I regularly read an article that I enjoy reading and that I find relevant for psychotherapy. I summarize it and discuss how I see it as relevant for clients on my blog. Do you have questions, comments, or suggestions for other articles to read? Leave a comment below the post. 

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This is an integrated discussion of two articles by Dr. Julianne Holt-Lunstad and her colleagues: Social Relationships and Mortality Risk: A Meta-analytic Review (2010), Potential Public Health Relevance of Social Isolation and Loneliness: Prevalence, Epidemiology, and Risk Factors (2017)

Being socially connected with others is not only good for our well-being but also for our health. Dr. Julianne Holt-Lunstad and her colleagues have a collection of studies showing that being or feeling lonely are significant risk factors for our health. What are the potential implications of Dr. Holt-Lunstad’s body of research for psychotherapy? How may therapy help people reduce feelings of loneliness? Are there potential limitations I sometimes consider for the clients I see? 

The Studies

Social connection can come in many forms and many people are deprived from that in their day-to-day lives. Some people are surrounded by people, yet still struggle with feelings of loneliness. Others experience loneliness because their interactions with the people they love the most are not satisfactory.They don’t feel understood, valued, or appreciated. Or they experience that their partner is not responsive to their needs. That’s a lonely place to be and from a health perspective, it turns out, potentially dangerous. 

In a meta-analysis study from 2010, Dr, Holt-Lunstad and her colleagues found that people who have higher quality relationships die later than those who are more socially isolated or who have lower quality relationships. They also found that the lack of social connection with others has a greater impact on our health than other known risk factors, like being more sedentary or having greater levels of obesity. The benefits of a better social connection even equal the quitting of smoking 16 cigarettes per day (or more). 

By working to improve the quality of our relationships and reaching out for others we are taking care of our mental and physical health. It is true that we may sometimes postpone taking important actions concerning our health. We shouldn’t underestimate the benefits we can have however by working on our relationship problems. In another article published in 2017, Dr. Julianne Holt-Lunstad and her colleagues found that the accumulation of multiple risk factors for social disconnection (e.g., living alone or not being part of social groups) throughout one’s life increases the chance of a lonely senescence. If people instead build their lives within a supportive family environment, they will be more protected against the potential harms of social disconnection. While social connection may buffer against, for example, stress, it itself is thought to satisfy a biological urge. Dr. Holt-Lunstad and her colleagues also point out that while loneliness-related mortality affects people of all ages, other factors in older age (like retirement, children leaving the home, or hearing impairments) can further increase the risk of social isolation. Forming social connections early in life thus becomes all the more important. 

Implications for clients I see during therapy

In my work as a therapist using Emotionally Focused Therapy as a model of intervention, I focus only indirectly on decreasing objective social isolation. More specifically, I try to help the client understand how their own feelings and behaviors can block them to become part of a supportive network. An upbringing in which parents overly focused on the importance of being independent could potentially lead some people to experience difficulties in reaching out for others later in life. Rejections in previous relationships can also make people feel afraid of not being accepted. This person may sometimes feel miserable when someone points out something that went wrong or could be improved. Understanding these blockages could allow my clients to feel they can rely more on others and feel more confident that significant social interactions can be built. 

When a client is in a relationship and feels lonely, my work is directly with the two people involved. My work is based on helping them have a clear picture of what happens in their interaction that leads them to feel disconnected and not understood. I can then help them repair emotional injuries from past events and re-shape the way they interact so they can feel understood and loved. 

Limitations when applying these studies to therapy

But bridging from research to therapy is quite a step. While Dr. Holt-Lunstad and colleagues’ focus on the importance of social connection in general and on being part of a broader social network, my work as a therapist is based on attachment within the intimate partner relationship. It is possible, and I believe likely, that a better partner relationship leads to not only better health, but also to the confidence in becoming part of a larger, more supportive, and more stable social network. 

Another limitation that I see for my work as a therapist is the type of people these researchers focused on. My clients are Brazilians and/or expats. Although I have little doubt that social connection matters for Brazilians, I wonder whether the mechanisms for feeling close and being healthy are similar or not.  For expats, I am pretty sure there are differences. As I experience it myself as an expat, living far away from one’s main social network matters. Could therapy help expats feel more secure to reach out for new connections? Can therapy help them improve the relationships they are building in their new country? My guess is that therapy can help provide a secure base from where expats can feel more open to explore new ways for being with others. 

Conclusion

A large collection of studies shows the importance of building social networks and of having positive bonds with others. Therapy may be a way of taking care of this important factor for our health. As an attachment based approach, Emotionally Focused Therapy can support my clients to focus on how their relationships shape them and also on improving their bonds.

Image by Gabby