To a casual observer, all therapy sessions may look alike; you go to a professional, pay some money and talk about your problems. Then, somehow, something magical happens and you start feeling better.
The reality, though, is much more complex. Some lists identify over 50 different types of therapy available. There are likely even more.
So, knowing a little about what kind of therapy is available can be very helpful. In this article we will explore an approach called Interpersonal Therapy (IPT for short) and how it is used in the treatment of bulimia nervosa.
What is IPT?
Interpersonal Therapy is based on a simple idea: how you relate to others impacts your emotional and mental health. This idea grew out of the work of a psychiatrist named Harry Stack Sullivan who believed that an individual’s personality was significantly influenced by his/her interpersonal relationships.
Problems in these relationships will then result in mental and emotional problems such as depression or an eating disorder. A study out of Loughborough University in the United Kingdom put it this way, “Interpersonal skill deficits may cause vulnerability to developing mental health problems and may also play a role in maintaining it.”
IPT is designed to help resolve relational problems in 4 main areas:
Role Disputes are problems relating to others. Specific examples of role disputes include different expectations within a relationship, conflict in a relationship, or difficulty forgiving someone.
Role Transitions occur when someone has difficulty adjusting to a transition in life, including divorce of parents, moving to a new city, becoming a parent, graduation from school or getting married.
Unresolved Grief means that an individual has not moved through the grief process in such a way that it negatively impacts his or her quality of life.
The key feature is that the individual’s grieving process has long-term effects such as impacting his/her eating and mood.
Interpersonal Deficits occur when individuals have problems making and sustaining healthy relationships. This can look like isolating from others, blaming others for personal problems, avoiding conflict or maybe even compulsive sexual interactions.
Additionally, IPT is a more structured approach to treatment. It is often time-limited with treatment involving three distinct phases. The initial phase is dedicated to identifying the problems, including exploring the client’s history of relationships and life transitions.
The middle phase focuses on learning and implementing new and healthier strategies for dealing with relational and transitional problems. And in the final phase, the therapist and client review the progress made and skills learned.
How does IPT work with bulimia?
IPT was originally used to treat depression but, in the early 1990’s it began to be used to specifically treat bulimia.
But if the focus in Interpersonal Therapy is relationships—not the symptoms that brought someone in for therapy—how does it help?
In other words, someone struggling with bulimia comes to a therapist because she can’t stop binging and purging but spends time in therapy talking about relationships. Does this really help?
Almost any therapeutic approach is going to discuss more than the symptoms themselves. Whether the approach is Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) or Psychoanalysis, the therapist and client will likely discuss family history, self-perception, life experiences, body image and a host of other possible topics.
However, IPT specifically focuses on how an individual relates to other people in their lives and believes that if these relationships improve and a person learns to better handle conflict, loss, transition and relational deficits, there will be an improvement with behaviors related to bulimia.
- Christopher Fairburn, Professor of Psychiatry at the University of Oxford explains that IPT might work through several mechanisms:
IPT helps patients overcome interpersonal problems which have resulted from bulimia, thus helping prevent further problems
- IPT can help individuals develop healthier interpersonal relationships which results in improved self-evaluation. In other words, they begin to see themselves in a more positive light and don’t rely on the unhealthy mechanisms of evaluating themselves wholly based upon eating, weight and body shape.
- IPT “gives patients a sense that they are capable of influencing their interpersonal lives and therefore may lessen their need to control their eating, weight and shape.”
Does Interpersonal Therapy Work?
The medical department at the University of Leipzig in Leipzip, Germany researched the effectiveness of Interpersonal therapy in the treatment of bulimia and stated the following:
Several randomized clinical trials show that IPT has a moderate to good efficacy in the treatment of bulimia nervosa that is lower than that of cognitive-behavioral therapy (CBT) in the short term, but equal in the long term, using similar mechanisms of change.
This doesn’t sound very impressive but, in actuality, “moderate to good efficacy” is high marks for therapy. Cognitive-behavior therapy is generally considered the best approach to treating eating disorders and some studies have found IPT to be just as effective.
In fact, in 2004 the National Institute of Clinical Excellence (NICE) based in the United Kingdom officially recognized IPT as a treatment of choice for bulimia.
How do I find a therapist who practices IPT?
You can find qualified eating disorder treatment centers in our directory listings. Additionally, many therapists have personal websites and list the different approaches used in sessions.
Ideally, you will want to work with someone who has experience with IPT and eating disorders. Just because a therapist uses IPT does not mean they have worked with bulimia.
Many therapists are eclectic in the therapeutic approaches used and will sometimes combine principles from CBT, DBT or psychoanalytic theory in order to help their clients. If you have questions about the approaches used by a therapist, don’t hesitate to contact the professional and ask about his or her approach before going to your first appointment.
Contributor: W. Travis Stewart, LPC, NCC writer for Eating Disorder Hope
About the author: Travis Stewart earned a Master of Arts in Counseling (2001) and a Master of Arts in Theological Studies (2003), both from Covenant Seminary in St. Louis, MO. Travis is a Licensed Professional Counselor in the State of Missouri and a writer for Eating Disorder Hope and Addiction Hope.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on November 23, 2015
Published on EatingDisorderHope.com
Interpersonal Psychotherapy for Binge Eating Disorder
Find a Therapist specializing in Interpersonal Psychotherapy for Binge Eating Disorder. List your practice
Interpersonal Psychotherapy for Binge Eating Disorder
Status: Strong Research Support
Interpersonal Psychotherapy (IPT) for binge eating disorder is based on an intervention originally developed for the treatment of depression. In IPT, the focus is on interpersonal difficulties in the patient’s life. The connection between these problems and the development and maintenance of the eating disorder is identified at the beginning of treatment, but only implied thereafter. IPT for binge eating disorder is administered in either group or individual format, and is conducted in approximately twenty weekly sessions, which encompass three phases. The first phase of IPT is devoted to identifying specific interpersonal problems areas currently affecting the patient, and choosing which of these areas to focus on for the remainder of treatment. The four typical interpersonal problem domains are role disputes, role transitions, interpersonal deficits, and unresolved grief. Interpersonal precipitants of current binge eating episodes are highlighted during this phase. In the second phase of IPT for binge eating disorder, the therapist encourages the patient to take the lead in facilitating change in the interpersonal realm. The therapist’s role involves keeping the patient aware of the time frame of treatment and focused on the problem areas, clarifying issues raised by the patient, and encouraging change. The third phase covers maintenance of interpersonal gains and relapse prevention.
Key References (in reverse chronological order)
- Wilson, G.T., Wilfley, D.E., Agras, W.S., & Bryson, S.W. (2010).Psychological treatments for binge eating disorder. Archives of General Psychiatry, 67, 94-101.
- Wilfley, D.E., Welch, R.R., Stein, R.I., Spurrell, E.B., Cohen, L.R., Saelens, B.E., Dounchis, J.Z., Frank, M.A., Wiseman, C.V., & Matt, G.E. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of General Psychiatry, 59(8), 713-721.
- Wilfley, D. E., Agras, W. S., Telch, C. F., Rossiter, E. M., Schneider, J. A., Cole, A. G., Sifford, L., & Raeburn, S. D. (1993). Group cognitive-behavioral therapy and group interpersonal psychotherapy for the nonpurging bulimic individual: A controlled comparison. Journal of Consulting and Clinical Psychology, 61, 296-305.
- Wilfley, D.E., Mackenzie, K.R., Welch, R., Ayres, V., & Weissman, M.M. (2000). Interpersonal Psychotherapy for Group. New York: Basic Books.
- Wilfley, D.E., Grilo, C.M., & Rodin, J. (1997). Group psychotherapy for the treatment of bulimia nervosa and binge eating disorder: Research and clinical methods. In J.L. Spira (Ed.), Group therapy for medically ill patients (pp. 225-295). New York: Guilford Press.
- Klerman, G. L., Weissman, M. M., Rounsaville, B. J., & Chevron, E. S. (1984). Interpersonal psychotherapy of depression. New York: Basic Books.
- Contact Christopher G. Fairburn, DM, FRCPsych (Oxford University)
- Denise Wilfley, PhD. (Washington University) at [email protected] (research only)
Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice