Couples treatment for major depression: critique of the literature and suggestions for some different directions

Abstract

Current couples approaches to the treatment of depression show considerable promise for some couples, but have substantial room for improvement – in terms of efficacy as well as applicability and acceptability to a broader population. Although conjoint approaches have been shown to be efficacious in reducing couple distress and are possibly efficacious in ameliorating depression that co‐occurs with couple distress, methodological problems hamper generalization from the published findings. Therefore, it is not clear that most depressed persons are likely to benefit from currently available conjoint formats. Most basically, there may often be obstacles that prevent or delay partner involvement, highlighting the need for treatments that can enhance relationship functioning without relying on a conjoint format. Existing treatment delivery systems may also fail to reach a considerable segment of the population. Developing a more flexible set of options for implementing couple‐focused treatment, as well as rethinking dominant assumptions about depression, may be integral to extending the viability of couples therapy for depression.

Individual distress and dyadic adjustment over a three‐year follow‐up period in couple therapy: a bi‐directional relationship?

“…The scoring range was 0-151 with higher scores representing better adjustment. A commonly accepted cut-off level for identifying poor dyadic adjustment (other concepts used are marital dissatisfaction or marital distress) is 97 based on one standard deviation below the mean for non-distressed couples (Christensen and Heavey, 1999;Gupta et al, 2003). In the current sample, Cronbach's alpha at admission was .90.…”

Efficacy of Couple Therapy as a Treatment for Depression: A Meta-Analysis

“…However, although some narrative reviews do exist [9,10], data from clinical trials have never been subjected to systematic quantitative analyses. Therefore, we sought to fill this gap by appraising and summarising the research evidence on the role of couple therapy among psychosocial treatments for depression.…”

The Associations Between Intensive Residential Couple Therapy and Change in a Three-Year Follow-Up Period

“…Continuous scales with scores ranging from 0 to 4, 0 to 5, or 0 to 6, as well as categorical yes/no items were included. The scoring range was 0-151 with higher scores representing better adjustment and with B97 as cut-off (Christensen and Heavey 1999;Gupta et al 2003). Psychometric analyses support the reliability and validity of the DAS (Christensen and Heavey 1999;Corcoran 2000).…”

“…Clinical significance is demonstrated when two criteria are fulfilled: (1) the change after treatment can be demonstrated to be reliable (Jacobson and Truax 1991), and (2) the patients are not distinguishable from a relevant non-clinical reference group after treatment (Kendall and Grove 1988). A follow-up score above the cut-off, 97, indicated 'non-case' status (Christensen and Heavey 1999;Gupta et al 2003). The reliable change index (RCI) was computed by dividing the difference between preand post-scores by the standard error of the difference between the two scores.…”