Systemic couple therapy and depression
Northey, William F Jr
Jones, E., & Asen, E. (2000). Systemic couple therapy and depression. New York: Karnac Books, 132 pp.
As the primary therapists for the London Depression Intervention Trial (LDT), a project that compared the effectiveness of antidepressants, individual cognitive-behavioral therapy (CBT), and systemic couple therapy (SCT), Elsa Jones and Eia Asen needed to describe and document what they did as couple therapists. This book represents the work before, during and after the LDIT and is divided into three sections reflecting the different stages of the project. The first chapter describes the LDIT and the results. Systemic couple therapy was found to be significantly more effective, had significantly fewer dropouts and had a more positive impact on the clients’ lives than the other two treatments. These findings are similar to studies in the U.S. where psychotherapy has been found to be as effective in the short term, and more effective in the long term than antidepressants. Because of the strict inclusion criteria, the authors acknowledge that couples who participated in treatment might not be representative of couples in most clinical practices; however, given that the manual was developed to describe what these experienced therapists already did in their clinical practice, the applicability to other settings is strengthened.
There is a common misperception that most treatment manuals are developed by researchers and then “given” to therapists to “do.” Although this does happen occasionally, the more common process for developing a treatment manual is for experienced therapists to attempt to explicate what they do in their clinical practices. The authors are self-described “post-Milan” therapists, with Jones leaning more towards social constructionism and feminism, whereas Asen is more aligned with structural and strategic models. The manual, originally written to satisfy the grantors of the LDT, is an excellent description of what is done in “systemic couples therapy” regardless of the theoretical orientation of a particular therapist.
The second part of the book is a description of the model used in the LDT. And rather than being a prescriptive set of procedures, the model represents well the art of the psychotherapy process. After describing the three phases of the therapy process, the authors go on to describe the “technical aspects” of their model. Given their theoretical leanings, their protocols will be familiar to most family therapists. They do, however, preface their discussion of these technical aspects with the following: “Each therapist is likely to use most of these techniques during the course of therapy with each couple, though individual differences between the therapists are likely to result in certain techniques being used more than others.” (p. 22). Again, given that the development of the manual was a collaborative effort of these two experienced, practicing clinicians, capturing what is done that makes SCT unique, while not limiting the skill and judgment of the therapist, was crucial. Some of the techniques depicted are: Hypothesizing, joining and engaging, circular interviewing, enactment, focusing on strengths, problem solving, life-space techniques (e.g., genograms, family circles), refraining and homework.
In the final section of the book the authors offer their unique perspectives on the therapy process. Jones and Asen’s differing philosophical perspectives on couple therapy and depression made for some very interesting reading. For example, issues of gender, poverty, racism, and abuse are addressed throughout the book and the authors are quite cognizant that being white psychotherapists, in a randomized clinical trial, in a medical setting, carries with it certain meanings, attributions, and expectations. Throughout the case examples, the interplay between culture, race, and SES is overtly addressed. Like many practicing marriage and family therapists, Jones and Asen struggle with their role in expanding the meaning of depression for the couples’ with whom they work to include other contextual variables (e.g., gender, race, poverty). “Participation in this project has affirmed our perception of the complex interweaving of contexts-social, political, economic, cultural, gender, class, individual, interactions-that shape the experience labeled as `depression”‘ (p. 121).
William F Northey, Jr., PhD
American Association for Marriage and Family Therapy
Copyright American Association for Marriage and Family Therapy Apr 2002
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