PPRNet Clinical summary: Interpersonal Distress as a Criterion for Personalizing Psychotherapy for Depression

Over many years, psychotherapy researchers have tried to enhance treatment outcomes for depression by matching patients to treatments (e.g., CBT or psychodynamic) with minimal success. This approach is not practical because most therapists are not trained in many treatment orientations. More recently, some have suggested identifying a single meaningful patient variable that might be used to indicate what to focus on within a therapeutic orientation to improve outcomes. A candidate patient variable is interpersonal problems, which are known to be related to depressive experiences and to predict psychotherapy outcomes. Patients with higher interpersonal distress tend to have a worse response to therapy and a weaker therapeutic alliance. However, there is also evidence that those with more interpersonal problems may do better with psychodynamic therapy that addresses maladaptive interpersonal patterns in the therapeutic relationship (i.e., transference-focused) versus a psychodynamic treatment that does not focus on transference. In this study, Gomez Penedo and colleagues randomly assigned 100 patients with depression to receive Supportive Expressive Therapy (SET) that focused on maladaptive relational patterns or Supportive Therapy (ST) that was mostly empathic and validating in nature without a significant interpersonal focus. As predicted, those patients with higher interpersonal problems at the beginning of treatment did significantly better in SET than ST. In addition, those with higher interpersonal problems who received SET versus ST showed greater improvements in the therapeutic alliance during treatment.

Practice Implications

This study suggests that personalizing treatments to patients based on their pre-treatment level of interpersonal problems leads to added benefit for the patient. A patient with greater interpersonal problems would benefit most from a therapy that explicitly helps patients to improve their self-understanding through the interpretation of interpersonal themes in the therapeutic relationship and their lives in general. These patients may benefit more from gaining greater insight into their relational patterns and emotional responses, including focusing on the therapeutic relationship and repairing alliance ruptures.

Gómez Penedo, J. M., Peysachov, G., Babl, A., & Zilcha-Mano, S. (2025). Interpersonal distress as a criterion for personalizing depression therapy. Journal of Counseling Psychology. Advance online publication. https://dx.doi.org/10.1037/cou0000785.