Treating Depression Within a Couple

Treating Depression Within a Couple: Q&A with Lisa Gordon, Ph.D. 

DEPRESSION 

• Can you share ways to talk about depression with each other so one is not defensive, feeling labeled? I like the language that someone has depression, rather than someone is depressed, which highlights that depression is an illness and not a weakness, like you have the flu not you are the flu.  I also like to normalize our human vulnerability to something breaking when there is a preponderance of stress.  For some people, something breaking manifests as depressed mood, and for some people, something breaking manifests as obesity, high blood pressure, a back going out, etc.   

• Is my depression about me or am I depressed because I’m with the wrong partner? How can I separate the two?  This is understandable that this is hard to separate because the two are closely linked.  You can start in either place, treating the depression or treating the relationship distress.  If, for instance, you seek individual therapy and medication management for depression and symptoms are well-managed, but the relationship distress persists, I think you need to look at the potential independent role of relationship distress.  And vice versa.   

• What advice do you give a spouse who is living with someone dealing with depression as far as being supportive, but protecting your own mental health? It can be hard to keep a positive attitude when your loved one is often negative and angry. Tolerating a loved one’s negative mood or irritability is an act of love, and we cannot continue to give this act of love if we do not replenish ourselves.  Ensure you have adequate sleep, nutrition, and exercise, and balance concentrated bursts of empathy and acceptance with self-care.   

• My partner’s depression makes it really difficult to form and maintain deep relationships inside and outside of our relationship, which is extremely isolating for me. I want to be supportive, but I also don’t want my happiness to be held hostage by my partner’s depression. How can I be supportive, but take care of myself too?  Taking care of yourself is essential to maintaining your role as loving partner to anyone, and especially to someone with depression.  We use the acronym SEEDS to remember basic human needs that need to be met if we are to rise to any additional challenges.  S = SLEEP. E = Eating, E = Exercise, D = Doctor’s Orders, e.g., medications, appointments, S = Sobriety for some and Social Support for others.  I think it’s interesting that sleep, exercise, and social support are characterized the same way as oral medication and food.  

• My husband suffers from depression, which substantially impacts his ability to establish a secure attachment with our young daughter. He gets upset and withdraws when she shows a preference for me, further impacting their bond and connection. Instead of self-reflecting, he blames her (she's 4). Any advice from me is taken as criticism. How do I help? Notice what he does well, notice what about him your daughter is responsive to, and guide them to those activities.  Empathize with his feelings of inadequacy or rejection – those feelings always hurt no matter the circumstances.  Less energetic activities for shorter periods of time may feel better for both of them, and reinforce your husband for his efforts and successes.   

• How to address issues of intimacy in a couple relationship as that may be affecting the partner?  Describe your experience from the perspective of “I,” e.g., I miss you, I miss this part of our relationship, I worry that I’m not attractive to you anymore.  Often there is the assumption that these statements will feel critical, yet having no reaction to lost intimacy may send the message “Sex with you wasn’t that important anyway.”  “I don’t care that we’re not intimate anymore.” 

• Why am I not enough? Why can’t my partner see all the good in their life?  They can’t see the positive in their life because the negative thoughts and bias toward negative information are symptoms of depression.  They can’t see the positive because the symptoms of depression blind them to the positive, not because the positive (truly spectacular!) isn’t positive enough.   

• How do you balance the understanding that these are symptoms with the need for respect and accountability? What about abuse dynamics?  Use your gut as a guide.  If you feel compassionate and generous when tolerating symptoms of depression, then you are giving the right amount to your partner and yourself.  If you feel resentful, used, and small, then you are likely giving too much and receiving too little.   

• In the long run, what has worse implications on my children, going through divorce or dealing with truly unhappy parents?  I don’t know that these are mutually exclusive, i.e., people can be married and manage depression well and people can be divorced and have depression.  We shield our children as best as possible from all threats, whether they come from within our home or outside our home, when parents are married or divorced.   

TREAMENT 

• How would someone introduce the idea of couples counseling if their partner with depression does not want to go to therapy? Likely a person with depression will not want to go to therapy, as this is a cardinal symptom of depression, a loss of want.  I would probably ask if my partner were willing to attend one session of therapy with me because I need support and knowledge to move through this stage of life.   

• What if someone is not willing to accept they are suffering from depression?  If they are willing to seek remedy, I probably wouldn’t worry too much about the label.  Can you both agree that there is distress, e.g., symptoms, diminished functioning, physical ailments, that could benefit from attention? 

• How does treating depression within a couple differ from treating individual depression?  The goals for treating depression, both within individual and couple’s therapy, will be to increase activity, increase social support, change cognitions, and regulate emotion.   Compared to individual therapy, the focus of couple’s therapy will be on achieving these goals as a team and working on behaviors and thoughts within the context of the relationship.   

• What frameworks and techniques have you found to be helpful in treating depression in general and of those what can you pass on to the spouse of the "depressed" partner? I work within a CBT model for both couples and individuals, which means that I focus on changing behaviors and thoughts in an effort to shift emotions/mood. 

• Any suggestions on how to include young children in treatment?  I don’t know that I would include young children in treatment, beyond telling them some version of the truth, e.g., “Mommy and Daddy have a meeting to get some help with a problem they’re having.” 

• How might a couple talk with their kid(s) about depression in a united way?  Mommy/Daddy has been feeling sad (or other symptoms), and what we have come to understand is that they have an illness called depression.  And just like with other illnesses, like strep throat, there is treatment for it.  Mommy and Daddy are meeting with the doctor and doing what they tell us so that Mommy/Daddy feels better soon.  Do you have any questions?