STRUCTURE OF IPT
Like IPT for other disorders, IPT-ED consists of three phases: initial, intermediate, and termination. Typically, IPT-ED spans fifteen to twenty treatment sessions over four to five months. The IPT-ED clinician addresses maladaptive patterns in current interpersonal relationships, which are linked consistently throughout treatment to eating disorder symptoms. As IPT-ED is a time-limited treatment, success depends on the clinician’s ability to quickly identify problematic interpersonal patterns, to link them to eating disorder symptoms, and to facilitate the client’s awareness of these connections while conducting the interpersonal inventory. Thus, patient and clinician must identify the problem area(s) and treatment goals as early as possible.
The initial phase of IPT-ED typicallylasts one to five sessions and includes diagnosis of the eating disorder, the identification of interpersonal problem areas, and the delineation of treatment goals. The patient’s current and past eating disorder symptoms are assessed by a standard diagnostic instrument, a formal eating disorder diagnosis is made, and the patient is assigned the “sick role" The sick role identifies the patient as needing help, and excuses him or her from those responsibilities that cannot be managed because of his or her symptoms, particularly the excessive caretaking that is often characteristic of individuals with eating disorders. By assigning the sick role, the patient is given permission to focus fully on the process of recovery.
Next, the clinician and patient discuss treatment expectations. The clinician assures the patient that he or she has been diagnosed with a known disorder with effective treatment options and a good prognosis. The clinician then explains the rationale of IPT, emphasizing that therapy will focus on identifying and altering current dysfunctional interpersonal patterns related to the eating disorder symptoms.
To determine the precise focus of treatment, the clinician conducts an interpersonal inventory with the patient. The inventory provides a framework for clarifying the interpersonal issues that sustain the eating disorder symptoms and that will define the treatment goals. The interpersonal inventory chronicles the patient’s important life events, interpersonal relationships, social support, and eating disorder symptoms. The interpersonal inventory is crucial to the development of an effective treatment plan. It enables the clinician to connect stressful interpersonal events to changes in the patient’s self-concept as they relate to eating disorder symptoms, to outline problematic interpersonal relationships, and to identify potential sources of social support.
The clinical importance of conducting a comprehensive interpersonal inventory cannot be overemphasized. Accurate identification of the patient’s primary problem area(s) is often complicated and is crucial to successful treatment. In original implementations of IPT, up to three sessions have been devoted to completing the interpersonal inventory; however, conducting a longer (approximately two hour) first session to complete the entire interpersonal inventory may increase the effectiveness of IPT-ED. This extended initial visit enables patients to understand the rationale for IPT, and to see connections between their symptoms and their interpersonal functioning more quickly. Often by the end of this first, extended session, the therapist is able to propose a tentative interpersonal formulation.
In the interpersonal formulation, the clinician links the patient’s eating disorder to at least one of the four interpersonal problem areas: interpersonal role transitions, interpersonal disputes, grief, and interpersonal deficits. While the clinician and patient may identify multiple interpersonal problem areas, the time-limited nature of IPT-ED requires that therapy focus on the one or two areas most relevant to the patient’s eating disorder symptoms. In addition, the clinician and patient should identify specific goals to work on during treatment. These goals should be developed collaboratively by clinician and patient, and should relate directly to the patient’s identified problem areas and disordered eating behaviors. It is useful for the clinician to put these goals in writing, much like a treatment contract. The goals developed at this stage will be referenced at each future session and will guide the day-to-day work of the treatment.