LEARNING FROM OUR CLIENTS Eija-Liisa Rautiainen, Katharina Auberjonois and Monica Hartzell EFTA congress, Paris,

Co-research interviews after couple therapy for depression Eija-Liisa Rautiainen psychologist and family therapist Kuopio University Hospital, Finland

THE CONTEXT OF THE STUDY Couple therapy was offered in psychiatric outpatient clinics for persons diagnozed as depressed and their spouses Couple therapy was offered in psychiatric outpatient clinics for persons diagnozed as depressed and their spouses Aim: To develop couple therapy for depression in this context, to include the therapists into research in a new way Aim: To develop couple therapy for depression in this context, to include the therapists into research in a new way Dialogical and reflective approach to couple therapy, no manual for the therapies Dialogical and reflective approach to couple therapy, no manual for the therapies

Depressed people are often helped without attention paid to their families Depressed people are often helped without attention paid to their families Depression is a huge problem, ways of helping depressed persons need to be developed further Depression is a huge problem, ways of helping depressed persons need to be developed further Collaborative approach to research Collaborative approach to research – Bringing psychotherapy research near to the everyday clinical work, listening to the users of the health care services

THE INTERVIEWS Co-research interview method developed by Tom Andersen Co-research interview method developed by Tom Andersen 25 interviews, where the therapists and the couples were interviewed in the same room, each of them listening when the others were interviewed 25 interviews, where the therapists and the couples were interviewed in the same room, each of them listening when the others were interviewed 25 couples, 28 different therapists in three centers 25 couples, 28 different therapists in three centers –Grounded Theory-analysis

QUESTIONS FOR THERAPISTS What did you have in mind when you asked these clients to come today? What of your contributions to the therapy- meetings do you think the clients appreciated the most? Might there be something they would have liked to talk about but what was never discussed? Where there times when you yourself had thoughts in your mind that you never disclosed, but in hindsight think that might have been useful to talk about? If it had been possible to talk about that, how might you have done it with them?

Where there moments that you remember as difficult for yourself as a therapist? How did you overcome these difficulties? Was this therapy similar to therapies you have had with other clients, or was it different? What have you learned from these clints? What have you learned from each other as therapists?

QUESTIONS FOR CLIENTS Would you like to comment on what you heard during the conversation between the therapists and myself? They talked about this and this, what are your comments on that? In addition to what the therapists talked, is there something you would like to talk about? Is there something particular you remember from the therapeutic meetings?

Where there times you wanted to talk about something you never got to talk about? Where there times you tried to say something they didn ’ t hear? What was most helpful for you? How was it helpful?

RESULTS Most of the couples found that couple therapy for depression had been helpful Most of the couples found that couple therapy for depression had been helpful Therapists' willingness to help, their ability to ask good questions and make it possible for the spouses to talk in a new way had been helpful Therapists' willingness to help, their ability to ask good questions and make it possible for the spouses to talk in a new way had been helpful Spouse's participation to the therapy had been valuable Spouse's participation to the therapy had been valuable – For some, getting help with relationship problems was central – For others, having the spouse's support and recoveirng together was important The couples and the therapists appreciated similar things in therapy (the collaborative interviews) The couples and the therapists appreciated similar things in therapy (the collaborative interviews)

RESULTS Couple therapy had not always worked well Couple therapy had not always worked well –Both couples and the therapists spoke about problems in the collaboration –Sometimes couple therapy had not helped with relationship problems, in other occasions the depressed person's situation had not become better –Problems in therapeutic relationship, therapy got stuck –Confusion concerning couple therapy

RESULTS Taking part to the study remained the therapists of the importance of working with the families of the people diagnozed as depressed Taking part to the study remained the therapists of the importance of working with the families of the people diagnozed as depressed Therapists learned e.g. about the importance of the beginning of the therapy: talking about the goals, listening to clients' hopes and obstacles for working Therapists learned e.g. about the importance of the beginning of the therapy: talking about the goals, listening to clients' hopes and obstacles for working

EXPERIENCES OF THE INTERVIEWS Both the therapists and the clients found the interviews interesting Both the therapists and the clients found the interviews interesting It was also possible to talk about difficult things It was also possible to talk about difficult things The interviews were many times quite intensive experiences The interviews were many times quite intensive experiences The interviews sometimes reinforce familiar things for the participants, sometimes bring surprises The interviews sometimes reinforce familiar things for the participants, sometimes bring surprises Good method for research, developing therapists' work and for therapists' training Good method for research, developing therapists' work and for therapists' training

Co-research interviews are a good opportunity for the therapists to learn from their clients. Co-research interviews are a good opportunity for the therapists to learn from their clients. –Open and collaborative situation –Research comes close to everyday work –Reflective positions, separating listening and talking –Willingness to let the clients evaluate one's own work and evaluate it in the precense of the clients is needed from the therapists –In the interviews the therapists learn to talk about their own work in an open and respecting way

PhD thesis Coconstruction and collaboration in couple therapy for depression, Coconstruction and collaboration in couple therapy for depression, http://julkaisut.jyu.fi/?id= http://julkaisut.jyu.fi/?id= –Rautiainen E-L & Aaltonen, J. (2010) Depression: The differing narratives of couples in couple therapy. The Qualitative Report, 15, –Rautiainen, E-L., & Seikkula, J. (2009) Clients as Co- researchers: How Do Couples Evaluate Couple Therapy for Depression? Journal of Systemic Therapies, 28, –Rautiainen, E-L., & Seikkula, J. (2010) Focusing on therapists in co-research interviews: How do therapists see couple therapy? Journal of Systemic Therapies, 29,