Attachment Style

Abstract

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.

Effectiveness of the ‘Hold me Tight’ Relationship Enhancement Program in a Self‐referred and a Clinician‐referred Sample: An Emotionally Focused Couples Therapy‐Based Approach

“…() and Levy et al. (), who found insecure attachment to be negatively related with outcome, but contradicts with findings reported by Wiebe and Johnson (). We conjecture that these contradictory findings may be explained by a severity effect.…”

“…Research about associations between baseline insecure attachment or relational distress on the one hand, and treatment outcome on the other, is inconclusive. Insecure attachment was shown to have negative relations with outcome in a meta‐analysis on individual therapy (Levy, Ellison, Scott, & Bernecker, ) and a study on couples therapy (Conradi, De Jonge, Neeleman, Simons, & Sytema, ), while others found positive associations in couples therapy (c.f. Wiebe & Johnson, ).…”

Attachment style among outpatients with substance use disorders in psychological treatment

“…Meyer, Pilkonis, Proietti, Heape, and Egan (), following 149 psychiatric patients treated with psychotherapy and/or pharmacotherapy, found better treatment outcome for the patients initially classified as secure. A review of three meta‐analyses counting fourteen outcome studies ( n = 1,467) also reported better treatment outcome for patients with secure attachment, while a high anxious attachment predicted worse outcome in psychotherapy (Levy, Ellison, Scott, & Bernecker, ). Attachment style may be seen as moderating and mediating variables, and as a meaningful outcome in itself, in complement to symptom change (Daniel, ).…”

The role of attachment characteristics in dialectical behavior therapy for patients with borderline personality disorder

“…With respect to borderline pathology, all attachment studies using interview measures (George & West, , ; Main & Goldwyn, /1988/1996) and half of the attachment‐style studies reported a strong association between borderline personality disorder (BPD) and indices of disorganized attachment with unresolved trauma, often combined with preoccupied or fearful attachment strategies (Agrawal, Gunderson, Holmes, & Lyons‐Ruth, ; Bakermans‐Kranenburg & van IJzendoorn, ; Buchheim et al, ; Buchheim & George, ; Levy et al, ). Several studies have examined how attachment representations or styles may relate to the psychotherapy outcome (e.g., Levy, Ellison, Scott, & Bernecker, ; Taylor, Rietzschel, Danquah, & Berry, ). In various studies, successful psychodynamic psychotherapy was associated with a secure or organized attachment representation (Buchheim et al, , ; Levy et al, ) or style (Meyer, Pilkonis, Proietti, Heape, & Egan, ; Mosheim et al, ; Stefini et al, ; Strauss et al, ).…”