Setting up Resilient Services for Couple Therapy for Depression

Published in CTFD resources on September 28th 2021

Background:

Tavistock Relationships, (TR), internationally renowned for its couple expertise in training and clinical delivery, was commissioned by NHS England to create and develop the training for Couple Therapy for Depression, (CTfD), as a modality additional to CBT, for delivery within IAPT services nationally. The model seeks to redress the precipitating and maintaining factors in dysfunctional interactions and cognitions between partners as a result of depression. 

The model draws on RCT studies and ‘best practice’ in behavioural, cognitive, emotionally-focussed, systemic and psychodynamic couple therapies. TR also devised the competency framework to assess practitioners in this modality. The training includes IAPT context, including the Stepped-Care Model, use of session-by-session measures and training in use throughout treatment of the IAPT minimum data set.

Success of Couple Therapy for Depression Training:

Creation of this innovative training has resulted in TR successfully delivering both commissioned and non-commissioned training and supervision in Couple Therapy for Depression nationally since 2010. Since 2010, TR has trained, on average, 50 practitioners a year, all from a wide variety of therapeutic backgrounds and original trainings, with 2016/2017 seeing a marked increase to 90-100 + practitioners by end of March 2017. Trainings have been delivered in and to regions in Yorks&Humber, North East of England, North West of England, Bristol, Manchester, Worcester, Leeds (multiple trainings), London (multiple trainings) and Bury St Edmunds.

Feedback from those attending the most recent CTfD training in Leeds, October 2016: Survey Monkey collated 100% said that the training input had ‘improved their awareness of relationship issues’ with 76.19% reporting ‘a great deal’. Trainees fed back on evaluation forms, “Interesting, useful and helpful. Positive and encouraging learning environment. Well presented, engaging and practical. I feel enthusiastic to start training with couples” and “Clearly structured framework, valued the way the course was built up which made the volume of material and pace more manageable. Good balance of theory and practice”.

IAPT recovery rates for Couple Therapy for Depression, as published in the most recent IAPT report, (October 2016), are 61.8 anxiety and 58.8 depression. These are the highest recovery rates within IAPT, measured against CBT and all other non-CBT modalities and are the end result of practitioners receiving a comprehensive and supportive training in this modality with on-going supervisory input.

The current picture:

Despite these outstanding recovery rates, Couple Therapy for Depression delivery within IAPT across the UK is patchy and TR, as the organisation that designed the training and as the leading training providers nationwide, seeks to redress this imbalance and are actively doing so. ‘Thinking couple’ in terms of depression is still a relatively new concept within IAPT. Counsellors and practitioners that undertake the training, also undertake an active ambassadorial role for this couple service, in that they help to educate their referrers and fellow workers in this new way of working within IAPT. (TR has materials and handouts available for these ambassadors to use if required).

Building resiliant services:

As training providers nationwide, we have been privileged to watch Couple Therapy for Depression services prosper and grow, with motivated therapists delivering this model to appropriate couple referrals. PWPs and other referrers need training to understand both the contra-indicators to working with this model and how to speak about the relational element of depression with patients. TR has designed a half-day training for PWPs to address this and suggest that services consider this CPD for their PWP teams, (see attached training outline).

In addition to setting up services, TR is increasingly able to identify best practice in the delivery of Couple Therapy for Depression. As well as training for referrers, we recommend that a minimum of 3 practitioners are trained in delivery of couple therapy in each service or centre, to allow for vital on-going peer support and CPD. In addition, where possible, we suggest that one lead practitioner is identified to then go on to the Couple Therapy for Depression Supervisor training, (training 31st January, 2017, application form and criteria attached), to offer on-going and consistent specialist supervision to the Couple Therapy for Depression team. TR also runs one-day refresher and trouble-shooting courses to trained practitioners where specific aspects of the model are revisited and also provides opportunity for peer networking across IAPT couples practitioners, (Couple Therapy CPD, London, February 6th, 2017).

The IAPT service for couples where one or both is diagnosed with depression

Appropriate referrals for PWPs and other referrers:

• COUPLE COMMITMENT TO THE RELATIONSHIP – couple need to have been together for over 6 months. The commitment may be ambivalent as in a ‘not knowing’ whether they will stay together but if they are actively wanting to separate, this is not a helpful way of working
• CAUSAL OR MAINTAINING FACTOR TO THE DIAGNOSIS OF DEPESSION THAT HAVE A RELATIONAL ELEMENT – where decreasing stress and increasing positive aspects of the relationship will be effective in the treatment of depression
• COUPLE COMMITMENT TO THERAPY – to try and work together as a couple which can feel quite different to individual work
• MILD TO MODERATE DIAGNOSIS OF DEPRESSION – if someone is suicidal or has suicidal ideation, this is not a suitable treatment
• MENTAL ILL-HEATH IN A STABLE CONDITION
• NO VIOLENCE CONTRACT AGREED
• SEEKING HELP FOR OR CEASED SUBSTANCE ABUSE, INCLUDING ALCOHOL, DRUGS, PORN AND GAMBLING ADDICTIONS
• DEPRESSED PATIENT NEEDS PARTNER’S SUPPORT AND ENCOURAGEMENT TO AID RECOVERY – and compliance with medication regime

PWP half-day masterclass on appropriate refferals

DAY INCLUDES:

• Couple Therapy for Depression service and IAPT context, including Choice of Therapy
• Small group discussions on couple dynamic in relation to diagnosis of depression: causal and maintaining factors
• Brief overview of CTfD model: powerpoint presentation
• Identifying suitable referrals and contra-indicators to working with a couple
• Skills in how to ‘think couple’ and how to techniques as to how to ‘ask couple’
• Role-plays in talking about intimate relationships with depressed patient/s
• Illustrative filmed vignettes of couples in distress, suffering from depression
• Opportunity to discuss relevant current cases