Do NHS talking therapies services and couple therapy for depression have a relationship problem?

Abstract

PHOTO CREDIT: Antoni ShkrabaCouple Therapy for Depression (CTfD) is unique being the only NHS Talking Therapies Services (NHSTTS) therapy involving partners. As a couple therapy it is systemic as well as behavioural. CTfD is an effective intervention for both depression and relationship distress and achieves good recovery-rates for depression and anxiety compared with other ‘high-intenstty’ therapies.Delivery of CTfD in NHSTTS is inadequate. Over a third of NHSTTS provide no CTfD. When they do, delivery is so minimal that depressed clients cannot generally access CTfD. Since 2010, 1172 CTfD therapists have been trained yet, in 2021/2, only 1574 couples received CTfD (approximately one couple seen per year per therapist). This is wasteful given the investment of time and money.Constraints affecting delivery e.g. individually-focused organisational culture of NHSTTS, misunderstanding of the role of CTfD therapists, inappropriate referrals, inadequate supervision and delivery on a minimal scale, are discussed and recommendations outlined.Clients deserve genuine choice, staff need support to deliver CTfD effectively, and referral quantity and quality require urgent attention.