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Content and FocusIn counselling psychology the therapeutic relationship is considered as one of the most fundamental aspects of psychological therapy. It can be argued that cognitive behavioural therapy (CBT) is a therapeutic modality which has given more attention to techniques and ‘doing’ therapy, rather than the therapeutic relationship itself. Unsurprisingly, this raises some questions on the use of the therapeutic relationship, especially when working purely from a CBT perspective. The current paper aims to briefly review how the therapeutic relationship is operating in CBT, and furthermore to discuss how attachment theory can inform the practice of counselling psychologists who work with CBT. For the purpose of this paper, I will discuss a composite client presentation based upon my clinical work with an individual who I have named ‘Tom’.ConclusionsOn the basis of the existing literature, it can be understood that views such as ‘the therapeutic relationship in CBT is necessary but not sufficient to bring about change’, are continuously changing. Therefore, the need for counselling psychologists who practise CBT in having a more relational focus in their practice is essential and attachment theory can assist them in working more with the therapeutic relationship.

Content and FocusThere is an ongoing debate about how practitioners understand ‘mental disorders’ in terms of assessment, formulation and treatment. The current diagnostic procedures are defined by rule-based classifications that largely rely on symptom clusters, such as the Diagnostic and Statistical Manual of mental disorders (DSM) and the International Classification of Diseases (ICD), and are influenced by the medical model which supports the concept of nosology. Under this notion, psychological difficulties are seen as pathological and, therefore, questions are raised about what is ‘normal’ and ‘abnormal’. The aim of this paper is to make a critique on the use of standard psychopathological classifications in understanding human distress and the example of so-called schizoid personality disorder will be discussed in non-conventional psychiatric terms. Additionally, a formulation-driven approach which derives from the basic tenets of attachment theory will be utilised to understand schizoid personality disorder. Considerations for counselling psychology practice are also discussed in light of an integrative therapeutic framework, which brings together concepts from Cognitive Behavioural Therapy (CBT) and psychodynamic therapy.ConclusionsThe current psychopathological classifications provide a descriptive guidance on labelling symptoms but the limited attention paid on the aetiology of disorders raises important questions. A need for revision of what constitutes a psychiatric ‘illness’ is apparent and furthermore the inclusion of a formulationdriven approach in the psychopathological manuals can be invaluable as it can offer a heuristic focus in understanding human psychological distress.

Content and FocusThere is an ongoing debate about how practitioners understand ‘mental disorders’ in terms of assessment, formulation and treatment. The current diagnostic procedures are defined by rule-based classifications that largely rely on symptom clusters, such as the Diagnostic and Statistical Manual of mental disorders (DSM) and the International Classification of Diseases (ICD), and are influenced by the medical model which supports the concept of nosology. Under this notion, psychological difficulties are seen as pathological and, therefore, questions are raised about what is ‘normal’ and ‘abnormal’. The aim of this paper is to make a critique on the use of standard psychopathological classifications in understanding human distress and the example of so-called schizoid personality disorder will be discussed in non-conventional psychiatric terms. Additionally, a formulation-driven approach which derives from the basic tenets of attachment theory will be utilised to understand schizoid personality disorder. Considerations for counselling psychology practice are also discussed in light of an integrative therapeutic framework, which brings together concepts from Cognitive Behavioural Therapy (CBT) and psychodynamic therapy.ConclusionsThe current psychopathological classifications provide a descriptive guidance on labelling symptoms but the limited attention paid on the aetiology of disorders raises important questions. A need for revision of what constitutes a psychiatric ‘illness’ is apparent and furthermore the inclusion of a formulationdriven approach in the psychopathological manuals can be invaluable as it can offer a heuristic focus in understanding human psychological distress.

Content & FocusThe last two decades, in particular, have witnessed an increased interest in the clinical implications of attachment theory in individual adult psychotherapy. By and large, the majority of empirical studies on the importance of adult attachment patterns in individual psychotherapy have focused on exploring the effect of clients’ attachment organisation. The present paper reviewed the existing literature on the effects of therapists’ attachment organisation on the process and outcome of therapy. In particular, 14 known studies were reviewed, exploring how trainee and qualified therapists’, as well as other clinicians’, attachment styles could influence the working alliance, the depth of their interventions, their emotional empathy and psychological mindedness, their countertransference behaviours towards clients and finally the outcome of therapy.ConclusionsFindings from these studies showed that a secure attachment organisation in therapists could positively affect the process and outcome of therapy, whilst an insecure attachment organisation was negatively associated with both process and outcome of therapy. Nevertheless, a few studies provided us with different results. Overall, it can be suggested that the relationship between therapists’ attachment and the process of therapy is not as simple as we assume because other factors may interfere in this relationship.The findings, the methodological characteristics and limitations of the 14 reviewed studies are discussed throughout this paper.