For GPs

Interpersonal Therapy with Dr Cate Howell

Focussed psychological strategies drawn from Interpersonal Therapy can greatly assist understanding of the interaction of mental health symptoms with relationship issues (psychoeducation) and how to manage interpersonal conflict or sensitivities (such as communication challenges).

Other approaches such as cognitive-behavioural strategies, can also be integrated with IPT. It is important to remember that change is always possible, and thanks to neuroplasticity, we can work on developing a more secure attachment style over time, and this will aid our relationships. Below is an excerpt of information from Dr Cate Howells Interpersonal Therapy FPS activity. To learn more, check out her website here.

We are social creatures, and at the core of mental health presentations there may be significant relationship issues or challenges (such as dis-satisfaction, conflict, or abuse), which may, for example, cause anxiety or depression symptoms. Interpersonal Therapy utilises a relationship lens in addressing mental health problems, and one theory that may be drawn upon in exploring interpersonal relationships is ‘Attachment Theory’.
Developed by Dr John Bowlby and Mary Ainsworth, this theory considers our early attachments or bonds with parents or caregivers, suggesting that these may shape our expectations and behaviours in later relationships. Research has shown that when parents or caregivers are responsive to their infant’s needs, this provides a ‘safe base’ for the infant to feel secure enough to then explore their world. Developing a secure attachment helps us to learn to manage our emotions and helps us in later partner relationships.
Several main patterns or styles of attachment have been identified: 

• Secure style: The infant learnt that the parent was a safe base and responded to their needs. If an adult has a secure attachment style, they feel okay with displaying interest and affection, as well as with being alone and independent. They can cope with rejection but report being happiest in relationships. They tend to choose partners well, because they are not interested in being treated badly by others.
• Insecure avoidant style: The infant experienced a lack of intimacy with the parent. The infant learnt that the parent did not respond to their emotions, especially when they were needy or angry, so they learnt to repress their feelings and become independent. Adults with avoidant attachment are often uncomfortable with intimacy. They may avoid commitment or avoid too much contact with their partners.
• Insecure ambivalent (or anxious) style: The infant with this style learnt that even if the parent was physically present, they would sometimes but not necessarily always soothe them. As result they tend to ‘over activate’ their attachment system and become clingy. Adults with an anxious attachment style have difficulty in being single compared with the other styles and, as a result, are more likely to have unhealthy relationships.
• Disorganized or chaotic style: These infants often experienced physical or sexual abuse, and the parents may have had severe mental health or substance-related issues. The infant learnt to be fearful of the parent, as the parent also represented danger. They displayed a chaotic mix
of behaviours (moving towards the parent, then away). Adults with a disorganized attachment style are likely to have more chaotic relationships, with conflict and crises.

It is said that psychological issues occur, and interpersonal relationships break down when an individual’s need for attachment is not being met. This can occur both when we cannot effectively communicate our needs and when our partner is not able to respond adequately to our needs. Awareness of attachment styles can also help us understand behaviours, be less distressed by them, and work on changing them.

The attachment model can help us understand how we respond in relationships, and when getting to know potential partners we can also be aware of their level of security. Here are some examples of how attachment style can influence our responses, and what me may need to work on:

• If we have an avoidant attachment style, we often partner with those with an anxious style. We need to foster their ability to be intimate emotionally with a partner and not pull away (such as in conflict situations), and to allow mutual support.
• If we have an anxious attachment style, we need plenty of reassurance from our partners, and trust issues may occur. If we partner with someone with an avoidant style, there will be challenges. However, for those with an anxious style, learning to communicate needs or choosing more secure partners, will result in more fulfilling relationships.

References:
Howell, C. (2023). The Flourishing Woman A mental health and wellbeing guide. Exisle.
McLeod, J. & McLeod, J. (2011). Counselling Skills A practical guide for counsellors and helping professionals (2nd Ed.). Open University Press. “