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Clinical Atlas Prestige · Evidence-first

Psych MEQs / SAQsPsychotherapy

Psych MEQs / SAQs · Psychotherapy

MEQ: Couples therapy for depression with marital discord and safety rules

FRANZCP-style MEQ on couples therapy definition, models, depression and SUD evidence, IPV/safety, and combined care.

20 marks20 min
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar in an outpatient clinic. A 42-year-old accountant with recurrent major depression (PHQ-9 = 17) presents with their partner of 11 years. Arguments about money and intimacy have escalated for 2 years; they sleep in separate rooms. The patient drinks 4–5 standard drinks most evenings ‘to cope with the rows.’ No mania history; no psychosis. They take escitalopram 10 mg daily for 5 weeks with partial effect. Both ask for ‘couples counselling.’ In private, the partner denies fear of physical violence but describes occasional coercive control (checking the patient’s phone). (i) Define couples therapy and name three major evidence-based models; which dual targets apply here (5). (ii) Outline assessment priorities including IPV and substance use (5). (iii) Discuss evidence for couple therapy in depression and for behavioural couples approaches when alcohol is involved (5). (iv) Propose a treatment plan including combined care, model choice, and when conjoint work would be unsafe (5). (20 marks)

Model answer

Reveal model answer

(i) Definition, models, dual targets (5). Couples therapy is structured dual-client psychological treatment of a dyad aiming to reduce relationship distress and/or improve individual psychiatric outcomes via joint sessions targeting interaction patterns, communication, emotional bonds, and partner-supported recovery.[1] Name any three of: TBCT/BMT, IBCT, CBCT, EFT, insight-oriented marital therapy, or disorder-specific packages (depression-focused couple therapy; BCT for SUD).[1][5] Dual targets here: major depression and chronic marital discord, with alcohol as a third maintaining factor linked to conflict.[3][6]

(ii) Assessment priorities (5). Confirm MDD diagnosis and severity; suicide/violence risk; bipolar screen; private IPV/coercive control interview with each partner (phone-checking is a red flag for control even if physical violence denied); map alcohol pattern, dependence features, and partner accommodation; relationship history/strengths/conflict topography; goals and separation ambivalence; secrets policy; baseline measures (PHQ-9, AUDIT, DAS/CSI); cultural context.[6][1]

(iii) Evidence (5). Meta-analysis and Cochrane synthesis support couple therapy for adult depression with effects on depressive symptoms comparable to individual psychotherapy and added benefit for relationship distress when that domain is targeted.[2][3] Behavioural couples therapy for alcohol/drug use disorders shows better substance-related and relationship outcomes than individual-based treatment alone in meta-analysis.[4] Population data link marital distress with mood and substance disorders — not “just couples counselling.”[6]

(iv) Plan and safety (5). Optimise antidepressant (escitalopram 10 mg at 5 weeks is early; plan dose review per usual practice) plus structured couple work if both consent and safety allows; consider IBCT/TBCT for chronic polarisation or BCT elements for alcohol recovery contracts; brief alcohol intervention; mid-course measures; parallel individual sessions if needed.[2][5][4] Unsafe conjoint work if escalating coercive control/violence, fear of retaliation, acute high suicide risk needing containment, mania, severe intoxication, or one partner refuses dual-client frame — then individual safety pathways and SUD/depression care first.[1]

References

  1. [1]Baucom DH, Shoham V, Mueser KT, Daiuto AD, Stickle TR Empirically supported couple and family interventions for marital distress and adult mental health problems J Consult Clin Psychol, 1998.PMID 9489262
  2. [2]Barbato A, D'Avanzo B, Parabiaghi A Couple therapy for depression Cochrane Database Syst Rev, 2018.PMID 29882960
  3. [3]Barbato A, D'Avanzo B Efficacy of couple therapy as a treatment for depression: a meta-analysis Psychiatr Q, 2008.PMID 18259866
  4. [4]Powers MB, Vedel E, Emmelkamp PM Behavioral couples therapy (BCT) for alcohol and drug use disorders: a meta-analysis Clin Psychol Rev, 2008.PMID 18374464
  5. [5]Christensen A, Atkins DC, Berns S, et al. Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples J Consult Clin Psychol, 2004.PMID 15065953
  6. [6]Whisman MA Marital distress and DSM-IV psychiatric disorders in a population-based national survey J Abnorm Psychol, 2007.PMID 17696721