Depressed Clients Research Articles

Effect of older adult health and age on psychology doctoral trainees’ expectations of clinical work with older adult clients

ABSTRACT This experimental, repeated-measures study investigated the effects of client health and client age on doctoral psychology students’ clinical expectations for their work with older adult clients. Doctoral clinical and counseling psychology trainees (N = 223) completed measures assessing clinical expectations for three older adult clients of varying health status (healthy, recent Alzheimer’s Disease (AD) diagnosis, heart disease) who all presented with depressive symptoms. Trainees were randomly assigned to the 71-year-old or 81-year-old condition. Trainees perceived a depressed client with a recent AD diagnosis as a less appropriate candidate for therapy, less motivated and less responsible for therapy, and less able to develop a therapeutic relationship. Additional health-based differences in prognosis, comfort, and competence were moderated by client age. Although age did have a small effect, the health of the older adult client had a stronger influence on trainees’ clinical expectations for work with older adults. Cognitive health concerns were perceived as a greater barrier to clinical work with older adults than were physical health concerns. Health biases for clinical work with older adults could impact the quality of mental healthcare provided.

Nursing Care for Depressive Clients: A Review

Nursing Care for Depressive Clients: A Review

Do NHS talking therapies services and couple therapy for depression have a relationship problem?

PHOTO CREDIT: Antoni ShkrabaCouple Therapy for Depression (CTfD) is unique being the only NHS Talking Therapies Services (NHSTTS) therapy involving partners. As a couple therapy it is systemic as well as behavioural. CTfD is an effective intervention for both depression and relationship distress and achieves good recovery-rates for depression and anxiety compared with other ‘high-intenstty’ therapies.Delivery of CTfD in NHSTTS is inadequate. Over a third of NHSTTS provide no CTfD. When they do, delivery is so minimal that depressed clients cannot generally access CTfD. Since 2010, 1172 CTfD therapists have been trained yet, in 2021/2, only 1574 couples received CTfD (approximately one couple seen per year per therapist). This is wasteful given the investment of time and money.Constraints affecting delivery e.g. individually-focused organisational culture of NHSTTS, misunderstanding of the role of CTfD therapists, inappropriate referrals, inadequate supervision and delivery on a minimal scale, are discussed and recommendations outlined.Clients deserve genuine choice, staff need support to deliver CTfD effectively, and referral quantity and quality require urgent attention.

Recurrent depression and relational trauma: a single case of memory processing

Abstract Cognitive behavioural therapy (CBT) is an effective treatment for depression, but a significant minority of clients are difficult to treat, including those with histories of relational trauma. The model of Beck et al. (1979) proposes that adverse childhood experiences lead to negative core beliefs, and these create a susceptibility to depression. However, Beck’s model does not identify trauma as a subset of adverse experiences. An alternative view is that traumatised clients internalise conflicting representations of self and it is conflict, interacting with trauma memories, that creates a vulnerability for depression. In this formulation, methods from the treatment of post-traumatic stress disorder (PTSD) could be incorporated into the treatment of depression, to emotionally process trauma memories and resolve self-identity conflicts. The aims of this study were to: (1) report the treatment of a 67-year-old man with recurrent depression and a history of prolonged relational trauma, and (2) to explore how memory processing from the treatment of PTSD can be incorporated into the treatment of recurrent depression. A single case observational design was used in the long-term treatment of a depressed traumatised client. The client received 47 individual sessions over 19 months in routine clinical practice in a tertiary CBT service. He completed repeated measures of mood, memory intrusions and sleep disruption. The client responded well to treatment with clinically significant improvements across measures of mood, memory and sleep. The effects were sustained over an 18-month follow-up. Memory processing was successfully integrated into a high-intensity treatment for recurrent depression. This is a promising approach for depressed clients with histories of relational trauma. Key learning aims (1) To consider how imaginal reliving can be incorporated into CBT for recurrent depression, when relational trauma is present. (2) To consider the cognitive processing mode of depressed traumatised clients when appraising beliefs about self and others. (3) To consider vulnerability to depression based on intrusive memories and conflicting self-representations, not only core beliefs.

PREPARING TO MEET THE NEEDS OF OLDER ADULTS: WORKFORCE, TRAINING, AND EDUCATION ISSUES

Abstract Due to projected growth in the older adult population in the United States, those working in healthcare and education will encounter increasing numbers of older adults. This population shift presents challenges and opportunities for individuals working in these settings to be ready to meet the needs of older adults. In this symposium, we highlight research on several issues critical to preparing the workforce in healthcare and education for older adults’ specific needs. Poon’s paper addresses geriatric behavioral health workforce needs identified by a survey of licensed behavioral health providers. Several barriers to providing care to older adults are identified by these providers. Rodriguez et al. investigated the clinical practice experiences and challenges from ten years’ worth of alumni of the VA Geriatric Scholars program. This training program provides a model for improving clinical practice with older adults. Hollis-Sawyer examines older students’ first experiences taking a course in an online teaching setting and provides specific suggestions to maximize their learning environment. Patterson et al. present an extensive scoping review of end-of-life training for medical students that identified several themes that can direct efforts to improve end-of-life care for older adults. Finally, Caskie et al. address health biases and age biases in doctoral psychology trainees’ anticipated clinical work with depressed older adult clients of varying health statuses and provide guidance to psychology programs for improving training. This symposium aims to provide those working in healthcare and educational settings with ways to address workforce preparedness to meet the needs of older adults.

The use of homeworkin emotion-focused therapy for depression.

Emotion-focused therapy (EFT) is an empirically supported treatment of depression, and an integrative, transdiagnostic therapy approach focusing on transforming emotions that are the cause of a person's emotional pain and suffering. In-session experiential work and two-chair interventions are consolidated and expanded by between-session homework which is viewed as a natural extension of in-session work. As the focus on emotion in EFT necessitates the provision of a safe, attuned, empathic relationship and a good collaboration on the tasks and goals of therapy the use of homework is very well-suited to this approach. An EFT case example is discussed to illustrate how homework can be an important ingredient to strengthen and facilitate change in treating a depressed client with a core underlying feeling of shame related to unresolved childhood trauma.

Bringing Mental Health Services to Community Settings

Senior centers and aging service providers provide national infrastructure for delivering mental health services to older adults in need. Given that older adults involved in senior centers, dining sites, and other aging services exhibit high mental health needs, this infrastructure shows great promise for preventing and ameliorating depression, anxiety, loneliness, and other mental health issues. This session describes three programs and evaluation results of behavioral health screening and interventions integrated into senior centers and aging service organizations, delivered by embedded mental health clinicians and older adult volunteers. The first presentation describes an ongoing three-site RCT of behavioral activation delivered by master's level clinicians or a streamlined behavioral activation intervention delivered by older adult volunteers for depressed senior center clients, describing the methods, interim training results, and preliminary feedback from clients and volunteers. The second presentation describes a large-scale dissemination initiative of mental health screening and services across 30 senior centers in New York City, involving 894 older adults screened and 4,749 intervention sessions delivered in one year by embedded mental health clinicians, with reductions in depressive and anxiety symptoms for many. The third presentation describes a pilot RCT with 40 depressed senior center clients, comparing a Stay Connected virtual intervention delivered during the COVID-19 pandemic to usual care, observing improvements in depressive symptoms for the Stay Connected intervention. The three programs illustrate the value of screening and evidence-based interventions delivered by embedded mental health clinicians, aging service personnel, and older adult volunteers. The discussant will review key findings and themes and facilitate discussion among the speakers and audience.

Cultural adaptations of group CBT for depressed clients from diverse backgrounds: A systematic review

Abstract Cognitive behavioural therapy (CBT) is considered a frontline treatment for major depressive disorder (MDD) and is recommended as a preferred option in many Western healthcare settings. CBT has proven effective for clients from the majority population in Western countries, but to meet the needs of diverse clients it may require adaptation. The benefits of culturally adapted group CBT (CA-GCBT) for clients from diverse backgrounds remains uncertain. The objective of this review is to systematically identify, evaluate, and integrate the existing empirical literature on CA-GCBT for depressed clients from diverse backgrounds. A comprehensive search was conducted in April 2021 across various databases, including, MEDLINE, PsycINFO, Cinahl, Academic Search, and APA PsycArticle. Quantitative studies meeting the inclusion criteria resulted in a total of ten articles being included in the review. Results from the analysis revealed a statistically significant reduction in depressive symptoms following CA–GCBT in nine out of the ten studies, with one study providing descriptive results. Additionally, improvements were observed in dysfunctional beliefs, functioning, and quality of life ratings. These findings suggest promising outcomes for racially minoritised clients in Western countries and racial majority clients in non-Western countries. Adaptations in CA-GCBT primarily focus on modifying the group delivery, therapy content, staffing, processes, and client-specific factors. Overall, CA-GCBT shows promise as a treatment for depressed clients from diverse backgrounds. However, further evaluation is necessary to establish its efficacy in clinical practice more robustly, to identify which adaptations are most effective for specific populations and to explore the experiences of implementing or attending such group interventions. Key learning aims (1) To explore the benefits of CA-GCBT for depressed clients from diverse backgrounds. Although CBT is a frontline treatment for MDD and often delivered in group format, it remains unclear whether CA-GCBT is beneficial. (2) To summarise findings about the benefits of CA-GCBT for racially minoritised clients in Western countries and racial majority clients in non-Western countries. (3) To outline the modifications made to common CBT group approaches to enhance cultural responsiveness for clients from diverse backgrounds. (4) To provide support to therapists, healthcare services, and broader healthcare structures seeking to implement evidence-based knowledge when adapting group CBT for diverse cultural groups. This enables them to modify existing group CBT protocols or consider specific CA-GCBT interventions.

Investigating post-traumatic stress disorder (PTSD) and complex PTSD among people with self-reported depressive symptoms.

Trauma has been increasingly linked to depression. Previous studies have suggested that comorbid post-traumatic stress disorder (PTSD) may be associated with poor outcomes in depression treatment. However, the prevalence and correlates of ICD-11 PTSD and complex PTSD (CPTSD) in people with depression remain unclear. This study examined the prevalence and correlates of ICD-11 PTSD and CPTSD in an online convenience sample of 410 adults from 18 different countries/regions who reported clinically significant levels of depressive symptoms (indicated by a Patient Health Questionnaire-9 score ≥10). According to the International Trauma Questionnaire results, 62.68% of participants met the ICD-11 criteria for PTSD/CPTSD (5.6% PTSD, 57.1% CPTSD). Participants with CPTSD reported more types of trauma and higher levels of interpersonal stress than those without PTSD. Participants with CPTSD also reported higher levels of mental health problems, including depressive, dissociative and psychotic symptoms, than those without PTSD. Only disturbances in self-organization (DSO) symptoms but not classical PTSD symptoms had a significant relationship with depressive symptoms, when other major variables (including trauma, interpersonal stress, and comorbid psychotic and dissociative symptoms) were controlled for. Trauma-related symptoms should be regularly screened for in clients who report depressive symptoms. Depressed clients who have comorbid trauma disorders have more trauma and interpersonal stress and exhibit more severe mental health problems. They may require specific trauma-focused interventions in addition to standard depression treatments.

Brief Solution Focused Therapy in Ukraine to Work with People with Emotional, Cognitive and Behavioural Disorders

Aim. To study the way how Brief Solution Focused Therapy (BSFT) tackles emotional, cognitive and behavioural disorders. To provide basic definitions of such disorders and identify major approaches and techniques focusing on Brief Solution Focused Therapy aspects that may be applied in psychotherapeutic works with these people. Methods. Ana\lysis and synthesis of scientific data regarding defining emotional, cognitive and behavioural disorders. Distinguishing basic diagnostic signs of such disorders in clients. Methods of BSFT psychotherapy. Results. The following BSFT techniques proved to be the most effective in the work on emotional disorders: problem-free talk, compliments, resource questions and scaling. These techniques can be called the most emotional ones – the techniques that call for your emotions, replenish your psychological resource, help rebuild your emotional attitude to the situation, look at it from a different angle. BSFT-based psycho-correction and psychotherapy of cognitive impairments and behavioural disorders is longer and more fundamental. Effective techniques are goal setting, resource identification, and also there are special turning points, such as the technique of life analysis, which is a variant of scaling as a method, use of coping questions. Conclusions. BSFT-methods are effective in addressing different disorders – both partial (emotional, behavioural, cognitive) and more complex ones. The fact that BSFT does not focus on the negative emotional conditions, the problem and its causes, enables the depressive clients, grieving clients and clients experiencing loss to relatively fast discover their resources and start building plans, demonstrating how it is possible to optimize the process of overcoming complicated life situations.

CBT for difficult-to-treat depression: single complex case

Abstract Cognitive behavioural therapy (CBT) is an effective treatment for depression but a significant minority of clients are difficult to treat: they are more likely to have adverse childhood experiences, early-onset depression, co-morbidities, interpersonal problems and heightened risk, and are prone to drop out, non-response or relapse. CBT based on a self-regulation model (SR-CBT) has been developed for this client group which incorporates aspects of first, second and third wave therapies. The model and treatment components are described in a concurrent article (Barton et al., 2022). The aims of this study were: (1) to illustrate the application of high dose SR-CBT in a difficult-to-treat case, including treatment decisions, therapy process and outcomes, and (2) to highlight the similarities and differences between SR-CBT and standard CBT models. A single case quasi-experimental design was used with a depressed client who was an active participant in treatment decisions, data collection and interpretation. The client had highly recurrent depression with atypical features and had received several psychological therapies prior to receiving SR-CBT, including standard CBT. The client responded well to SR-CBT over a 10-month acute phase: compared with baseline, her moods were less severe and less reactive to setbacks and challenges. Over a 15-month maintenance phase, with approximately monthly booster sessions, the client maintained these gains and further stabilized her mood. High dose SR-CBT was effective in treating depression in a client who had not received lasting benefit from standard CBT and other therapies. An extended maintenance phase had a stabilizing effect and the client did not relapse. Further empirical studies are underway to replicate these results. Key learning aims (1) To find out similarities and differences between self-regulation CBT and other CBT models; (2) To discover how self-regulation CBT treatment components are delivered in a bespoke way, based on the needs of the individual case; (3) To consider the advantages of using single case methods in routine clinical practice, particularly with difficult-to-treat cases.

“Do More, Feel Better”: Pilot RCT of Lay-Delivered Behavioral Activation for Depressed Senior Center Clients

This pilot randomized control trial (RCT) tested “Do More, Feel Better” (DMFB), a lay-delivered Behavioral Activation intervention for depressed senior center clients. The study examined: (1) the feasibility of training older lay volunteers to fidelity; and (2) the acceptability, safety, and impact of the intervention. Twenty-one lay volunteers at four senior centers were trained in DMFB. Fifty-six depressed clients were randomized to receive 9 sessions of DMFB or Behavioral Activation delivered by social workers (MSW BA). Research assessments of overall client activity level (BADS) and depression severity (HAM-D) were conducted at baseline and Weeks 3, 6, and 9. Eighty-one percent of lay volunteers who underwent training were formally certified in DMFB. Depressed clients receiving each intervention reported high levels of satisfaction and showed large and clinically significant changes in 9-week activity level (d ≥ 1.35) and depression severity (d ≥ 3.34). Differences between treatment groups were very small for both activity level (dMSW = 0.16; 95% CI, -0.70 to 1.02) and depression (dMSW = 0.14; 95% CI, -0.63 to 0.91). Increases in activity level were associated with decreases in depression (β = -0.42; 95% CI, -0.55 to -0.30). Both interventions appeared to work as intended by increasing activity level and reducing depression severity. “Do More, Feel Better” shows the potential of evidence-based behavioral interventions delivered by supervised lay volunteers, and can help address the insufficient workforce available to meet the mental health needs of community-dwelling older adults.

Psychological impact of early miscarriage and client satisfaction with treatment: comparison between expectant management and misoprostol treatment in a randomized controlled trial.

To compare the short- and long-term emotional distress (grief, anxiety and depressive symptoms) after early miscarriage and satisfaction with treatment between women randomized to expectant management vs vaginal misoprostol treatment. This was a preplanned analysis of data collected during a randomized controlled trial comparing expectant management with misoprostol treatment in women with early anembryonic or embryonic miscarriage and vaginal bleeding. If the miscarriage was not complete on day 31 after inclusion, surgical evacuation was recommended. The main outcomes were levels of anxiety and grief, depressive symptoms and client satisfaction with the treatment, which were assessed using the following validated psychometric self-assessment instruments: Spielberger State-Trait Anxiety Inventory (STAI, Form Y), Perinatal Grief Scale (PGS), Montgomery-Åsberg Depression Rating Scale (MADRS-S; self-reported version) and Client Satisfaction Questionnaire (CSQ-8). All women were assessed at four timepoints: on the day of randomization, on the day when the miscarriage was judged to be complete, and at 3 months and 14 months after complete miscarriage. The psychometric and client satisfaction scores were compared between the misoprostol group and the expectant-management group at each assessment. Analysis was performed by the intention-to-treat principle. Ninety women were randomized to expectant management and 94 to misoprostol treatment. The psychometric and client satisfaction scores were similar in the two treatment groups at all assessment timepoints. At inclusion, 41% (35/86) of the women managed expectantly and 37% (34/92) of those treated with misoprostol had a STAI-state score of > 46 ('high level of anxiety'), and 9% (8/86) and 10% (9/91), respectively, had symptoms of moderate or severe depression (MADRS-S score ≥ 20). In both treatment groups, symptom scores for anxiety and depression were significantly higher at inclusion than after treatment and remained low until 14 months after complete miscarriage. Grief reactions were mild in both groups, with a median PGS score of 40.0 at 3 months and 37.0 at 14 months after complete miscarriage in both treatment groups. Four women treated with misoprostol and two women managed expectantly had a PGS score of > 90 (indicating deep grief) 3 months after complete miscarriage, while one woman managed expectantly had a PGS score of > 90 14 months after complete miscarriage. Women in both treatment groups were satisfied with their management, as indicated by a median CSQ-8 score of > 25 at each assessment. More than 85% of participants in each of the two groups reported that they would recommend the treatment they received to a friend. The psychological response to and recovery after early miscarriage did not differ between women treated with misoprostol and those managed expectantly. Satisfaction with treatment was high in both treatment groups. Our findings support patient involvement when deciding on the management of early miscarriage. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

GUIDING ASPECTS OF ISLAMIC EXISTENTIAL-COGNITIVE BEHAVIOUR THERAPY FOR EXISTENTIAL DEPRESSION

The CoVid-19 pandemic had again activated the neuronal circuit on our existential crisis as human beings asking basic existential questions: Where were we from, who are we, why are we here, how we supposedly should live here and where are we going? - Instinctively it appears evidently in the soul while facing threats that may lead to death like the pandemic exposes us to. This study critically explores and analyses through content analysis method on available published ‘Islamic’ documents, which are purposively sampled based on relevancy to the existence. We shared what we found related to existential psychotherapy using cognitive behavior therapy for depressed Muslim clients in supporting the current call for integrating Islamic teachings and practice. Mainly, being intersubjective is very crucial for therapists’ competency because Muslim clients are from diverse Islamic backgrounds.

Dance movement therapy for depressed clients: Profiles of the level and changes in depression

ABSTRACT This research identified participant profiles in level and changes in depression among working age (18–64 years old) clients (N = 137) diagnosed with depression, who participated in a 20-session dance movement therapy (DMT) intervention. Using Latent Profile Analysis Mild, sharply reducing depression (9%), Mild, reducing depression (58%) and Severe, reducing depression (33%) profiles were established, using Beck Depression Inventory scores gathered at pre-intervention, post-intervention, and follow-up points. At the pre-intervention point, being in full-time work was related to the Mild, sharply reducing depression profile. Being on a disability pension, having a history of one`s own or a close person`s substance abuse, a more fearful attachment style, and deficiencies in mindfulness skills were related to the Severe, reducing depression profile. All participants benefited from the short-term DMT intervention, which may offer a good outcome for patients with less complex depression, whereas those with more complicated symptomology may require longer treatment.

Impulsivity in depressed clients

This study aims to explore impulsivity as a component of aggression in depressed clients. This study used a qualitative method with a phenomenological study approach. There were 11 study participants in this investigation. A thematic analysis was used in analyzing the data. The study produced four themes: (1) uncontrolled anger as the initial expression of impulsivity, (2) anger manifestations through reckless actions, (3) homicidal versus suicidal thoughts during the impulsive phase, and (4) self-efficacy at the end of impulsivity. Impulsivity is the main form of aggression in depressed clients. Nurses need to pay attention to impulsive behaviors in depressed clients, especially by helping clients to build good coping strategies and improve the quality of their social relations so that they can break the chain of the characteristics of impulsivity.

Emotional Needs and Schematic Functioning in Depression: A Narrative Review

"Grounded in cognitive theory, the schema therapy model of psychopathology proposes a set of maladaptive cognitive structures, called early maladaptive schemas, resulting from the invalidation of emotional needs. More recently, the schema therapy model has been adapted for use with depressed clients. However, the utility of addressing emotional needs in the psychotherapeutic treatment of depression has not been established. The present paper aims to provide a narrative review of the current literature on basic needs as motivational factors in depression and their relation to schematic functioning. Theoretical considerations and practical evidence on the use of constructs related to basic motivation in depression are drawn from the literature on the cognitive and schema therapy-based models of depression. The implications for the theoretical understanding of needs are discussed, as are future directions for the research of schematic functioning in depression."

Depressive symptoms among clients attending monk healers and primary care clinics in Thailand: a comparative follow-up study.

The aim of this study was to conduct a comparative follow-up assessment of clients with depressive symptoms attending monk healers or primary care clinics in Thailand. Consecutively attending clients of three monk healing and three primary care centres who screened positive (a score of 9 or more) on the Primary Health Questionnaire (PHQ)-9 at the study site were followed up at 3 months after baseline assessment. In 3 monk healer sites, 448 clients agreed to be screened with the PHQ-9 for depression, and 94 screened positive, and in 3 health centres 582 clients agreed to be screened, and 92 screened positive for depressive symptoms on the PHQ-9. In 2 monk healing sites, 79 clients (84%) were followed up at 3 months, and in 3 health centres, 79 clients (85.9%) were followed up at 3 months. At 3-month follow-up, mixed modelling found significant interaction effects (a time-by-condition interaction, i.e., between-group changes) on depression scores (P = <0.001). Depressive symptoms significantly decreased over time, but there was no significant difference in decline between the two groups. Clients attending monk healers decreased more in depressive scores compared to clients attending primary care centres, though there was no group effect with respect to number of depressed clients.

Inflexibly Enacted Traditional Masculinity Norms (IE-TMNs) and Their Impact on Adolescent and Young Adult Depression: The Hybrid Case Study of "Tommy"

The purpose of this study is to explore and discuss the effects of inflexibly enacted traditional masculinity norms (IE-TMNs) on adolescent and young adult males with depression and how to address such issues in therapy. This study provides a literature review of the subject of IE-TMNs and how such a worldview holds a potentially negative influence and impact on the physical and mental health of boys and young men. Specifically, the study aims to highlight how these beliefs, attributes, and values influence the extent to which these individuals seek help, express emotion, and utilize healthy coping skills when experiencing depressive symptoms and how such behaviors can be addressed in therapy. Treatment considerations are explored through the hybrid case example of "Tommy," a depiction of a depressed college freshman following IE-TMNs while going through a difficult life transition. A fictional case, Tommy serves as a composite character informed by real life psychotherapy cases and clinical examples found in relevant literature. Tommy’s course of treatment depicts potential clinical issues that could come up when working with a depressed male client with strong internalized masculinity norms and how some of these themes can be adequately addressed to create a more flexible masculine identity. Through use of a qualitative, disciplined inquiry approach, I explore therapeutic interventions that could be utilized to meet the unique needs of such a client within the context of historical, contextual, and cultural factors. Tommy’s case material is analyzed qualitatively and quantitatively in accordance with the pragmatic case study research format (Fishman, 2013). The hybrid case of Tommy explores how client-centered therapy, motivational interviewing, harm reduction interventions, and cognitive-behavioral interventions can be integrated to assist adolescent boys and young men with strongly internalized and rigid beliefs about masculinity, while also utilizing Bronfenbrenner’s ecological systems theory to explore the proximal and distal factors in one’s environment that contribute to such a worldview. The hybrid case study of Tommy is designed to serve as a resource for therapists working with clients with IE-TMNs and provides guidance about how to alter unhelpful coping strategies; increase emotional expression and help-seeking behaviors; and explore personal beliefs, goals, and values. This case study concludes with a critical discussion of future directions for research on this topic, as well as the advantages and limitations of the hybrid case study design.

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

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.