The underuse of couple therapy for depression in Improving Access to Psychological Therapies Services (IAPTS): a service evaluation exploring its effectiveness and discussion of systemic barriers to its implementation

Abstract

Couple therapy for depression (CTfD) is an intrinsically systemic, behaviourally‐based, interactional model. It is underused despite recommendation by the National Institute for Health and Care Excellence (NICE) and data from Improving Access to Psychological Therapies Services (IAPTS) demonstrating its effectiveness compared with other therapies. In 2016/17, only 1,842 CTfD interventions were delivered nationally, compared with vastly greater cognitive behavioural therapy and counselling provision (NHS Digital, 2018). Depressed clients’ access to CTfD is extremely restricted. IAPT CTfD service evaluation data for 81 couples indicated good outcomes for CTfD in terms of depression, anxiety and relationship satisfaction, despite mean interventions of 7.27 sessions. Recommendations for addressing the underuse of CTfD include increasing capacity through delivery targets, CTfD promotion and improved referral processes. Strengthened links between IAPTS, CTfD training courses and systemic therapists, and expanding systemic training and supervision, would support CTfD implementation and increase family inclusiveness and patient choice. Depressed clients deserve access to CTfD equivalent to individual therapies.Practitioner points CTfD is a NICE‐recommended NHS couple therapy with equivalent effectiveness to other IAPT therapies yet is underused. A CTfD service evaluation showed good outcomes for depression, anxiety and relationship satisfaction, despite brief intervention lengths. Leadership, organisational change and training are required for IAPTS to widen patient choice and address barriers to CTfD implementation. Strengthened links between IAPTS and systemic therapists are needed.