Experiences of working-age adults with depression of psychodynamic couple therapy: a thematic analysis using a phenomenological approach

Background: Depression is a complex condition that affects over 320 million people worldwide and entails risks of relapse and suicide. As a result of the increasing number of adults experiencing symptoms of depression and anxiety in the United Kingdom, Improving Access to Psychological Therapies (IAPT) services have been established to assist individuals with these difficulties. The National Institute for Health and Care Excellence (NICE) guidelines have recommended behavioural couple therapy for the treatment of depression, but public provision is limited. Despite the wide range of literature that explains the link between couple wellbeing and mental health outcomes for adults and children, there is an evidence gap around the experiences of psychodynamic couple therapy. Method: Five participants completed a semi-structured interview, following at least six months of couple therapy for the treatment of severe distress and depression. They were recruited from an internationally renowned couple therapy provider in London, using a purposive sampling technique. Data was analysed using a phenomenological approach to thematic analysis. Results: Participants described the therapist as a “third person” who became a referee, and mediated the communication within the couple and provided a different perspective, which enabled a safe environment for reciprocal listening. A crucial aspect of couple therapy was the process of making links with the past, which enabled participants to understand their current behaviour as individual and dysfunctional areas as a couple. The process of creating connections with the past was meaningful for all participants, and some perceived fostering self-reflective skills as a practical tool, but others wanted to receive direct guidance. Three main active ingredients facilitated the therapeutic process: the therapist’s ability to understand the couple as individuals rather than as a unified entity; the therapist neutrality and capacity to empathise and connect with the couple. At the end of therapy, most participants reflected that their overall therapy experience has been helpful and highlighted a positive impact in terms of their depression, perspectives and connecting with emotions, not only for the couple involved but also in the wider system. Conclusions: This study highlighted the intertwined dynamic between relationship difficulties and depression. Participants were not able to make a clear distinction between these two experiences and this microcosm may reflect the difficulties that clients face in public services, which have historically held an individualistic perspective of distress.