Klerman’s interpersonal therapy: what is it and how does it work?

This type of psychological therapy was designed primarily to help patients with depression.

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

Its approach is primarily interpersonal, focusing on the patient's relationships. Let's see more in depth how it manages to improve the well-being of the people and to which current it can be related.

The interpersonal therapy of Klerman what is it?

The interpersonal therapy of Klerman is a brief treatment, originally designed to treat the depression, that is centered in 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 implies, focuses on analyzing the relationships between the patient's pathology and the psychosocial context in which he/she lives, i.e., how he/she relates to the psychosocial context in which he/she lives.that is, how he/she relates to other people. This treatment gives greater importance to how the patient lives in the present rather than focusing on his or her past, although it does not ignore it. It takes into account how the social environment acts as a support and recovery network for the patient.

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

Psychological approach

The approach behind this therapy is eclectic, that is to say, it is based on postulates of several currents, such as psychoanalysis, cognitive-behavioral therapy and humanism, without being totally encompassed within any of them.psychoanalysis, cognitive-behavioral therapy and humanism, without being totally encompassed within any of them. It should also be said that as it is a pluralistic approach, it is also applicable in an infinite number of socioeconomic and cultural contexts.

It takes psychoanalytic aspects from Stack Sullivan's interpersonal theory, as well as aspects from Bowlby's attachment theory, who was also a psychoanalyst. Attachment theory allows to understand the relational problems of the patient, taking into account his attachment style formed in childhood and how this affects his daily functioning.

Despite all these points, Klerman's interpersonal therapy departs from psychoanalytic theories of personality, and does not claim to formulate one that relates the patient's personality traits to his or her symptomatology.. Nor, and related to cognitive-behavioral therapy, does it claim to address negative thinking schemes, false attributions, and cognitive distortions.

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

Addressing the disorders

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

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

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

The therapy works with some of the patient's cognitions, but not with the intention of extinguishing them completely. Nor is this aspect approached in a structured way, i.e., no detailed protocols or self-reporting in the form of 'homework' to do at home are used.. Although some behavioral techniques can be added, such as systematic desensitization or exposure therapy, these are not used as a general rule.

In terms of the person's life, Klerman's interpersonal therapy focuses on four areas that may be behind your relational problems:

• Grief after losing a loved one.
• Conflicts in significant relationships, including relationships with oneself.
• Difficulties adapting to life changes.
• Difficulties in emerging from social isolation.

Thus, once the patient's main difficulties related to his or her psychological problems have been detected, it is possible to promote the development of social skills, 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, i.e. it means that the therapeutic process is carried out in a reduced number of sessions.. This type of treatment involves 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 conducted on an individual basis.

Normally, the therapy is carried out in the following three phases.

1. Initial or diagnostic phase

This makes up the first three sessions of the therapy, in which the patient explains his or her symptomatology and social problems that may or may not be the triggering and maintenance factor of such problems. of such problems.

The therapist makes a provisional diagnosis, which will allow him to focus the course of therapy and see what should be done 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 with which the patient is afflicted..

It is at this point that the therapist assesses whether the patient should be subjected to pharmacological treatment, in addition to evaluating the response he/she is giving in relation to the psychological treatment being applied.

3. Last or conclusive phase

These are sessions 11 and 12, or more if the treatment has been stretched a little. It basically consists of educating the patient in order to maintain the improvement obtained during the therapy..

Clinical applications

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

It should be noted that, although this therapy is mostly used in the clinic, it is intended to be brief, lasting no more than 16 weeks, sometimes it is chosen to be applied as a maintenance therapy for those who have 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 originally designed to be applied to adults, adaptations have been made for the elderly and adolescents. When applied to 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 adults of reference or caregivers.

Bibliographical references:

• Heerlein, A. (2002). Interpersonal psychotherapy in the treatment of major depression. Revista chilena de neuro-psiquiatría, 40(1), PP. 63 - 76.