The Couple Relationship and Depression

FULL PROGRAMME

09.00 EST
Introductions

09.05
Dr David Hewison
From NICE Guidance to real-life therapy: the development of Couple Therapy for Depression.
This presentation will answer the question: how do you get from a NICE research-based recommendation to a practical, real-life, couple therapy that treats depression effectively? It will explore the original research evidence and the complications that unfolded from the fact that they were based on a discredited model of therapy. The competency frameworks will be explored and the mix of head-scratching, compromise and inventiveness that were necessary to develop a new framework for Couple Therapy for Depression. Finally, the framework’s innate contradictions and how they were turned into a ‘state of the art’ therapy that could be taught to therapists and delivered to couples, will be discussed.

09.35
Q&A

09.45
Kate Thompson
Couple Therapy for Depression: case histories and clinical challenges
In Mourning and Melancholia, Freud described
‘Mental features of melancholia are a profoundly painful dejection, cessation of interest in the outside world, loss of the capacity to love, inhibition of all activity, and a lowering of self-regarding feelings to a degree that finds utterance in self-reproaches and culminates in a delusional expectation of punishment’. (1917, p. 243)

Describing a case history in detail, taking the audience inside a couple’s experience of depression and therapy, we will consider the function that mental ill-health serves within the couple dynamic, and how it restricts development, intimacy and growth. The complex task for the therapist in delivering this integrated model, that necessitates moving between more active behavioural techniques and stepping back to allow psychodynamic understanding and a more systemic picture of the couple’s world and history to develop, will be described and illustrated with clinical examples.

10.15
Q&A

10.30
Melanie Shepherd
Relational Aspects of Depression
The relational aspects of depression are core to Couple Therapy for Depression. This presentation suggests some practical ways, guided by questions, to address these with couples. The questions enable the therapist to structure initial sessions, maintain their focus on the depression and relationship distress, if any, and make a therapy plan. The therapist’s questions support the couple to explore what triggered and maintains the depression; to see patterns they get stuck in, make links with their histories, draw on their strengths and commitment, and agree goals. The presentation will focus mainly on the questions which specifically address the relational aspects of depression.

11.00
Break

11.30
Panel
Discussion around a filmed clip with depressed couple with input from participants

12.00
Velia Carruthers
Couple Therapy for Depression efficacy data and filmed interview of couple who have undergone CTfD in NHS
This session seeks to apply the concepts presented by previous speakers around the bi-directional pull between depression and the couple dynamic. A film of a couple presenting with depression and relationship distress is discussed identifying the unconscious couple ‘fit’, the role of depression, their mutual defensive trap and polarisation. Evidence of CTfD’s efficacy is also presenting in analaysis from Tavistock Relationship’s research department. By tracking the data from PHQ9 (measuring depression), GAD7 (measuring anxiety) and linking this to data from each couple’s Couple Satisfaction Index, TR has linked increase in Couple Satisfaction post treatment to recovery from depression and anxiety which some consider the ‘holy grail’ and justification in working with couples and the relational aspect of depression, rather than focussing treatment solely on the individual patient diagnosed with depression.

12.30
Ann Hardy
Moving from Open Ended Therapy to Working Within a Time Limited Model
For practitioners who are used to delivering open-ended therapy, there are challenges and rewards in adopting a time-limited and focused model. This presentation considers subjects such as taking a more active and interventionist stance; the use of tools, exercises and homework; keeping a focus only on those aspects of the couple functioning that contribute to the maintenance of depression; and how to bring the work to a close, when a couple would prefer to continue. These are discussed from the perspective of a Tavistock Relationship therapist who has been delivering this model, while still working psychodynamically with her existing client base.

13.00
General Discussion

13.30
End