Interpersonal therapy worksheet

What is the theory behind this Interpersonal therapy worksheet?

This worksheet is based on Interpersonal Psychotherapy (IPT) which is a brief and focused therapy that has proven to be effective in primarily treating major depression along with other mental disorders. The basic premise of IPT is that an individual’s mood and consequently their symptoms are strongly linked with the quality of their interpersonal relationships. 

The therapist helps an individual through interpersonal crises and related situations that have preceded the current mood episode with the aim of reducing symptoms and improving functioning.

How will the worksheet help?

This worksheet is adapted from the ‘Interpersonal Inventory’ which is a psychosocial assessment used in IPT. It helps the therapist gather vital information about the quality of the client’s close relationships and their social support system.  This information can then be used to highlight problem areas in the interpersonal context that are a cause or consequence of their symptoms.  

How to use the worksheet?

This worksheet is to be used in the initial sessions to understand the quality of the client’s interpersonal relations so that a focused treatment can be planned. 

Ask the client to use the worksheet for each of the important people in their lives.  

Interpersonal therapy worksheet

Complete the worksheet for each of the important people in your life. 

  • How are you related to this person? ____________________________________
  • On a scale of 1 – 10, how close are you with this person? ___________________
  • How do you feel in their presence?


  • Do you trust this person with your personal problems? Why?


  • Can you rely on this person during hard times? Why?


What are some positive aspects of your relationship?What are some negative aspects of your relationship?

  • If you could change one negative aspect about this relationship what would it be? Why?



Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. Basic Books

International Society of Interpersonal Psychotherapy. (n.d.) Overview of IPT. Retrieved October 26 2022 from:

You can download this worksheet here.

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