Predictive Validity of Patient and Therapist Attachment and Introject Styles (original) (raw)
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Journal of the Medical Association of Thailand Chotmaihet Thangphaet, 2012
Objective: Explore how therapist's interpersonal and attachment styles have an impact upon both the therapeutic alliance formed and therapy outcomes. Material and Method: One hundred twenty one outpatients attending for routine psychiatric services were monitored for symptom outcomes, comprising depression, anxiety, and interpersonal problems. Patients were also asked about the level of therapeutic alliance that had been formed, covering goals, tasks, and the bond developed, using the Working Alliance Inventory (WAI). At the same time, the participating therapists reported upon their interpersonal styles by categorizing them into domineering or submissive styles using the IIP-32 questionnaire and their attachment styles by categorizing them into secure or preoccupied styles using the ECR-R. To explore therapist factors such as interpersonal and attachment styles, as well as to establish the presence of gender matching, the working alliance was used as a dependent variable. Results: Multivariate analysis revealed that neither the gender of the therapist nor the gender of the patient, or the therapists' styles, had an effect on the Working alliance or working outcomes. The multivariate test for WAI-goal (Wilks' Lambda F (3, 134) = 4.24, p = 0.007), interpersonal style (Wilks' Lambda F (3, 134) = 2.77, p = 0.044), attachment style (Wilks' Lambda F (3, 134) = 2.76, p = 0.045) and IIP-Style*Attachment Style (Wilks' Lambda F (3, 134) = 3.13, p = 0.028) produced statistically significant results, while working alliance-goal was the only predictor of the level of anxiety and depression in patients (p = 0.014 and p = 0.002, respectively). Submissive style was positively correlated to anxiety (p = 0.011) and interpersonal difficulties (p = 0.006), whilst surprisingly, a secure attachment style was found to have a positive correlation with anxiety and depression. However, when both styles were combined, the resulting style negatively predicted anxiety (p = 0.002). Conclusion: Therapist factors were found to have no effect on working alliance, as reported by the patients; however, it was reported that when the therapists employed a secure or submissive attachment style, this played a role in helping to reduce symptoms. The working alliance-goal element was found to be a predictor of a reduction in levels of both anxiety and depression among patients.
Psychology and Psychotherapy: Theory, Research and Practice, 2005
The aims of this study were to explore the relationship between therapists' selfreported attachment styles and therapeutic orientation with the self-reported general therapeutic alliance and therapist-reported problems in psychological therapy. A sample of 491 psychotherapists from differing therapeutic orientations responded to a postal questionnaire. The questionnaire contained standardized measures of therapeutic alliance quality, attachment behaviours, a checklist of problems in therapy, and a brief personality inventory. Therapist-reported attachment styles generally explained a significant additional proportion of the variance in alliance and problems in therapy, over and above variance explained by general personality variables. Self-reported secure attachment style was significantly positively correlated with therapist-reported general good alliance. Self-reported anxious attachment styles were significantly negatively correlated with good alliance, and significantly positively correlated with the number of therapistreported problems in therapy. Therapeutic orientation independently predicted a small but significant amount of the variance in reported general alliance quality in addition to that explained by attachment behaviours. It is now widely believed that comparable outcomes are achieved by different therapies despite differences in their underlying assumptions about the development of psychological dysfunction, and in therapeutic techniques employed (e.g. Horvath &
Journal of personality assessment, 2017
The aim of this study was to examine the factor structure and the psychometric properties of the Psychotherapy Relationship Questionnaire (PRQ; Bradley, Heim, & Westen, 2005 ), a clinician report instrument that measures a wide spectrum of thoughts, feelings, motives, conflicts, and behaviors expressed by patients toward their therapists in psychotherapy. A national sample of psychiatrists and clinical psychologists (N = 314) of different theoretical orientations completed the PRQ, as well as the Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen & Shedler, 1999a , 1999b ) to assess the personality of a patient in their care. Factor-analytic procedures identified 6 transference dimensions that showed excellent internal consistencies: (a) hostile, (b) positive/working alliance, (c) special/entitled, (d) anxious/preoccupied, (e) avoidant/dismissing attachment, and (f) sexualized. Factor scores were significantly related to patients' personality characteristics and psychol...
E-Journal of Applied Psychology, 2012
Attachment theory is an encompassing theory for understanding human reactions to life stressors, such as loss and separation, and interpersonal problems are common reasons for seeking psychotherapy. Psychotherapy may be an opportunity to revise insecure attachment and handle interpersonal problems. This study examined attachment styles and interpersonal problems in a clinical sample of psychotherapy patients (n = 168) at the start of psychotherapy. The main aim was to study how self-reported attachment styles, measured by the Attachment Style Questionnaire (ASQ), correlated with interpersonal problems measured using the Inventory of Interpersonal Problems (IIP). Avoidant-related and anxious-related attachment scales correlated positively to the total IIP scores. Inconsistent with findings in nonclinical samples, specific interpersonal problems in the dominant and affiliative parts of the IIP correlated positively to both the anxious-related and the avoidantrelated attachment scales. The findings imply that a challenge for the therapist at the start of psychotherapy is to balance providing security with encouraging exploration of feelings, thoughts, and behaviour in the patient's interpersonal problems in current relationships. Exploring individual profiles of attachment styles helps to clarify motives in expressed interpersonal problems.
Psychotherapy, 2014
The purpose of this study was to test the notion that complementary attachments are best for achieving a secure base in psychotherapy. Specifically, we predicted third to fifth session alliance from client-and therapist-rated attachment style interactions. Using a combined sample of 46 therapy dyads from a community mental health clinic and university counseling center, the client-and therapist-perceived therapy alliance, attachment anxiety, and attachment avoidance were examined at the beginning of therapy. The results of an Actor-Partner Interdependence Model (APIM; Kenny & Cook, 1999, Partner effects in relationship research: Conceptual issues, analytic difficulties, and illustrations. Personal Relationships, 6,[433][434][435][436][437][438][439][440][441][442][443][444][445][446][447][448] indicated that there was no direct effect of either client or therapist attachment style on therapist or client early ratings of the alliance. One significant interaction emerged and indicated that client-perceived alliance was influenced by therapist and client attachment anxiety. The client-perceived early alliance was higher when more anxious therapists worked with clients with decreasing anxiety. The client early alliance was higher when less anxious therapists worked with clients with increasing anxiety. The findings partially support the notion that different attachment configurations between the therapist and client facilitate greater alliance, but this was the case only when assessing client-perceived early alliance and only with regards to the dimension of attachment anxiety. There were no significant main effects or interactions when exploring therapist-perceived alliance. Implications of the findings are discussed along with recommendations for future study and clinical training.
Psychotherapy Research, 2006
The authors evaluated 617 patients at hospital admission using an interpersonal interview analyzed with the Adult Attachment Prototype Rating in nine different psychotherapeutic hospitals. Attachment characteristics derived from this method served as predictors of treatment outcome. Outcome was quantified in all sites using the Symptom Checklist-90-Revised, Inventory of Interpersonal Problems, and, in a subsample, the Impairment Score (Schepank, 2003) as an observer rating. All measures were administered at patient admission and discharge. Additionally, patients completed the Bielefeld Questionnaire of Client Expectations (BQCE) at admission to assess self-reported attachment expectations toward the therapist. The study combined patients with a variety of clinical disorders (predominantly depressive and anxiety disorders, personality disorders, eating disorders) and confirmed the expected correlations of attachment characteristics with diagnoses and other clinical variables (symptoms, interpersonal problems). Independent of study site, attachment strategies obtained with the prototype rating proved to be largely insignificant in predicting treatment outcome. In contrast, the patient self-reports using the BQCE predicted treatment outcome: Secure patients indicated the greatest benefit from inpatient (group) psychotherapy in most of the outcome measures, whereas preoccupied Áambivalent patients showed less improvement.
Psychotherapy Research, 2007
The aim of this study was to investigate the importance of therapists' and patients' interpersonal problems as well as the impact of the therapeutic alliance on symptomatic outcome in psychotherapy. Of interest were direct effects of interpersonal problems, represented through the dimensions of affiliation and control, as well as possible interaction effects between patient and therapist variables on outcome. Further hypotheses referred to therapist differences in the predictive impact of the therapeutic alliance for outcome. Outcome ratings of 1,513 psychotherapy inpatients treated by 31 psychodynamically oriented individual psychotherapists were studied. Therapists' and patients' interpersonal dispositions were assessed with the Inventory of Interpersonal Problems, and patients answered standardized outcome measures before and after therapy and retrospectively evaluated the therapeutic alliance at discharge. The results indicate that dominant patients profited better from their therapy and that therapists' interpersonal disposition did not have a direct influence on outcome. The influence of the therapeutic alliance on outcome varied among the therapists. The general positive effect of therapeutic alliance on outcome was stronger for less affiliative therapists. Limitations of the study and implications of the results are discussed.