Family Therapy Combined with Individual Therapy

Jacobson, Dobson, Fruzetti, Schmaling, and Salusky (1991) compared behavioral couple therapy, CT, or their combination in depressed (but not necessarily maritally distressed) women. In terms of depression outcomes, they found that the combined treatment performed as well as CT in both maritally distressed and nondistressed women, and that CT was superior to behavioral couple therapy in nondistressed couples. In terms of marital outcomes, there were no significant differences between groups. This was surprising: Jacobson et al. had hypothesized that the combined treatment would be superior to either treatment alone. They have suggested that the reason for the lack of findings was that couples in the combined treatment received suboptimal doses of both behavioral couple therapy and CT (Addis & Jacobson, 1991). Another possibility is that the treatment approach and rationale for the two modalities needed to be more truly integrated.

Finally, Miller et al. (2005) examined the impact of combined treatments on patients with severe major depression. Each patient was randomly assigned to one of four treatment arms: pharmacotherapy alone, pharmaco-therapy + CT, pharmacotherapy + family therapy, or pharmacotherapy + CT + family therapy. Depending on their level of cognitive distortions and family dysfunction at baseline, patients were classified as either "matched" or "mismatched" to their particular treatment. For example, assigning a patient with a high level of cognitive distortion but a low level of family dysfunction to pharmacotherapy + family therapy would be considered a "mismatch." These authors reported two findings relevant to the current topic. First, patients who were "matched" to treatment did somewhat better than those who were mismatched. Second, patients in one of the two conditions that included family therapy showed more improvement than those who did not receive family therapy. Although its complicated design tempers conclusive statements about family therapy, this study does provide some evidence that the addition of family therapy to other, individual treatments may improve outcomes in severely depressed individuals. This may be particularly true when they show evidence of family problems.

In summary, the small amount of research on the integration of family interventions with individual CT for depression is promising but not conclusive. However, the basic research documenting a strong association between family functioning and major depression is very compelling. Therefore, we continue to believe that it makes sense theoretically to address family problems directly in conjunction with CT.

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