Pseudosecure vs. individuated-secure client attachment to therapist: Implications for therapy process and outcome

Abstract

Clients with pre-therapy Avoidant attachment who nevertheless "earn" individuated-secure attachment to their therapist appear to benefit more from therapy.

Suppressor effects in associations between patient attachment to therapist and psychotherapy outcome

“…Therefore, we explored the associations between secure, preoccupied, and avoidant attachment to therapist in more detail with a larger inpatient sample. Based on the results by Mallinckrodt et al () and the reflections on avoidant attachment in the passage above, the following research questions and hypotheses were addressed: On the basis of the Mallinckrodt et al's () findings, we expected that more secure attachment to therapist is associated with a more favourable outcome but that more avoidant and more preoccupied attachment to therapist is associated with a less favourable outcome. On the basis of the Mallinckrodt et al's () findings, we expected that preoccupied attachment to therapist suppresses the association between secure attachment and psychotherapy outcome. On the basis of the argumentation in Section , we expected that avoidant attachment to therapist suppresses the association between secure attachment and psychotherapy outcome. In an explorative analysis, we evaluated which patient attachment to therapist dimension remains significantly associated with the outcome when statistically controlling for the other two patient attachment to therapist dimensions. …”

“…Moreover, we were interested in the question if pseudo‐security is related to preoccupied attachment to therapist and/or avoidant attachment to therapist. Mallinckrodt et al () reported that preoccupied attachment to therapist suppressed the association between secure attachment to therapist and the outcome in most studies but not in an inpatient sample. Therefore, we explored the associations between secure, preoccupied, and avoidant attachment to therapist in more detail with a larger inpatient sample.…”

“…Reviews reported that patient attachment styles and therapist attachment styles influence the alliance and the outcome (Daniel, ; Degnan, Seymour‐Hyde, Harris, & Berry, ; Diener & Monroe, ). The attachment the patient has with the therapist influences psychotherapy processes and outcomes as well (see Mallinckrodt et al, , for an overview). Secure attachment to therapist correlated with a more favourable outcome, whereas preoccupied and avoidant attachment to therapist were associated with a less favourable outcome.…”

“…Mallinckrodt et al () proposed a distinction between individuated‐secure and pseudo‐secure attachment to the therapist. Patients with pseudo‐secure and individuated‐secure attachment to therapist present some similar features, especially in the early sessions.…”

“…Patients with pseudo‐secure and individuated‐secure attachment to therapist present some similar features, especially in the early sessions. For example, both types of patients appear to bond easily, self‐disclose readily, regard their therapist in strongly positive terms, and place high value on the therapeutic relationship (Mallinckrodt et al, ). A crucial difference is that patients with a pseudo‐security pattern but not patients with an individuated‐security pattern idealize their therapists.…”