Family Member as Coach

A fifth option is to include a family member as a "coach" (Emanuels-Zuurveen & Emmelkamp, 1997). In this case, therapy remains focused primarily on the depressed person and not on family problems. Therapists employ standard CT strategies to help the patient manage depression. The coach's role is to attend sessions to provide emotional support to the patient and to serve as a bridge between therapy sessions and the rest of the patient's life. Because the coach is aware of skills that the patient is learning in therapy, he/she will be able to prompt the patient to use them at home. Specific tasks in which a coach may participate include assisting with the choice of activities for behavioral activation, providing support for behavioral activation at home, helping the patient to identify and challenge dysfunctional thoughts at home, or learning other skills (e.g., problem solving) to support the patient in implementing them at home.

It may be particularly helpful for a family member to be engaged as a coach at the early stages of treatment, when depression may interfere with the patient's ability to concentrate, remember, and get mobilized. It is also useful to have a coach if the patient is very avoidant; the coach can remind the patient that his/her worst fears can be confronted or responded to, that earlier predictions of failure or criticism did not pan out, and so forth. In all cases, the patient should want the coach to attend, and the coach should not encourage dependence or be too intrusive.

There are several caveats relative to the use of a partner or family member as a coach. First, it is important that the relationship between the identified patient and the coach be reasonably supportive. If not, the coach may prove to be overly critical, or the patient may not be receptive to his/her comments. In the worst case, the problems between the coach and the patient may interfere with the explicit focus on the patient and his/her problems. Second, the patient must agree that he or she wants to have a family member as a coach. In relationships in which power struggles are frequent, having one person in the role of a coach and the other as a patient may prove to be too great a power imbalance. Third, it is important that the partner or family member not feel overwhelmed by or resentful about the responsibilities of being a coach.

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