Golant and Golant (2007) gave an example of an 8-year-old boy's externalizing behavior after his parents went through a separation and his father's departed:
As the self-proclaimed new "man of the family," he began acting out as if he were an irate parent, bossing around his little brother, yelling at him and hitting him. He seemed to regress emotionally. & #8230;When his mother & #8230; tried to comfort him, he would push her away. But at other times he became clingy and whiny. (pp. 107-108)
How married couples can work to decrease depression and anxiety
Based on a review of the research literature, Mead (2002) observed that the first order of business is to insure that the depressed partner is maintaining an appropriate level of antidepressant medication. When that is accomplished, the couple can benefit from marital therapy that takes the depression into account. Mead suggested the following as elements to be focused on in such therapy: (a) Educating the couple about the nature of marital distress and depression, (b) increasing exchanges of positive behaviors, (c) building acceptance of each other's differences, (d) reducing the exchange of blaming, coercion, and aversive stimuli, especially aversive stimuli aimed at changing each other's behavior, (e) increasing problem-solving and communication skills, (f) reducing negative thinking about self, partner, and the world beyond, and (g) planning for the probable recurrences of marital problems and depressive episodes. An additional element, suggested by the findings of Jeglic et al. (2005), is the nondepressed or nonanxious spouse taking measures independently of marital therapy to avoid burnout. Golant and Golant (2007) suggested that these measures include getting social support (participating in community and/or self-help groups), maintaining friendships instead of isolating with spouse, keeping a journal that helps identify triggers of stress, preserving routines to maintain stability, continue hobbies, and taking time out for self-renewal.
It appears that psychotherapy involving a depressed individual has become more and more attuned to social context. This review revealed a trend, over the last thirty years, from individual to spousal to family therapy -- the last when there are children in the mix.
Although Keitner's (2005) primary focus was on treating the depressed individual, he used family therapy as a means to that end. Keitner noted that one of the family's most difficult tasks is to find a midpoint between pushing the depressed parent beyond his or her capability and accepting the negative outlook and self-doubt of that parent. He concluded that effective therapy helps the family be mindful of the depressed parent's limited energy, motivation and ability to concentrate while at the same time helping to determine and carry out the actions that the person with depression can take for self-support -- reconceptualizing their illness and making small changes that can help to minimize feelings of hopelessness and helplessness.
Keitner (2005) reported a study that randomly assigned severely depressed patients to one of four conditions: (a) antidepressant medication alone; (b) combined antidepressant medication and individual therapy; (c) combined antidepressant medication and family therapy; or (d) combined antidepressant medication, individual therapy and family therapy. According to Keitner, the family therapy was based on: an emphasis on "macro" stages of treatment (assessment, contracting, treatment, closure) instead of the idiosyncratic "micro" moves of each therapist (e.g. directive vs. nondirective speech); inclusion of the entire family; active collaboration and open, direct communication between therapist and family members; focus on behavioral change and the family's responsibility for change; and emphasis on current problems rather than past grievances. Compared to no family therapy treatment, the addition of family treatment to antidepressant medication and/or individual therapy led to greater proportions of patients who improved and to significant reductions in interviewer-rated depression and thoughts of suicide.
The above discussion of marital and family therapy concerns depression and not anxiety in one of the partners. Dehle and. Weiss (2002) noted the lack of research on the role of anxiety on intimate relationships. Their study examined state anxiety and marital adjustment in a sample of 45 couples. They found that husbands' anxiety at Time 1 predicted their own and their wives Time 2 reports of marital adjustment. (There was no treatment between Time 1 and time 2.) However, wives' anxiety at Time 1 did not predict their own or their husbands' Time 2 reports of marital adjustment." Marital and family therapy, which can be effective when one spouse is depressed, might be as effective for couples with an anxious husband. However, this writer did not find empirical support for such a proposition. Perhaps here is one of the many places where we say as psychologists, "Further research is needed."
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, (4th ed.). Washington DC: Author.
Brampton, S. (2008). Shoot the damn dog: A memoir of depression. New York: Norton.
Dehle, C. & Weiss, R. (2002). Associations between anxiety and marital adjustment. The Journal of Psychology 328(11). Expanded Academic ASAP. Retrieved April 14, 2010
Fendukian, L & Wilson, J. (Eds.). (2008). Gale encyclopedia of mental health (2nd ed., Vol. 1).
Golant, M & Golant, S. (2007). What to do when someone you love is depressed. New York:
Heene, E., Buysse, A,. & VanOost, P. (2007). An interpersonal perspective on depression: The role of marital adjustment, conflict communication, attributions, and attachment within a clinical sample. Family Process, 46(4), 499-514.
Holden, C. (2003). Getting the short end of the allele. Science, 291+ ExpandedAcademic ASAP.
Retrieved April 11, 2010.
Jeglic, E., Griffith, J., Pepper, C., Miler, A, et al. (2005) A caregiving model of coping with a partner's depression. Family Relations, 54(1). 37-45.
Jekielek, S. (1998). Parental conflict, marital disruption and children's emotional well-being.
Social Forces, 905(31).
Keitner, G. (2005, October). Family therapy in the treatment of depression. Psychiatric Times,
Kouros, C, Merrilees, C. & Cummings, E. (2008) Marital conflict and children's emotional security in the context of parental depression. Journal of Marriage and Family, 70(3),
Kung, W.W. (2000). The intertwined relationship between depression and marital distress:
Elements of marital therapy conducive to effective treatment outcome. Journal of Marital
and Family Therapy, 26(1),51-63.
Mead, D. (2002). Marital distress, co-occurring depression, and marital therapy: A review.
Journal of Marital and Family Therapy, 28(3), 299-314.
Meadows, S., McLanahan, S., & Brooks-Gunn, J. Parental…