Depression is very common in today’s
world. It affects not only the individual who has it, but also the partner and other
members of their family.
The impact of depression varies depending
on the severity of depression. Some couples suffer badly because of one partner’s
major depression. They are either living parallel lives or are living
separately. If they have children the latter are the worst affected. Such couples
get caught in a vicious circle in such a way that untreated depression deteriorates
their relationship and deteriorating relationship aggravates depression and
hopelessness. At some stage it becomes difficult to pinpoint the actual cause
and effect.
Major depression continues to reoccur
and it becomes a life-time challenge, taxing the couple emotionally,
financially and socially.
It has been observed that individual
or partner-involved therapy may not be effective in major depression. Couple therapy,
especially Behaviour Couple Therapy may,
however, prove effective since it takes into account the reciprocity of
relationship distress and depression. It aims to change the relationship to alleviate
depression. BCT is based on the reasoning that thinking, feeling and behaviour
are inter-related and a change in one brings a change in the other two. Since behaviour
is observable and measurable, BCT stresses to change the behaviour. It focuses
on changing the communication, problem-solving skills, cognitive functioning
and intimacy.
BCT assumes that depression
develops when people do not get an appropriate positive reinforcement after
showing the desired behaviour. Various experiments have demonstrated that
performance level decreases when the organism fails to get a certain reward
that it used to get earlier. Depression also develops when people are not able
to avoid aversive stimuli. Experiments have proved that an animal develops
helplessness when his instrumental behaviour fails to terminate an aversive
stimulus.
BCT focuses on changing the
relationship patterns of couples which may have caused helplessness and
hopelessness and so indirectly it treats the depression. BCT also collaborates
with pharmacological treatment if symptoms are severe and there are safety
issues.
The assessment process of BCT is
very intensive. The therapist assesses both; the relationship functioning and
individual functioning. The assessment is rather an intervention in itself as
the therapist tries to create positive feelings and hope in the couple. BCT
applies various techniques to have a clear cut assessment of the severity of
the problem. Therapist interacts with the couple, asks questions, takes history,
and enquires about their future plans. He/she also talks to each partner separately.
In addition therapist uses various self-report questionnaires.
Since BCT acknowledges that all
these techniques have their own limitations to give accurate data as depressed
people have pessimistic view about themselves and others, so it asserts to rely
on the clinical observation of the therapist for the final conclusion. Therapist
actually utilizes negative appraisals in determining the cognitive patterns and
the areas of dissatisfaction of each partner.
In the last part of assessment, the therapist shares the observation and assessment
with the couple, conveys to them the importance of their role in the treatment
process, gives rationale of BCT and set certain rules for the treatment
sessions. Of the two main rules; first is that till the treatment is over they
will postpone any plans for separation and the second is that they will not
keep any secrets from each other.
All techniques of BCT are well
structured. Sometimes giving some psycho-education is also helpful. Positive reinforcement
is given after thorough investigations.
BCT also stresses on communication.
This is very important because depressed people are passive and they avoid
interaction. Partners are also trained to resolve small problems together and
are encouraged to resolve complex issues.
BCT is an optimistic approach. When
it is used in collaboration with medical therapy it can give significant
positive results.
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