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Journal of Contemporary Psychotherapy

, Volume 38, Issue 1, pp 11–21 | Cite as

Attachment, Contemporary Interpersonal Theory and IPT: An Integration of Theoretical, Clinical, and Empirical Perspectives

  • Paula Ravitz
  • Robert Maunder
  • Carolina McBride
Original Paper

Abstract

Interpersonal Psychotherapy (IPT) is an effective, pragmatic treatment for depression but interpersonal explanations of its effectiveness are not fully developed. This paper presents an integration of aspects of attachment theory and contemporary interpersonal theory which explains how interpersonal interactions contribute to a clinical understanding of depression and its treatment through IPT. We test hypotheses of interpersonal change in a case series of depressed patients treated with IPT. The results demonstrate that both attachment insecurity and interpersonal problems improve significantly over a 16 week course of treatment. Further research into the interpersonal processes that alleviate depression is needed.

Keywords

Attachment Circumplex Contemporary interpersonal theory Interpersonal psychotherapy (IPT) Depression 

Notes

Acknowledgement

We wish to acknowledge and thank Dr. Adele Efendov, Dr. Alan Ravitz and Jasna Todorovic for their help with this manuscript.

References

  1. Ainsworth, M., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale: Erlbaum.Google Scholar
  2. Akiskal, H. S., & McKenney, W. T. (1975). Overview of recent research in depression: Integration of ten conceptual models into a comprehensive clinical picture. Archives of General Psychiatry, 32, 285–305.PubMedGoogle Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (DSM-IV) (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  4. Barber, J. P. (1996). The role of avoidance and obsessiveness in matching patients to cognitive and interpersonal psychotherapy: Empirical findings from the treatment for depression collaborative research program. Journal of Consulting and Clinical Psychology, 64, 951–958.PubMedCrossRefGoogle Scholar
  5. Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226–244.PubMedCrossRefGoogle Scholar
  6. Bartholomew, K., & Shaver, P. R. (1998). Methods of assessing adult attachment: Do they converge? In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships. New York: Guilford.Google Scholar
  7. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory manual (2nd ed.). San Antonio, TX: Psychological Corporation.Google Scholar
  8. Belsky, J. (1999). Patterns of attachment in modern evolutionary perspective. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (pp. 141–161). New York: Guilford.Google Scholar
  9. Bifulco, A., Kwon, J., Jacobs, C., Moran, P. M., Bunn, A., & Beer, N. (2006). Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Social Psychiatry and Psychiatric Epidemiology, 41, 796–805.PubMedCrossRefGoogle Scholar
  10. Bifulco, A., Moran, P. M., Ball, C., & Bernazzani, O. (2002a). Adult attachment style. I: Its relationship to clinical depression. Social Psychiatry and Psychiatric Epidemiology, 37, 50–59.PubMedCrossRefGoogle Scholar
  11. Bifulco, A., Moran, P. M., Ball, C., & Lillie, A. (2002b). Adult attachment style. II: Its relationship to psychosocial depressive-vulnerability. Social Psychiatry and Psychiatric Epidemiology, 37, 60–67.PubMedCrossRefGoogle Scholar
  12. Bolton, P., Bass, J., Neugebauer, R., Verdeli, H., Clougherty, K. F., Wickramaratne, P., et al. (2003). Group interpersonal psychotherapy for depression in rural Uganda: A randomized controlled trial. JAMA: The Journal of the American Medical Association, 289, 3117–3124.CrossRefGoogle Scholar
  13. Bowlby, J. (1969). Attachment and loss: Vol. 1: Attachment. New York: Basic Books.Google Scholar
  14. Bowlby, J. (1980). Attachment and loss: Vol. 3: Loss: Sadness and depression. New York: Basic Books.Google Scholar
  15. Bowlby, J. (1988). A secure base. London: Routledge.Google Scholar
  16. Diamond, D., Clarkin, J. F., Stovall-McClough, K. C., Levy, K., Foelsch, P., Levine, H., et al. (2003a). Patient-therapist attachment: Impact on the therapeutic process and outcome. In M. Cotina & M. Marrone (Eds.), Attachment theory and the psychoanalytic process (pp. 127–178). London: Whurr Publishers, Ltd.Google Scholar
  17. Diamond, D., Stovall-McClough, K. C., Clarkin, J. F., & Levy, K. (2003b). Patient-therapist attachment in the treatment of borderline personality disorder. Bulletin of the Menninger Clinic, 67, 227–259.PubMedCrossRefGoogle Scholar
  18. Elkin, I., Shea, M. T., Watkins, J., Imber, S. D., Sotsky, S. M., Collins, J. F., et al. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program: General effectiveness of treatment. Archives of General Psychiatry, 46, 971–983.PubMedGoogle Scholar
  19. First, M. S., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured clinical interview for DSM-IV axis I disorders-patient edition (Version 2). New York: Biometric Research Institute.Google Scholar
  20. Fonagy, P., Leigh, T., Steele, H., Kennedy, R., Mattoon, G., et al. (1996). The relation of attachment status, psychiatric classification, and response to psychotherapy. Journal of Consulting and Clinical Psychology., 64, 22–31.PubMedCrossRefGoogle Scholar
  21. Fraley, R. C., Waller, N. G., & Brennan, K. A. (2002). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350–365.CrossRefGoogle Scholar
  22. Frank, E., Kupfer, D. J., Perel, J. M., Cornes, C., Jarrett, D. B., Mallinger, A. G., et al. (1990). Three-year outcomes for maintenance therapies in recurrent depression. Archives of General Psychiatry, 47, 1093–1099.PubMedGoogle Scholar
  23. Frank, E., Shear, M. K., Rucci, P., Cyranowski, J. M., Endicott, J., Fagiolini, A., et al. (2000). Influence of panic-agoraphobic spectrum symptoms on treatment response in patients with recurrent major depression. The American Journal of Psychiatry, 157, 1101–1107.PubMedCrossRefGoogle Scholar
  24. Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.PubMedCrossRefGoogle Scholar
  25. Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278–296.PubMedGoogle Scholar
  26. Hesse, E. (1999). The adult attachment interview: Historical and current perspectives. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (1 ed., pp. 395–433). New York: Guilford Press.Google Scholar
  27. Horowitz, L. M., Rosenberg, S. E., Baer, B. A., Ureno, G., & Villasenor, V. S. (1988). Inventory of Interpersonal Problems: Psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology, 56, 488–460.CrossRefGoogle Scholar
  28. Joiner, T., Coyne, J. C., & Blalock, J. (1999). On the interpersonal nature of depression: Overview and synthesis. In T. Joiner & J. C. Coyne (Eds.), The interactional nature of depression: Advances in interpersonal approaches (pp. 3–19). Washington, DC: American Psychological Association.Google Scholar
  29. Kiesler, D. J. (1996) Contemporary interpersonal theory & research. New York: John Wiley & Sons, Inc.Google Scholar
  30. Klerman, G. L., Weissman, M. M., Rounsaville, B. J., & Chevron, E. (1984). Interpersonal psychotherapy for depression. New York: Basic Books.Google Scholar
  31. Klohnen, E. C., & Bera, S. J. (1998). Behavioral and experiential patterns of avoidantly and securely attached women across adulthood: A 30-year longitudinal perspective. Journal of Personality and Social Psychology, 74, 211–223.PubMedCrossRefGoogle Scholar
  32. Krupnick, J. L., Sotsky, S. M., Simmens, S., Moyer, J., Elkin, I., Watkins, J., et al. (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 64, 532–539.PubMedCrossRefGoogle Scholar
  33. Lesperance, F., Frasure-Smith, N., Koszycki, D., Laliberta, M. A., Swenson, J. R., Ghatavi, K., et al. (2007). Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: The Canadian Cardiac Randomized Evaluation of antidepressant and Psychotherapy Efficacy (CREATE) trial. JAMA, 297, 367–379.PubMedCrossRefGoogle Scholar
  34. Markowitz, J. C., Klerman, G. L., Clougherty, K. F., Spielman, L. A., Jacobsberg, L. B., Fishman, B., et al. (1999). Treatment of HIV-positive patients with depressive symptoms. Archives of General Psychiatry, 55, 452–457.CrossRefGoogle Scholar
  35. Markowitz, J. C., Kocsis, J. H., Bleiberg, K. L., Christos, P. J., & Sacks, M. A. (2005). Comparative trial of psychotherapy and pharmacotherapy for “pure” dysthymic patients. Journal of Affective Disorders, 89, 167–175.PubMedCrossRefGoogle Scholar
  36. Maunder, R. G., & Hunter, J. J. (2001). Attachment and psychosomatic medicine: Developmental contributions to stress and disease. Psychosomatic Medicine, 63, 556–567.PubMedGoogle Scholar
  37. McBride, C., Atkinson, L., Quilty, L. C., & Bagby, R. M. (2006). Attachment as Moderator of treatment outcome in major depression: A randomized control trial of interpersonal psychotherapy versus cognitive behavior therapy. Journal of Consulting and Clinical Psychology, 74, 1041–1054.PubMedCrossRefGoogle Scholar
  38. McCullough, J. P. Jr (2000). Treatment for chronic depression: Cognitive behavioral analysis system of psychotherapy. New York: Guilford Press.Google Scholar
  39. Mickelson, K. D., Kessler, R. C., & Shaver, P. R. (1997). Adult attachment in a nationally representative sample. Journal of Personality and Social Psychology, 73, 1092–1106.PubMedCrossRefGoogle Scholar
  40. Mufson, L., Dorta, K. P., Moreau, D., & Weissman, M. M. (2004a). Interpersonal psychotherapy for depressed adolescents (2nd ed.). New York: Guilford Press.Google Scholar
  41. Mufson, L., Dorta, K. P., Moreau, D., & Weissman, M. M. (2004b). The origins and development of interpersonal psychotherapy for depression. In Interpersonal psychotherapy for depressed adolescents (2nd ed., pp. 19–29). New York: Guilford Press.Google Scholar
  42. Mufson, L., Dorta, K. P., Wickramaratne, P., Nomura, Y., Olfson, M., & Weissman, M. M. (2004). A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 61, 577–584.PubMedCrossRefGoogle Scholar
  43. Mufson, L., Weissman, M. M., Moreau, D., & Garfinkel, R. (1999). Efficacy of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 56, 573–579.PubMedCrossRefGoogle Scholar
  44. O’Hara, M. W., Stuart, S., Gorman, L. L., & Wenzel, A. (2000). Efficacy of interpersonal psychotherapy for postpartum depression. Archives of General Psychiatry, 57, 1039–1045.PubMedCrossRefGoogle Scholar
  45. Ravitz, P. (2004) The interpersonal fulcrum – interpersonal therapy for treatment of depression. CPA Bulletin, 36, 15–19.Google Scholar
  46. Reynolds, C. F. III, Frank, E., Perel, J. M., Imber, S. D., Cornes, C., Miller, M. D., et al. (1999). Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: A randomized controlled trial in patients older than fifty-nine years. JAMA, 281, 39–45.PubMedCrossRefGoogle Scholar
  47. Sibley, C. G., Fischer, R., & Liu, J. H. (2005). Reliability and validity of the revised experiences in close relationships (ECR-R) self-report measure of adult romantic attachment. Personality and Social Psychological Bulletin, 31, 1524–1536.CrossRefGoogle Scholar
  48. Stuart, S., & Robertson, M. (2003a). Interpersonal psychotherapy: A clinician’s guide. London: Arnold.Google Scholar
  49. Stuart, S., & Robertson, M. (2003b). Theory and clinical applications. In Interpersonal psychotherapy: A clinician’s guide (pp. 13–34). London: Hodder Arnold.Google Scholar
  50. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: Norton.Google Scholar
  51. Travis, L. A., Bliwise, N. G., Binder, J. L., & Horne Moyer, H. L. (2001). Changes in clients’ attachment styles over the course of time-limited dynamic psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 38, 149–159.CrossRefGoogle Scholar
  52. Waters, E., Merrick, S., Treboux, D., Crowell, J., & Albersheim, L. (2000). Attachment security in infancy and early adulthood: A twenty year longitudinal study. Child Development, 71, 684–689.PubMedCrossRefGoogle Scholar
  53. Weinfield, N. S., Sroufe, L. A., & Egeland, B. (2000). Attachment from infancy to early adulthood in a high-risk sample: Continuity, discontinuity, and their correlates. Child Development, 71, 695–702.PubMedCrossRefGoogle Scholar
  54. Weissman, M. M. (2006). A brief history of interpersonal psychotherapy. Psychiatric Annals, 8, 553–557.Google Scholar
  55. Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books.Google Scholar
  56. Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2007). Clinician’s quick guide to interpersonal psychotherapy. New York: Oxford University Press.Google Scholar
  57. West, M., Rose, M. S., Verhoef, M. J., Spreng, S., & Bobey, M. (1998). Anxious attachment and self-reported depressive symptomatology in women. Canadian Journal of Psychiatry, 43, 294–297.Google Scholar
  58. West, M. L., & Sheldon-Kellor, A. E. (1994). Patterns of relating: An adult attachment perspective. New York: Guilford Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Paula Ravitz
    • 1
  • Robert Maunder
    • 1
  • Carolina McBride
    • 1
    • 2
  1. 1.Department of PsychiatryUniversity of TorontoTorontoCanada
  2. 2.Centre for Addiction and Mental HealthTorontoCanada

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