial or diagnostic phase

It forms the first three sessions of therapy, in which the patient explains his symptoms and social problems that may or may not be the trigger and maintenance factor for such problems.

The therapist makes a provisional diagnosis, which will allow you to focus the course of therapy and see what should be influenced to improve the patient’s well-being.

2. Intermediate or focused phase

It goes from the fourth to the tenth session. In this period, the therapist addresses in greater depth the problems of which the patient is afflicted .

It is at this time that the therapist values ​​the need for whether the patient should undergo a pharmacological treatment, in addition to assessing the response he is giving in relation to the psychological treatment that is being applied.

3. Last phase or conclusive

It is sessions 11 and 12, or more in case the treatment has been stretched a bit. It basically consists of educating the patient to maintain the improvement obtained during therapy .

Clinical applications

Klerman’s interpersonal therapy has proven effective especially for what was initially developed: depression . Since then, it has been modified to be used in other mental disorders, such as addictions or eating disorders.

It should be said that, although this therapy is mostly used in the clinic with the intention that it be brief, not lasting more than 16 weeks, sometimes it is chosen to apply it as maintenance therapy that has recurrent depression .

Be that as it may, this therapy has been shown to be effective in several psychological disorders, apart from major depression:

  • Bulimia nervosa
  • Bipolar disorder.
  • Postpartum depression.
  • Cyclothymia

It should be said that, although it was initially designed to be applied in adults, adaptations have been made for elderly and adolescent people. Applied in children, it is based on the premise that disorders such as depression occur in contexts in which the child maintains a dysfunctional relationship with the reference adults or caregivers.

 

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