Book Review

New Applications of Interpersonal Psychotherapy

N Engl J Med 1993; 329:1973-1974December 23, 1993

Article

New Applications of Interpersonal Psychotherapy
Edited by Gerald L. Klerman and Myrna M. Weissman. 408 pp. Washington, D.C., American Psychiatric Press, 1993. $49.95. ISBN: 0-88048-511-6

New Applications of Interpersonal Psychotherapy is really two things. It is a discussion of psychotherapy and research in psychotherapy, but perhaps more important, it is a legacy of the late Gerald L. Klerman. Dr. Klerman was a distinguished American psychiatrist who made major contributions in psychopharmacology and biologic psychiatry. His efforts as head of the Alcohol, Drug Abuse, and Mental Health Administration enhanced both research and teaching in psychiatry, as well as the quality and delivery of care to patients. Despite his prominence in biologic psychiatry, Dr. Klerman had a commitment to psychosocial psychiatry, particularly in the area of research. He would frequently acknowledge the difficulty of doing research on psychosocial interventions such as psychotherapy because of the problems in defining the interventions and the sometimes extended periods needed to assess outcome. However, as noted in the book's dedication, he emphasized the need to do research in psychosocial psychiatry in order to ensure that clinical treatment is based on empirical data, as opposed to ideology.

This book is not about the many varieties of dyadic psychotherapy in use today. Dr. Klerman and Myrna M. Weissman, Ph.D., his long-time collaborator and his wife, developed a specific model of brief psychotherapy for depression called “interpersonal psychotherapy” (G.L. Klerman, M.M. Weissman, B. Rounsaville, and E. Chevron. Interpersonal Psychotherapy: Efficacy and Adaptations. New York: Basic Books, 1984). Interpersonal psychotherapy is a specific, semistructured treatment in which the focus is on education about depression and depressive symptoms and on the patient's relation to the environment, particularly his or her social functioning. In contrast to traditional psychodynamic psychotherapy, interpersonal psychotherapy focuses on the here and now and makes no attempt to address issues related to underlying personality structures. Although the technique has not been widely used clinically, many of its essential elements can be adapted for clinical work, and it is a specific intervention that can readily be studied.

New Applications of Interpersonal Psychotherapy is divided into three sections. The first, by Drs. Klerman and Weissman, gives an overview of the concepts behind the technique and its use in the treatment of depression. The second section contains seven chapters by a variety of authors on the use of interpersonal psychotherapy in various kinds of depression: recurrent depression, depression in different parts of the life cycle, such as adolescence or late life, or depression in particular situations such as marital disputes or with patients positive for the human immunodeficiency virus. The final section, by Klerman, Weissman, and others, discusses the use of interpersonal psychotherapy for such problems as stress, drug abuse, and eating disorders.

All the sections are well written and clear about the use of the techniques of interpersonal psychotherapy. In accordance with the approach of the editors, some of the chapters also contain research data assessing the efficacy of interpersonal psychotherapy. In some instances there is a refreshing openness about the usefulness of this type of therapy as compared with psychotropic medication or other forms of psychotherapy. There is considerable detail about the nature and process of educating patients about their difficulties, assessing their environmental and interpersonal problems, and working with them to resolve their dilemmas. It should be noted, however, that interpersonal psychotherapy is recommended primarily for nonpsychotic disorders. Furthermore, given the short-term, here-and-now emphasis of this particular type of therapy, it has not been recommended for the treatment of personality disorders.

This book is primarily for mental health professionals, particularly those who practice psychotherapy or who are interested in research in psychotherapy. It may also have some appeal to primary care physicians. Its main drawback is that it does not describe the original form of interpersonal psychotherapy in detail, so that one must refer to the previous book for specifics. Still, there is a richness of thought and discussion here that adds to one's understanding of the role of this particular kind of psychotherapy. In the end, however, this is not just a book about psychotherapy. It is a testament to the work of Drs. Klerman and Weissman, to the collaboration between Dr. Klerman and many other professionals, and to the important work of Dr. Klerman and its effects on the many lives he touched.

James A. Chu, M.D.
McLean Hospital, Belmont, MA 02178