Telecare as Institutional Interaction: Checking up on the Client and Creating Continuity

This article studies the functions of telecare-mediated discussions in mental health floating support services. Home Screen, the telecare studied, is a touchscreen computer software that enables real-time audiovisual contact between users. The results indicate that Home Screen functions as a medium to discuss and check clients’ current situation and to sum up and plan their goals. The functions of Home Screen are not stable, but instead they are produced and negotiated in the interaction. Portraying Home Screen as a transitional device, this article supports the view that telecare enables clients to remain in their homes while receiving the care needed.     

Into the Wilderness—A Case Study: The Psychodynamics of Adolescent Depression and the Need for a Holistic Intervention

Adolescent depression has become epidemic in the United States, with statistics showing that one in five adolescents may suffer from depression (Brent and Birmaher in N Engl J Med 347(9), 2002). This article examines adolescent depression from a psychodynamic perspective, and identifies the psychodynamics of adolescent depression as the affective correlates that stem from unresolved developmental conflicts, issues of separation/individuation, the search for identity and the development of the true self. This article presents wilderness therapy as a holistic intervention which can be used to address the intrapsychic, developmental and relational factors that give rise to adolescent depression. Wilderness therapy is a modality of mental health treatment that takes place outdoors and utilizes challenge and adventure, group work and other structured clinical interventions. A clinical case study presents wilderness therapy as an effective intervention for adolescent depression that can promote positive self-image and enhanced coping skills, and discusses limitations and implications for social work practice.     

Elderly People's Perceptions of a Telehealthcare System: Relative Advantage,Compatibility, Complexity and Observability

The use of telehealthcare systems to promote independent living for elderly people is growing. The results presented in this article, derived from an initial user lab test of a telecare system—GiraffPlus—indicate that the crucial factor for adoption of telehealthcare systems is not usability but the system's ability to support autonomy in everyday life. Eleven users tested the usability and reported what they perceived as possible benefits of having such a system at home. To support autonomy, customization is crucial for the system to be perceived as meaningful for the individual. Our analysis confirms previous research.     

Narrative Therapy,Eating Disorders and Groups: Enhancing Outcomes in Rural NSW

Abstract

The present paper reports on a study conducted with seven women who identified themselves as experiencing depression as well as an eating disorder and who live in a rural region of northern New South Wales. Self-referred, the women participated in a weekly group for 10 weeks, with a mixture of topics, conducted within a narrative therapy framework. A comparison of pre- and post-group tests demonstrated a reduction in depression scores and eating disorder risk. All women reported a change in daily practices, together with less self-criticism. These findings were supported by a post-group evaluation survey that revealed that externalisation of, and disengagement from, the eating disorder strongly assisted the women to make changes in their daily practices. Although preliminary and short term, the outcomes of the present study indicate that group work conducted within a narrative therapy framework may result in positive changes for women entangled with depression and an eating disorder.     

The Use of Computerized Self-Help Packages to Treat Adolescent Depression and Anxiety

Despite the efficacy of cognitive-behavioral therapy (CBT) in treating adolescent anxiety, few sufferers seek treatment. Barriers to accessing psychologists include a shortage of skilled therapists, long waiting lists, and affordability. The Internet is a medium possibly able to address issues of accessibility and affordability. This study aimed to assess the efficacy of online therapy in the treatment and prevention of adolescent anxiety and depression. Participants (N = 38) were randomly allocated to one of four conditions: online CBT, face-to-face CBT, combined face-to-face/online CBT, and control. Combined face-to-face/online CBT is more effective in treating symptoms of depression and anxiety compared to stand-alone online or face-to-face therapy. The present study suggests that for those who are unable to access face-to-face therapy, computerized therapy may be a viable option. This is an important finding, especially in light of current capacity to treat and accessibility problems faced in the treatment of adolescent depression and anxiety.     

Comparing the effectiveness of individual and group therapy for students with symptoms of anxiety and depression: A randomized pilot study

Abstract

Objective: To examine the effectiveness of individual versus group therapy for anxiety and depression among university students. Participants: Forty-one university students experiencing moderate to severe symptoms of anxiety and/or depression participated during one of three academic semesters from 2015 to 2016. Methods: Participants were randomly assigned to either 6-weeks of individual or group therapy and completed outcome measures at pre-and-post-treatment. Results: Significant reductions in both depression and anxiety scores were found across time, with no significant difference between group and individual therapy outcomes. Exploratory analysis of attitudes toward therapy found that while individual therapy was rated more favorably than group therapy overall, attitudes toward therapy became more favorable from pre to post-treatment for all participants. An interaction showed differences in attitudes toward individual and group therapy according to participants’ randomly assigned treatment. Conclusions: These findings support the increased usage of group therapy within university counseling centers, with implications for stepped care discussed.     

Costs of Treating Depression With Individual Versus Family Therapy

Depression is one of the most common concerns that bring clients to treatment. Although marriage and family therapy has been shown to be an effective treatment, little research exists regarding the cost‐effectiveness of related services. In this study, we examined claims data for 164,667 individuals diagnosed with depression to determine (a) differences in the cost of treating depression according to type of therapy and license type, (b) differences in recidivism rates by age, gender, type of therapy, and type of mental health professional, and (c) differences in cost‐effectiveness by therapy modality and type of professional. The results showed that services provided by marriage and family therapists resulted in the lowest recidivism rate, and family therapy services were the least expensive.     

DEPRESSION IN MATURE MARRIAGES: IMPACT AND IMPLICATIONS FOR MARITAL THERAPY

Recent reviews of MFT literature have shown a failure to address mental health issues of the aging. Chief among these issues is depression, one of the most common psychological disorders found in older people. Although the relationship between depression and aging is a well-researched topic, few studies approach this common problem from a systemic perspective. Using data from a national survey of preretirement- and retirement-aged couples, this paper discusses the association between depression and marital quality in mature marriages as well the possibility of mediating variables such as the personality construct hardiness. Implications for marital therapy with older couples experiencing depression and future research are discussed.     

Depression,the Family,and Family Therapy

The potential contribution of family therapists to the treatment of depression remains underdeveloped. Family therapists need to articulate how changes in family functioning might benefit depressed persons, as well as how other problems in the families of depressed persons tend to go unrecognised. Furthermore, family therapists need to be alert to how undetected depression in adults and children may interfere with their ability to meet their goals with families who seek therapy for other persons. This article provides family therapists with (1) an overview of the nature and experience of depression; (2) an introduction to antidepressant medication; (3) a summary of research findings relating depression to its family context and (4) a brief overview of developments in the marital and family treatment of depression.     

The Children's Depression Scale in Family Therapy: Hearing the Hurt

In this article I review the changes in thinking about childhood depression since the 1950s, with an emphasis on the struggles to find language for childhood depression. My interface with these changes is described, with a particular focus on the development of the Children's Depression Scale (CDS). Clinical applications of family therapy using the CDS in treatment of childhood depression are then illustrated with a composite case example. The idea is developed that depression in children can be seen as a blocked communication, and that increasing emotional expressiveness in families is an appropriate therapeutic aim and intervention. The relevance of the historical context to current practice is considered.     

Young people's narratives of depression

This article reports on findings from a study, which aimed to gain insight into young people's depression as a part of their life course by analysing written accounts of 81 young Finnish people who self-identified as having been depressed. The participants’ accounts were seen as reflecting both their actual life and their narrative interpretations of it in relation to the prevailing normative conceptions regarding youth. The accounts can be grouped into four main story types. The story type referred to as growing up on a sidetrack depicts depression as having its origins in childhood adversities that hinder the realisation of normative goals. Falling off the track depicts how a young person's life can be derailed as a result of experiences that cause or exacerbate depression. In the story missing the track, depression is intertwined with one's experience of failure in meeting normative expectations, whereas the story questioning the track features the problematisation of such expectations. The results underscore the importance of tackling different adverse conditions in childhood, adolescence and young adulthood in a timely fashion, as well as the importance of therapy, counselling and guidance, which help young people to manage difficulties and depression in their life.     

Depression movement in family therapy with depressed adolescents

Family therapists presume, observe, and predict that depression can move from member to member in the family system depending upon the dynamics of the system as a whole. When an adolescent who is depressed begins to improve in family treatment, many family therapists have reported that the parents will often begin to experience an increase in their level of depression. This observation has been reported but has not been objectively measured. In this clinical study of four families, adolescent and parental depression during family therapy is measured to determine if depression movement does occur during family treatment. Results indicate that in three of the four families the parents did initially show depression level increases reactive to improvement in the adolescent. Such findings are supportive to the idea that some forms of adolescent depression often do serve a family system function.     

The effectiveness of couple therapy in Germany: a replication study

The utility of couple therapy has been investigated in a number of controlled clinical efficacy investigations, demonstrating the superiority of most forms of couple therapy relative to control groups. Despite its widespread use, the effectiveness of couple therapy in field settings is largely unknown. In 1997, Hahlweg and Klann published an effectiveness study of couple therapy as practiced in German and Austrian marital counseling agencies. The purpose of the current investigation was to replicate their earlier findings in a similar setting with identical measures. The findings demonstrate that the results are remarkably similar across the two studies and that couple therapy in these applied settings helps to alleviate relationship distress as well as individuals' depression.     

The intertwined relationship between depression and marital distress: elements of marital therapy conductive to effective treatment outcome

Within the framework of the interpersonal view of depression, this article examines the linkage between depression and four aspects of marital relationship: stress, support, role expectations, and interactional dynamics. Acknowledging the intertwined relationship between depression and marital adjustment, existing models of martial therapy for married depressed patients are examined for the extent to which they address these four aspects. The empirical evidence for the efficacy of these models is also reviewed, suggesting elements of marital therapy that are conducive to effective treatment outcome.     

A comparison of two programmes for victims of child sexual abuse: a treatment outcome study

This study aimed to evaluate the comparative effectiveness of individual therapy and combined individual and group therapy in the treatment of the psychological sequelae of child sexual abuse. The Child Behaviour Checklist (CBCL), the Youth Self Report form (YSR), the Children's Depression Inventory (CDI) and the Trauma Symptom Checklist for Children (TSCC) were administered before treatment and 6 months later to a group of 20 young people who participated in individual therapy (IT) programmes and to a group of 18 young people who participated in programmes that involved combined individual and group therapy (IGT). For both types of programmes, statistically significant improvement occurred on the following scales: the total problems, internalizing problems, externalizing problems, withdrawn, somatic complaints, anxious/depressed, social problems, attention problems and aggressive behaviour problems CBCL scales; the total depression, interpersonal problems and anhedonia CDI scales; and the depression and anger TSCC scales. The only scale for which one therapy programme led to greater improvement than another was the CDI ineffectiveness scale. The IGT programme led to a reduction in the mean CDI ineffectiveness score, whereas a slight increase in the mean ineffectiveness score occurred in the IT group. There were no significant differences in the rates of clinically significant improvement associated with the two treatments and no major differences between cases who improved and those that did not improve over the course of therapy. From this study, it may be concluded that after 6 months, individual therapy and combined individual and group therapy were equally effective in the treatment of the psychological sequelae of child sexual abuse. Copyright © 2002 John Wiley & Sons, Ltd.     

When Baby Brings the Blues: Family Therapy and Postnatal Depression

Postnatal depression impacts on a significant number of women and their families. As a topic it is attracting much interest from researchers as we become clearer about its impact on the long‐term mental health of both women and their partners, as well as on the couple's relationship and their children's mental health. This article will provide a brief overview of postnatal depression and the current research associated with it, and consider the usefulness of systemic family therapy interventions. Examples of these are included along with a clinical vignette.     

Functional disability among chronic pain patients receiving long-term opioid treatment

This study of 2,163 adult chronic, non-cancer-pain, long-term opioid therapy patients examines the relationship of depression to functional disability by measuring average pain interference, activity limitation days, and employment status. Those with more depression symptoms compared to those with fewer were more likely to have worse disability on all 3 measures (average pain interference score >5, OR = 5.36, p < .0001; activity limitation days ≥ 30, OR = 4.05, p < .0001; unemployed due to health reasons, OR = 4.06, p < .0001). Depression might play a crucial role in the lives of these patients; identifying and treating depression symptoms in chronic pain patients should be a priority.     

DEPRESSION, BIOLOGY, MARRIAGE AND MARITAL THERAPY

Marital therapists have an, as yet, unrecognized contribution to make to the treatment of depression. It is incumbent upon them to keep abreast of the growing literatures concerning both biological and interpersonal aspects of depression, and to inform other mental health professionals, policy makers, and depressed persons and their families as to what marital therapy has to offer. Consistent with this goal, this article provides an introductory overview of recent findings concerning the biology of depression, the relative merits of medication versus psychotherapy, and the complex relationships between marriage and depression. While there is considerable evidence that many depressions have a biological component and that medication is an efficacious way of providing symptomatic relief, this in no way contradicts findings concerning the efficacy of psychotherapy and the importance of the marital relationship in the outcome of a depressive episode.     

A STRUCTURAL APPROACH TO UNRESOLVED MOURNING IN SINGLE PARENT FAMILY SYSTEMS*

The mother's depression is considered as a special problem in the family therapy of single parent families. It is seen as resulting from unresolved mourning that is maintained by the family system. Several reasons why the single parent family's structure seems inherently vulnerable to unresolved mourning are offered. Some techniques of Structural Family Therapy are proposed in a specific order to facilitate mourning in such families. A successful mourning experience requires a restructuring of the family that provides energy for the remainder of the therapy.     

Depressed College Students and Tricyclic Antldepressant Therapy

Abstract

Charts of all outpatients (n = 267) seen during three consecutive months of 1977 by a university student mental health clinic were retrospectively reviewed for reports of depression. Over one-fourth of university students (n = 76) seen during this period were noted to present with significant symptoms and signs of depression. Charts of depressed patients were further analyzed for distribution by final diagnostic category, demographic data, and treatment outcome results. The majority of depressed patients were diagnosed as depressive neurosis while the second most common diagnosis was adjustment reaction. A significant proportion of patients with a final diagnosis of depressive neurosis had initially been diagnosed as adjustment reaction. Vegetative signs of depression were Infrequently noted In patients with adjustment reaction. These patients were usually treated with psychotherapy alone and showed symptomatic Improvement in one-half of cases. Vegetative signs, especially sleep disturbance, were noted in one-half of patients with depressive neurosis. These patients were often treated with tricyclic antidepressants plus psychotherapy, which resulted in significantly greater Improvement in both dysphoria and vegetative signs than treatment with psychotherapy only. Treatment outcomes for depressed patients thought to have concomitant character disorders were uniformly poor.

Thus, depressed college students In the present study represented several distinct diagnostic groups, of which patients with depressive neurosis showed optimal treatment outcomes following tricyclic antidepressant therapy.