Treatment of depressed-maritally discordant individuals: Is there a psychological treatment of choice?

Abstract

Since Coyne’s (1976) seminal paper on the interpersonal aspects of depression, the importance of marital processes in depression increasingly has moved to center stage in clinical conceptualization and theory. Marital discord and depression are clearly linked (Beach, Sandeen & O’Leary, 1990), and problematic relationships are often central to the development and course of depression (cf. Coyne & Downey, 1991). This central fact is being increasingly recognized by disparate groups with varying agendas, but a common interest in advancing the quality of mental health care. The final report of the American task force on women and depression highlighted the role of interpersonal processes, particularly transactions occurring within intimate relationships, in the pathogenesis of depression for women (McGrath, Keita, Strickland, & Russo, 1990). Unhappy marriages have been shown to pose a major risk for the development of unipolar depression (Weissman, 1987). It has been reported that simply being married is a predictor of slower recovery from a depressive episode (George, Blazer, Hughes, & Fowler, 1989), married persons do more poorly on antidepressant medication than do others (Keller et al., 1984), and being maritally discordant is a predictor of relapse following pharmacological treatment for depression (Hooley & Teasedale, 1989). A decade ago one might have asked if marital or family interventions had anything to add to the more commonly used individual and somatic approaches. Indeed, some centers specializing in the treatment of depression did not even systematically assess for the presence or severity of marital problems. However, one is now more likely to be confronted with the assertion that marital therapy for depressed-discordant individuals is “common sense.” Indeed, in discussions with clinical colleagues, some have expressed concern that when individual work or pharmacotherapy is done in the context of marital discord and depression it