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Group, Family and Couples Therapy for Depressive Disorders

Rashmi Nemade, Ph.D., edited by Kathryn Patricelli, MA

As the name suggests, group therapy (including family and couples' therapy) is a form of treatment involving a small group of people.  There are generally between 4 and 12 people who meet regularly to talk, interact, and discuss problems with each other. Therapy groups are typically run by one or more group therapists who keep the group organized and on track. Therapy groups can be very structured with specific goals set for each meeting or flexible where group members discuss whatever is important that week. Groups are often set up to address particular therapy issues. For instance, a therapy group might address men's issues, women's issues, focus on anger management, social anxiety, or chronic illness support. People are typically invited into the group based on the degree to which they fit the profile of an ideal member. This means that they have issues that the group is designed to address or are the right gender, and based on how likely it is that they may be able to contribute to the group.

However, they are structured, most therapy groups have some basic ground rules that are usually discussed during the first session. Individuals are usually asked not to share what goes on in sessions with anyone outside of the group. This rule protects the confidentiality of the other members. It also encourages people to be open and honest in their sharing. Group members may also be encouraged to avoid seeing other members socially outside of therapy because of the harmful effect it might have on the dynamics of the group.

In individual forms of therapy, the emphasis is on the patient-therapist.  In group therapy, this is replaced with an emphasis on patient's relationships with other patients. Group therapists set plans and goals within the therapy setting. However, they are happier when they are able to get out of the way and allow group members to speak to one another directly. People are often more open to feedback that they get from peers than they are to feedback they get from therapists who are often seen as authority figures.

In a group therapy session, members are encouraged to openly and honestly discuss the issues that brought them to therapy. They try to help other group members by offering their own suggestions, thoughts and understanding about problems that are discussed. A well-functioning therapy group offers its members a safe and secure place where they can discuss and work out problems and emotional issues. Participants learn about their thoughts and behavior by listening to peers who are struggling with similar issues. They learn by offering support and feedback to peers. They also learn by accepting the support and feedback from other members.

Group therapy is often a good fit for people who are having interpersonal difficulties, including depression, anger and social anxiety problems. Affected group members usually benefit from the social interactions that are a basic part of the group therapy experience.

Group therapy provides a sense of identity and social acceptance for some people. It can be very comforting to realize that other people with depression have similar symptoms, emotional issues, and life stress. Learning how others cope with depressive symptoms provides new strategies or ideas that people can try in their own lives. Group interactions can also offer people unique looks into their own behavior. It can provide immediate feedback about the success of new skills. For instance, many people are not aware of their negative body language, such as tendency to slump, look down, sit with crossed hands and feet, etc. They also may not be aware of their style of communication. Both negative body language and communication style can be pointed out to them directly in the group. Group members may also offer one another social support by providing words of encouragement and understanding. Lastly, by helping others in the group work through their problems, members can gain a personal sense of self-esteem.

As is the case with individual therapy, group therapies may use different psychological theories. For example, a person with depression may participate in a cognitive behavioral group that uses the meetings as a workshop for teaching cognitive restructuring and similar exercises involved in monitoring and changing thoughts and behavior. Alternatively, a group might be run more dynamically in nature and focus on interpersonal relationships, both at home and within the group itself. Sometimes, group therapy is used as a way to transition people out of individual therapy. Groups can also be a cost effective way to continue therapy after insurance benefits run out because group therapy sessions usually cost substantially less than individual therapy sessions. Group therapy is probably not helpful as the only therapy for people with severe depression unless it happens as part of a larger program. However, research suggests that cognitive behavioral group therapy can be very effective for people with mild to moderate depression.

Family and Couples Therapy

Couples therapy occurs when intimate relationship partners (married or otherwise) enter therapy together. Family therapy occurs when an entire family comes for therapy. Both of these forms of therapy tend to take a family systems approach to therapy. Therapists working from this approach treat the entire unit in front of them (e.g., the entire couple; the entire family) as the patient.  The individual members of these groups are seen as parts of that single patient. Couples and families may start therapy by problems that a single individual within the couple or family is having. However, the family systems therapist will tend to view the identified problem as a problem shared by all system members. In this way of doing therapy, a husband's depression is considered, at least in part, as a symptom of something going wrong with the relationship. It is not simply something going wrong with the husband.

Family therapy and couples therapy sessions dig into the details of the interactions between partners, or family members as a core part of treatment. Both therapies look at the role of the person with depression in the overall psychological well-being of the family (or couple), as well as the role of the family (or couple) in creating depressive symptoms. Both family therapy and couples therapy aim to identify and then change destructive relationship patterns that may be contributing to the system's difficulties. For instance, if a family has been blaming one of its members, and that member has become depressed, the therapist will call attention to this blaming behavior. If one spouse is assist with or enabling the other's abuse of alcohol, and both spouses are depressed, the therapist will call attention to this issue too. Family and couples therapy can also uncover hidden issues and/or teach people new strategies for dealing with emotions and behavior.

Family and couples therapy isn't generally viewed as a good primary means of receiving therapy for people with depression.  However, but it can be an excellent extra therapy strategy because people with depression are both affected by and affect their relationship partners. Family or couples therapy is most useful when a person's depressive symptoms are: 1) seriously jeopardizing his or her marriage and family functioning, and/or 2) clearly being caused (or maintained) by dysfunctional marital and family interaction patterns. Patients with mood disorders have a very high rate of divorce. Many people report that they would not have married their spouse if they knew that he or she would develop a mood disorder. Family and couples therapy, therefore, can be a crucial and effective component of treating depression.

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