Couples therapy — structured clinical viva

You are the psychiatry registrar. A 38-year-old teacher with major depression and their partner of 8 years present together. They describe a pursue–withdraw cycle: one criticises about ‘emotional distance,’ the other shuts down. PHQ-9 is 15 on sertraline 100 mg with partial benefit. No current physical violence; private screens negative for IPV. They ask whether ‘EFT is better than behavioural couple therapy’ and whether medication must stop for therapy to work. Discuss definition, mechanisms, major models, landmark evidence (distress, depression, SUD, PTSD), safety rules, and combined care.