PROCESS OF MARITAL THERAPY WITH DEPRESSED PATIENTS

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The Principal Investigator is currently more than half way through the treatment phase of an outcome study comparing the effectiveness of individual cognitive therapy, conjoint behavioral marital therapy, and a wait-list control group in the alleviation of depressive symptomotology in maritally discordant couples. It is anticipated that over 30 couples will receive a trial of behavioral marital therapy. Preliminary results suggest that behavioral marital therapy can be effective in this population. We wish to study intensively the change process for couples receiving this new form of treatment for depression. Three interlocking sets of analyses are proposed: (1) a set of analyses which examine the impact of therapist and spouse behavior on in session patient behavior, (2) a set of analyses which examine the same therapist and spouse behaviors in terms of their impact on symptom remission during the course of therapy, and (3) a set of analyses which examine the relationship of these process variables to final outcome. By examining the process of therapy simultaneously at the micro, intermediate, and macro levels of analysis, we hope to provide a description of therapy process which is both detailed enough to guide clinical activity as well as clinically relevant enough to exert an impact on clinical practice. The current proposal is focussed on the component of therapy which is unique to the couple format, viz: the contribution of the spouse to the therapy process. It has only been very recently that couple format approaches have been introduced in the major treatment modalities for depression. Accordingly, the study of ways to maximize the potential positive impact of the spouse on the therapy process is particularly timely. It is also hoped that the three level approach advanced for the study of therapy process may prove hueristic for clinically relevant process work in other areas.