Bowlby's attachment theory describes characteristic patterns of relating to close others and has important implications for psychotherapy. Attachment patterns have been characterized as secure (healthy interdependence with others), anxious (overdependence on others), and avoidant (difficulty relying on others). We update a previous meta-analysis to determine the association of patient attachment with psychotherapy outcome. Metaanalysis of 36 studies (3,158 patients) suggested that patients with secure attachment pretreatment show better psychotherapy outcome than insecurely attached patients. Further, improvements in attachment security during therapy may coincide with better treatment outcome. Finally, preliminary moderator analyses suggest that those who experience low pretreatment attachment security may find better treatment outcome in therapy that incorporates a focus on interpersonal interactions and close relationships. The article closes with research limitations, diversity considerations, and therapeutic practices.K E Y W O R D S attachment style, meta-analysis, psychotherapy outcome, psychotherapy relationship 1 | INTRODUCTION Attachment theory, originally developed by John Bowlby to explain human bonding, has profound implications for conducting and adapting psychotherapy. The concept of attachment style refers to a person's characteristic ways of relating in intimate relationships with "attachment figures." Attachment style involves one's confidence in the

Attachment theory, developed by Bowlby to explain human bonding, has profound implications for conducting and adapting psychotherapy. We summarize the prevailing definitions and measures of attachment style. We review the results of three meta‐analyses examining the association between attachment anxiety, avoidance, and security and psychotherapy outcome. Fourteen studies were synthesized, which included 19 separate therapy cohorts with a combined sample size of 1,467. Attachment anxiety showed a d of −.46 with posttherapy outcome, while attachment security showed a d of.37 association with outcome. Attachment avoidance was uncorrelated with outcome. The age and gender composition of the samples moderated the relation between attachment security and outcome: samples with a higher proportion of female clients and a higher mean age showed a smaller relation between security and outcome. We discuss the practice implications of these findings and related research on the link between attachment and the therapy relationship. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 67:193–203, 2011.

No abstract

In a 5-year follow-up assessment, 33 students who had taken an undergraduate helping skills course indicated that they had continued to use the helping skills in both their professional lives and personal relationships. On average, there were no significant changes from pretraining to follow-up on empathy, natural helping ability, or facilitative interpersonal skills. Furthermore, although students had increased in self-efficacy for using the skills during training, on average they maintained their self-efficacy levels at the follow-up. The 15 participants who had further mental health education, however, scored higher at follow-up on empathy, natural helping ability, self-efficacy for using the skills, and facilitative interpersonal skills compared with the 18 participants who had no further mental health education (controlling for pretraining levels), suggesting that continued exposure to and practice using the skills helped them continue to improve their helping abilities. Qualitative data indicated that participants typically had positive experiences in the helping skills course. Implications for training and research are provided. Public Significance StatementParticipants reported that they used the helping skills in both their professional and personal lives 5 years after training, suggesting that the effects of helping skills training extend over time. Furthermore, those who pursued further mental health education continued to improve in their helping abilities more than did those who did not continue further mental health education.

No abstract