Interpersonal Psychotherapy for Clients With Eating Disorders
Heather L. Waldron, Marian Tanofsky-Kraff, and Denise E. Wilfley
Interpersonal psychotherapy (IPT) is a brief, triphasic, time-limited therapy that focuses on improving interpersonal functioning and, in turn, psychiatric symptoms by relating symptoms to interpersonal problem areas and developing strategies for dealing with these problems (Freeman & Gil, 2004; Klerman, Weissman, Rounsaville, & Chevron, 1984). IPT was originally developed in the late 1960s by Gerald Klerman et al. (1984) for the treatment of unipolar depression. In the late 1980s, IPT was successfully modified for clients with bulimia nervosa (BN; Fairburn et al., 1991; Fairburn, Peveler, Jones, Hope, & Doll, 1993) and shortly thereafter adapted into a group format for individuals with binge eating disorder (BED; Wilfley et al., 1993, 2002; Wilfley, Frank, Welch, Spurrell, & Rounsaville, 1998; Wilfley, MacKenzie, Welch, Ayres, & Weissman, 2000). IPT has been found to be an effective treatment for BN and BED.
IPT is grounded in theories developed by Meyer, Sullivan, and Bowlby, who postulated that interpersonal functioning is a critical component of psychological adjustment and well-being. Meyer (1957; see also Frank & Spanier, 1995; Klerman et al., 1984) suggested that psychopathology was rooted in maladjustment to one's social environment. Sullivan (1953) believed that individuals could not be understood in isolation from their interpersonal relationships and posited that enduring patterns in these relationships could either encourage self-esteem or result in anxiety, hopelessness, and psychopathology. IPT is also associated with the work of Bowlby (1982), who originated attachment theory. Bowlby emphasized the important link between early attachment and the later development of interpersonal relationships and emotional well-being. He hypothesized that failures in attachment resulted in later psychopathology.
The interpersonal roles and relationships relevant to IPT include the nuclear family, extended family, friendship groups, work setting, and neighborhood or community The IPT model acknowledges a two-way relationship between social functioning and psychopathology: Social role disturbances can serve as precursors for psychopathology, and psychopathology can result in impairments in one's ability to perform social roles (Bowlby, 1982). Thus, in IPT, interpersonal functioning is recognized as a critical component of psychological adjustment and well-being. We should note that IPT makes no assumptions about the causes of psychiatric illness; however, it does assume that the development and maintenance of some psychiatric illnesses occur in a social and interpersonal context. It also assumes that the onset, response to treatment, and outcomes are influenced by the interpersonal relations between the client and significant others.
In this chapter, we provide an overview of IPT for eating disorders. First, we summarize the theoretical and empirical bases of IPT for the treatment of eating disorders (EDs). Next, we explain the delivery of IPT for EDs, phase by phase, along with a description of the major tenets of the treatment. This description is followed by a case example that illustrates the use of IPT with a client with BED. Finally, we describe future directions, including novel adaptations of IPT and the need for widespread dissemination and implementation of IPT in community settings. Although we review the major tenets of IPT here, more extensive information on IPT, detailing empirical background, theoretical foundation, and strategies and techniques, is provided in a comprehensive book by Weissman, Markowitz, and Klerman (2000).