Couples therapy — structured clinical viva

Markers want dual-client definition, private IPV screening as a non-negotiable, fair comparison of TBCT/IBCT/EFT without brand warfare, evidence stacked for distress and disorder-specific packages, and explicit combined care (sertraline continues) rather than anti-medication ideology.[1][2][4]

Structured psychological treatment of a dyad aiming to reduce relationship distress and/or improve individual psychiatric outcomes through joint sessions; dual-client frame; not mediation or one-sided individual therapy with a silent partner.[1]

Negative reciprocity and low positive exchange (behavioural frame); polarisation/mutual trap (IBCT); secondary reactive emotions masking attachment fears in a pursue–withdraw cycle (EFT). Depression further reduces intimacy and problem-solving — bidirectional maintenance.[2][7][1]

TBCT: behaviour exchange, communication training, problem-solving. IBCT: acceptance strategies (empathic joining, unified detachment) plus selective change. EFT: de-escalate negative cycle, restructure attachment interactions, consolidate bond. All can help; choice by formulation, preference, and therapist competence.[2][7][1]

Overall MFT efficacy syntheses (Shadish).[8] Christensen TBCT vs IBCT RCT and five-year follow-up — both produce large gains; early IBCT edge then convergence; separation still occurs in a substantial minority.[2][3] Cochrane/meta-analytic couple therapy for depression — depressive symptoms improve comparably to individual therapy with relationship benefits.[4] Powers BCT meta-analysis for SUD if alcohol asked.[5] Monson CBCT PTSD RCT if trauma asked.[6] EFT research review for attachment model.[7]

Continue sertraline; optimise if partial response; couple therapy is not a reason to stop antidepressants unsupervised.[4] Private IPV screens already negative — still reassess if control tactics emerge; stop standard conjoint problem-solving if violence becomes active.[1]

Both are clients; the pattern between them is the focus; we will practise safer talking and problem-solving while treating depression with tablets and, if needed, individual sessions; approximate course and measures; check understanding and safety.[1][4]