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Dynamic Interpersonal Therapy (DIT) is a manualised, time-limited, psychodynamic therapy for patients with treatment-resistant depression linked to interpersonal problems. This paper examines the central thread of DIT; a case formulation called the interpersonal affective focus (IPAF). The IPAF is a brief psychodynamic case formulation of a problematic response to interpersonal threats that is rooted in internalised object relationships. It has two dimensions: an interpersonal focus and an affective focus. The interpersonal focus is a way of viewing the self in relation to others, which creates a bias towards perceiving the self and others in particular ways. The affective focus is an emotional reaction that contributes to interpersonal problems due to the inflexible character of the behaviours it evokes. A composite case study illustrates the value of using an IPAF to explore patients’ internal representations and work through painful emotional states that may be contributing to their relational problems. However, it also illustrates that for DIT patients with borderline aspects to their personality organisation, extra care may need to be taken with the pacing and timing of the approach.

The interpersonal affective focus (IPAF) in dynamic Interpersonal Therapy (DIT): a composite case study