Dynamic interpersonal therapy (DIT) is a NICE-recommended therapy for depression and anxiety
DIT emphasises the importance of unconscious feelings and past experiences, but offers a structured course of therapy sessions
DIT therapist Sarah Aldridge explains how this therapy works
I was unaware of the decline in psychodynamic therapy within the NHS when I was undertaking my training in this area, in 2008. This wasn’t necessarily a cynical ploy on behalf of the training college but more reflective of the psychotherapists’ complacency (and blind panic?) at the national roll out of Cognitive behavioural therapy (CBT) often at the expense of longer term, non-evidence based psychodynamic therapies.
However, around this time, somewhat belatedly, dynamic interpersonal therapy (DIT) was being developed by a team of leading clinical psychologists and psychoanalysts as a brief model of psychodynamic therapy, based on newly developed psychodynamic competencies that could be evidenced in research as leading to good outcomes. The model is in some way an attempt to provide psychodynamic therapy (valued by many and yet how of reach of the majority due to time and money) to more people in public services, particularly in the NHS.
How does dynamic interpersonal therapy work?
DIT is a 16-session psychodynamic treatment for depression that is manualised, meaning there are set phases within the work, with specific tasks rather than being non-directive. Alessandra Lemma, Peter Fonagy, and Mary Target developed the model to help people deal with their depression when it is linked to a relationship or attachment threat.
Like longer term psychodynamic therapy, it aims to understand more unconscious feelings and experiences from the past and link them to how they affect the way we feel and behave in the present. It will all sound very familiar to a psychodynamic practitioner. What is different is the way the therapy follows a formula based on the available evidence.
DIT uses object relations and attachment theories as well as a mentalising techniques. It is relational and the therapist retains an analytic attitude. During the initial phase the therapist builds a picture of the patient’s difficulties particularly in relationships and interpersonal settings, eliciting an internal working model from the patient via their narrative. Unlike other therapies, this is then formulated into an Interpersonal Affective Focus – an IPAF’ to be discussed with the patient in the fourth session.
An example of DIT
A typical IPAF could be: the patient describes a childhood with parents who were neglectful both emotionally and physically. She presents with difficulties with her husband who she says takes no interest in her wishes or needs. Her sense of others is that they are untrustworthy and self-interested and that she is powerless and insignificant. This provokes anger and frustration, but she cuts off so then perpetuates the pattern rather than voicing her needs. Her less conscious aspect of the conflict is the deep terror of losing her sense of identity.
The middle phase (sessions 5-12) works on this pattern to encourage a shift and understand resistance to change. The end phase from sessions 13-16 involves closing the work and giving of a goodbye letter. The letter, borrowed from cognitive analytic therapy, describes the work and reflects on what was experienced in the relationship. There are obvious connotations of being a ‘transitional object’ and no doubt there is something powerful about writing in this intimate way, holding them in mind during this process and for the patient receiving a letter that reflects how much has been heard and understood.
What issues does dynamic interpersonal therapy help?
Although DIT was designed as a treatment for depression, it can also prove helpful with people struggling with symptoms of anxiety, when they relate to a relationship difficulty. Clients need to be open to think about their difficulties, and have a reflective capacity, interested and curious about their lives and inner world. It would not be recommended for people when there are drug or alcohol issues or people with a very complex range of issues as clients will need to be able to focus on the agreed goal. It is helpful for people who would benefit from a more active stance than in longer term therapies.
I have translated this treatment into private practice, admittedly those who are interested are suggested DIT by someone ‘in the counselling industry’ as well as being attracted to a brief therapy rather than open-ended treatment. But it is a growing area for private practice, making a meaningful therapy available for those who perhaps are in a more transitional place in their lives and can’t or don’t wish to commit to something longer term.
Until recently, training in DIT was available from the Anna Freud Centre, for those with experience and training in psychodynamic theory. Extended Dynamic Interpersonal Therapy (e-dit) is a new course offered, for those counsellors or psychologists with differing models of training.
DIT is now a NICE recommended treatment for depression and anxiety and available in NHS IAPT services (Improving Access to Psychological Therapies). You can self-refer to all IAPT services or go through your GP. For private therapy, you can start here and see therapists who offer DIT here.