Interpersonal Reconstructive Therapy

Interpersonal reconstructive therapy incorporates aspects of biological and psychoanalytic attachment theories into a case formulation model that explains symptoms in relation to client views of safety and threat.

Therapy follows a set series of steps, and the therapist chooses treatment and specific interventions on the basis of the case formulation and at what point in the therapeutic process the client may be. The client's sense of safety is a central concern, as this core mental schema will change as a result of the therapy process.

In this program, Dr. Lorna Smith Benjamin works with a 19-year-old single woman with severe anxiety who was hospitalized after attempting suicide. Dr. Smith-Benjamin works to understand the worldview of the client and help her begin to move from feeling hopeless and unseen toward a sense of agency.

The client in this video is portrayed by an actor on the basis of a composite of case descriptions.

Dr. Benjamin's version of how to integrate the best of effective psychotherapies in practice is called interpersonal reconstructive therapy (IRT) therapy, a model that works with all types of therapeutic approaches — cognitive behavioral, psychodynamic, existential or otherwise.

This approach has been tested for effectiveness on a population that has a documented record of treatment resistance so severe they could not be admitted to a randomized control trial (RCT).

The strategy for testing effectiveness is to determine whether theoretical mechanisms of change were activated during treatment and whether that related directly to outcome. This is a research strategy presently recommended by the director of the National Institute of Mental Health because it does not ignore all of the individuals in an RCT who did not respond to the main effect.

The three components of IRT are

• natural biology
  an attachment-based view of the development, structure, and function of the safety and threat systems that regulate affects
• structural analysis of social behavior
  a reliable and valid metric of internalized representations of attachment figures and current social interactions
• IRT case formulation model
  which explains how current symptoms are related to rules and values regarding safety and threat that evolved in relationship with attachment figures

The IRT treatment model draws on natural biology and the IRT case formulation to guide selection of interventions for a given patient at a given point in his or her progression through five therapy steps. The case formulation and treatment models are illustrated in this video program.

Lorna Smith Benjamin, PhD, received her doctorate in psychology from the University of Wisconsin in 1960. Her primary advisor was Harry F. Harlow.

After 4 years of internship and postdoctoral clinical training in the Department of Psychiatry at the University of Wisconsin, she became a faculty member in the department. For the next 18 years, she taught and supervised psychology interns and psychiatry residents while maintaining a full-time private practice.

In 1987, she moved to the University of Utah at Salt Lake City where she began a different kind of academic career, one that emphasized research in psychopathology and psychotherapy. It was here that she developed her interpersonal model of personality and personality assessment, the structural analysis of social behavior (SASB). The model is also useful in choosing and tracking therapeutic interventions.

Dr. Benjamin received an honorary degree from the University of Umea in Sweden for her work with the SASB.

She has lectured extensively throughout the United States and abroad, and is currently Emeritus Professor at University of Utah, Department of Psychology, and Adjunct Professor at University of Utah, Department of Psychiatry.

In addition to her academic positions, she currently has an active consulting practice with the University of Utah Hospital, supervises and trains therapists, and maintains a private practice.

She is the author of numerous journal articles, book chapters, and books.

• Benjamin, L. S (2003/2006), Interpersonal reconstructive therapy: A personality based approach to complex cases. New York: Guilford Press.
• Benjamin, L. S. (1974). Structural analysis of social behavior (SASB). Psychological Review, 81, 392–425.
• Benjamin, L. S. (1979). Structural analysis of differentiation failure. Psychiatry: Journal for the Study of Interpersonal Processes, 42, 1–23.
• Benjamin, L. S. (1993). "Every psychopathology is a gift of love." Presidential Address reprinted in Psychotherapy Research, 3, 1–24.
• Benjamin, L. S. (1996). Introduction to the special section on structural analysis of social behavior (SASB). Journal of Consulting and Clinical Psychology, 64, 1203–1212.
• Benjamin, L. S. (1996/2003). Interpersonal diagnosis and treatment of personality disorders, second edition. New York: Guilford Press.
• Benjamin, L. S. (2015). The arts, crafts, and sciences of psychotherapy. Journal of Clinical Psychology: In Session, 71, 1070–1082.
• Benjamin, L. S. (in press). Interpersonal reconstructive therapy for anger, anxiety and depression: It's about broken hearts, not broken brains. Washington, DC: American Psychological Association.
• Benjamin, L. S., & Critchfield, K. L. (2010). An interpersonal perspective on therapy alliances and techniques. In J. C. Muran & J. Barber (Eds.), The therapeutic alliance: An evidence-based approach to practice & training (pp. 123–149).  New York: J. Wiley & Sons.
• Benjamin, L. S., Rothweiler, J. R., & Critchfield, K. L. (2006). Use of structural analysis of social behavior as an assessment tool. Annual Review of Clinical Psychology, 2, 83–109.
• Critchfield, K. L., & Benjamin, L. S. (2010). Assessment of repeated relational patterns for individual cases using the SASB-based Intrex questionnaire. Journal of Personality Assessment, 92, 480–489.
• Critchfield, K. L., & Benjamin, L. S. (2008) Internalized representations of early interpersonal experience and adult relationships: a test of copy process theory in clinical and nonclinical populations. Psychiatry: Interpersonal and biological processes, 71, p. 71–92.
• Critchfield, K. L., Benjamin, L. S., & Levenik, K. (2015). Reliability, sensitivity, and specificity of case formulations in interpersonal reconstructive therapy: Addressing psychosocial and biological mechanisms of psychopathology. Journal of Personality Disorders, 29, 547–573.
• Humphrey, L. L., and Benjamin, L.S. (1986) Using structural analysis of social behavior to assess critical but elusive family processes: A new solution to an old problem. American Psychologist, 41, 979–989.

APA Videos

• Adolescent Girls Who Are Suicidal
  David A. Jobes
• Adolescents With Bipolar Disorder
  David J. Miklowitz
• Attachment-Based Family Therapy
  Guy S. Diamond
• Cognitive Therapy for Borderline Personality Disorder
  Mary Anne Layden
• Dialectical Behavior Therapy for Adolescents With Multiple Problems
  Alec L. Miller
• Interpersonal Reconstructive Therapy for Passive–Aggressive Personality Disorder
  Lorna Smith Benjamin
• Mentalization-Based Therapy
  Norka T. Malberg

APA Books

• A Concise Guide to Personality Disorders
  Joel Paris
• Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment and Intervention, Second Edition
  Christopher L. Hunter, Jeffrey L. Goodie, Mark S. Oordt, and Anne C. Dobmeyer
• Personality Disorders: Toward Theoretical and Empirical Integration in Diagnosis and Assessment
  Steven K. Huprich
• Personality Disorders and the Five-Factor Model of Personality, Third Edition
  Edited by Thomas A. Widiger and Paul T. Costa
• Understanding and Treating Pathological Narcissism
  John S. Ogrodniczuk