**3. The development of Interpersonal Psychotherapy (IPT)**

IPT was developed for the treatment of depression and originates from theories in which interpersonal functioning is recognised to be a critical component of psychological wellbeing. The work of 1930's psychiatrist Harry Sullivan first suggested that patients' mental health was related to their interpersonal contact with others. Challenging Freud's psychosexual theory, Sullivan emphasized the role of interpersonal relations, society and culture as the primary determinants of mental health (Sullivan, 1968). Sullivan's work was further developed by Gerald Klerman and Myrna Weissman in the 1980's, who studied depression treatments using the interpersonal approach. Whilst studying the efficacy of antidepressants, alone or paired with psychotherapy, it was found that 'high contact' counselling was effective, leading to the further development of the therapy which was renamed interpersonal psychotherapy (Klerman et al, 1984). These positive results led to the inclusion of IPT in the NIMH Treatment of Depression Collaborative Research Program, which compared this therapy with antidepressants, placebo and Cognitive Behavioural Therapy (CBT) for depression (Elkin et al., 1989). As a part of this study the original IPT manual, Interpersonal Psychotherapy for Depression, was published as a manual for the research project (Klerman et al, 1984). Patients in all conditions showed significant reduction in depressive symptoms and improvement in functioning, those having the antidepressant Imipramine plus clinical management generally doing best, the two psychotherapies second best, and placebo plus clinical management worst. There was no significant difference between the two psychotherapies.

Since then, there have been several systematic reviews of studies investigating the efficacy of IPT for depression (Jarrett & Rush, 1994; Klerman, 1994; Feijo de Mello et al., 2005). They concluded that IPT was superior to placebo in nine of thirteen studies and better than CBT overall. However IPT plus medication was no more effective than medication alone. The researchers also found that several factors were associated with good therapy outcome, including the ability to engage in more than one perspective and to take responsibility for actions, empathy for others, a desire to change, good communication skills, and a sense of cooperation and willingness to engage with the therapist.

Feske et al (1998) examined predictors of outcome in 134 female patients with major depression, and found that those who did not improve experienced higher levels of anxiety and were also more likely to meet diagnostic criteria for panic disorder. In addition, they found that poor outcome was associated with greater vocational impairment, longer duration of episode, more severe illness, and surprisingly, lower levels of social impairment. Other authors have found that despite comparable efficacy between IPT and CBT, IPT was more affected by personality traits and therefore less suitable for those with personality disorders (Joyce et al. 2007).
