Couple therapy

What does the evidence say?

A Cochrane review has analysed the role of marital therapy in alleviating depressive symtptoms. By means of a meta analysis it as found that there was no evidence to suggest that marital therapy was more or less effective than individual talking therapies in :

alleviating depressive symptoms
reducing the number of participants who suffered from persistent depression

However, it was found that the persistence of depression was better within the marital therapy group compared to "no" or "minimal treatment.

Numerous clinical trials have indicated that the couple therapy alleviates depressive symptoms by improving relationship disputes.

Stage 2 : Communication and problem solving

The focus of this stage is to enhance communication skills and .. problem solving skills betwee the couple. Attention is paid to body language, listening, responding, and recalling skills. Couples are taught to listen to each other respctfully, and convey their understanding. Initially the topics are focused around positive concepts, training the individuals to practice their communication skills as part of their homework. After this concept has been mastered, the topics then progress to more conflicting dialogue, in aid to introduce and adapt to problem solving skills. Couples will learn how to discuss and effectively solve their problems. As all stages, the concept is practiced on a small scale facilitated by the therapist, offering encouragement where necessary, and is then set as homework to practice.

Stage 1: Treatment plan and goal therapy

At this stage the therapist alleviates tension, by reassuring the couple that although depression and relationship probles are interrelated, one does not cause the other. The therapist can describe what they think the stressful factors contributing to the disputes are. Depressive symptoms are exlained to the couple, enabling them to understand each others behaviour, dialogue, and susbequent action. If abuse adultery or other such problems arise, the therapist will be able to reduce the stress of "leaving" the relationship. Prior to this, the outcomes and consequences are explained. By the end of the session, the therapist must feel reasonably satisfied that such detrimental behaviour will not be continued. The therapist also tries to enhance the frequency of positive behaviours, such as caring behaviours or gestures e.g. as affectionate or concerning behaviours. Both partners are encouraged to write down a list of such positive behaviours that they can implement ideally on a daily basis. In response to these behaviours, appreciation for beaviours should be expressed, and thanking each other will encourage the action to be repeated. In later sessions adding each partner can add similar behaviours to each others list.

Stage 3

This involves consolidating the practices learnt within the first two stages. The therapist will summarise the key issues resolved over the duration of the therapy, and each partner will write what they found most useful. Key stressors will then be reminded to the couple, and they will also be reminded of how to look out for early warning signs to prevent recurrent depression. Booster sessions and treatment fading sessions is also another measure taken, and will fist take place on a weekly, then fortnightly, then monthly basis in order to enable the couple to gain greater confidence to manage between themselves. Couple check ups can be undertaken every 2 years to also see identify any underlying stressors.

"although depression and relationship problems are interrelated, one does not cause the other"

Whether a civil partnership or successful marriage all sorts of relationships can all have their down falls. However it is particularly problematic when it is accompanied by depression. Even one depressed partner can have a significant impact on the relationship, however couple therapy aims to alleviate and resolve underlying relationship disputes, and depression. There are typically three stages to couple therapy, all explained below.

What does NICE say?

Couple therapy courses should last over a duration of 5-6 months consisting of 15-20 sessions. Couple therapy is indicated in patients who have a regular partner and have had a poor response to individual a brief individual intervention .