Conclusions

A large amount of evidence suggests that major depression and family functioning are closely linked. Major depression is associated with poorer family functioning in cross-sectional studies; family problems predict onset and course of illness in depression; and depression is linked to subsequent poorer family functioning. In this chapter, we have demonstrated that it is both feasible and useful to formulate an integrative case conceptualization and to include family members in the cognitive-behavioral treatment of depression. We have presented a series of increasingly intensive family interventions that a CT therapist may use, including (1) treating an individual alone, (2) including family members in a few sessions for the purpose of assessment, (3) providing psychoeducation to family members, (4) brief problem solving with family members, (5) including a family member as a therapy "coach," and (6) conducting full-scale family therapy in addition to (or in lieu of) individual therapy. The limited research that is available suggests that including family members in treatment in some way may improve likelihood of success. We hope that this chapter spurs increased interest among both clinicians and researchers in understanding and treating cognitive, behavioral, and interpersonal aspects of depression.

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