What Is Dynamic Interpersonal Therapy (DIT)? A Complete Guide

Most people who experience depression recognise that their relationships play a significant role. Perhaps a breakdown in a close friendship left you feeling worthless, or a pattern of conflict with a partner has left you emotionally drained. You may have noticed that you tend to end up in the same kinds of painful relational situations, even when you try your hardest to do things differently.

Dynamic interpersonal therapy (DIT) was developed to address exactly this connection between relationship patterns and emotional distress. It is a structured, time-limited psychodynamic therapy that helps you understand how the ways you relate to others may be contributing to your depression or low mood. Rather than focusing solely on symptoms, DIT looks beneath the surface to identify the core relational dynamics driving your difficulties.

Developed by Alessandra Lemma, Mary Target and Peter Fonagy at the Tavistock and Portman NHS Foundation Trust, DIT was designed specifically for NHS Improving Access to Psychological Therapies (IAPT) services. It offers a psychodynamic alternative to cognitive behavioural therapy within a framework that is structured, evidence-based and deliverable in a fixed number of sessions. NICE recommends DIT as a treatment option for moderate to severe depression, placing it alongside other established therapies as a credible, research-supported approach.

What is dynamic interpersonal therapy?

DIT is a 16-session structured psychodynamic therapy that focuses on how relationship patterns contribute to emotional distress, particularly depression. It draws on attachment theory, object relations and mentalisation-based concepts to offer a focused, time-limited treatment that combines psychodynamic depth with practical structure.

At the centre of DIT is the concept of an interpersonal affective focus (IPAF). The IPAF is a formulation of the core relational pattern that is driving or maintaining your difficulties. It captures a recurring way of relating to others that involves specific emotional dynamics. For example, you might crave closeness but expect rejection, leading you to withdraw before you can be hurt, which in turn deepens your isolation and depression. Or you might suppress your own needs to keep the peace, only to feel increasingly resentful and depleted.

The IPAF is not a label or a diagnosis. It is a collaboratively developed understanding of the relational pattern that sits at the heart of your emotional difficulties. Once identified, it becomes the compass for the rest of the therapy, guiding the conversations and reflections that follow.

DIT also places significant emphasis on mentalising, the capacity to understand your own and other people’s behaviour in terms of underlying thoughts, feelings and motivations. When depression takes hold, mentalising often deteriorates. You may become rigid in how you interpret others’ behaviour, lose touch with your own feelings, or struggle to step back and reflect on what is happening in your relationships. DIT helps to restore and strengthen this capacity, which has benefits that extend well beyond the specific relational pattern targeted in therapy.

How does DIT work?

DIT follows a clear three-phase structure across its 16 sessions. Each phase has a distinct purpose, and the progression from one to the next gives the therapy a sense of direction and momentum.

Phase one: assessment and formulation (sessions 1 to 4)

The opening phase is devoted to understanding your current difficulties and mapping the relational landscape of your life. Your psychologist will explore your key relationships, both past and present, and pay close attention to the emotional themes that emerge. Together, you will identify your IPAF, the core relational pattern that is most closely connected to your depression.

This is a collaborative process. Your psychologist will listen not only to what you describe but also to how you describe it, noticing the emotions that surface and the way you position yourself in relation to others. The IPAF is then shared with you, often in both written and diagrammatic form, so that you have a clear, shared framework for the work ahead.

Phase two: the middle phase (sessions 5 to 12)

The middle phase is where the core therapeutic work takes place. Sessions focus on exploring how the IPAF plays out in your current relationships, in your past, and importantly, in your relationship with your psychologist. You will be encouraged to notice when the pattern is active, what feelings it evokes and what it leads you to do.

A distinctive feature of DIT is the use of the therapeutic relationship itself as a window into your relational patterns. If your IPAF involves expecting criticism, for example, your psychologist will pay attention to moments when you seem to brace for negative feedback in sessions, and will bring these observations into the conversation with warmth and curiosity. Experiencing the pattern in real time, and exploring it together, is often more powerful than simply talking about it in the abstract.

Throughout this phase, your psychologist will support you in developing your mentalising capacity. This might involve exploring what a particular interaction made you feel, what you imagined the other person was thinking, and what alternative explanations might exist. Over time, this strengthens your ability to respond to interpersonal situations with greater flexibility.

Phase three: the ending phase (sessions 13 to 16)

The final phase addresses the ending of therapy, which DIT treats as a significant event in its own right. Endings can activate many of the relational themes that brought you to therapy in the first place, making this a valuable opportunity for further learning and growth.

Your psychologist will help you review your progress, consolidate your understanding of your IPAF and plan for maintaining your gains. You will reflect on how the pattern has shifted, what you have learned about yourself and your relationships, and how you can continue to apply this understanding going forward. Because the ending is anticipated from the very beginning, both you and your psychologist can use the final sessions purposefully.

Who can benefit from DIT?

DIT was developed primarily for depression and has the strongest evidence in this area. However, the approach can also be helpful for a range of difficulties that are connected to relational patterns. You might benefit from DIT if you are experiencing:

• Depression, particularly when your low mood feels connected to what is happening in your relationships or to recurring patterns of conflict, loss or disappointment
• Emotional distress that does not fit neatly into a single diagnostic category but is clearly linked to interpersonal difficulties
• Relationship difficulties, including struggles to form or maintain close relationships, difficulty expressing your needs, or a tendency to repeat painful relational dynamics
• Grief and bereavement, especially when a loss has activated longstanding relational patterns that intensify the emotional impact
• Adjustment difficulties following major life transitions such as relationship breakdown, retirement, or significant changes in role or identity
• Anxiety that centres on relationships, whether this involves fear of rejection, difficulty trusting others, or a pattern of withdrawing when things become emotionally intense

DIT is particularly well suited for people who recognise that their emotional difficulties are rooted in the way they relate to others. If you have found that symptom-focused approaches have helped manage your day-to-day difficulties but have not addressed the deeper relational patterns beneath them, DIT may offer a valuable alternative perspective.

What to expect from a DIT session

Each DIT session lasts 50 minutes. Unlike more structured therapies such as CBT, sessions do not typically involve homework, worksheets or structured exercises. Instead, the work happens through conversation, reflection and the experience of being understood within the therapeutic relationship.

A typical session begins with your psychologist inviting you to share what has been on your mind since the last session. This might be a relationship interaction that troubled you, a shift in mood, or a thought that stayed with you during the week. Your psychologist will listen carefully, paying attention to the emotional tone, the relational dynamics at play, and any connections to your IPAF.

Much of the session involves a collaborative exploration of these experiences. Your psychologist might ask what you imagined the other person was feeling, what you noticed in your own body, or what you found yourself doing in response. These questions support mentalising, helping you develop a more nuanced understanding of what is happening beneath the surface of your interactions. There is no expectation that you will have ready answers. The process of wondering together is itself therapeutic.

It is worth noting that DIT is not simply a space to talk through your week. While it is conversational and reflective, it is also purposeful. Your psychologist will draw links between your current experiences and the IPAF, gently drawing attention to the pattern as it emerges. At times, they may observe how the pattern is playing out between the two of you in the session itself, offered with warmth rather than judgement. This kind of real-time, relational exploration is one of the most powerful aspects of the approach.

The evidence base for DIT

DIT is recommended by NICE as a treatment option for moderate to severe depression. This recommendation reflects a growing body of evidence supporting the approach, developed primarily within NHS settings in the United Kingdom.

Research conducted at the Tavistock and Portman NHS Foundation Trust, where DIT was developed, has demonstrated significant improvements in depressive symptoms and interpersonal functioning. Importantly, these findings come from routine clinical practice rather than controlled research trials alone, suggesting that DIT works well in real-world NHS settings.

Studies have also highlighted improvements in mentalising capacity among people who complete DIT, supporting the theoretical model that underpins the approach. Enhanced mentalising appears to be one of the key mechanisms through which DIT achieves its effects, helping people develop more flexible and reflective ways of understanding their relationships.

DIT sits within a broader tradition of short-term psychodynamic therapy, which has accumulated substantial evidence over the past two decades. Meta-analyses consistently show that short-term psychodynamic therapies are effective for depression and that their benefits tend to increase over time after therapy ends. This pattern, sometimes referred to as the “sleeper effect,” suggests that the understanding gained in therapy continues to develop and deepen long after the final session.

DIT vs other therapies

If you are considering therapy for depression or emotional distress, you may be weighing up different approaches. Here is how DIT compares to some of the other options.

DIT vs CBT

CBT is a structured, goal-oriented therapy that focuses on identifying and changing unhelpful patterns of thinking and behaviour. It is highly effective for depression and anxiety and is the most widely available therapy within NHS services. DIT differs in that it focuses on underlying relational patterns rather than specific thoughts and behaviours. If your depression feels closely connected to your relationships and you are drawn to understanding the emotional roots of your difficulties, DIT may be a better fit. If your difficulties are more clearly maintained by specific thinking patterns, CBT may be the more appropriate starting point.

DIT vs psychodynamic therapy

DIT is itself a psychodynamic therapy, but it differs from traditional psychodynamic therapy in important ways. Traditional psychodynamic work tends to be open-ended and broadly exploratory, without a fixed timeframe. DIT takes the most powerful elements of this tradition, particularly the focus on unconscious relational patterns and the use of the therapeutic relationship, and packages them into a 16-session structure. This makes DIT more accessible and focused, while retaining the depth that characterises psychodynamic approaches.

DIT vs counselling

Counselling provides a supportive, empathic space to talk through your concerns and can be very helpful during times of difficulty or transition. DIT is more targeted, working with a specific formulation (the IPAF) and using the therapeutic relationship actively to explore and shift relational patterns. As a manualised, evidence-based treatment with a defined structure, it is distinct from the more open and supportive nature of most counselling.

Accessing DIT online

DIT translates naturally to the online environment. The therapy is built around conversation, reflection and the careful exploration of relational dynamics, none of which requires physical presence in the same room. Video sessions provide sufficient visual and emotional information for the attuned, responsive work that DIT involves.

Many clients report that being in their own environment helps them feel more at ease when discussing difficult relationship dynamics. The practical benefits of online therapy, including the removal of travel time and the ability to access specialist therapists regardless of location, make it easier to commit to the full 16-session course.

At The Online Psychologists, DIT is delivered by HCPC-registered clinical and counselling psychologists with specific training in dynamic interpersonal therapy. When you contact us, we begin with a matching process to pair you with a psychologist experienced in DIT who is a good fit for your particular difficulties. Sessions are held weekly, last 50 minutes, and follow the same structured three-phase model used in NHS settings.

If you think DIT might be helpful for you, or if you are unsure which type of therapy would best suit your needs, we are happy to discuss your options. Tell us what’s bringing you here and Dr Rachel Whatmough will consider your concerns, begin a clinical formulation, and help you find the right approach and the right psychologist for your situation.