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<p>Major Depression is a common and complex disorder that is often difficult to treat. Mentalization, facilitated by secure attachment, has been found to serve as a protective function against Borderline Personality Disorder. The aim of the current study was to investigate whether mentalization has the same protective function against depression and to analyze the connection between mentalization and self-rated attachment. Furthermore, the relation between Anxious/Avoidant attachment patterns and the anaclitic/introjective sub-types of depression were examined. Twenty participants with Major Depressive Disorder were interviewed with the <em>Depression Specific Reflective Function Interview</em> (DSRF) and SCID-I. They also completed the self-report questionnaires Experiences in Close Relationships (ECR), Depressive Experiences Questionnaire (DEQ) and Montgomery Åsberg Depression Rating Scale (MADRS). The results revealed a relation between high mentalization ability as measured by DSRF and low levels of depression and between an anxious attachment pattern and introjective depression. Moreover, low scores on DSRF combined with high levels of anaclitic and introjective symptoms accounted for 65% of observer rated depression severity. The results suggest that depression treatment might benefit from focusing on increasing the mentalizing ability and reducing anxious attachment patterns and from an awareness of the symptoms characterized by both the introjective and anaclitic sub-types of depression.</p>

Major Depression is a common and complex disorder that is often difficult to treat. Mentalization, facilitated by secure attachment, has been found to serve as a protective function against Borderline Personality Disorder. The aim of the current study was to investigate whether mentalization has the same protective function against depression and to analyze the connection between mentalization and self-rated attachment. Furthermore, the relation between Anxious/Avoidant attachment patterns and the anaclitic/introjective sub-types of depression were examined. Twenty participants with Major Depressive Disorder were interviewed with the Depression Specific Reflective Function Interview (DSRF) and SCID-I. They also completed the self-report questionnaires Experiences in Close Relationships (ECR), Depressive Experiences Questionnaire (DEQ) and Montgomery Åsberg Depression Rating Scale (MADRS). The results revealed a relation between high mentalization ability as measured by DSRF and low levels of depression and between an anxious attachment pattern and introjective depression. Moreover, low scores on DSRF combined with high levels of anaclitic and introjective symptoms accounted for 65% of observer rated depression severity. The results suggest that depression treatment might benefit from focusing on increasing the mentalizing ability and reducing anxious attachment patterns and from an awareness of the symptoms characterized by both the introjective and anaclitic sub-types of depression.

Introduction: Excessive self-criticism constitute a huge suffering for the individual. Clinical experiences and research indicate that the phenomenon is difficult to treat and one of the strongest obstacles against a healing process. The aim of this study is to develop grounded hypothesis of what can be useful ways of relate to and/or intervene regarding excessive self-criticism. Starting point is the experience and knowledge of licenced psychodynamic psychotherapists.  Questions:What is the experience of working with patients who suffers from excessive self-criticism? In which ways and what is it that causes this condition difficult to treat?Which clinical strategies are perceived to work, respectively not work?  Method:Six semi-structured interviews with experienced psychotherapists which were coded with thematic inductive analysis.  Results: Six themes: 1) Observe reactions suggestive of self-criticism. 2) Separate the patient from self-criticism. 3) Analyse why. 4) Be a counterforce. 5) Synthonicity and mistrust. 6) Build a counterforce within the patient.  Discussion:Based on theory and research, the discussion leads to hypothesis of useful therapeutic approaches: 1) Long experience of the phenomenon. 2) Empathic, warm relational and active stand, a reinforcing counterforce. 3) Specific interventions with the aim to activate the patient’s own empathy, compassion and trust – and to others. / Inledning:Överdriven självkritik innebär ett stort lidande för individen. Kliniska erfarenheter och forskning tyder på att fenomenet är svårbearbetat och ett av de starkaste hindren i vägen för en läkningsprocess. Syftet med studien är att utveckla grundade hypoteser om vad som kan vara användbara sätt att förhålla sig och/eller intervenera vid överdriven självkritik. Studien har som utgångspunkt psykodynamiska legitimerade psykoterapeuters erfarenheter och kunskaper.  Frågeställningar:Vad är psykoterapeutens erfarenheter av att arbeta med patienter som lider av överdriven självkritik? På vilka sätt och vad är det som orsakar att tillståndet är svårbehandlat? Vilka kliniska strategier upplevs fungera respektive inte fungera i behandlingen?  Metod:Sex semistrukturerade intervjuer, genomförda med erfarna psykoterapeuter, vilka undersöktes med tematisk induktiv analys. Resultat:Sex teman: 1) Observera reaktioner som tyder på självkritik. 2) Skilja ut patienten från självkritiken. 3) Undersöka varför. 4) Vara en motkraft. 5) Syntonicitet och misstro. 6) Bygga upp en motkraft hos patienten. Diskussion:Utifrån teori och forskningsnivån lyfts resultatdiskussionen till grundade hypoteser om användbara förhållningssätt: 1) Lång erfarenhet av fenomenet. 2) Ett empatiskt, varmt relationellt och aktivt terapeutiskt förhållningssätt och att fungera som en förstärkande motkraft. 3) Specifika interventioner i syfte att aktivera patientens egna empati, medkänsla och tillit – och gentemot andra.

Tidigare studier har visat på att i varje missbrukares liv, finns cirka fem anhöriga som riskerar att utveckla medberoende. Riskfaktorerna associerade med medberoende påverkar därför förekomsten av psykiska ohälsa och ökar risken för att utveckla andra sjukdomar såsom depression, ångest och känslomässiga problem. Syftet med studien var att undersöka hur medberoende i nära relationer kan utveckla självdestruktivt beteende och psykisk ohälsa. Med hjälp av en kvalitativ metod och intervjuer som datainsamlingsmetod blev syftet med denna studie genomförd. Studien grundades på semistrukturerade intervjuer där totalt sex informanter deltog. Resultatet i studien visade på liknande resultat genom alla intervjuer, såsom förekomsten av psykiska sjukdomar, självdestruktivt beteende och vikten av introjektiv identifikation. Dessa tre kategorier kompletterar varandra i den skrivna ordningen. Resultatet tyder på att det kan vara så att den medberoende inte kan utveckla psykisk ohälsa utan fenomenet introjektiv identifikation och självdestruktivt beteende. För att det ska utvecklas någon form av psykisk ohälsa skulle den medberoende personen behöva utveckla ett självdestruktivt beteende, och resultatet tyder på att det inte är möjligt utan introjektiv identifiering i kontexten nära relationer. Dock med hjälp av anknytningsteorin och coping-strategin, visade slutsatsen att inte alla medberoende utvecklade psykisk ohälsa. Förekomsten av psykisk ohälsa påverkas av individens tidiga anknytningsmönster och copingförmåga. Studien ledde till slutsatsen att psykisk ohälsa är ett stort problem bland individer med medberoende. Medberoende är inte fastställt som en sjukdom, trots att risken för att eventuellt utveckla psykisk ohälsa finns. Trots de följdsjukdomar som medberoende medför är det ingen prioritering inom folkhälsopolitiken. / Previous studies have shown that in every drug addicted person’s life there is about five relatives which risks developing co-dependency. Therefore, the riskfactors affect the relative’s mental health and increase the risk of developing other illnesses such as depression, anxiety and emotional issues. The aim of the study was to investigate how co-dependency in close relationships can develop self-destructive behavior and mental illness. With the use of a qualitative method and interviews as a data collecting method, the aim for this study became fulfilled. The study was based on semi-structured interviews, performed by six participants. The results showed similar outcomes for all interviews, such as the prevalence for mental illness, self-destructive behaviour and the importance of introjective identification. These three categories complement each other in the order written. The results indicates that a co-dependent individual could not, without the phenomenon introjective identification and self-destructive behaviour acquire mental illness. However in order to acquire some kind of mental illness the co-dependent person would have to develop self-destructive behaviour, and the results showed that it is not possible without introjective identification in the context of a close relationship. Although, with the use of attachment theory and coping-strategy, the conclusion showed that not every co-dependent developed mental illness. The prevalence of illnesses was affected by the individuals early life attachment-pattern and coping skills. The study led to a conclusion that mental illness is a big issue among co-dependent individuals. Co-dependency is not a determined as a disease, despite the risk of possibly developing mental illness. It is still not a prioritization among public health authorities.