Lisa A Uebelacker Marjorie E Weishaar Ivan W Miller

Depression and family problems frequently co-occur. In this chapter, we describe an integrated approach that a cognitive therapist may use to conceptualize and manage depression and family problems in adults and older adolescents. Although we do not describe how to conduct full-scale family therapy per se, we do focus on (1) how to conceptualize depression from an integrated cognitive and interpersonal viewpoint; and (2) a menu of interventions that are consistent with cognitive therapy and include the family. These interventions, which range from a one-session family meeting to concurrent family and individual therapy, allow the clinician to develop an integrative case conceptualization and then act on it.

Given the heterogeneity of family structures in the United States today, it is critical not to adhere to a rigid definition of family. Family can include, but is not limited to, partners, parents, children, stepchildren, extended family, neighbors, godparents, ex-partners with joint care for children, or roommates. A broad definition of family may be particularly important when working with certain ethnic or racial groups. For example, when asked to describe their family, some African Americans include "Active kin," or people who are not related by blood or by marriage, but are considered to be part of the family (Chatters, Taylor, & Jayakody, 1994). Therefore, when working with a depressed patient, we remain open to including a wide variety of people in the conceptualization and treatment of depression and family problems. Although much family work is with spouses or partners, this is only one subset of the many possibilities. For those therapists who are accustomed to working with partners, it is worth noting that many of the principles that apply to working with partners apply to working with the family as a whole.

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