What is Dynamic Interpersonal Therapy? Everything Explained

Last Updated on September 12, 2024

Dynamic Interpersonal Therapy (DIT) is a relatively recent psychotherapeutic approach that has garnered attention for its structured and time-limited nature, specifically designed to address mood disorders such as depression and anxiety. 

Developed by Alessandra Lemma, Peter Fonagy, and Mary Target, DIT identifies a primary problematic pattern of relating that can often be traced back to early relationships. This pattern, known as the Interpersonal Affective Focus (IPAF), is considered the driving force behind the individual’s current distress.

DIT operates on the premise that psychological symptoms often manifest difficulties in how we relate to others. DIT has been integrated into the NHS Talking Therapies program in the UK and is supported by the National Institute for Health and Clinical Excellence (NICE) guidelines for depression. It offers an alternative for patients who may not have responded to other interventions, such as Cognitive Behavioral Therapy (CBT), or for those who prefer a psychodynamic approach.

History and Origin of Dynamic Interpersonal Therapy

The origins of DIT can be traced back to the early 1970s with the advent of Interpersonal Psychotherapy (IPT), which Gerald Klerman and Myrna Weissman developed as a short-term, focused approach for treating major depression. IPT itself was influenced by the work of American psychiatrist Harry Stack Sullivan, who believed that interpersonal relationships are at the core of psychological well-being and disorders.

Over the years, IPT has been adapted for various mental health conditions and different populations. However, it was the Improving Access to Psychological Therapies (IAPT) initiative in the UK that prompted the development of a more structured and time-limited model that would be compatible with the National Health Service’s approach to treating depression. That led to the creation of DIT.

DIT was formally developed in 2010 by Alessandra Lemma, Peter Fonagy, and Mary Target. These key figures collaborated to create a model that would meet the IAPT requirements while still providing a psychodynamic approach to treatment. Their work ensured that DIT was grounded in evidence-based practice and could be offered alongside other treatments, such as Cognitive Behavioral Therapy (CBT).

Core Principle of Dynamic Interpersonal Therapy

At the heart of DIT is the concept that our psychological symptoms, particularly depression, are often related to our interpersonal experiences. It emphasizes understanding and working through these relational patterns to alleviate symptoms such as anxiety and depression. 

DIT helps patients explore and understand their internal world and how it affects their relationships with others. The therapy aims to identify a core repetitive pattern of relating that is problematic and to work through this pattern in the context of the therapeutic relationship.

By examining these patterns, DIT aims to help individuals comprehend and change their interpersonal dynamics, leading to improved mental health and well-being.

The DIT Process: What to Expect

The DIT (Dynamic Interactional Therapy) process typically begins with an initial assessment, which is a critical step in understanding the client’s current situation and needs. The initial assessment includes:

• An informal socializing period.
• Agenda setting.
• Review of previous sessions.
• Teaching new material.
• Summarizing progress.
• Agreeing on home practice before the next session.

It’s a collaborative effort setting the stage for effective goal setting. 

The goal-setting stage is equally important, as it helps in breaking down long-term aspirations into manageable short-term objectives. This structured approach ensures that the goals are meaningful and achievable, providing a clear roadmap for the client’s journey toward recovery and personal growth.

What to Expect in a DIT Session?

• The pace of the session should be comfortable for the client, with the information presented in small chunks, if necessary, to accommodate any cognitive difficulties the client may have.

• It involves discussing current concerns and past events to identify patterns affecting present interactions and feelings.

• It encourages you to reflect on thoughts and feelings to handle your interpersonal difficulties better.

• DIT can be used alongside medications, such as antidepressants, if necessary.

• Handouts provided during the DIT process include sections of text, main points highlighted in boxes, questions, tables, and suggested home practice assignments, all designed to facilitate the goal-setting process.

• The overall aim of the initial assessment and goal setting in the DIT process is to create a structured plan that guides the client towards recovery, resilience, and the achievement of their personal goals.

Structured Sessions: A Step-by-Step Guide

The therapy is divided into three distinct phases:

1. Initial Phase

This phase involves assessing the patient’s suitability for DIT and creating a formulation of their primary interpersonal issues. It sets the stage for the work to come, establishing the therapeutic alliance and setting the focus for the therapy.

2. Middle Phase

During this phase, the therapist and patient work together to identify and understand a problematic, recurrent interpersonal-affective pattern (IPAF). Techniques are employed to explore this pattern within the context of the patient’s current relationships and past experiences.

3. Ending phase

The final sessions are dedicated to consolidating the gains made during therapy and preparing for its conclusion. This phase helps the patient to integrate new insights and apply them to their daily life outside of therapy.

Typical Duration and Course of DIT

Dynamic Interpersonal Therapy (DIT) is a brief, structured form of psychotherapy that focuses on interpersonal relationships and is typically delivered in 16 sessions. 

• The initial phase of engagement and assessment usually spans the first four sessions. 
• The middle phase of therapy, which covers sessions 5 to 12, is where the majority of the therapeutic work takes place. 
• The final phase, covering sessions 13 to 16, focuses on consolidating gains, planning for the future, and preparing for the end of therapy. 

For those interested in training, there are options such as the 5-day DIT training for psychoanalytically or psychodynamically trained practitioners and a more extensive 20-day DIT training for those who may not have all the psychodynamic competencies required. 

Accreditation for these courses is provided by recognized bodies such as the British Psychoanalytic Council, ensuring that practitioners meet the standards required to deliver this form of therapy.

Ideal Candidates for DIT

DIT is rooted in psychodynamic principles and is designed to help individuals understand and is particularly effective for:

Depression

DIT is recommended as an intervention for depression by the National Institute for Health and Clinical Excellence (NICE). It helps individuals understand the underlying interpersonal issues contributing to their depressive symptoms.

Anxiety

Those with anxiety may find relief through DIT by addressing the relational patterns that exacerbate their anxiety.

Relational Issues

DIT can help individuals who struggle with forming or maintaining relationships, whether they are personal, familial, or professional.

Attachment Issues

By focusing on attachment styles and how they impact current relationships, DIT can aid individuals in forming healthier connections.

While DIT can be beneficial for a wide range of individuals, it is particularly suited for those who:

• Are you experiencing depression or anxiety related to interpersonal issues
• Have a desire to understand their relational patterns 
• Are you open to a time-limited therapy
• Prefer a structured approach to therapy

Contraindications: When DIT May Not Be Suitable

While DIT can be a powerful therapeutic tool, it is not suitable for everyone. Certain conditions may serve as contraindications for DIT, meaning that the therapy might not be the best option for individuals with these conditions. 

• Individuals with severe mental health disorders that require more intensive, long-term treatment may not benefit from the short-term nature of DIT.

• Additionally, those who have difficulty engaging in the reflective and introspective processes required by DIT may find it challenging to benefit from this therapy.

Comparing DIT with Other Therapeutic Approaches

Like other psychodynamic therapies, DIT delves into the unconscious processes and motivations behind behaviors. However, it is more structured and time-limited than traditional psychoanalysis, providing a clear framework and focus for therapy sessions.

Behavior therapy

Behavior therapy, including its subset cognitive-behavioral therapy (CBT), differs from DIT in its emphasis on learning’s role in developing behaviors. CBT, for instance, combines both cognitive and behavioral techniques to modify dysfunctional thinking and behavior.

Humanistic therapies

Humanistic therapies, such as client-centered therapy and existential therapy, prioritize the individual’s capacity for self-determination and growth. They differ from DIT in their non-directive approach and focus on the client’s current experiences rather than past relationships.

Integrative or holistic therapies

Integrative or holistic therapies do not adhere strictly to one theoretical approach but instead combine elements from various therapies to tailor treatment to the individual client. It contrasts with DIT’s structured and focused methodology.

In practice, DIT’s structured approach can be particularly beneficial for individuals seeking a more goal-oriented and time-limited therapy. Moreover, DIT’s focus on relationship patterns offers a unique perspective that can complement other therapeutic approaches.

What to Look for in a DIT Practitioner

When seeking a Dynamic Interpersonal Therapy (DIT) practitioner, it’s important to ensure they have the proper qualifications and training. A qualified DIT practitioner should have completed an accredited DIT course and be designated as a BPC-accredited practitioner. Additionally, they must have completed a minimum of one year of personal psychoanalytic/psychodynamic psychotherapy or counseling and at least 150 hours of supervised psychodynamic practice. 

It’s also essential that they are registered with a recognized professional body such as HPC, BACP, BPC, or UKCP. DIT is a brief, semi-structured therapy designed for mood disorders. It is recognized by the Department of Health and the National Institute for Health and Clinical Excellence (NICE) as an effective treatment for depression. 

When choosing a DIT practitioner, verifying these credentials and their adherence to ethical codes can help ensure you receive quality care tailored to your needs.

Questions to Ask Your Therapist

Questions to consider asking a therapist when starting DIT could include:

1. What is your experience with Dynamic Interpersonal Therapy?
2. Can you explain how DIT might help with my specific concerns?
3. How do you track progress during the 16-week program?
4. What happens if I don’t feel improvement after the therapy sessions?
5. How does DIT integrate with other treatments I might be receiving, such as medication?

It’s also important to ask about the therapist’s qualifications, approach to therapy, and experience with treating similar issues to ensure a good fit for your needs.

How Does DIT Help in Overcoming Relationship Issues?

DIT helps individuals understand and address patterns of relationships that may contribute to their psychological distress. By exploring the connection between their symptoms and current relational issues, clients can identify and change unhelpful interaction patterns. 

Through this exploration, clients can gain insight into how past experiences influence their present interactions and begin to make conscious changes to improve their relationships and, consequently, their mental health.

For instance, DIT can help a person recognize a tendency to become involved in relationships where they feel undervalued and work towards establishing more mutually satisfying connections.

How Does DIT Help in Managing Anxiety and Depression?

DIT is also beneficial for managing anxiety and depression. It operates on the understanding that improving interpersonal functioning can lead to a reduction in psychiatric symptoms. By focusing on key relationships that contribute to a person’s distress, DIT provides a framework for tackling interpersonal issues that may exacerbate anxiety and depression.

During DIT, therapists help clients link their mood with ongoing relational problems, such as conflicts with a partner or difficulties in expressing needs and emotions. By addressing these problems, clients can experience a decrease in their symptoms of anxiety and depression. 

What is the Cost of DIT?

The cost of DIT can vary widely depending on factors such as the therapist’s experience, location, and whether the therapy is covered by insurance. While some therapists may offer a sliding scale fee, others may charge a fixed rate per session. 

For instance, online platforms like BetterHelp may start at around $65 per week. In USA, average fee can range from $75 to $175 per session. In the UK, fees can range from £55 to £65 per session. 

It’s important to note that many insurance plans do cover psychotherapy, which can significantly reduce out-of-pocket expenses. To determine the exact cost of DIT, it would be best to consult with a therapist who offers this specific modality and inquire about their fees and the potential coverage by your insurance plan.

Can DIT be Combined with Medication?

Regarding the combination of DIT with medication, it is not uncommon for therapists to integrate DIT with pharmacotherapy, especially in cases of severe depression or other mental health conditions where medication can help manage symptoms more effectively.

Research has shown that combining psychotherapy with medication can often lead to better outcomes than either treatment alone. For instance, studies have indicated that interpersonal therapy, when combined with medication, can be more effective at managing major depression than medication alone. That is also supported by evidence suggesting that such a combination may help prevent the recurrence of depressive episodes. 

The decision to combine DIT with medication should be made collaboratively between the patient and their healthcare provider, considering the individual’s specific needs, symptoms, and circumstances. The healthcare provider can assess the severity of the condition and determine the most appropriate treatment plan. 

Challenges and Limitations of Dynamic Interpersonal Therapy

Despite its effectiveness, DIT faces several challenges and limitations.

• Workforce Gap: One significant challenge is the workforce gap; DIT professionals represent a small fraction of therapists, limiting access to this form of therapy. 

• Complex Trauma Histories: Besides, DIT’s focus on present-day issues may not fully address the needs of individuals with complex trauma histories, as it does not delve deeply into past experiences. The therapy requires active engagement and commitment from the patient, which can be a barrier for those who are unable or unwilling to participate fully in the therapeutic process. 

• Psychiatric Disorders: While DIT is beneficial for a range of mental health conditions, its primary design for depression means it may not be the best fit for all psychiatric disorders. The structured nature of DIT, while providing a clear treatment framework, may also restrict the flexibility needed to tailor therapy to individual patient needs. 

FAQs

Conclusion

Dynamic Interpersonal Therapy is a powerful tool for those struggling with the interplay between their relationships and mental health. It offers a focused approach that can bring about significant improvements in a relatively short period. By fostering a deeper understanding of oneself and one’s relationships, DIT can lead to lasting positive changes in both interpersonal dynamics and overall well-being.