What is dynamic interpersonal therapy (DIT)?

Dynamic Interpersonal Therapy (DIT), like many forms of psychotherapy and counselling, supports that what happened in our past may be affecting our present – how we currently feel, think, and behave. Psychodynamic theory deals with our unconscious processes, maintaining that when things are very painful we may try – and often succeed – to ignore them. Our efforts to suppress painful feelings and memories can make them very difficult to access and they therefore have the potential to affect our present day lives in ways that are difficult to identify and overcome alone. 

DIT is a time-limited, highly structured psychotherapeutic treatment, usually lasting 16-weeks. Grounded in psychodynamic theory, this brief model was developed by Alessandra Lemma, Peter Fonagy and Mary Target in 2010. It was developed in as part of the IAPT (Improving Access to Psychological Therapies) service, to ensure that a psychoanalytically-informed model of therapy was available to people alongside cognitive behavioural therapy (CBT). DIT is now offered at Step 3 within IAPT. 

NICE (The National Institute for Health and Clinical Excellence) guidelines for depression state that dynamic interpersonal therapy should be considered for clients with depression who have not responded to CBT, or where the client actively opts for a psychodynamic approach. 

Dynamic interpersonal therapy, as the name suggests, focuses on relationships. The belief is that when we are able to deal with a relationship problem (whether this lies within a platonic, family, work-based, or romantic relationship), our psychological symptoms, such as anxiety and depression, often improve. 

The aim of dynamic interpersonal therapy is to help clients identify and understand core repetitive relationship patterns. Often these can be traced back to childhood. DIT views psychological symptoms as often being related to confused and detrimental thinking around attachment in relationships. Attachment is the term used to describe how and to what extent we allow ourselves to trust and depend on others, and therefore the kinds of relationships we foster in our lives. 

Once the core relationship pattern is identified, clients can begin to make better relational choices, to move themselves away from harmful relationships and help them to create more satisfying, healthy ones. DIT helps clients to better understand themselves and others. DIT sees relationships as being at the core of wellbeing; with good relationships, psychological symptoms like depression often lift.

Welldoing.org dynamic interpersonal therapist Sarah Aldridge explains how she uses DIT:

"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. The model was developed 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."

How does DIT therapy work?

Initial phase

During the initial phase your therapist works with you to find out what you find difficult in life and how these difficulties affect your relationships. This phase usually lasts 3-4 sessions. Once a picture of your needs has been painted, your therapist will work with you to decide what it would be most helpful to deal with over the 16 sessions. This main concern is called the Interpersonal Affective Focus (IPAF), i.e. a particular way in which the client perceives others in relation to a self-perception.

Middle phase of DIT

In the middle phase of DIT (sessions 5-12 usually), the therapist will largely remain quiet, listening to the narratives the client brings and to what emerges in the dynamics between client and therapist. The IPAF is the focus of the middle phase of the work. The therapist will seek to understand their clients' unconscious processes and defence patterns. 

The relationship between therapist and client becomes a model for creating better relationships outside of the therapy room. Your therapist may often draw attention to what you are feeling in the sessions, or to what they notice as defence mechanisms. By exploring how these may play out in the relationship between you and your therapist, the aim is to better understand your difficulties overall. 

Ending phase

Usually four sessions are dedicated to bringing the therapy to a close. 

Dynamic interpersonal therapy differs from other forms of psychotherapy in that the therapist and client directly discuss the plan for the duration of therapy; this is a more directly collaborative, goal-setting approach that is not found in other longer-term psychotherapeutic work. 

What are the goals of dynamic interpersonal therapy?

Dynamic interpersonal therapy seeks to help clients:

  • understand themselves and others
  • reflect on their thoughts and feelings
  • become more assured in their relationships
  • become more adept at managing relationship difficulties
  • be able to take responsibility in their relationships
  • sustain emotional and physical intimacy with others
  • reduce anxiety and depression

Who benefits from dynamic interpersonal therapy?

DIT therapist Sarah Aldridge continues: "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."

Dynamic interpersonal therapy may be suitable if you feel both that CBT is not in-depth enough for your difficulties, and that you don't necessarily feel you can dedicate the time to open-ended psychodynamic work. As explored above, DIT focuses on alleviating feelings of anxiety and depression that either play out in or are caused by difficulties in relationships. 

These relationship difficulties may feel like:

  • it may feel risky to get close to others
  • you may always give more than you take in relationships and end up feeling undervalued and drained
  • you may lack in confidence and feel resentful towards others who appear to you to be 'better'
  • you may have trouble expressing your feelings to others
  • you may compare your relationships to others and worry that there must be something wrong with you because you can't seem to maintain good relationships
  • you may feel invisible or ignored in your relationships

Last updated on 12 March 2020