Social work in Israel with children and mothers who returned from Hamas captivity

Abstract

Summary

During the events of October 7, 2023, 240 men, women, and children were kidnapped by Hamas terrorists to the Gaza Strip. The current study explores challenges faced by social workers at Schneider Children's Medical Center in Israel as they performed an intervention with returning hostages from Hamas captivity and their families. This traumatic event is unprecedented in its characteristics, complexity, and the need to treat this unique group with a very limited prior research and clinical knowledge, within a short hospitalization period ranged from 5 days to 2 weeks. This qualitative phenomenological approach research aims to identify and describe themes related to the personal and professional encounters of 13 social workers with the returnees and their families.

Findings

The findings highlight a central theme: parallel processes in creating connections between different social workers and returning hostages. This process facilitated the creation of connections that allowed the return of nascent trust, security, and control among the returning hostages and their families.

Applications

Given the unique characteristics of the trauma, the social workers had to address the returning hostages’ collapse of basic existential feelings of trust, control, and security in themselves and others. The research suggests the feasibility of establishing secure attachment in a short period. The study also points to the necessity of considering initial attachment processes in the planning and guidance of social services for future trauma victims.

Introduction

The events of October 7, 2023, during which hundreds of terrorists infiltrated Israel, murdered, abused, raped, and kidnapped 240 men, women, and children to the Gaza Strip, shocked Israeli society and profoundly fractured the sense of security of all its citizens. This unprecedented event, in which an entire nation was, and continues to be, exposed to life-threatening situations, naturally leads to significant emotional distress and affects all citizens. On November 24, 2023, the first phase of the agreement to return the hostages from Gaza was carried out. A total of 16 children, 6 mothers, and 1 grandmother who had been held by Hamas, were admitted to the Department for Returning Hostages, a unique department established on the occasion of their return at Schneider Children's Medical Center. The Ministry of Health formulated an intervention protocol for the returning hostages, including definition of the role of the social worker as a case manager. This role included initial contact with the returning hostages and their families, escorting them, coordinating interventions with various teams inside and outside the hospital, and coordinating a discharge plan for continued support in the community.

The current research studies the personal and professional voices of the social workers regarding their initial encounter with the returning hostages and their families, from the moment of their arrival from captivity through to their discharge from the hospital, from the perspective of attachment theory and research.

John Bowlby (1982), the father of attachment theory, posited that humans are born with an attachment behavioral system that drives them to seek closeness to significant others (attachment figures) in times of distress. This system serves basic regulatory functions, providing protection from threats and alleviating distress among all ages. Attachment figures serve two main functions: a “safe haven” (physical and emotional) that allows for the regulation of negative emotional states when the child perceives its environment as ambiguous, incomprehensible, and anxiety-inducing, and a “secure base” that encourages positive emotional states leading to exploration in times of calm. According to Bowlby (1980), attachment relationships form the central circle, the Circle of Security, around which human life revolves throughout the lifespan. This circle of security is based on the regulation between attachment behaviors (“safe haven”) and exploratory behaviors (“secure base”), which determines the balance between the need for dependence and the ability to engage in independent activities. The regulation process includes emotion management, the regulation of thought processes and behavior, and action on the environment to alter or decrease stress. Bowlby (1973) described individual differences in the functioning of the attachment system. Interactions with attachment figures characterized by responsiveness during times of distress promote a sense of security in attachment, which helps the efficient regulation of emotions in distressing situations and contributes to optimal functioning (Shaver & Mikulincer, 2013). Research indicates that in distressing situations, secure attachment in children and adults is associated with regulatory efforts marked by balance, cognitive flexibility, relatively low levels of stress and distress, maintenance of mental well-being, and an effective approach to interpersonal communication (Granqvist et al., 2012). Conversely, when attachment figures are unavailable and unreliable, and fail to provide relief from distress, secondary insecure attachment patterns may develop: anxious attachment, characterized by hyperactivation, or avoidant attachment, characterized by deactivation, both in relation to the attachment figure and distressing situations. Anxious attachment has been found to be associated with a wide range of emotion-focused coping including pessimistic beliefs about the ability to cope with the distress (e.g., Holmberg et al., 2011), and psychosomatic complaints (Mikulincer & Shaver, 2007). In contrast, avoidant attachment has been associated with distancing strategies such as denial or blocking of any emotional state that evokes distress, (e.g., Holmberg et al., 2011; Shaver & Mikulincer, 2013). Although attachment relationships are shaped during early childhood (Bowlby, 1988), many studies indicate that attachment patterns can change subtly or dramatically considering relationship experiences throughout life, and the current context (Mikulincer & Shaver, 2007, for a review).

The abduction of children and mothers into Hamas captivity in Gaza, and their return to Israel, is a unique event, unprecedented in its scale, acute traumatic characteristics, and complexity. Consequently, there is very limited prior research and clinical knowledge on which to rely when planning and building an initial therapeutic intervention at the hospital. Various studies examined factors that inhibit and assist the work of social workers in public health services with trauma people from “nontrivial”/unique communities (Balestrery, 2015, 2024; Lin et al., 2016; Reynaga et al., 2023). These studies indicate that psychological experience gaps between workers and patients can contribute to loss of trust between parties, refusal to cooperate with the workers team, anger (Balestrery, 2015; Lin et al., 2016; Reynaga et al., 2023), dissatisfaction with the regular institutional tools and interventions (Balestrery, 2024; Lafit, 2020), and even lead to secondary traumatization of the patient (Balestrery, 2024). Furthermore, integrating connection-building skills through “connection conversation” during, and after, the first medical encounter was found to enhance the sense of security and trust and improve intervention outcomes (Balestrery, 2024). These skills included encouraging social workers to view patients through their own life experiences and life events, exploring in dialogue how the past exists in the present, learning their preferences (Lin et al., 2016) and goals, and the best ways to achieve these, and examining institutional policies and practices, considering the needs of the patients and their families (Herek, 2016).

Study of the implications of exposing men, women, and children to abductions, torture, sexual violence, executions, and enslavement, is limited, for example, studies on refugees from northern Iraq who fled the Islamic State of Iraq and Syria (ISIS) attack in August 2014 (Cetorelli et al., 2017; Tagay et al., 2017; Tekin et al., 2016). These studies indicate that a significant percentage of the refugees exhibited symptoms of posttraumatic stress disorder (PTSD) and major depression. Additionally, secure attachment patterns among the workers teams were found to be a resilience factor in preventing secondary traumatization among the refugees. In contrast, insecure attachment patterns were classified as high-risk for the emergence of secondary trauma symptoms (Denkinger et al., 2018). Similarly, a study on trauma victims who were prisoners of war found that secure attachment was associated with a reduced risk of developing PTSD, compared to prisoners of war classified as insecure (Dieperink et al., 2001). The researchers argued that since insecure patients are less likely to rely on relationships, they are more likely to use these less effectively in coping with trauma.

The current study

The current study addresses the unprecedented challenge faced by social workers at Schneider Children's Medical Center in Israel in their work with returning hostages from Hamas captivity and their families during the initial phase of their return from captivity and the hospitalization period. The duration of hospitalization ranged from 5 days to 2 weeks. The primary role of the social workers was to provide formal and informal continuous support to the mothers and children returning from Hamas captivity throughout their hospitalization and across all areas of the Returning Department (from the moment they woke up in the morning, through mealtimes, medical examinations, challenging nights, medical tests, and also formal and informal therapeutic dialogue and beyond). They carried out this role with deep sensitivity and attentiveness to the unique needs of each returnee. Given the extraordinary circumstances, the social workers were available around the clock to address any arising needs, spending the majority of their time alongside the returnees within the department. The two main objectives of the study are to identify and describe themes related to the personal and professional encounters of the social workers with the returning hostages and their families, and to develop preliminary information that may contribute to the preparation for the anticipated return of the remaining hostages, and similar future events.

Method

Participants

Thirteen of the 15 social workers who accompanied the returning hostages and their families participated in the current study. Their ages ranged from 35 to 65 years. Approximately 10 social workers had 10 to 30 years of professional hospital experience; the remaining three had more than 3 years of hospital experience. Eleven held master's degrees, one had a PhD in the field, and one was a doctoral candidate. All had additional therapeutic training (e.g., family therapy, trauma and crisis interventions, cognitive-behavioral therapy, psychotherapy). All participants were mothers.

Two of the 15 social workers dropped out. Two of the 13 participants chose to partly participate. Their choice was not due to technical issues, and they chose not to elaborate on their choice. Due to the sensitivity of the subject and the fact that the research was conducted at their workplace, it was important for us to allow a sufficiently safe space for those who chose not to drop out or participate partially.

The nature of the research was explained to all participants. Their consent was obtained, and their right to withdraw from the study at any stage they wished was explained. They were informed that participation might evoke emotional difficulties and raise painful experiences and questions. Therefore, they were offered the option of referral to therapeutic services at the hospital, if needed. In addition, the research was submitted to an independent local ethics committee at Rabin Medical Center. To maintain the privacy of the participants, the names shown are fictitious, and identifying details have also been changed.

The qualitative phenomenological approach

The qualitative phenomenological approach focuses on learning about phenomena and situations from the subjective viewpoints of those experiencing these (Smith, 2004). The premise is that human experience has essences shared by different people, including central meanings of the experience as revealed through analyzing experiences of different people in the same context (Creswell, 1998). Alongside shared meanings, human experience includes unique attributes that distinguish one person's experience from another (Moustakas, 1994). The current study explored the unique experiences of the social workers regarding their encounters with the returning hostages and their families during the hospitalization period. Data collection began 2 months after the last returnees were released from the hospital.

Data collection and analysis procedure

The current study utilized two qualitative research tools: the social workers were asked to write about their encounters with the returning hostages and their families, freely and without a page limit. Additionally, they were randomly divided into two groups for semistructured group sessions (five and six in each group, respectively). Two social workers chose to participate in the individual writing task only. The two groups were facilitated by an external researcher—an expert in the field of attachment, and a trained psychotherapist. The group session focused on each of the social worker's most prominent memory from the moment they learned about the intake of the returning hostages and their families, until discharge from the hospital. Memories play a crucial role in life, being part of the personal identity and continuity of a person's sense of self (Habermas & Kober, 2015). In this discussion seven questions were intertwined. These questions were based on attachment theory (e.g., “Did your personality characteristics affect the way you interact with the returnees? and if so, in what ways?”). The duration of each session lasted about 2 hours. The two meetings were recorded with the participants’ consent, and transcribed verbatim.

The analysis focused on both the social workers’ write-ups of their experiences and upon the group sessions. Data analysis was conducted by four analysts including the head of the social service, who did not directly accompany the returnees, a social worker who had taken part in accompanying the returnees (the latter did not take part in the analysis of the descriptions brought by her as a participant), an independent social worker from another department in the hospital, and the external coresearcher, an expert in the field of attachment, psychotherapist, and the moderator of group sessions.

The data analysis process included several stages, starting with comprehensive familiarization with the materials by cross reading all transcripts. In the next stage, ideas, categories, and themes related to the social workers’ experiences with the returning hostages and their families were identified (Preissle, 2006). Subsequently, common features relating to ways of creating personal and professional connections between the social workers and the returning hostages and their families were identified. Finally, these features and ideas were discussed until one major common theme was formulated, reflecting a common process in which each social worker established initial contact in her own unique way.

Throughout the analysis stages, and during the selection of descriptions reflecting the participants’ experiences and the interpretative explanations reflecting these, the researchers adhered to the texts, making rich use of quotations.

The participants and the researchers of the current study referred to the challenging experience of participating and/or researching such a traumatic and complex event in which they were emotionally involved by virtue of being Israeli citizens. Along with the feeling of identification with the anxiety, worry, and pain, as well as the great tension and excitement due to the magnitude of the task, they described feelings of pride, satisfaction, and privilege to be a part of such a significant historic event. Some of them described a self-process of recovery they experienced thanks to their involvement as participants and/or researchers, the reading and analysis processes, the fruitful discussion among the analysis team, and the process of writing the article.

Results

The analysis revealed a central theme: from captivity to liberation: parallel processes in creating connections between different social workers and different returning hostages. This theme reflects a complex internal and external process common to all social workers, beginning with identifying, and simultaneously finding ways to regulate, their personal distress. This calmness allowed the transition to empathy with the returning hostages and their families, creating a parallel process that served as a basis for connection. This conscious presence in parallel space allowed the social workers to move forward to the next stage of emotional–functional intervention. This shared process is manifested uniquely for each participating social worker. Below are some examples.

1. “From excitement to anxiety, from humility to heroism—bridging the gap”:

The initial stage involves the social worker identifying and narrowing the gap between her emotional state and that of her returning hostage. For example, Yael described feeling a gap between her excitement and the perceived distress of her returning hostages upon their arrival:

I almost didn't want to stand by the window (overlooking the landing helicopter). It felt inappropriate. I tried to explain the issue to myself. Why was it inappropriate? I felt there was too much joy. I took a step back, worked with myself to narrow this gap […] My returning hostage was in a bad place at first […] as if she had risen from the dead, from some pit […] A gap between my excitement and her panic. (Yael)

Yael later describes the strategy that helped her narrow the gap. She realized quickly that to leave this parallel state of anxiety panic, she had to “hit reality”:

I was very anxious at the end… The ability to identify parts within me at any given moment helped narrow the gap from joy to anxiety. […] My parallel process with that of the returning hostage and the family, my anxiety, their panic. The girl was terrified, full of lice. I hit reality, Allowing the real, practical reality - cleaning lice. The girl did not resist, and the family, in parallel, immediately moved into a “need to function” mode. (Yael)

Yael described another parallel process, which she called a “parallel dissonance”:

Outside the hospital, people treat me as if I did something heroic, and I don't feel that way. But they also treat the returning hostages as “celebrities” who did something heroic […] I did my job. You've done enough things in your life, difficult things, and suddenly they zoom in on this because it's famous and talked about…? Parallel dissonance. Humility… You must be very, very humble there […] This gap doesn't synchronize for me… [I felt] A sense of guilt, because what did I really do? (Yael)

Yael described the parallel dissonance she felt regarding the issue of “humility—heroism” in the group meeting. According to her, the feeling is of “coming to light.” Due to the publicity and public interest in everything related to the returning hostages, her “regular” and self-evident functioning was interpreted “outside” as heroic. Similarly, the returning hostages “came to light” twice, from the dark captivity and anonymity.

2. “Those from the posters, nowhere to escape—connection to simplicity”:

Another parallel process in creating the connection was identified in Maya's sharing. Perceiving the returning hostages before their arrival as “those from the posters” (pictures of the hostage displayed in Israel and worldwide) made her apprehensive about the meeting. The strategy of focusing on “simple,” and simplifying the task, allowed Maya to create a parallel experience to that of the returning hostages and thus help them effectively. Below are two examples.

Maya described an image that came to her from her previous “simpler” role as a social worker in a boarding school to help herself and thus her returnees perceive “those from the posters” as ordinary, simple people, like herself:

When I arrived at the boarding school in the morning I saw the girls in pajamas, and I told myself this is my job, but these are their lives […] Pajamas, simplicity, work, people […] Then I thought: in my department, they were in pajamas, these are the faces from the posters, and here suddenly with slippers, and these are their lives […] It's the simplest, they are here, and these are people, and you can see and smell them, and they are in pajamas, and they have all kinds of issues. […] As a caregiver, what is care? As in the boarding school world, space and presence are the care, it exists there all the time. From the moment they entered there was a therapeutic space […] the whole facility was care. (Maya)

The following quote also illustrates Maya's simplification strategy in creating a parallel process with her returnee. Maya's choice in leading her returnee to sit on a “simple” bench outside the crowded and well-publicized Returnees Department helped her in providing appropriate and effective help to her returnee. Maya did not remain in her “nowhere to escape” experience, but placed the experience of her returnee at the center, which allowed her to be fully attentive to her needs, and, in return, provide her with responses (functional aspect):

There was constant need to escape from here. My returning hostage was constantly preoccupied with whether there were other emergency exits from which she could leave […] She asked me if I knew of other places to sit. She acted as if she was still in captivity […] She asked for permission to go out to smoke. I took her outside the facility, and we talked there without smoking. […] Regular people, just regular people, who had regular, simple lives, and they tried to bring me (Maya’s experience) into the simplicity of their lives: “Let's order food from Landwer, what do you want?” (Maya)

3. “What comes first? Where to start? So many variables to address—flowchart and prioritization”:

The moment imprinted in Lydia's memory is leaving the elevator and seeing the relatively large number of family members who arrived, immediately flooding her with thoughts about the number of components she “needed to hold,” and the accompanying excitement and anxiety. She described her natural choice to switch to a “flowchart” of prioritizing, which helped her cope. Her account reflects the parallel between her emotional–cognitive experience and that of the family, especially the family matriarch:

I was assigned an extended family. Many variables, some of them lost, others tense and highly excited. Okay, where should we start? I needed to know everyone, contain and give space to each one. Even physically, where to sit? Whom to approach and whom not? They lost part of the family…were they raped? I felt excitement alongside something terrible, anxiety, some uncertainty […] I didn't know, neither did the family. They needed to simultaneously contain so many elements, excitement, worries, losses, and whom to address? To whom to give? With whom to be? I was seemingly in the same state as they were, the feelings and thoughts simultaneously. (Lydia)

She later described the parallel process with the returning mother:

I felt the same in the initial conversation with the mother: “I don't know where to start, I am lost [the mother].” A truly parallel process with her. The moment she looked at me, talked about the family, and wanted to cry, I also wanted to cry, but she held back, and I did too. So much complexity to hold: with whom to start, me and her? With the child who doesn't speak and doesn't want to share? Maybe with the little one? How to hold all this? (Lydia)

From staying in the parallel process, Lydia moved to the next stage:

“Holding this entire flowchart together in hand, head, heart - for them. Transmitting it to them.” She called it: “Exiting the place of getting lost” (Lydia):

First, I gathered the whole family together and started with food and drink. Then, I moved between them according to their body language, sitting next to this one, and that one, then that one […] the first stage of the process with the mother was legitimizing everything she felt, including the things she was ashamed of. Second stage, what is the most urgent for her at any given moment, focus. The mother decided to first focus on how to get organized with the children. (Lydia)

4. “Seeking pure, joyful moments—moments of sanity”:

According to Ronit, what helps her, personally and professionally, is focusing on positive aspects within significant moments. She described a similar process of “distilling” positive feelings and holding these within her prior to the arrival of the returning hostages:

I was full of worries, concerns and deep sadness. Some families lost, some families still with captives. What helped me was distilling pure happy moments […] A video call from returnees to their families shortly after crossing the border into Israel. This was a moment of pure joy, before we discover the harm, the worries, before starting to “do” […] During the landing of the helicopter with the returnees, I consciously focused on the happy moment of togetherness, clapping and being so happy. A moment of grace. This also gave me personally strength to receive them before we all face a very difficult reality. Later I brought the returnees and their family back to these moments –it brought a smile and strengthens them […] I knew in advance that our time was limited, so I distilled this strategy for an initial, limited, concise intervention. (Ronit)

5. “I am with the mother, mother lioness ¹ —and it was right”:

Ruth shared a process of natural connection to the “mother within me” as a strategy that helps her function personally and professionally. Her words reveal a connection between the “mother lioness” she is, and the returning “mother lioness.” During the week she was informed of the fruition of the deal, she felt tense, making it difficult to eat. In addition, on her way to meet her returning mother, she felt tense and thought about having not yet eaten, an emotional–cognitive response reminded her of her reactions as a mother to her children. According to Ruth, this reflection helped her reduce her tension and create openness to a therapeutic connection with the returning mother as a figure who, herself, needed “maternal” care. These internal thoughts also helped Ruth create a parallel process with her returning “lioness mother":

I managed to eat only after the mother started eating. That's me. It's always important to me that my children eat first. I went to prepare a plate for myself only after she ate. I waited until she fell asleep, and then I felt I could return home for a few hours […] During the next day, she described her personal struggle against the horrors she experienced. I held back my tears in front of her, which was hard […] Her desire and need to receive help and proper care for herself and her children indicated that she would be okay […] She revealed herself as a woman with tremendous strength, a “mother lioness,” who did everything to protect her family. Like me, she is an educated mother who is at the center of the home's foundation. (Ruth)

6. “180 Degrees—moving between two beings”:

Naama is our final example. She was assigned to accompany two returning hostages who were fundamentally different in personality, coping methods, and emotional and concrete needs. Her “flexible” attentiveness—the ability to choose different parts of her personality simultaneously and consciously, in line with the personalities and needs of each of the different returning hostages—helped her help them. According to Naama, her primary characteristic in the process of creating an initial connection is first identifying the attributes and awareness level of the person, then locating those impressions within herself and responding accordingly.

Similarly, two different parallel processes occur in creating the connection between Naama and her two different returning hostages. The first process, with the first returning hostage, is characterized initially by Naama's quick identification of the hostage's “survival mechanism”: her quick ability to mobilize strength, courage, and confidence in moving from a state of emotional overwhelm, primarily anger, to a positive adaptive and functioning being.

She was very pleasant and vital […] I'm surprised at how quickly she moves from a state of anger to a “helping mode” […] My feeling is primarily admiration. I'm in awe of her survival mechanisms and her strength, even in the hardest moments in captivity. I observe her courage and confidence and quickly identify and mobilize my similar survival mechanisms. This gave me the courage and strength to connect with and help her. (Naama)

The process with the second returning hostage was entirely different. According to Naama, as she is “a completely different person, and her captivity experience is entirely different.” The following quote illustrates Naama's use of flexibility in her state of consciousness for the sharp transition to the next parallel process:

She seems fragile, and something in her completely different story shatters my sense of security and relief that characterized the connection with the first returning hostage. In conversations with her, she describes difficult moments - the time in the shelter, the abduction, the unimaginable horrors, the strong feeling of abandonment. She is extinguished, sad, and very distressed […] Something in her story resonates with my personal experience of abandonment in my family. It breaks my heart. As the days pass, the connection with her strengthens. When she tells me I have become part of her family, I feel relief, and I can facilitate my place as her caregiver […] The returning hostages struggled to part, and it was difficult for me to part from them as well. The day of discharge was marked by mixed feelings. Her words and strong hug expressed her difficulty in parting. I thought to myself: “I do not abandon my family, friends or patients”, and to her I whispered: I am with you. (Naama)

This example illustrates the extraordinary personal and professional mental flexibility required of the social worker in creating parallel processes with her different returning hostages.

Discussion

This study focused on the encounter with returning hostages from Hamas captivity and their families during hospitalization, from the perspective of the hospital social work team, 2 months following the discharge. This encounter can be challenging, and complex given the extreme and unprecedented event, and the time limitation to the hospitalization period only. The analysis revealed a theme that may reflect a common therapeutic strategy among all the social workers—From captivity to liberation: parallel processes in creating connections between different social workers and different returning hostages. The richness, content, and organization of the descriptions demonstrate an effective internal emotional, reflective, and functional process among the social workers, as well as with the returning hostages and their families. This process contributed to the creation of connections that allowed the return of nascent trust, security, and control among the returning hostages and their families and, in turn, their return to basic life functions such as normative verbal and nonverbal interpersonal communication, sleep habits, nutrition and hygiene, and the beginning of normative parental and child functioning.

This personal and professional process may align with what Bowlby (1980) termed the circle of security. According to Bowlby (1980), the way the attachment figure responds to the child's distress signals has a central impact on regulating the transition from distress to calm, that is, a circular motion between dependence and independence.

In alignment with Bowlby’s circle of security the current study data analysis reveals a new model termed “Security Spiral” ² which illustrates the workers intervention. The model includes four circles of security that the social workers set in motion simultaneously, in a spiral manner. At the base of this first “security spiral” is an internal intrapersonal circle of security among the social workers themselves. The October 7 trauma affected the entire Israeli society, including the social workers in hospitals. The latter's reports indicate an initial process in which they served as their own need for “safe haven,” while identifying their personal distress at each stage, and various strategies that allowed them to quickly regulate it. In a relatively calm emotional and cognitive state, the social workers enable simultaneously to drive the second circle of security, where they served as a “secure base” and “safe haven” for the returning hostages and their families in the initial attachment relationship.

The findings indicate that the social workers’ encounter with the returning hostages and their families began with a process in which they had to identify their own emotional place concerning the events of October 7 in general, and the intake of the returning hostages in particular, simultaneously and at any given moment, as well as assess the emotional state of the families and later, the returning hostages. All participants referred directly and indirectly to a conscious parallel process, an identificatory process they experienced with the returning hostages and the families. This reflective process allowed them to feel and understand the emotional state of the returning hostages and the families and helped them achieve the very important goal in the context of returning from captivity—the return of nascent trust, security, and control on the way to recovery. This finding may support results from studies conducted among trauma victims from unique, “nontrivial” populations (e.g., Balestrery, 2024; Lafit, 2020). These studies suggest that psychological experience gaps between workers and patients can contribute to the loss of trust between patients and the workers.

To serve as a “safe haven” for the returning hostages and their families, the social workers had to leave the “parallel” identificatory place and serve as attachment figures. Their accounts might indicate a reflective process of emotional, cognitive, and sometimes reactive regulation to find the balance between identification and empathy. This helped the social workers remember that the returning hostages are the focus, not themselves; to center the experience of the latter and their families, to be fully attentive to all their needs, and to provide appropriate therapeutic responses. The data analysis illustrates how the social workers’ simultaneous activation of two “circles of security” catalyzed the broader “security spiral.”

A third circle emerged—within which the families could serve as a “safe haven” and “secure base” for their returning hostages, based on the trust and security established with the social workers. For example, a preliminary conversation between a social worker and family members led to an effective intervention by the family members with their returning hostage when she expressed distress, and they managed to regulate their overwhelming emotions and focus on calming her. Similarly, a fourth circle was set in motion, within which the returning mothers could return to serve as a “safe haven” and “secure base” for their children in the most basic routine functions. The circumstances during captivity forced them to adapt to these functions in the absence of “shelter” and security, and under constant existential threat. The findings indicate that upon their return from captivity with their children, the nascent trust and security in the relationship with the social workers in the therapeutic space helped them return to these functions for their children in routine functions such as setting boundaries and routine agenda. The social workers contained and normalized the difficult feelings and thoughts the mothers expressed (second circle), a response that contributed to the regulation of the difficult feelings and thoughts which, in turn, helped the mothers themselves contain and normalize their children's responses (fourth circle).

Like other studies among trauma victims from unique populations (Balestrery, 2024; Lafit, 2020), the findings of the current study demonstrate gaps between the psychological experience of the social workers and that of the returning hostages and their families. As mentioned, narrowing these gaps was made possible through the parallel process. The data analysis reveals differences among the social workers in the ways of creating the parallel process, as described in detail in their accounts.

Similarly, in moving to strategic and functional aspects, all the social workers reported constant and at any given moment thinking and reflection processes, but differed in their thinking, action, and functional strategies, as can be seen from their accounts. These differences may lie in interpersonal differences between them in the characteristics of their interactions with their attachment figures. According to Bowlby (1973), different types of responsive/available interactions with attachment figures during distress contribute to optimal functioning and promote a sense of security in attachment.

According to Bowlby (1980), one of the characteristics of “attachment” refers to a long-term, not momentary or transient, relationship. That is, the formation of a “circle of security” involves a collection of interactions in the relationship over an extended period. Unlike this claim, the findings of the current study suggest the nascent formation of a “circle of security” in the relationship of the social workers with the returning hostages and their families in a very limited time, despite the collapse of feelings of trust, control, and security due to the trauma of abduction and captivity. The nonstandard characteristics of the intervention and its outcomes within the framework of this unusual and unprecedented event may explain this phenomenon—the responsiveness and availability of the social workers to the needs of the returning hostages and their families around the clock, and in all areas of the facility during the entire hospitalization period, their emotional, cognitive, and functional flexibility at any given moment and in a new situation, the nascent trust and security expressed by the returning hostages and families in their response to the initial connection with the social workers, the intimate conversations created with most, expressions of seeking security and comfort from the social workers, turning to them for help, mutual difficulty during separation. All these may align with studies suggesting that secure attachment in children and adults is associated with regulatory efforts and situational assessment in distress, characterized by balance, cognitive flexibility, relatively low levels of stress and distress, and effective interpersonal communication, strengthening relationships and using these as a source of support (Granqvist et al., 2012).

The strategies described by the social workers in the current study are similar to findings of studies that examined “connection conversation” skills of teams, including social workers in public hospitals, with trauma victims from unique populations (Balestrery, 2024; Herek, 2016; Lin et al., 2016). These skills include conversations focusing on the life experiences of the patients, life events that led to their current state, how the past exists in the here and now, the patients’ preferences, and changing institutional policies and practices according to the special needs and desires of the patients and their families. These studies also indicate that “connection conversation” skills during and after the first medical encounter, while moving, learning, and growing, contribute to increasing the sense of security and trust and improving intervention outcomes. This finding supports the findings of the current study regarding the contribution of the parallel process in creating the connection to expressions of nascent trust and security in the relationships of the social workers with the returning hostages and their families, and their return to basic routine functions, within the short hospitalization period.

Limitations

The study findings regarding the establishment of nascent security, control, and trust between the social workers and the returning hostages and their families during the short hospitalization period may align with the 50 day duration of captivity. At the time of writing this article, many hostages of various ages have been held by Hamas for over 250 days. Therefore, a more in-depth consideration of the hospitalization period and the ways to establish nascent trust and security among future returning hostages with the social work team and their families will be necessary. Future research with this, and similar, populations should address this.

Second, the current study is based on qualitative data analysis. Future research should include quantitative measures, such as questionnaires, to generalize the findings to similar populations. The study sample is unique, specific, and small, relying on self-reports by the social workers and the analysis of group sessions. A larger sample and a broader range of tools would enhance the data and provide validity and reliability.

The current study was conducted from the perspective of attachment theory and research. In future research it is important to study this topic from additional perspectives related to crisis work, trauma-informed practice, some consideration of the possibilities of vicarious trauma and secondary traumatic stress, and resilience.

In addition, the current study focusses upon female hostages and female social workers. Future research should also address male hostages and male social workers and take into consideration the social workers’ need for support within the organizations, from supervisors, team colleagues, and workers’ family and friends. Clearly, more research is also needed about the feelings and experiences of the hostages themselves and their experiences with social workers.

The current study was conducted as part of the first release of the hostages from Hamas captivity. These hostages were released in a hostages–prisoners’ exchange. Later, several hostages were rescued by the Israeli army. Therefore, it is worthwhile to examine the relationship between the rescue method and attachment characteristics and the role of previous attachment patterns, among both the social workers and the returnees.

Conclusions

The October 7 event is unprecedented in its scale, traumatic characteristics, complexity, and the need to work with this unique group of hostages with a lack of prior research and clinical knowledge, within a constrained environment and a short hospitalization period. The current study findings may shed light on factors that aid the initial intervention by social work teams with returning hostages and their families during hospitalization and help develop an intervention plan for “new” returning hostages rescued from captivity, the remaining hostages (when they return), and similar future events.

One unique aspect of intervention with returning hostages from Hamas captivity and their families is that while they were hospitalized and received medical treatment, the primary need was emotional–functional intervention. Logically and appropriately, given the unique characteristics of the trauma, the brutal abduction, and the harsh captivity under Hamas, the social workers had to address the returning hostages’ collapse of basic existential feelings of trust, control, and security in themselves, others, the military, the state, and the world. Therefore, in the planning and guidance processes of the social services in hospitals for the arrival of trauma victims with similar characteristics to those of October 7, it is critical to consider initial attachment processes between the social workers and the returning hostages and their families.

The findings of the current study indicate the importance of considering the “parallel process” in creating the connection, the “spiral of circles of security,” reflective processes, each caregiver's unique way of creating a connection, in preparation for similar cases. Peer learning among social workers regarding different methods to enrich the range of helping possibilities, and, thereby, increasing the likelihood of more effective interventions should also be considered.

Due to the nature of the events, the greatest attachment-related injury might lie in the returning hostages’ sense of abandonment by the military and the State, for example, to whom they previously relied almost without question. The study findings suggest the effectiveness of the social workers’ intervention strategy in creating a close and quality connection with the returning hostages and their families may highlight the importance of their role in enabling the returning hostages to rebuild the feeling that there is someone on whom to rely regarding the other (individuals and/or services from the State) and the world. This feeling is crucial to restore resilience, and the ability to return to adaptive functioning in various life areas, also outside the family circle (e.g., Cetorelli et al., 2017; Mikulincer & Shaver, 2007; Shaver & Mikulincer, 2013).

In the family context, unlike their possible contribution to rebuilding nascent trust in the other and the State—the social workers may also contribute to accelerating the recall/activation of precaptivity attachment roles of the family members toward the returning hostages, and of the returning mothers toward their returning children.

From the social workers’ perspective, the Department for Returning Hostages served as a single bounded therapeutic space, which helped them “hold” their parallel experiential and attachment process with the returning hostages and provide appropriate professional responses anywhere and anytime during hospitalization. This point should be highlighted as an intervention optimization strategy for similar cases.

Extensive consideration of the processes of creating a quality initial connection between social workers and returning hostages gains additional significance in light of studies examining the long-term implications of secure attachment among refugees from northern Iraq, who were exposed to abduction, captivity, and brutal violence by ISIS (Cetorelli et al., 2017; Tagay et al., 2017; Tekin et al., 2016), and trauma victims who were prisoners of war (Dieperink et al., 2021). Secure attachment among the workers teams and between these and the patients in these studies was associated with the absence of long-term mental illness, including the restoration of resilience, prevention of secondary traumatization, and prevention of PTSD.

The current study makes two main theoretical contributions. As mentioned above, findings indicate the feasibility of establishing security in the connection in a short period of time. The second aspect refers to the “security spiral” model as a possible extension of Bowlby's “circle of security.” Attachment researchers (e.g., Mikulincer & Shaver, 2007; Shaver & Mikulincer, 2013) discuss the sense of secure attachment separately at each developmental stage throughout life. These researchers refer to the implications of the circle of security early in life on the later circles within and beyond the family context. The current study's “security spiral” model consists of four concentric circles of security that operate simultaneously within the same limited time, frame, and space.