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Interpretation enhances reality

Psychotherapy in which the therapist also offers interpretations of behavior is more helpful in reducing depression among patients who have difficulty managing relationships

Depression and loneliness. Illustration:
Depression and loneliness. Illustration:

For five decades, many studies show that psychotherapy only helps about 50% of patients, and this is especially true when it comes to clinically depressed patients. The effectiveness of psychotherapy is tested in several ways, including: the reduction or disappearance of the symptoms of the mental problem and the increase in well-being, satisfaction with life and self-esteem.

Prof. Sigal Zalka-Mano, a clinical psychologist from the Department of Psychology at the University of Haifa, studies psychotherapy to understand why it helps certain patients and not others, and to what extent it is possible to influence this. "The effectiveness of psychotherapy," she says, "depends on a variety of factors, including the character of the patient. It is possible that if we make correct adjustments in the treatment, if we understand which treatment is suitable for each patient, we will be able to achieve more than 50% efficiency. Our research supports this."

In their latest study, supported by the National Science Foundation, Prof. Zalka-Mano and her team sought to examine the suitability of psychotherapy based on the patient's attachment style. The attachment theory, developed by the British psychoanalyst John Bowlby in the years 1982-1969, deals with the parent-child relationship in the first years of life as the basis for a person's relationships and perceptions of himself and the world. It is considered one of the most influential psychological theories of the last 50 years. According to which, there are several attachment styles, and the most common distinction is between secure and insecure attachment (which is divided into two main types: anxious or avoidant).

Those with a secure attachment style manage close and long-term relationships that are characterized by great trust. They feel comfortable in relationships, are not afraid of abandonment, have high self-esteem, sociable, open, create new relationships easily, trust the other and will turn to them in times of need. In contrast, those with an insecure-anxious attachment may seek intimacy but are afraid of abandonment and can develop dependence, obsession, jealousy and emotional instability. Those with an insecure-avoidant attachment are very afraid of intimacy and avoid it, do not trust others and trust only themselves, even in times of distress.

The study by Prof. Zalkha-Mano and her team included 100 patients diagnosed with clinical depression. Their communication style was identified through questionnaires in which they were asked, for example, how much they turn to others for support and help / fear that they are not loved / rely only on themselves. Prof. Zalkha-Mano: "We focused on the attachment style because a patient is avoidant or anxious, often does not believe that the therapist will be able to help him, develops a fear of abandonment and dependence, and does not assist in treatment. We hypothesized that if the therapist actually maintains a space of observation and provides a slightly distant emotional experience (that is, will also provide interpretations of the patient's condition and not only express closeness and support), he will increase the effectiveness of the treatment. Therapists usually get very close to those with insecure attachment because they demand it. Here we tried to create a different, corrective experience. This is to help the patient understand that he can trust a person even if he is less emotionally close to him at a given moment."

As part of the study, patients with secure and insecure attachment (anxious or avoidant) received for 16 weeks one of two treatments: a treatment in which the therapist supports them and strengthens them and therefore is experienced as very close, or a treatment in which the therapist supports them but also maintains a space for observation and offers possible interpretations of the behavior, thoughts and feelings (which may lead to a certain emotional distance). The patients were then interviewed, filled out clinical questionnaires, wrote digital diaries in which they described their feelings, underwent hormonal tests (for example, of the level of the hormone oxytocin, which is secreted during a positive social interaction, and of the hormone cortisol, which is secreted during stress), their facial expressions were analyzed in the laboratory (for example, how much they express joy) and more. It was found that the treatment that combines support and providing interpretations contributed much more to the reduction of depression symptoms and its disappearance and to the increase of mental well-being among patients with insecure attachment-anxiety, in accordance with the research hypotheses.

Prof. Zalkha-Mano provides an illustrative example: "A young woman with clinical depression who has difficulty finding a relationship because after every date she feels rejected and does not let the guy she knew (for example calls and text him repeatedly) and scares him, or she feels extreme insecurity and jealousy in relationships; Such a young woman expects great emotional closeness from the therapist and develops dependence on him. But when the therapist maintained a space of observation and emotional distance and helped her more by interpreting her behaviors - the symptoms of depression decreased and she experienced a new type of relationship in which she felt secure despite the momentary distance. In other words, the therapist increased her mental well-being and made her understand that there are other types of relationships that can be more meaningful and healthy for her."

Another study by Prof. Zalkha-Mano and her team, which is still underway, wants to check whether clinically depressed patients will benefit more from treatment that emphasizes their strengths or from treatment that tries to correct their weaknesses. There are still no results, but according to Prof. Zalka-Mano, "the hypothesis is that when the alliance between the therapist and the patient is good, you can focus on weaknesses, and when it is not good - it is better to focus on strengths."

Life itself:

Prof. Sigal Zalkha-Mano, married to Roy (a senior doctor in Ichilov), mother of two children (Daniel - 10 and Roni - 6), lives in Zichron Ya'akov, and likes extreme sports (such as mountain biking).

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