Individual Alone

The first option is to treat the individual alone, even if it is clear that family problems exist. This option might be chosen for pragmatic reasons (i.e., family members cannot or will not attend conjoint therapy). For example, even when a college student has conflict with his/her family of origin, that family may not be local and may therefore not be available to participate in therapy. In other cases, case conceptualization may dictate the choice of seeing an individual alone. For example, when a family member is so cognitively impaired (as in the case of Alzheimer's disease) that conjoint therapy would not be productive, a CT therapist may choose to work solely with an individual to manage the problem (although the therapist may choose to bring in other family members as well). In addition, in certain situations, such as in the case of severe family violence, conjoint therapy may be contraindicated (Holtzworth-Munroe et al., 1995).

Individual CT may be used to target depressive symptoms and behaviors that have an impact on the family. Behavioral interventions may focus on increasing the patient's assertiveness and setting limits, decreasing criticism, expression of both positive and negative feelings in a constructive manner, increasing social activities, and completing family-related responsibilities. Cognitive interventions may focus on changing the way an individual interprets his/her family member's behavior, and modifying dysfunctional beliefs about relationships. For example, a depressed individual may have unrealistic expectations, such as "My partner should know what I need without me having to ask" or "Families should never have disagreements" (Uebelacker & Whisman, 2005). Finally, a therapist may want to help individuals weigh the pros and cons of leaving a difficult or dangerous situation, and/or making a plan to do so.

By necessity, individual CT focuses only on changing the thoughts and behaviors of one family member. Therefore, there are limitations on the degree to which it can impact the entire family. If family problems—such as excessive conflict—contributed to the onset of the depression and persist even after the individual is no longer depressed, he/she may be at an elevated risk for relapse. Also, although we do not find it to be the case in general, there are times when positive changes in a patient have adverse effects on the family system. In these situations, a more direct intervention with the entire family may be indicated.

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