Group interpersonal therapy for depression (StrongMinds)

1. Introduction

Version followed: WHO Group Interpersonal Therapy (IPT) for Depression (WHO generic field-trial version 1.0; prepared by Verdeli, Clougherty and Weissman, Columbia University; WHO 2016, WHO/MSD/MER/16.4; 1 individual pre-group session plus 8 group sessions). Sources drawn on: the English edition (UNHCR-hosted copy) from Session 1 through Chapter 4 (middle-phase techniques and tasks, termination Session 8) and Chapter 5.1 (grief); the PAHO 2022 Spanish edition for the pre-group phase and Session 1. The manual's sections on disputes, life changes and loneliness (5.2–5.4) and its chapter on difficult situations are not cited here; for those problem areas only the WHO goals are sourced, and the step lists are the writer's synthesis from the manual's middle-phase techniques [synthesis] or [uncertain]. StrongMinds' current delivery (6 weekly sessions, volunteer facilitators) is taken from its 2026 Uganda trial protocol and its website [source: StrongMinds IPT-G trial protocol NCT07812311; StrongMinds website]. The original Ugandan adaptation (IPT-G-U, 16 weekly sessions; Bolton et al. 2003) is described where it differs.

Group interpersonal therapy (IPT-G) is a time-limited, manualised group form of Interpersonal Psychotherapy (Klerman and Weissman) simplified so that trained, supervised non-specialists can deliver it. The Ugandan version was tested in a cluster RCT in rural south-western Uganda (Bolton, Bass, Neugebauer, Verdeli, Clougherty, Wickramaratne, Speelman, Ndogoni, Weissman; JAMA 2003), with local same-sex lay leaders trained for two weeks by Verdeli and Clougherty [source: Bolton et al. 2003]. StrongMinds, an NGO treating mainly women with depression in Africa, describes that trial and Weissman's adapted manual as the basis of its approach; Weissman sits on its advisory board [source: StrongMinds 2018 news page]. The WHO 2016 manual is the publicly available generic version of the same model.

Core idea of change: depression is understood as an illness that is linked in time with one or more current interpersonal problems (grief, disputes, life changes, loneliness or social isolation). Naming the depression as a treatable illness, temporarily easing role demands, and then working in a supportive peer group on one or two of those interpersonal problems (each week linking mood to what happened, trying new ways of handling the problem, reporting back) relieves symptoms; improving the problem improves mood and vice versa [source: WHO 2016 manual ch. 1–3; Bolton et al. 2003]. Bolton et al. note they could not separate the effect of IPT content from that of simply meeting as a group, and participants valued group problem-solving [source: Bolton et al. 2003].

Not a licensed programme in the sense of MST or Triple P: the WHO manual is published under a Creative Commons (CC BY-NC-SA 3.0 IGO) licence, and WHO asks for trained, supervised facilitators rather than formal certification; new facilitators should be supervised through at least three complete groups by supervisors with mental health training [source: WHO 2016 manual, PAHO edition]. StrongMinds uses its own standardised IPT-G training curriculum and quality system. In its 2026 Uganda trial protocol, volunteer facilitators must have completed at least three delivery cycles and be rated at least "Intermediate" on StrongMinds' Volunteer Quality Assurance assessment; they get weekly group supervision from a Mental Health Coach (diploma or degree in psychology or a related field, counselling training, at least two years' experience); supervisors observe at least 20% of sessions with a fidelity checklist, and a random 20% of groups are audio-recorded and rated [source: StrongMinds IPT-G trial protocol NCT07812311, 2026]. Delivering IPT-G under the StrongMinds name therefore means working within StrongMinds or a partner programme; no separate external certification was found [uncertain].

2. Framework

[source: WHO 2016 manual (English edition ch. 3–4; PAHO 2022 Spanish edition ch. 1–3 and table of contents); Bolton et al. 2003; StrongMinds IPT-G trial protocol NCT07812311]

Format. 6–10 members per group (WHO); 8–10 in Uganda, recruiting until at least 8 had enrolled. Sessions last about 90 minutes (up to 2 hours if more than 10 members). Groups are usually single-sex; Uganda used strictly sex-segregated groups, led by a facilitator of the same sex, and excluded age outliers so members were of similar age. Facilitator and members must share a language. Meetings are weekly; WHO allows a switch to fortnightly after Session 3 if weekly meetings cannot be sustained.

Dose versions. WHO standard: 1 individual pre-group session + 8 group sessions (Session 1 initial phase, Sessions 2–7 middle phase, Session 8 termination). WHO 12-session variant: 9 middle-phase and 2 termination sessions. Uganda 2002 trial (IPT-G-U): 16 weekly 90-minute group sessions (dropout 7.8%; 54% attended at least 14) [source: Bolton et al. 2003]. StrongMinds (current): a six-week compression of the WHO 8-session format, six weekly sessions of about 90 minutes for groups of 8–12 in community venues (schools, churches, community centres). Pre-group: the facilitator meets eligible people, invites and prepares them. Session 1: introductions, ground rules, psychoeducation on depression, the four problem areas and goal setting. Sessions 2–5: work on each member's interpersonal problems, practising strategies with the facilitator and group, with weekly home practice. Session 6: review of skills and progress, relapse prevention and plans to maintain gains [source: StrongMinds IPT-G trial protocol NCT07812311]. StrongMinds' website describes the model as taking place "over 6 sessions", led by lay counsellors in communities, schools, health systems and correctional facilities, often through government partners [source: StrongMinds Depression Treatment page]. Moving between phases follows the fixed session plan rather than symptom criteria [synthesis from the session plans]; before the final session the facilitator reviews scores and plans referral for members not sufficiently improved [source: WHO 2016 ch. 4.4].

Weekly session routine. WHO Session 1 (about 90 min): Task 1 introductions, confidentiality, psychoeducation and hope; Task 2 linking each member's depression to problem areas (about 45 min); Task 3 explaining how the group works (about 15 min). WHO middle Sessions 2–7: Task 1 symptom review and depression rating (15–20 min); Task 2 linking depression to the past week's events (10–15 min, 3–4 members per session); Task 3 problem-area strategies (about 45 min); Task 4 home practice and close (about 15 min) [source: WHO 2016 English edition ch. 3–4]. Uganda description: the leader reviews each member's depressive symptoms; each member describes the past week's events and links them to mood; the group offers support and suggestions for change [source: Bolton et al. 2003].

Records. A depression rating scale at every session (WHO recommends the PHQ-9 where locally validated), weekly session notes (Annex 6), task checklists (Annex 7), all kept confidential. In Uganda, screening used two local depression-like syndromes, yo'kwekyawa and okwekubazida, which together covered the DSM-IV symptom criteria [source: Bolton et al. 2003]. In its 2026 trial StrongMinds pre-screens with the PHQ-4 at community sensitisation events (5 or more) and confirms eligibility with the PHQ-9 (10 or more), age 15 or older [source: StrongMinds IPT-G trial protocol NCT07812311].

Who is not suitable: people with plans to end their life in the near future (urgent care instead); people with severe impairment from psychosis, harmful alcohol or drug use, severe intellectual disability or dementia (Annex 3) [source: WHO 2016 manual].

3. Guiding principles

[source: WHO 2016 manual ch. 1–3 unless marked]

• Depression is an illness, not a fault. Name it with a non-stigmatising local term; tell the person it is not their fault or a failure. Meaning: never frame symptoms as weakness or laziness.
• Depression is linked to current interpersonal problems. Meaning: every session ties mood to real events and relationships of the past week, not to distant history.
• Focus narrowly: one or two problem areas. Meaning: if many problems are raised, help prioritise; the group works on a few main problems, not all of them.
• Concrete, achievable goals. Meaning: goals are things the person can try this week, chosen with them; narrow the options if they cannot choose.
• Instil hope without promising outcomes. Meaning: say depression is treatable and that group therapy has helped others; do not guarantee results.
• Temporarily ease role demands (sick role). Meaning: help the person lower expectations while ill, postpone major decisions and explain to family; this is time-limited and paired with active work on problems.
• Mobilise support and resources. Meaning: always ask who and what (family, community, services) can help with urgent material and emotional needs.
• Voluntary participation. Meaning: invite, do not pressure; members are never forced to speak.
• Confidentiality, with stated limits. Meaning: what is said in the group stays there; it is broken only for high risk of harm to self or others, telling the person first where possible.
• The group is the vehicle. Meaning: warm body language, invite members to support one another, ask others whether they relate; keep the focus on the group rather than on the facilitator [source: WHO 2016; Bolton et al. 2003].
• Culturally acceptable structure. Meaning: same-language, usually single-sex groups of similar age with a same-sex local leader [source: Bolton et al. 2003; WHO 2016].
• Measure every week. Meaning: rate depression at each session and track the trend; act on non-improvement by consulting the supervisor.
• Safety first. Meaning: assess suicide risk before the group and whenever cues appear; know the referral route (Annex 2).
• Work under supervision. Meaning: notes after every session, checklists, regular supervision with role play; supervised through at least three complete groups when new.
• Time-limited. Meaning: the end date is known from the start; mention the coming end in the pre-group session, in Session 1, several times during Sessions 2–6 and again in Session 7, so the last session is no surprise [source: WHO 2016 English edition ch. 4.4].

4. Intervention inventory

All example language is illustrative wording written for this guide, not text from the manuals. Steps are paraphrased. Sources: 4.1–4.14 the WHO 2016 manual, pre-group phase and Session 1 (PAHO and English editions); 4.15–4.16d, 4.17 (grief), 4.22 and 4.23 the English WHO manual ch. 4–5.1 (the seven middle-phase techniques, middle-phase tasks, termination, grief) [source: WHO 2016]. 4.18–4.20 use the WHO problem-area goals and middle-phase techniques, but their step lists come from general IPT practice and are marked [synthesis] because manual sections 5.2–5.4 were not read.

4.1 Screening and eligibility (pre-group)

• Purpose / when: first contact; decide whether IPT-G is appropriate.
• Steps: (1) Ask about the local depression idiom(s) in plain language (in Uganda, yo'kwekyawa and okwekubazida were used for screening only [source: Bolton et al. 2003]). (2) Administer the depression rating scale (PHQ-9 if locally validated) and record the score as the baseline. (3) Ask about thoughts of death or suicide; if there is a plan for the near future, the person is not suitable for the group and needs urgent care; thoughts without plans or recent attempts do not exclude (follow Annex 2 and consult the supervisor). (4) Screen for exclusion conditions: psychosis, harmful alcohol or drug use, severe intellectual disability, dementia (Annex 3); refer these. (5) Check practical ability to attend (time, transport, childcare).
• Example language (illustrative): "Many people around here describe a heaviness where they lose interest in everything and cannot sleep. Has anything like that been happening to you?" / "Sometimes when people feel this low they think about dying or ending their life. Has that happened to you?"
• Watch for: under-reporting of suicidal thoughts; alcohol use disguised as a mood complaint; men under-endorsing symptoms [synthesis].

4.2 Naming the depression

• Purpose / when: pre-group Task 1, once screening confirms depression.
• Steps: (1) Tell the person their symptoms fit depression, using a non-judgemental local term. (2) List back the symptoms they reported so they see the pattern. (3) State that it is an illness, not their fault and not a personal failure. (4) Convey acceptance through tone and posture.
• Example language (illustrative): "What you describe, the poor sleep, no appetite, no strength for your work, losing interest, is an illness we call depression. It is common, and it is not your fault."
• Watch for: relief versus shame; if the local term is stigmatising, find another with the person.

4.3 Instilling hope

• Purpose / when: pre-group and end of Session 1; whenever hopelessness blocks engagement.
• Steps: (1) Say depression is treatable. (2) Mention that group therapy of this kind has helped others in similar circumstances. (3) Credit the person's courage in coming. (4) Avoid promising specific results.
• Example language (illustrative): "This illness can get better. Groups like this one have helped many people who felt the way you feel now. Coming today was already a first step."
• Watch for: promising cures or material help the programme cannot give.

4.4 Giving the sick role

• Purpose / when: pre-group Task 1; relieves guilt over reduced functioning.
• Steps: (1) Explain that while ill, the person may not manage everything they usually do. (2) Use an analogy such as a broken leg: no one expects someone with a broken leg to carry heavy loads until it heals. (3) Suggest explaining this to family. (4) Advise postponing major life decisions until mood improves. (5) Encourage balanced sleep, neither too much nor too little. (6) Make clear this is temporary, while treatment works.
• Example language (illustrative): "If you had broken your leg, your family would not expect you to dig the garden this week. Depression is similar for a while. Could we think about who at home you could explain this to?"
• Watch for: the sick role turning into prolonged withdrawal; balance it with weekly practice tasks [synthesis].

4.5 Mobilising practical support and resources

• Purpose / when: pre-group Task 1 and throughout; urgent material or health needs that worsen depression.
• Steps: (1) Ask about urgent needs (childcare, health care, food, money). (2) Ask who has helped in the past and what helped. (3) Identify family, community and service supports, material and emotional. (4) Agree one concrete step to reach one source of help.
• Example language (illustrative): "Who has helped you before when things were hard? Is there someone who could watch the children on the day the group meets?"
• Watch for: the facilitator taking on case-management tasks beyond their role; use referral routes [synthesis].

4.6 Timeline

• Purpose / when: pre-group Task 2; find the interpersonal events linked to the onset of depression.
• Steps: (1) Ask when the person last felt well. (2) Ask when symptoms began and when they worsened. (3) For each point, ask what was happening in their life and relationships (deaths, conflicts, moves, illness, separation). (4) Place symptoms and events on a simple timeline (the manual provides one, Annex 5). (5) Point out connections.
• Example language (illustrative): "When did you last feel like yourself? … And what was happening at home around the time the sleeplessness started?"
• Watch for: events the person minimises; the onset often clusters with a loss or conflict.

4.7 Problem-area review

• Purpose / when: pre-group Task 2, after the timeline.
• Steps: Ask conversationally (not as a rigid interview) about each of the four areas: (1) Grief: death of someone important; how the person has mourned. (2) Disputes: open or hidden disagreement with someone close. (3) Life changes: real or expected changes such as moving, illness, poverty, separation, migration. (4) Loneliness / social isolation: long-standing difficulty starting or keeping relationships. Note which are present and which seem most tied to the depression.
• Example language (illustrative): "Has someone close to you died in the past months? … Is there someone at home you are often in conflict with, or not speaking to?"
• Watch for: normal grief alone may not need IPT-G; consult the supervisor if grief symptoms are severe or persistent [source: WHO 2016].

4.8 Interpersonal inventory

• Purpose / when: pre-group Task 2; map the person's relationships.
• Steps: (1) List the most important people (partner, children, relatives, friends, neighbours). (2) For each, ask whether they are a source of stress, support, or both; how the person feels around them; whether the relationship has changed recently. (3) Ask what the person would like to change in difficult relationships and keep in supportive ones. (4) Follow up on attempts to communicate and on other supports. The manual illustrates this with a woman whose husband had another relationship and spent money on it, with a sick child and fear of abandonment.
• Example language (illustrative): "Who are the people who matter most in your life right now? … When you are with your sister, how do you feel? … If you could change one thing between you and your husband, what would it be?"
• Watch for: domestic violence or coercion behind a 'dispute' (assess safety, see section 5) [synthesis].

4.9 Choosing problem areas and goals (formulation)

• Purpose / when: pre-group Task 3.
• Steps: (1) Summarise how the depression connects to one or two priority problem areas. (2) Ask the person if this fits. (3) Help them choose one or two concrete goals; if they cannot choose, narrow the options for them. (4) Record areas and goals for Session 1.
• Example language (illustrative): "It sounds like the sadness became heavy after your husband started staying away and the money stopped. That conflict seems to be the main problem linked to your depression. What would you like to be different with him by the end of the group?"
• Watch for: goals that depend wholly on another person changing; reframe toward what the member can try.

4.10 Inviting to the group and explaining the rules

• Purpose / when: end of pre-group session.
• Steps: (1) Invite without pressure. (2) Explore hesitations (confidentiality worries, hopelessness) and re-explain benefits. (3) Explain logistics: number of sessions, weekly, about 90 minutes, punctuality, place and transport. (4) Explain confidentiality and its limits. (5) Confirm agreement. (6) Write notes afterwards and store them securely.
• Example language (illustrative): "The group has about eight women who are also struggling with this illness. We will meet here every Tuesday for eight weeks, about an hour and a half. What is said in the group stays in the group. Would you like to join?"
• Watch for: agreement given to please the facilitator; check practical barriers concretely.

4.11 Introductions and commonality exercise (Session 1, Task 1)

• Purpose / when: open the first group; begin cohesion.
• Steps: (1) Welcome members; have them greet and introduce each other, often in pairs (each introduces their partner). (2) Run a light icebreaker; the manual names a "point of convergence" activity (punto de convergencia) in which small groups discover things they have in common. (3) Have the group restate the confidentiality rule.
• Example language (illustrative): "In pairs, find out your partner's name, where she lives and one thing she enjoys, then you will introduce her to us." / "In your threes, find two things all of you share."
• Watch for: members who stay silent; do not force them.

4.12 Group psychoeducation on depression with nonverbal monitoring (Session 1, Task 1)

• Purpose / when: Session 1; normalise symptoms and reduce isolation.
• Steps: (1) Describe depression in non-stigmatising terms, going through the common symptoms on the rating scale. (2) Watch for nods and other signs of recognition and invite those members to share. (3) Mention thoughts of death among the symptoms; if a member who denied suicidal thoughts earlier nods, speak with them privately at the end of the session to assess risk. (4) Close the task by instilling hope (4.3).
• Example language (illustrative): "People with this illness often lose sleep, feel tired all the time, stop enjoying things, feel worthless, and some even think life is not worth living. I see some of you nodding."
• Watch for: shame in front of neighbours; keep the explanation general rather than pointing at individuals.

4.13 Linking each member's depression to problem areas in the group (Session 1, Task 2)

• Purpose / when: Session 1, about 45 minutes.
• Steps: (1) Explain generally that problems such as illness, bereavement and conflict reasonably affect mood, and that the group will work on a few main problems. (2) Review each member's problem areas and goals from the pre-group session. (3) Invite members to talk about their lives: warm body language, ask for a volunteer, and if none, gently invite a specific member without forcing. (4) Link what each says to the problem area tied to their depression. (5) Ask others if they relate and invite them to support one another.
• Example language (illustrative): "Grace, you told me your mother-in-law has turned against you since the land dispute. Would you tell the group a little about that? … Has anyone else had trouble with in-laws?"
• Watch for: one member's story taking all the time; keep turns balanced.

4.14 Explaining how the group works (Session 1, Task 3)

• Purpose / when: last ~15 minutes of Session 1.
• Steps: (1) Explain the structure: weekly meetings of about 90 minutes, each opening with a check-in of about 15 minutes and ending with about 15 minutes to plan each member's goal for the coming week; the group ends at the eighth meeting. (2) Go over the rules: regular attendance, that no material goods are given out, and that a member thinking of dropping out should raise it with the group. (3) Confirm the next meeting, invite questions, and afterwards write confidential notes [source: WHO 2016 English edition ch. 3, Task 3].
• Example language (illustrative): "Each week we will start by checking how each of you is feeling, then talk about what happened during the week and how it affected your mood, and then work together on the problems you chose."

4.15 Weekly depression rating review (Sessions 2–7, Task 1)

• Purpose / when: start of every middle session.
• Steps (15–20 min): (1) Start on time, welcome members and restate the rules if needed. (2) Rate each member's depression with the agreed scale, using the method that fits literacy: members fill it in themselves, the facilitator reads the items aloud and members answer, or the facilitator completes it. (3) Compare with earlier weeks and name changes aloud. (4) Note any member who is worsening or endorses suicidal thoughts for private follow-up and supervision [source: WHO 2016 English edition ch. 4, technique 1 and Task 1; Bolton et al. 2003]. Rating aloud in front of the group reduces privacy; use individual or written rating where possible [synthesis].
• Example language (illustrative): "Last week your score was 18, today it is 13. What do you think helped?"
• Watch for: time; with 8–10 members keep this brisk. Worsening scores trigger supervision.

4.16 Linking mood to the past week's events (Sessions 2–7, Task 2)

• Purpose / when: every middle session; the core IPT link.
• Steps (10–15 min): (1) Choose 3–4 members this session, ideally a mix of people with good and bad events since the last meeting; make sure every member has a turn at least every other session. (2) Ask what happened since the last meeting, especially with the people in their problem area, and how they felt. (3) Draw the link in both directions, events to mood and mood to events, and name improvements as well as setbacks [source: WHO 2016 English edition ch. 4, technique 2 and Task 2; Bolton et al. 2003].
• Example language (illustrative): "So on Thursday your husband shouted about the school fees, and that night you could not sleep and felt hopeless. And on Saturday, when your neighbour visited, you felt a little lighter. Do you see how what happens with people affects your mood?"
• Watch for: members who report only symptoms; ask for the interpersonal event behind them.

4.16a Communication analysis (middle-phase technique 3)

• Purpose / when: a member reports an upsetting interaction with someone in her problem area; the WHO manual asks for at least one per member during the middle phase [source: WHO 2016 English edition ch. 4].
• Steps: (1) Pick the most upsetting recent interaction. (2) Reconstruct it in sequence: what each person said and did, and what the member saw and felt at each point [source: WHO 2016 ch. 4]. (3) Ask what she wanted to happen and what she thinks the other person wanted. (4) Ask what she might say or do differently, invite group ideas, and lead into decision analysis or role-play [synthesis for steps 3–4].
• Example language (illustrative): "Take us back to Sunday. What did he say first? And what did you say? How did you feel when he said that?"
• Watch for: summaries ("we fought") instead of the actual exchange; ask for the words used. It is working when members start to see their own part and other options [synthesis].

4.16b Decision analysis (middle-phase technique 4)

• Purpose / when: a member is stuck about what to do about a problem (a dispute, a change, isolation).
• Steps: (1) State the problem clearly. (2) Brainstorm as many options as possible with the group, without judging any. (3) Weigh the pros and cons of each. (4) The member chooses one option or a combination to try; turn it into home practice [source: WHO 2016 English edition ch. 4].
• Example language (illustrative): "Let's list every possible thing Esther could do about the rent, even ideas that sound strange. Now, what is good and bad about each? Which one do you want to try?"
• Watch for: the group pushing its favourite option; the member chooses. Exclude options that would expose her to violence (section 5) [synthesis].

4.16c Role-play (middle-phase technique 5)

• Purpose / when: to rehearse a planned conversation or replay a recent one, usually after communication or decision analysis.
• Steps: (1) Agree the conversation to practise. (2) A group member plays the other person; sometimes the member plays both roles in turn [source: WHO 2016 English edition ch. 4]. (3) Keep it brief. (4) Ask the member how it felt and the group what worked; adjust and replay [synthesis for steps 3–4].
• Example language (illustrative): "Rose, could you be the mother-in-law? Mary, start the way you plan to on Saturday. How was that? What would you change?"
• Watch for: role-plays turning into re-enactments of painful scenes; keep them short and focused on the new approach [synthesis].

4.16d Interpersonal skills building (middle-phase technique 6)

• Purpose / when: communication problems keep a dispute, isolation or difficult change going.
• Steps: teach and practise the skills the manual lists: choosing a good time to raise an issue; keeping to the specific point; making expectations clear; trying to understand the other person's view; give-to-get negotiation (offer something to get something); showing appreciation. Adapt to culture, for example indirect communication where direct confrontation is unacceptable [source: WHO 2016 English edition ch. 4].
• Example language (illustrative): "When is he calm enough to listen? What exactly do you want him to do? What could you offer him in return?"
• Watch for: skills taught in the abstract; attach each to a member's real situation and practise it in role-play [synthesis].

4.17 Problem-area strategies: grief

• Purpose / when: death of a significant person linked to the depression.
• Goal (WHO): help the member accept and mourn the loss and find meaning and a life without the person, with new activities, roles and supports [source: WHO 2016 English edition ch. 5.1].
• Steps [source: WHO 2016 English edition ch. 5.1, paraphrased, except where marked]: (1) Explain the grief process, including that grief can return around anniversaries and holidays. (2) Reassure the member that the aim is not to take her grief away but to help her carry it. (3) Gently invite her to describe the death, how she learned of it, the last contact and who supported her, without pressing for details. (4) Invite her to tell the story of the relationship, the good parts and, if she is willing, the difficult ones. (5) Link the loss to her current mood (technique 2); [synthesis:] invite members who have lost someone to respond. (6) Explore future plans, the roles lost, and ways to rebuild connections and activities. (7) If grief is disrupting daily life, agree a set time for mourning so that work and care can continue.
• Example language (illustrative): "Tell us about your son. What was he like? … What do you miss most? … Is there something you used to do with him that you could do with someone else?"
• Watch for: severe or persistent grief: consult the supervisor [source: WHO 2016]. Burial rituals matter to most people; where the body was not recovered or a customary burial was impossible, explore an alternative ritual [source: WHO 2016 ch. 5.1]. Multiple losses (e.g. HIV-related deaths in the Uganda context) may need extra time [synthesis].

4.18 Problem-area strategies: disputes

• Purpose / when: open or hidden disagreement with someone close linked to the depression.
• Goals (WHO): understand what each side wants, learn to communicate, practise, and mobilise supports [source: WHO 2016].
• Steps [synthesis: no published step list for disputes is cited; the techniques named are the WHO middle-phase techniques, ch. 4]: (1) Clarify the dispute: who, about what, for how long. (2) Communication analysis of a recent exchange (4.16a). (3) Ask what the member wants and what she thinks the other person wants. (4) Decision analysis with the group (4.16b): other ways to raise the issue, timing, who could mediate. (5) Build the skills needed (4.16d), using indirect routes where direct confrontation is not culturally acceptable [source: WHO 2016 ch. 4]. (6) Role-play the chosen approach (4.16c). (7) Agree home practice; review it next session.
• Example language (illustrative): "What do you want from your husband about the money? … What do you think he wants? … Let's practise. Rose, could you play the husband? Mary, show us how you might start the conversation."
• Watch for: risk of violence when confronting; never set a task that could expose the member to harm (section 5).

4.19 Problem-area strategies: life changes (role transitions)

• Purpose / when: real or expected changes (moving, illness, poverty, separation, migration).
• Goals (WHO): recognise emotions about the change, see any positive aspects, learn adaptation skills, seek support [source: WHO 2016].
• Steps [synthesis: no published step list for life changes is cited; uses the WHO goals and middle-phase techniques]: (1) Explore what was lost with the old situation and feelings about it. (2) Explore the new situation, including anything positive or possible. (3) Use decision analysis (4.16b) for the practical choices the change demands. (4) Identify skills or knowledge needed for the new role and practise them (4.16c–d). (5) Identify people who could help. (6) Set a small step toward adapting as home practice.
• Example language (illustrative): "What did you lose when you had to leave your village? … Is there anything in this new place that could be good for you? … Who here knows how to start selling at the market?"
• Watch for: changes that are unjust or ongoing (eviction, displacement); acknowledge reality and focus on support [synthesis].

4.20 Problem-area strategies: loneliness / social isolation

• Purpose / when: long-standing difficulty starting or keeping relationships.
• Goals (WHO): identify what contributes to loneliness and learn to start and keep friendships [source: WHO 2016].
• Steps [synthesis: no published step list for loneliness is cited; uses the WHO goals and middle-phase techniques]: (1) Review past relationships: what worked, what went wrong. (2) Use relationships within the group as practice (notice how the member connects with others here). (3) Pick one person to contact; role-play the opening (4.16c) and build the skills needed (4.16d). (4) Home practice: make one contact and report back. In the manual's middle-phase case example, a member isolated after two bereavements is helped with small steps and a communication analysis of a visit to a friend [source: WHO 2016 English edition ch. 4.3].
• Example language (illustrative): "Who in your village do you feel easiest with? … What could you say to her when you meet at the borehole? Let's try it here."
• Watch for: members for whom the group itself becomes the only relationship; build outside links before termination.

4.21 Eliciting group support and suggestions

• Purpose / when: throughout middle sessions, after a member presents a problem.
• Steps: (1) After a member describes her week, ask the group whether anyone has faced something similar. (2) Invite suggestions for what she could try. (3) Ask the member which suggestion fits her. (4) Acknowledge contributions. [source: Bolton et al. 2003; WHO 2016]
• Example language (illustrative): "Has anyone here found a way to talk to a husband who drinks? … Which of these ideas feels possible for you?"
• Watch for: advice that is pressuring or moralising; the member keeps the choice.

4.22 Between-session practice tasks (Task 4 of each middle session)

• Purpose / when: end of each middle session.
• Steps (about 15 min, Task 4): (1) Each member chooses one specific practice linked to her goal and to the session's work, to try before the next meeting (the manual's example: a woman working out how to ask her husband for help with his relatives' visits). (2) Make it concrete (who, when, what). (3) Close: confirm the next date, invite questions, and remind members that change can take time. (4) Next session she reports back; review what happened and how her mood changed [source: WHO 2016 English edition ch. 4, technique 7 and Task 4].
• Example language (illustrative): "So this week you will visit your sister on Sunday and tell her about the children's illness. Next week tell us how it went."
• Watch for: tasks not done; explore what got in the way rather than criticise (section 5).

4.23 Termination (Session 8; Sessions 11–12 in the 12-session variant)

• Purpose / when: final session(s).
• Steps [source: WHO 2016 English edition ch. 4.4, paraphrased]: Beforehand: mention the ending in the pre-group session, Session 1, several times in Sessions 2–6 and in Session 7; before the last session review each member's latest scores and plan referral for anyone not sufficiently improved. In the session: (1) Welcome members and check symptoms. (2) Review the change in each member's symptoms and progress on her goals. (3) Explore feelings about the group ending, and share your own. (4) Identify problems likely to come up and the skills members will use for them. (5) Ask each member how she would recognise depression coming back and make a personal action plan (who to contact, what to do, where help is). (6) For members who have not improved enough, say this reflects a limit of the group approach for them, not their failure, and discuss further options. Optional adaptations: in literate groups, a personal notebook to take home (the final session then runs about twice as long); a culturally fitting closing ritual. The manual also supplies a reminder note for each member (Annex 8).
• Example language (illustrative): "When you came you could hardly get up; today you told us about visiting your sister twice. What will you do if the heaviness starts to come back?"
• Watch for: fear of relapse; invite other members to respond, review warning signs and where to get help, and name the sadness of ending while affirming the work done [source: WHO 2016 ch. 4.4 sample dialogue]. StrongMinds' final (sixth) session covers skills and progress review, relapse prevention and maintenance planning, with no scheduled therapy sessions afterwards; its website says members identify support structures they can lean on after therapy [source: StrongMinds IPT-G trial protocol NCT07812311; StrongMinds website]. Reports of ongoing graduate peer groups were not verified [uncertain].

4.24 Session notes, checklists and supervision

• Purpose / when: after every session.
• Steps: (1) Complete weekly session notes (Annex 6) and task checklists (Annex 7) promptly. (2) Store securely. (3) Bring scores, risk concerns and non-improving members to supervision. (4) Use role play in supervision to rehearse difficult moments. [source: WHO 2016]
• Watch for: skipped notes; new facilitators need supervision through at least three full groups.

5. Handling problems

The WHO manual's chapter on difficult situations lists silent and dominating members, irregular attendance, alcohol or drug effects, community rumours, children or friends wanting to attend, and members wanting to leave; only its headings are cited here, so responses to those items are [synthesis] unless marked [source]. The manual's middle-phase case example (ch. 4.3) does show the facilitator handling a dominant or discouraged member and stepping in when one member's remark may sound unsupportive to another.

• Suicidal thoughts. Plans for the near future: not suitable for the group; arrange urgent care and consult the supervisor (Annex 2). Thoughts without plans or recent attempts: may join, with risk reviewed at each rating. A member who denied suicidal thoughts but nods when suicide is discussed: speak privately after the session and assess [source: WHO 2016]. StrongMinds' 2026 trial protocol excludes people with active suicidal ideation (PHQ-9 item 9), who receive a risk assessment by a Mental Health Coach, psychological first aid and referral with follow-up within 48 hours [source: StrongMinds IPT-G trial protocol NCT07812311]. [synthesis:] Agree a safety plan, involve a trusted person with consent, and counsel on restricting access to means at home (secure storage or removal by a family member). Break confidentiality only for high risk, telling the member first where possible [source: WHO 2016].
• Reluctant to join or to speak. Do not force. Explore the reason (confidentiality fears, hopelessness) and re-explain the benefits [source: WHO 2016]. In the group, invite gently by name after others have spoken; let a silent member start by saying whether she relates to someone else's story [synthesis].
• Not improving. Track weekly scores and consult the supervisor; before the final session review scores and plan referral for members not sufficiently helped, telling them this reflects a limit of the group approach for them, not their failure [source: WHO 2016 English edition ch. 4.4]. [synthesis:] Check that the chosen problem area is the right one, that practice tasks are realistic, and for missed exclusion conditions (alcohol, psychosis, medical illness).
• Excluded conditions emerging. Psychosis, harmful alcohol or drug use, severe intellectual disability or dementia make group IPT inappropriate; refer [source: WHO 2016]. A member arriving intoxicated: speak with her privately, ask her to return sober next week, and address the drinking in supervision and referral [synthesis].
• Dominating or unsupportive member. Acknowledge her contribution, summarise it, then turn to others ("Thank you, Agnes. Let's hear from someone who has not spoken yet" — illustrative) [synthesis]. If a remark could sound dismissive to another member, step in at once, reframe it and support the member who was speaking, as the facilitator does in the manual's case example [source: WHO 2016 ch. 4.3]. Speak privately if it continues; ask her to help draw out others [synthesis].
• Irregular attendance / non-adherence. Contact the member between sessions to ask what got in the way; address practical barriers (transport, childcare, work); WHO allows fortnightly sessions after Session 3 if weekly attendance is impossible [source: WHO 2016 for fortnightly; rest synthesis]. When practice tasks are not done, explore what blocked them, shrink the task and try again rather than criticise [synthesis].
• Member wanting to leave. Explore the reason privately (stigma, family opposition, feeling worse, practical); problem-solve; respect the decision and offer an alternative route to care [synthesis].
• Community rumours or stigma about the group. Agree with members how to describe the group to others; reinforce confidentiality; where appropriate, engage local leaders about the group's purpose [synthesis].
• Children or friends wanting to attend. Keep the group closed for confidentiality; help the member arrange childcare (4.5) or a supervised space for small children [synthesis].
• Confidentiality breach between members. Raise it in the group without blaming, restate the rule, and discuss how members can keep each other's stories safe [synthesis].
• Disputes involving violence. Before any communication task, ask about safety; do not set tasks that confront a violent partner; follow local protection and reporting procedures and refer to support services [synthesis]. StrongMinds' trial protocol excludes people facing gender-based violence that needs immediate safety intervention, and its group confidentiality limits cover self-harm, harm to others and abuse of minors [source: StrongMinds IPT-G trial protocol NCT07812311].
• Overwhelming grief or trauma disclosures. Slow down, validate, let the group offer support, and keep the focus on present-day links to mood; consult the supervisor if grief is severe or persistent [source: WHO 2016 for supervisor consultation; rest synthesis]. Trauma-focused work is outside IPT-G; refer if PTSD symptoms dominate [synthesis].
• Hopelessness linked to poverty. Acknowledge real constraints, mobilise practical resources (4.5) and pick goals within the member's control [synthesis].
• Rupture with the facilitator (member feels judged or unheard). Name it, ask for the member's view, acknowledge your part, and adjust [synthesis].
• Facilitator inexperience. Ugandan trainees were hesitant at first and took weeks to gain confidence [source: Bolton et al. 2003]; build in role-play rehearsal and close supervision for the first groups (supervision through at least three full groups) [source: WHO 2016].
• Small or hard-to-recruit groups. Male groups in Uganda were smaller on average [source: Bolton et al. 2003]; recruit until a minimum of about 6–8 can start [synthesis based on the stated group sizes].

Sources

Main sources:

• Bolton et al. (2003), Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial, JAMA (full reference below).
• Group Interpersonal Therapy (IPT) for Depression, WHO generic field-trial version 1.0, 2016 (English edition, UNHCR-hosted copy) (read from Session 1 to Chapter 5.1)
• Terapia interpersonal grupal para la depresión (WHO Group IPT manual, PAHO 2022 Spanish edition, OPS/NMH/MH/22-0004), used for the pre-group phase and Session 1.
• Group Interpersonal Therapy (IPT) for Depression, WHO publication page
• Group interpersonal therapy (IPT) for depression, PAHO page
• Evaluating the Effects of StrongMinds Community-Based Group Interpersonal Therapy on Depression and Secondary Outcomes in Uganda: study protocol (IDinsight, Gulu University, University of Melbourne; NCT07812311, 2026), ClinicalTrials.gov
• Depression Treatment, StrongMinds
• The Guide to Interpersonal Psychotherapy, StrongMinds

Books and papers cited:

• World Health Organization (2016). Group Interpersonal Therapy (IPT) for Depression (WHO generic field-trial version 1.0). Prepared by Verdeli H, Clougherty K, Weissman MM. WHO/MSD/MER/16.4. Spanish edition: OPS/NMH/MH/22-0004 (2022).
• Bolton P, Bass J, Neugebauer R, Verdeli H, Clougherty KF, Wickramaratne P, Speelman L, Ndogoni L, Weissman M (2003). Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA 289(23):3117–3124.
• Verdeli H, Clougherty K, Bolton P, et al. (2003). Adapting group interpersonal psychotherapy for a developing country: experience in rural Uganda. World Psychiatry 2(2):114–120 [background; no specific claims rest on it, uncertain].

Manual sections 5.2–5.4 (disputes, life changes, loneliness), the difficult-situations chapter and the annexes are not used here; items that depend on them are marked [synthesis] or [uncertain].