Free the hidden heart: Resources and attachment work in resistant depression


Depression is a world leading cause of disability, with huge human and social costs. Psychopharmacological treatments alone are effective in less than 30% of cases. Psychotherapy alone or combined with drugs, has gained recognition as the most important treatment tool, although it can be hard work for therapists, since the patient’s functioning is linked to the vicious circle of depression.

When the relationship between self and others is compromised, the person experiences detachment from their resources, adopting a blaming and judging attitude.  Attention is directed inward and ruminative; the window of tolerance can be very narrow, so that it shifts between hyper- and hypo arousal activity which can limit the free contact space between feelings and thoughts.  “Phobia” of a good self-image is common, preventing the person from having self- appreciation or receiving it from others. During an EMDR processing, this may lead to blockages when attempting to transitfrom negative to positive feelings. The relationship with the self is perceived as dull and disturbing, with a tendency to avoid feelings and sensations, which can lead to a mind-body dissociation. Anhedonia and impotence may reduce motivation both in client and therapist.

In order to address these difficulties, the EDEN project (European Depression EMDR Network) has developed numerous strategies and skills, subjected to an ongoing randomized controlled experiment.

This workshop will focus on the application of integrative tools for a comprehensive EMDR treatment of resistant depression: resource development and enriching listening skills, attachment
work with clients who possess overwhelming self-blame, body and self-soothing techniques, EMDR protocol informed cognitive interweaves to promote changes in the relationship between
emotions and sensations, leading the patient to develop trust, rather than maintaining avoidance, experiencing the therapist as an inner and “silent” guide during the entire process.






Luca Ostacoli
Gabriella Bertino

Original Work Citation

Ostacoli, L., & Bertino, G.  (2015, July).  Free the hidden heart: Resources and attachment work in resistant depression.  Presentation at the 16th EMDR Europe Association Conference, Milan, Italy



“Free the hidden heart: Resources and attachment work in resistant depression,” Francine Shapiro Library, accessed October 23, 2020,

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