The Insecure Psychotherapy Base: Using Client and Therapist Attachment Styles to Understand the Early Alliance (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 &
Evidence-Based Therapy Relationships: Research Conclusions and Clinical Practices
In this closing article of the special issue, we present the conclusions and recommendations of the interdivisional task force on evidence-based therapy relationships. The work was based on a series of meta-analyses conducted on the effectiveness of various relationship elements and methods of treatment adaptation. A panel of experts concluded that several relationship elements were demonstrably effective (alliance in individual psychotherapy, alliance in youth psychotherapy, alliance in family therapy, cohesion in group therapy, empathy, collecting client feedback) while others were probably effective (goal consensus, collaboration, positive regard). Three other relationship elements (congruence/genuineness, repairing alliance ruptures, and managing countertransference) were deemed promising but had insufficient evidence to conclude that they were effective. Multiple recommendations for practice, training, research, and policy are advanced.
Changing Attachments: The Client-Therapist Relationship and Outcome
2020
From the perspective of attachment theory (Bowlby, 1988), this study examined if client attachment to therapist developed over the course of psychotherapy and if changes in attachment to therapist were associated with treatment outcomes. Clients (N = 112), receiving psychodynamic therapy from trainee therapists (N = 29), completed the Client Attachment to Therapist Scale (Mallinckrodt, Gantt, & Coble, 1995) and the Outcome Questionnaire-45 (Lambert et al., 1996) at baseline and every eighth session. Multilevel linear growth curve analyses showed that secure attachment to therapist increased and avoidant-fearful attachment to therapist decreased. Multilevel linear regression showed that when within-client secure attachment to therapist was higher, subsequent symptoms improved more. Clientlevel and therapist-level effects were explored. Results suggest that the development of a secure attachment to therapist is important for positive treatment outcomes. Implications for practice and research are discussed.
The Effect of Attachment on the Therapeutic Alliance in Couples Therapy
2013
The Effect of Attachment on the Therapeutic Alliance in Couples Therapy Shawn A. Bills School of Family Life, BYU Master of Science There is substantial evidence that the strength of the therapeutic alliance in couples therapy is predictive of successful treatment outcome. However, little research has examined the factors that predict a strong therapeutic alliance in couples therapy. With evidence indicating that attachment styles play an important role in the development of healthy adult relationships, it was hypothesized that the attachment styles of partners in couples therapy would predict the development of a strong therapeutic alliance. Data from 115 heterosexual couples seen at a university-based MFT clinic in the southeastern region of the U.S. were used to test this hypothesis. Using multiple regression, results generally found that attachment styles generally predicted the therapeutic alliance among women, but there was only limited support among men. The results of the st...
Predictive Validity of Patient and Therapist Attachment and Introject Styles
American Journal of Psychotherapy, 2006
This study assessed introject and attachment styles of patients and therapists, and the match of these styles in patient/therapist dyads, to determine their relation to various psychotherapy process and outcome measures. The IN TREX was used to measure introject style (affiliation and autonomy) and the Relationship Scale Questionaire to measure attachment style (secure, fearfu preoccupied, dismissing). Therapists with more affiliative (self loving) and secure styles achieve better outcome results compared to therapists with les affiliative (self hating) and insecure styles. Further, the greater the difference in introject and attachment styles within the patient/therapist dyad, the better the outcome. There is a considerable body of evidence that a significant proportion of patients fail to benefit from psychotherapy. Treatment failure can occur for a number of reasons, including dissonance in the therapeutic relationship, inadequate or poor treatment, therapist problems, personality styles of therapist and patient, premature drop-out (Wierzbicki & Perkarik, 1993; Westin & Morrison, 2001), and many other possible causes. Personality traits of patients and therapists have received a lot of attention in an attempt to identify factors in predicting the development of a working alliance and in contributing to improved therapy process and outcome. Studies using interpersonal circumplex models found that hostile-dominant patient problems were negatively related to the alliance, while friendly-submissive problems were positively related to both alliance and outcome (
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International Journal of Offender Therapy and Comparative Criminology, 2013
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