The Secure-Base Approach to the Preliminary Hindrances of Conquering Mental Illness

So basically I wrote a psychological paper type thing for fun *I'm only 16 please don't be too mean!*


The Secure Base Approach posits that the most basic treatment of abnormality is always halted by a lack of hygiene, personal space and a support network. It suggests that these 3 tiers come together to form the ‘secure base’ from which a patient can go on to become cured of their mental illness. It also states that until these basic needs are addressed a patient is unable to motivate themselves to be cured or to cure themselves.

It is influenced by Maslow’s hierarchy of needs, but is more precise. Not only is it more precise in the tiers themselves but it is also more precise in its purpose: to be the first step in the treatment of psychopathology.

Unlike Maslow’s pyramid, however, the order of the pyramids does not indicate their basic-ness. The order of the tiers reflects the usual order through which a patient acquires a secure base, and it may be the easiest route even if it is not an absolute order.

Tier 1

The first tier is hygiene. This has commonly been a symptom of depression: that a patient will stop showering and bathing, because they simply don’t see the point. Many other psychiatrists and psychologists have put forward that a shower is often the first step in overcoming a mental illness.

This is different to hydrotherapy, however, as it is focussed on being clean in general rather than being water-specific. However, a facet of its importance may stem from being hydro-therapeutic.

Testing Tier 1

The importance of Tier 1 could be tested by taking a sample of perhaps 100-200 depressive patients ideally who all receive the same treatment. They should be assigned to one of two conditions: Those with an enforced hygiene schedule, and those without. This hygiene schedule may include showers, moisturizing, massages etc but the same amount of time occupied in these activities by the hygiene group must be spent in similarly relaxing activities by the non-hygiene group to ensure that no confounding variables are introduced.

The participants should be matched by the severity of their depression, but whether either one of each pair is assigned to each condition should be random. This is because depression is a continuum rather than binary disorder. The progress made by the patients after 2 weeks should be recorded, then again after a month. This could be done by giving the patient a questionnaire, using a structured interview to question the patient on their progress, or by using either of these techniques with their therapist or psychologist.

Tier 2

The second tier is personal space. This refers to the patient having their own room which others must ask permission to enter, i.e. it is private rather than communal. This allows the patient to have a sense of control which may contribute to a sense of self, which Jahoda’s ‘deviation from ideal mental health’ definition of abnormality placed as greatly important. This space must be personalised and contain their own belongings only, and the space must be large enough to house these belongings comfortably. For example, someone who has to live with their parents after having gone to University will still have their own room but it won’t count as personal space because they would have amassed enough stuff to fill a flat perhaps, but they are forced to keep it all in one room.

Testing Tier 2

The importance of Tier 2 could be tested by separating a sample of resident mental patients into 3 groups. The first group would be in a dorm with 5-7 others, the second group in private rooms that they are not allowed to personalise, and the third in private rooms which they are encouraged to decorate and personalise. Although more than one disorder could be tested, the results should be taken and interpreted separately as a sense of personal space may be a more important factor in recovery to some disorders than others.

The importance of space could be determined by comparing the progress of participants assigned to one of two conditions: having to keep all their belongings in their rooms, or being allowed to keep some of their possessions in a storage unit (which they have access to). Participants must be randomly assigned to these groups; a temptation might be to have participants’ therapists use the storage unit as a reward system however this would introduce bias to the study.

Tier 3

The third tier is the support network of friends and family. These should be trustworthy people the patient feels comfortable with and with whom they speak often. Part of a therapist’s use may be based on this.

Testing Tier 3

The importance of this could be tested by giving patients questionnaires on their relationships or by interviewing their friends and family. Alternatively, their brain activity could be measured during conversations to establish the strength of the relationship and the nature of the conversation. This could then be compared with their progress.


One limitation of this approach is that plenty of people are unable to be cured even though they have all the components of a secure base. This shows that the lack of a secure base

can’t be the only hindrance to becoming well. The approach was also designed with depressive patients in mind so may not be applicable to all disorders.

The approach may also be seen as ethnocentric since it was conceived of in a western, individualist culture and draws in part on the very individualist ideals of Maslow. However, the concepts themselves do have some transcendence above and beyond culture, so the approach isn’t entirely vapid.

One strength is that the approach is simple and can be the self-administered first step to recovery, meaning that it can be a cheap and fairly simple form of therapy. It also serves to empower the patient without blaming them for their lack of a secure base.

The most important limitation however is that the approach brings nothing new to psychology. Far from this, the approach simply bundles together pre-conceived ideas and gives them a new name. The approach then claims to posit that it can help with therapy, despite this being apparent in psychology long before the conception of this approach.

The End

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