Family Therapy and Chronic Depression

Family Therapy and Chronic Depression

Most patients with chronic depression report significant problems with many familial relationships, and yet there is virtually no empirical evidence concerning the efficacy of family treatment for these individuals. Though reports of reduced family functionality are high for those with chronic depression, few studies have directly addressed this issue. One study found that pharmacological treatments were effective at combating individual depression, but that the same improvements were not noted in family functioning.

This suggests that treatment of the family might be key in truly relieving depression and improving family functionality. One such method of treatment is the Problem-Centered Systems Therapy of the Family, which was developed from the McMaster Model of Family Functioning. This model measures functionality along six dimensions: problem solving, communications, affective responsiveness, affective involvement, roles, and behavior control. Each of these dimensions can be assessed both internally and externally.

As the short-term goal-oriented treatment branch of the McMaster Model of Family Functioning, the Problem-Centered Systems Therapy of the Family has four major stages: assessment, contracting, treatment, and closure. In this way, the problems in the family can be identified and assessed, and a "contract" made that delineates mutual expectations, goals, and behavioral changes. The treatment stage is meant to assist family members in acquiring the necessary knowledge and skills to make the changes contracted for, and closure involves a review f the process and long-term goals and adjustments.

In one particular study, a grown daughter was experiencing sever depression and had been recently hospitalized due to suicidality. Her parents began attending family therapy with her, with the main concern being to alleviate their daughter's depression. They also noted her lack of ability to hold down a job and achieve financial independence, and a series of boyfriends that they felt were not good for her. Finally, there were financial stresses due to the two-year separation of the parents, though they were now reunited.

The family was assessed as having problem solving difficulties, where disagreements were expected to settle themselves over time. Communication in the family was difficult when emotions became involved, though family roles were fairly well established and agreed upon. Affective responsiveness assessment revealed an over-abundance of emergency reactions and a lack of welfare response. Involvement techniques also needed addressing, so that support would be clear without being intrusive, but there were no major behavioral issues reported by the family that caused problems.

Other problems existed in the family's transactional problem, which involved the father becoming too intrusive and aggressive in his attempts to help and reach out to his daughter while the mother withdrew and the daughter felt increasingly more helpless. The mother, too, would end up feeling powerless, and the entire family became sadder as the situation remained unchanged, the therapist shared his assessment with the family, beginning with their strengths, and the identified issues were quickly agreed upon by the family members.

The contracting stage began in the second session, and though the parents initially insisted that they were only their to help their daughter through her depression, which they believed would solve many of the emotional stress issues in the family, they acknowledged that there were other problems in the family that needed attention. They agreed to use more supportive language to encourage each other, and to respect boundaries. This would allow the daughter to more effectively control her own personal development on the one hand, and allow the parents to take an emotional step back from her situation on the other.