Definitely, one (therapy) does not fit all (depressions): Mentalization based treatment for resentful self-critical depressive patients who abuse of attachment deactivating strategies

Abstract

Depression is one of the most prevalent mental disorders and a notably heterogeneous condition with regard to etiology, symptom expression, course, and treatment response. This is why it is extremely unlikely that a “one size fits all” approach to the treatment of depression will be particularly effective. Quite the contrary, it is clear that the future of the treatment of depression may lie in a combined disorder- and person-centred, tailored-made approach, which takes into account the broader interpersonal context and life history of the individual. Depressed patients with a characteristic cognitive-affective schema of self-critical perfectionism are prone to typical dysfunctional transactional cycles or dominant interpersonal narratives in which rage, distrust and ambivalence are apparent. In addition to this, in these subtype of depressed patients is common to find the overuse of attachment deactivating strategies, in response to threats to attachment relationships specially, and the inhibition of mentalizing as a defensive response to the feelings of rage, emptiness and sadness that are developmentally linked to attachment experiences. The implications of these findings for treatment, particularly with regard to the nature of the therapeutic relationship, are readily important. In this poster we take several cases in order to detail the main psychodynamics and the dominant interpersonal narratives of this subtype of depressed patients and to specify a therapeutic proposal tailored for them.

Disclosure of interest

The authors have not supplied their declaration of competing interest.