The interpersonal theory of depression

The Interpersonal Theory of depression is one of the many key psychological theories. Psychological theories seek to explain human behavior, thought, emotions, and the origin of psychological disorders. There are several theories that were formed as a means to explain several mental health issues and disorders like depression. However, before we begin to try to understand the theories of depression, we must first be clear on what depression is.

There are several theories or theoretical models for understanding depression. The article “Depression Theories” by McLeod outlines the most common five are behaviorist, psychodynamic, cognitive, humanistic, and interpersonal theories. The behaviorist approach focuses on 

What are the different psychological models for depression?

There are several theories or theoretical models for understanding depression. The article “Depression Theories” by McLeod outlines the most common five are behaviorist, psychodynamic, cognitive, humanistic, and interpersonal theories. 

The behaviorist approach focuses on observable behaviors and how the interaction between the environment influences behavior. According to McLeod’s article, depression is either learned through observation and reinforcement (social learning) or it is learned through the association of stimuli to negative emotions.

The article “Depression Theories” summarizes the psychodynamic model as one that focuses on an individual’s unique forces and drives, but particularly that which lies in the unconscious mind. According to Freud’s psychoanalytic theory under the psychodynamic model, depression is a result of two things, loss, and the super-ego. Loss can come in two forms, actual loss as a result of death and symbolic loss such as job loss. 

The Cognitive approach focuses on an individual’s thought process. It theorizes that an individual becomes depressed due to a negative mindset or perspective. Depressed people have mainly negative views of self, the world, and the future and tend to view experiences in a negative light. 

According to McLeod’s article, the humanistic approach is based on the individual and their specific needs and motivations. According to this theory, every human has needs and the strongest need, that creates a sense of life purpose is that of self-actualization. Self-actualization is the drive to achieve a sense of purpose in life and reach one’s full potential in terms of abilities and development. Anything that blocks the drive towards self-actualization can lead to depression. 

What is the interpersonal theory of depression?

The interpersonal theory of depression is one of the many psychological theories that strive to explain the cause of depression. Depression has been the focus of multiple psychology theories and each theorist attempts to understand the causes and progression of the disorder from a unique point of view. 

The interpersonal theory of depression focuses on the interaction with others and how these interactions may lead to depression. 

Who came up with the interpersonal theory to investigate the cause of depression?

The interpersonal theory was theorized by Harry Stack Sullivan an American psychiatrist. Chakrabarti’s article summarizes Harry Stack Sullivan’s theory which revolves around interpersonal relationships and their influence on experiences, behaviors, and personality. The article also explains that Sullivan believed that personality is temporary and is shaped by interactions with others over time. 

Harry Stack Sullivan was a trained psychoanalyst and the psychodynamic approach provided the foundation for a lot of the concepts he theorized. He then broke away from being exclusively psychoanalyst and tied together several concepts from the cognitive and the interpersonal approaches to form his theory as seen in the AllPsych article on Harry Stack Sullivan.

What are the main concepts in the interpersonal theory?

Interpersonal theories are based on interaction with others. According to Sullivan’s interpersonal theory that is summarized in Chakrabarti’s article, there are two primary needs that are believed to be the basis of emotional wellbeing. Chakrabarti then goes on to explain Sullivan’s theory and the two crucial human needs: security and satisfaction. The need for security is defined as freedom from anxiety that begins in infancy and the initial interaction with the mother and the balance between euphoria and anxiety. The need for satisfaction includes physiological needs, emotional contact, transformation throughout the various stages of development, and infant attachment. 

Chakrabarti’s article explain’s Sullivan’s concept of self, which is developed through experience and behaviors and the reaction they create from the mother. There are three forms of self: the good-me, bad-me, and not-me. The good-me is developed through behaviors that the mother approves and bring little or no anxiety to her. The bad-me is developed through anxiety-inducing behaviors in the mother. The not-me is the parts of self that the child obliterates because they are associated with intense anxiety from the mother. 

According to the interpersonal theory, personality is acquired through several stages (developmental epochs) and is known as the self-system as outlined in Chakrabarti’s article on Sullivan’s interpersonal theory.

1. The infancy stage is birth to age 1, where children receive tenderness and feel secure or learn anxiety from the mother. 
2. The child stage is age 1 to 4 where the child plays and seeks interaction and participation from adults.
3. The juvenile stage is age 4 to 8 where the child interacts with peers and competes, as well as seeks cooperation and compromise.
4. The preadolescent stage is age 8 to 13 where the child seeks intimacy, lovingness, and connection from a best friend or same-sex peers. This is considered a “chum period” or prototype for intimacy. 
5. The Early adolescent stage is in ages 13-16, where the child’s needs for intimacy, lovingness, and connection shift to opposite-sex peers and sexual interests arise. 
6. The late adolescence stage occurs after age 16 where sexual interests and interactions rise 
7. The adult stage is where stable relationships are formed with significant others and their personality and worldview become more concrete. 

Sullivan’s theory stated that there are three modes through which people experience and perceive the world around them: The prototaxic, parataxic, and syntaxic modes. The prototaxic mode is a holistic view, where the individual cannot differentiate the whole into smaller parts. The parataxic mode is a mode in which everything is causally related but without logical relationships. The syntaxic mode is the more rational and logical mode of thinking.

When applied, the interpersonal theory would explain depression as a result of interpersonal loss, and adverse interactions with significant people in the individual’s life. The interpersonal theory focuses on adverse life events and their link to an individual’s mood. 

Under the interpersonal approach, It is believed that depression is a medical illness and is not caused by the patient but rather mood disruptions are triggered by changes in the patient’s life. According to interpersonal theory, depression is caused by a disturbing change in one’s interpersonal environment as seen in Markowitz and Weissman’s article on Interpersonal therapy. These changes can be as a result of the death of a loved one, a major life change such as a career change or move, illness, and difficulty in an interpersonal relationship, or the end of a significant relationship. 

In some cases, the individual may have mood changes and as a result, their interpersonal relationships may be negatively affected which may then carry the episode into Major Depressive disorder (Markowitz and Weissman). 

What is depression?

Depression is a mood disorder, recognized in the DSM-V or the diagnostic and statistical manual which is the main diagnostic tool used by mental health professionals. Depression is also known as major depressive disorder or clinical depression. Torres, in the article “What is depression”,  states that depression is an episode of persistent sadness, loss of interest, and low energy.

Torres then goes on to list the following DSM-V symptoms for Major depressive disorder: may include feelings of hopelessness, guilt, and emptiness, self-blame, angry outbursts, irritability, sleep disturbances, changes in appetite, restlessness, slowed thinking, slowed speech, and slow movement, difficulty concentrating and remembering things, unexplained physical problems, and thoughts of death and suicidal attempts. 

How is depression diagnosed?

According to Trushels’s summary of DSM-V Depression diagnosis criteria, for a diagnosis to be made for depression or Major depressive disorder at least five of the above symptoms must be present within the same two-week period and either depressed mood or loss of interest/pleasure must be present within that time. These symptoms must also cause significant distress in a key area of the individual’s functioning e.g social or occupational functioning. 

Interpersonal therapy for depression                                                                                                                         

Out of the wonderful interpersonal theory came interpersonal therapy. There are a lot of different therapeutic approaches for depression, but one of the key approaches is the interpersonal approach based on interpersonal theory. 

Interpersonal therapy (IPT) focuses on interpersonal functioning and dealing with the issues that have occurred in the social context of the individual. Whether the mood changes occurred as a result of the interpersonal issues or they lead to changes in the interpersonal context of the individual, the main focus of interpersonal therapy is to solve the interpersonal problem (Markowitz and Weissman). Once the interpersonal issues are resolved, the depressive symptoms should also be resolved. 

In the article on Interpersonal therapy by Markowitz and Weissman, they state that interpersonal therapy usually occurs within a period of 12 to 16 weeks and is done in three phases, the beginning or initial phase, middle and end phase. This article further explains that phase one mainly involves gathering information in order to make a proper diagnosis for MDD and identify the issues the client may have within their interpersonal context. 

In this phase, the therapist would do a clinical interview as well as use diagnostic tools in order to confirm that it is actually clinical depression. Markowitz and Weissman’s article states that during this phase, it is also important to assess the severity of the depression and gather full information on the interpersonal issues at hand so that a proper treatment plan can be formed for the specific context of the client and their issues. According to Markowitz and WeissmanIt is also important to discuss the specific interpersonal issue with the client and link it to the diagnosis and inform them of the goal of the therapy and the expectations for the depressive symptoms to decrease after the interpersonal issues are dealt with. 

Phase two, the middle phase involves actively dealing with the interpersonal problem that is fueling the depressive symptoms. According to Markowitz and Weissman, whether the issue is bereavement, major change, relationship difficulties, or end, the therapist would strategically deal with the issues the client is struggling with and ensure the appropriate skills are taught and the goals are consistent with the specific issues. If the issue is bereavement, the client would be supported through the mourning process. Where there are major changes and role changes, the client would be supported through the adjustment process and be able to mourn the old roles and adjust to the new roles. In cases of relationship difficulties, the client would learn skills to express themselves, communicate their needs, resolve conflict, and more skills that are necessary for that specific context. Where a relationship has ended, the client would need to process it as a loss and grieve the relationship.

Markowitz and Weissman describe the final phase as one that is in preparation for termination. This phase involves preparing the client for termination and reflecting on the therapeutic process and progress. Therapy becomes a routine and the client-therapist relationship becomes an important one and it is important to prepare the client for the end. As the termination session approaches, the therapist and client would explore the accomplishments and successes throughout the therapeutic journey to boost the client’s sense of independence and self-efficacy 

References

Chakrabarti, P. (n.d.). Harry Stack Sullivan: Energy and Interpersonal Relationships. Library of Professional Psychology. Retrieved December 17, 2021, from https://library.psychology.edu/harry-stack-sullivan-energy-and-interpersonal-relationships/

Chapter 5.6: Harry Stack Sullivan » AllPsych. (n.d.). AllPsych. Retrieved December 17, 2021, from https://allpsych.com/personality-theory/psychodynamic/stack_sullivan/

Markowitz, J. C., & Weissman, M. M. (2004). Interpersonal psychotherapy: principles and applications. World Psychiatry, 3(3), 136-139. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414693

McLeod, S. (n.d.). Depression Theories. Simply Psychology. Retrieved December 18, 2021, from https://www.simplypsychology.org/depression.html

Torres, F. (n.d.). What Is Depression? American Psychiatric Association. Retrieved December 18, 2021, from https://www.psychiatry.org/patients-families/depression/what-is-depression

Truschel, J. (2020, September 25). Depression Definition and DSM-5 Diagnostic Criteria. Psycom.net. Retrieved December 18, 2021, from https://www.psycom.net/depression-definition-dsm-5-diagnostic-criteria/