Interpersonal reconstructive therapy

Domain I · Psychodynamic & depth psychology · Lorna Smith Benjamin · 2003

What it is

Interpersonal Reconstructive Therapy (IRT) is an integrative, case-formulation-driven, usually long-term psychotherapy. Lorna Smith Benjamin developed it for "nonresponders": patients with comorbid personality disorder and Axis I problems who have not improved in earlier treatment. Her clinic…

Format

• Format. Individual outpatient therapy, typically weekly. It is long-term: rarely under a year and often several years. Benjamin's site states there is no brief therapy for the "old brain" and that CORDS patients were sometimes seen for many years. The initial formulation interview runs through the…
• The friendly, moderately differentiated region is the "Attachment Group" (e.g., affirm, protect, and their complements); it is the therapy's target zone. Clinically useful predictive principles (Benjamin 1996):

Who practises it, and how they are trained or regulated

• SASB at training level (no instrument content reproduced). SASB rates any interpersonal or intrapsychic event on three dimensions:
• Training resources: Critchfield & Benjamin (2024), SASB: A Primer for Clinical Use. Benjamin (2018) calls SASB the "Rosetta Stone" of IRT. Intrex questionnaires measure SASB patterns; use them only as licensed, and they are not reproduced here.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Skills done half-heartedly, which points to unresolved GOL.
• Self-compassion felt as disloyalty, a sign of a GOL; return to A4.
• Medication used as Red avoidance of Step 4. No dosing guidance is given here.
• Shifting into blaming the partner; safety concerns (screen for intimate partner violence first).
• Therapist pushing (Control), which invites Red's resistance. It's working when change talk increases.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.