Attachment style and clinical outcome within a DBT-informed Therapeutic Community

Abstract

Purpose There is evidence that attachment style and clinical outcomes are related within Therapeutic Communities (TCs). This paper aims to examine any possible relationships between self-reported adult attachment style, therapy programme engagement and measures of psychological distress and dissociation on admission and discharge within a residential TC. Design/methodology/approach Ex-clients of the TC were contacted by post and invited to take part in this service evaluation. Additional data were sourced from a database of routinely collected outcome measures. Of 281 ex-clients, the final sample in this study was N = 32. Findings When attachment style is conceptualised dimensionally, participants identified most strongly with a fearful attachment style, and least with a preoccupied or secure style. A range of attachment styles were reported. A significant association was apparent between self-reported secure attachment and reduced levels of psychological distress upon discharge from the TC. The potential for changes in client attachment patterns following TC membership is discussed. Research limitations/implications The small sample size and correlational nature of this study means that results should be interpreted cautiously. Nevertheless, results are of clinical relevance for inpatient or residential therapy programmes (including TCs). Such programmes should routinely assess client attachment style to ensure appropriate interventions and adaptions are implemented. Originality/value To the best of the authors’ knowledge, to date, this is the first known study to report on the relationship between self-reported adult attachment style and psychological outcomes specifically for women with self-defeating behaviours within a TC.

Unboxing the therapeutic community for addictions: a locus-of-hope theory perspective

“…Another study also reported positive attachment change in ex-offenders with substance use problems undergoing a TC program (Miller and Klockner, 2019). More recently, it was found that secure attachment is connected to lower psychological distress among TC graduates (Dunlop and McFetridge, 2020). Meanwhile, TCs in prison settings advocated a communal experience of hope (Williams and Winship, 2018).…”