Cruwys et a 231 given the demonstrated imnortance of social identifica. connectedness in a meaningful way despite the clear prom tion in preventing and treating depression,future research ise that this strategy holds for a plethora of positive out may also b d to examine the s comes (He Barrington-Leigh. 12 tself We propos rted by de identity formation and?The curative benefit of the therapeutic alliance is well-esta 2001;Postmes Branscombe,2010 -provides a parsimo ed:ho wever,it has ot hit nd compelling tramework for conceptualizing th nnectedness in this regard we would antie ate that thera ndance of emergent evidence (as summarized in Table 2)supports this approach d8ah nade by a pra erceived by the patient nov nperative hat we b g this approach to bea er (.e.. und l that maat the co 01 "one of them"and "not like me").Of course.this shared it is likely to deliver tangible gains in p reventing and treating group membership ne and d as "the unbearabl oth vays d,if the y to a much of the clinical lite ntial micro skills and rapport building (e.g that which encou foundation for the prevention and remediation of this most ages empathy,open non-judg significant clinical issue vle Declaration of Conflicting Interests anding van der mole & 009 Sharpley,Halat,Rabinowicz,Weiland,&Stafford,2001). A Sc would sugge h。 Fundine tion is hase don the r ntion ofidentity. Laureate Girant no.FL110100199.see http//www are/The including shared goa 20121A1 of the shared .he harder to one based on demographiccharacteristics. Notes DS ant and poten he Here,we us ions will enhance the latter's influence and su ortive Similarly,although literature suggests that patients report that ence of a netw roup pro g coh ion,are of the ing soc al part on,socia group has py ienced co tica s,the frame ork in which this is conceptualized or investigated as an exercise in identity formation or maintenance. 2.The det cial ide tioare o the focus ecin Concluding Comment there is a This review has shown social connectedness to be impli- cated in the development progression t(C depre e 2011 primarily due to the absence of a coherent,plausible,and fellow gre bers is one and ma empirically substantiated theory of social relationship in the w depre o act i evels,typically de m et a Cruwys et al. 231 Given the demonstrated importance of social identifica￾tion in preventing and treating depression, future research may also be warranted to examine the social identity pro￾cesses at work in the therapeutic process itself. That is, how do various evidence-based therapies compare in supporting identity formation and increased social connectedness? The curative benefit of the therapeutic alliance is well-estab￾lished; however, it has not hitherto been conceptualized as an operationalization or instantiation of identity-based social connectedness. In this regard, we would anticipate that thera￾peutic efforts would meet with greater success when they are made by a practitioner who is perceived by the patient to be an in-group rather than an out-group member (i.e., under￾stood to be “one of us,” and hence “like me,” rather than “one of them” and “not like me”). Of course, this shared group membership need not be based on age, gender, and ethnicity, as there are many other ways in which clinicians can and should build a sense of shared identity with their patients. In particular, much of the clinical literature on micro skills and rapport building (e.g., that which encour￾ages empathy, open body language, and inclusive, non-judg￾mental language) indicates that clinicians’ interpersonal style is a key pathway to a sense of similarity, trust, and understanding (Kuntze, van der Molen, & Born, 2009; Sharpley, Halat, Rabinowicz, Weiland, & Stafford, 2001). A social identity analysis would suggest that therapeutic alliance reflects the emergence of a group-based relationship between the clinician and the patient, where the emergent cat￾egorization is based on the perception of identity-affirming fea￾tures including shared goals (akin to the optimal relationship between the teacher and the learner; for example, Bizumic et al., 2009; Reicher, Haslam, & Smith, 2012). Although the nature of the shared category may be harder to specify and define than one based on demographic characteristics, psycho￾logically, this does not make it any less relevant and potent. It also follows from H6 that fostering a patient’s perception that he or she shares group membership with the clinician on valued dimensions will enhance the latter’s influence and success. Similarly, although literature suggests that patients report that group processes, including cohesion, are one of the key bene￾fits of group therapy (Hornsey, Dwyer, Oei, & Dingle, 2009), little research has been informed by, or has tested, a theoretical framework in which this is conceptualized or investigated as an exercise in identity formation or maintenance. Concluding Comment This review has shown social connectedness to be impli￾cated in the development, progression, and treatment of depression. However, to date, literature has lacked clarity in terms of the nature of this relationship and its cause. This is primarily due to the absence of a coherent, plausible, and empirically substantiated theory of social relationships. Consequently, interventions for depression, both at public health and clinical levels, typically do not address social connectedness in a meaningful way despite the clear prom￾ise that this strategy holds for a plethora of positive out￾comes (Helliwell & Barrington-Leigh, 2012). We propose that the social identity approach—an influential theory of group processes that is supported by decades of evidence in social and organizational psychology (e.g., S. A. Haslam, 2001; Postmes & Branscombe, 2010)—provides a parsimo￾nious and compelling framework for conceptualizing the role of social connectedness in depression. Furthermore, an abundance of emergent evidence (e.g., as summarized in Table 2) supports this approach. It is now imperative that we bring this approach to bear directly on the issues at the core of depression. We contend not only that this makes good theoretical sense but also that it is likely to deliver tangible gains in preventing and treating a condition that Kong (2002) described as “the unbearable sadness of being” (p. 195). Indeed, if the best way to avoid depression is to make our being properly social, then it fol￾lows that social identification is an essential psychological foundation for the prevention and remediation of this most significant clinical issue. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding This research was funded by an Australian Research Council Laureate Grant no. FL110100199, see http://www.arc.gov.au/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Notes 1. As we observe below, many different terms have been used to refer to the social processes involved in depression, and this has been one of the barriers to theoretical integration. Here, we use the umbrella term social relationships to refer to the objectively observed presence of a network of supportive connections with others (e.g., involving social contact, social participation, social capital, and social networks). We use the umbrella term social connectedness to refer to the subjectively experienced connec￾tion to others (e.g., involving social support, belongingness, the absence of loneliness). 2. The determinants of social identification are not the focus of this review, but it would nevertheless be more correct to say that there is a reciprocal relationship between these social phenomena (trust, helping, social support) and social identification. Thus, just as shared social identity is a basis for help, support, and trust (e.g., see Haslam, Reicher & Levine, 2012), so too, help, support, and trust can also promote social identity development (Gleibs, Haslam, Haslam & Jones, 2011). Moreover, providing support to fellow group members is one way in which social identification is enacted and made real in the world. In this way, a virtuous cycle can be created whereby social identification leads individu￾als to act in identity-maintaining ways that, in turn, strengthen their (and others’) identification (S. A. Haslam et al., 2005). Downloaded from psr.sagepub.com at Remen University of China on September 6, 2015