Someone recently asked me why they needed to know about the interpersonal process. There seemed to be a misunderstanding that the interpersonal process is only focused on building rapport, when stronger rapport is, in fact, a byproduct of the interpersonal process. If you have similar questions about how or why this framework could strengthen your practice, read on.

Interpersonal Process as a Framework

It is important to know that the interpersonal process is not a new theory or technique. Instead, it is a framework that can be integrated with any modality you want to use. You lay your favorite theory or technique upon this framework. This makes the interpersonal process not only versatile, but the cornerstone of any practice in which it’s used. Your modality can change based on individual needs, but the framework stays consistent.

Keep in mind that the interpersonal process comprises three core components: process dimension, corrective emotional experience, and client response specificity. Of these three, process dimension is what this article will focus on. [fat_widget_right]

The Cognitive Domain: A Crucial Component of Process Dimension

Tyber and McCluer identify three domains that make up the process dimension: the cognitive domain, interpersonal domain, and familial/contextual domain. While interpersonal domain addresses how a person experiences attachment brokenness, and the familial/contextual domain is where this brokenness is reinforced, the cognitive domain is at the origin of an person’s attachment brokenness.

The cognitive domain addresses the practical application of much of the attachment research that has been done. Under the cognitive domain, we identify the origin of the attachment style a person had or has with their primary caregiver. As therapists, we seek to uncover how a person’s values and identity were established, how they developed coping mechanisms, their covert thought processes, their beliefs about themselves and the world, how their value of self-care was determined, and what they need to restore their identity.

Therapists use these subcategories of the cognitive domain to identify attachment brokenness that occurred in response to real life experiences. To understand the importance of healing attachment brokenness using the interpersonal process framework, let us first look at how we treat attachment brokenness in children.

The Experiential Approach in Action: Play Therapy, Theraplay, and the Neurodeck

Becoming a registered play therapist requires candidates to spend 15 hours in training that specifically address attachment and how to build, repair, and strengthen a child’s ability to attach to a primary caregiver. But what is the common theme between attachment play therapy, theraplay, and the Brain Booster Neurodeck? Simply put, the common thread in these three modalities is an experiential approach. Healthy attachment is developed through experience, not reframing.

As therapists, we seek to uncover how a person’s values and identity were established, how they developed coping mechanisms, their covert thought processes, their beliefs about themselves and the world, how their value of self-care was determined, and what they need to restore their identity.

Play Therapy

In play therapy, clinicians provide experiences that support healthy, safe touch through activities such as foil hand prints, lotion on hands or feet, holding hands during activities, or working together on a task. All these activities encourage safe touch and eye contact. Eye contact in particular is important for our limbic systems to communicate and bond, as we learn from clinicians such as Curt Thompson or Louis Cozolino. Communication between our limbic systems is nonverbal; hence, the importance of eye contact.

Theraplay

Theraplay is also quite experiential; in fact, it may be the most experiential of all the methods listed. Attachment brokenness is healed through re-experiencing the attachment-building interactions that were not provided (or were insufficiently provided) during the first years of life, such as eye contact made when a baby is fed and swaddled. In some cases, the child needs to be cuddled or rocked as they would have been as an infant, a process that is exceptionally experiential. It may also be that a traumatic event broke an initially secure attachment, in which case Theraplay is utilized to re-establish the previously secure attachment style.

The Neurodeck

The Neurodeck comprises activities that build the brain from the bottom up. It begins with activities that assist with sensory integration, utilizing many of the same type of activities used in other attachment play therapy techniques. These experiential approaches harness messy play and movement. For example, they may use the lotion activity mentioned above or swing a child in a blanket to mimic the rocking movements experienced in utero. As a clinician moves through the deck, the activities become increasingly relational. This is the attachment component of the Neurodeck approach.

While it is impractical to swing an adult in a blanket to provide experiential therapy, the interpersonal process provides relational experience to honestly, yet compassionately, bring awareness to a person’s interpersonal characteristics.

The deck specifically states that certain activities should be completed in a one-on-one context before they are used them in a group setting. The one-on-one context is important in establishing safety before engaging in group work. Attachment work is rooted in laying a foundation for understanding safe and unsafe characteristics in relationships through a one-on-one dynamic. This dynamic then informs the safety of other relationships, especially relationships in a group setting. Each phase in the protocol is experiential and progressive.

Addressing Attachment in Adults

It is evident how attachment work in children is achieved through experiential modalities. The same can be said for attachment work with adults. The cognitive domain mentioned above is at the root of an person’s attachment brokenness, while the interpersonal domain is where attachment brokenness is experienced, and the familial/contextual domain is where the brokenness is reinforced. Through our work as therapists, we provide an experiential repair for broken attachment that is evaluated through interpersonal skills. A person’s maladaptive interpersonal skills provide a wealth of information about what happened in the cognitive and familial domains, as well as crucial information for effective treatment planning.

While it is impractical to swing an adult in a blanket to provide experiential therapy, the interpersonal process provides relational experience to honestly, yet compassionately, bring awareness to a person’s interpersonal characteristics. Are they interacting in healthy ways that allow people to draw near to them and create a desire for others to be in a healthy relationship with them, or are they fracturing relationships unknowingly because they lack the awareness or skills to build healthy relationships? Sharing our experience of an person’s behaviors or words can help them develop self-awareness and contemplate whether they are communicating what they intend. This approach can also help with reality testing.

Strengths of Interpersonal Process

One strength of the interpersonal process framework is the way it helps build flexibility and other-focused awareness, which allows for healthy attachments and navigating unhealthy relationships more confidently and constructively. By highlighting awareness of how a person’s communication might be perceived by others, we broaden their understanding of themselves and of others. Maintaining a broader range of interpersonal understanding ideally increases a person’s window of tolerance in their relationships and creates a desire to repair a broken healthy attachment or confidently sever an unhealthy attachment. The individual becomes better equipped to advocate for positive change in their life through a strengthened commitment to repair healthy relationships or by valuing themselves enough to part ways with unhealthy relationships without behaving destructively.

The Effective Interpersonal Process Clinician

A provider who effectively uses interpersonal process reflects truths to people that help them feel heard and known so they may heal. Those on the receiving end of these truths may not always like what they hear. However, when they work with an empathic and skilled therapist, people can hear and understand their therapist’s reflections, even if they do not like what is said.

At the appropriate level of reflection, people learn to trust their therapist. Feeling known and understood improves rapport. In this context, rapport is equivalent to attachment. A grounded relationship with an effective interpersonal process therapist is emotionally supportive so people may engage in difficult, effective therapy that greatly improves treatment outcomes.

Reference:

Teyber, E., & McCluer, F. H. (2010). Interpersonal process in therapy: An integrative model (6th ed). Belmont, CA: Brooks/Cole.

Psychotherapy is the first form of treatment for depression or anxiety and involves a variety of treatment techniques. During psychotherapy, the person experiencing depression or anxiety speaks with a licensed psychologist or therapist who helps him or her to identify and work on the causative factors. These factors trigger depression or anxiety by working in combination with chemical imbalances in the brain or heredity factors.

Psychotherapy helps people with depression or anxiety in the following ways:

• Understanding the behaviors, ideas, and emotions that contribute to depression or anxiety
• Identifying the problems or events that contribute to depression or anxiety and understanding which aspects of the problem they can solve
• Helping to regain a sense of control and pleasure in their lives
• Teaching them problem solving skills and coping techniques

Although psychotherapy can be performed in different ways, such as individual, family, and group therapy, there are also different approaches that psychotherapists can use to provide therapy. After having a brief talk with the client, the therapist will decide on the approach to use based on the underlying factors that contribute to the person’s depression. Many therapists specialize in one or more specific techniques or approaches. These different approaches to psychotherapy include psychodynamic therapy, interpersonal therapy, cognitive behavioral therapy, and solution focused therapy.

Psychodynamic Therapy
This therapy assumes that the person is depressed due to unresolved, unconscious conflicts that often stem from childhood. The goal of this therapy is for the person to understand and cope better with these feelings by talking about such experiences. Psychodynamic therapy usually takes place over several months and can produce excellent results.

Interpersonal Therapy
Interpersonal therapy mainly focuses on the person’s behaviors and interactions with family and friends. The goal of this therapy is to enhance self-esteem and improve communication skills during a short period of time. This therapy usually lasts for 3 to 4 months and works well for depression caused by social isolation, mourning, major life events, and relationship conflicts.

Psychodynamic therapy and interpersonal therapy help people resolve depression or anxiety caused by loss or grief, role transitions (like becoming a parent or caregiver), and relationship conflicts.

Cognitive Behavioral Therapy
Cognitive behavioral therapy helps people experiencing depression or anxiety to identify and change inaccurate perceptions they have about themselves and the world around them. The psychotherapist helps the client to think differently by directing attention to both the accurate and inaccurate assumptions they have about themselves and others.

This therapy is recommended for the following types of persons:

• People who think and behave in ways that trigger and perpetuate depression
• People who experience disability or interpersonal problems due to depression

Solution Focused Therapy
Solution focused therapy is a symptom-specific approach, which means it targets one or two stressors that are causing problems. The result might be helping the person find a better way to handle the boss at work or children at home. A person may simply learn techniques to handle anxiety. One therapist commented that solution focused therapy is like getting new tools in your toolbox to use immediately in your life, therefore helping you feel better quicker.

For an individual living with depression or anxiety, psychotherapy can promote better understanding of the condition and associated symptoms. For a person with depression, being able to talk with a psychologist or therapist who is there to listen, inquire, and help can be comforting as well as rewarding. After just a few sessions of psychotherapy, clients may feel a difference. Research suggests that three to five sessions often cause significant change. Talking through the issues can help identify behaviors and detrimental reactions or circumstances. Coping techniques can also be investigated during therapy sessions, and progress reports can be used to keep track of how these techniques work. For individuals experiencing anxiety or depression, being surrounded by loved ones or being encouraged to attend therapy sessions can provide immense support.

Depression among older adults is an often-overlooked health crisis. Studies show that more than half of all people older than 60 diagnosed with depression fail to respond to initial treatment programs. In general, a psychotropic medication such as Lexapro (escitalopram) is one option of many as a first treatment. A variety of factors, however, complicate the successful treatment of elderly depression. Comorbid conditions, such as anxiety or poor physical health, may exacerbate the symptoms of depression. For reasons not fully understood, elderly patients respond more slowly to psychotropic medications in general. The patient’s level of independence likewise contributes to the success or failure of standard treatments. Despite the well-documented difficulty of treating depression in the elderly, relatively little work has been done to find more age-appropriate solutions to the problem.

In the case of elderly adults with depression, behavioral therapy may be at least as important as medication. One form of therapy known as depression care management (DCM) focuses on educating the patient about depression, their treatment, and practical measures for improving mood and daily functioning. Another therapy, known as interpersonal psychotherapy (IPT), is more intense and individually targeted. IPT resembles traditional cognitive-behavioral therapy, whereas DCM is more akin to routine counseling.

In a study of elderly adults, researchers tested whether DCM alone or coupled with IPT is more beneficial for those with a history of poor response to antidepressant medication. Study participants were administered standard prescriptions for Lexapro, which was increased as needed after an initial 6 weeks. People who experienced remission with medication alone were dropped from the study. Poor responders were divided into a DCM group and a DCM plus IPT group. Eighty percent of these individuals saw some improvement, while half experienced full remission of symptoms. Interestingly, there were no significant differences between the groups. Researchers theorized that “quantity” of therapeutic attention was less important than the existence of the attention at all. Therefore, the addition of DCM alone produced benefits; adding IPT did not produce more benefits.

The study was somewhat limited because researchers did not control for external variables, other than medical conditions that might argue against the use of Lexapro. In addition, some patients might have improved simply because of increased dosages and not behavioral interventions. More investigation is necessary to answer such questions.

References
Reynolds III, C. F., Dew, M. A., Martire, L. M., Miller, M. D., Cyranowski, J. M., Lenze, E., et al. (2010). Treating depression to remission in older adults: a controlled evaluation of combined escitalopram with interpersonal psychotherapy versus escitalopram with depression care management. International Journal of Geriatric Psychiatry, 25(11), 1134-1141.