The Role of Therapist Attachment in Alliance and Outcome: A Systematic Literature Review

Degnan, Amy; Seymour-Hyde, Annily; Harris, Alison; Berry, Katherine

doi:10.1002/cpp.1937

Cited by 84 publications

(61 citation statements)

References 49 publications

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“…Most notably, the fact that attachment theory is a universal theory of relationships, which applies to both voice hearers and mental health workers alike and emphasizes the functional nature of insecure attachment styles in the context of earlier relationships means that it has the potential to be less pathologizing than other models. Relatedly, attachment theory also provides a framework for conceptualizing the role of the mental health workers’ own relational histories and attachment styles within the therapeutic processes, including how these interact with those experiences and attachment patterns of voice hearers (122, 123). …”

Section: Discussionmentioning

confidence: 99%

Cognitive Attachment Model of Voices: Evidence Base and Future Implications

2017

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There is a robust association between hearing voices and exposure to traumatic events. Identifying mediating mechanisms for this relationship is key to theories of voice hearing and the development of therapies for distressing voices. This paper outlines the Cognitive Attachment model of Voices (CAV), a theoretical model to understand the relationship between earlier interpersonal trauma and distressing voice hearing. The model builds on attachment theory and well-established cognitive models of voices and argues that attachment and dissociative processes are key psychological mechanisms that explain how trauma influences voice hearing. Following the presentation of the model, the paper will review the current state of evidence regarding the proposed mechanisms of vulnerability to voice hearing and maintenance of voice-related distress. This review will include evidence from studies supporting associations between dissociation and voices, followed by details of our own research supporting the role of dissociation in mediating the relationship between trauma and voices and evidence supporting the role of adult attachment in influencing beliefs and relationships that voice hearers can develop with voices. The paper concludes by outlining the key questions that future research needs to address to fully test the model and the clinical implications that arise from the work.

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Section: Discussionmentioning

confidence: 99%

Cognitive Attachment Model of Voices: Evidence Base and Future Implications

2017

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“…The therapeutic relationship is here defined as the “feelings and attitudes that therapist and client have toward one another and the manner in which they are expressed” (Norcross & Lambert, , p. 4). This broadens the narrower conceptualization of the therapeutic relationship used in previous reviews (e.g., Berant & Obegi, ; Degnan, Seymour‐Hyde, Harris, & Berry, ), which only considered literature using client and therapist ratings of the therapeutic relationship. Our broader definition encompasses relevant yet less direct indicators such as the therapist's interpersonal behavior and in‐session emotional experience, such as countertransference.…”

Section: Therapists’ Internalized Relational Modelsmentioning

confidence: 99%

“…She concluded that the unequal nature of the therapeutic relationship might favor clients’ attachment patterns over therapists’ as predictors of the alliance, or perhaps that a narrower range of attachment styles among therapists compared to their clients, makes therapist effects difficult to detect. Degnan and colleagues () regarded the evidence as sufficiently convincing to recommend that therapists take account of their attachment style within therapy. All reviews noted the interaction of client and therapist attachment styles as an area for further research.…”

Section: Therapists’ Internalized Relational Modelsmentioning

confidence: 99%

“…As well as broadening the concept of internalized relational models beyond attachment by including introject, we have also questioned whether alliance is too narrow a concept to encompass therapeutic relationship factors. Therefore, this review includes the broader range of relationship factors emerging from the literature, giving access to a larger range of relevant papers: 22 papers were reviewed versus 11 identified by Degnan and colleagues (). The current systematic review seeks to address four questions: Does secure therapist attachment security/insecurity result in a more positively rated therapeutic relationship? Does positive therapist introject result in a more positively rated therapeutic relationship than negative therapist introject? Which interactions of patient‐therapist attachment styles or introjects relate to therapeutic relationship quality? Does the broadening of the inclusion criteria for relationship factors to include nondirect relationship factors provide new insights, or can alliance be used as a proxy for relationship factors? …”

Section: Therapists’ Internalized Relational Modelsmentioning

confidence: 99%

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A Systematic Review of the Effect of Therapists’ Internalized Models of Relationships on the Quality of the Therapeutic Relationship

Steel

Macdonald²,

Schröder

2017

J Clin Psychol

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Objective: Previous reviews have found equivocal evidence of an association between therapists' internalized relational models and the therapeutic relationship and have neglected empirical literature based on Sullivan's notion of introject. This review expanded upon previous reviews to examine the effect of therapist internalized relational models on a broader conceptualization of the therapeutic relationship. Method: Systematic search processes identified 22 papers measuring therapist attachment and/or introject and therapeutic relationship: 19 on therapist attachment, 5 on introject with 2 overlapping. Results: Overall, despite heterogeneity in design and variable methodological quality, evidence suggests that therapist attachment affects therapeutic relationship quality, observed in client-rated evaluation, therapist negative countertransference, empathy, and problems in therapy. Interaction effects between client and therapist attachment style were also found. Evidence suggesting that therapist introject also affects therapeutic relationship quality, including therapists' manner and feelings toward their clients, was stronger. Conclusion: Evidence clearly shows that therapists' internalized relational models affect the therapeutic relationship. More research is necessary to clarify exactly how therapist and client internalized relational models interact and translate these findings into clinical practice. C 2017 Wiley Periodicals, Inc. J. Clin. Psychol. 74:5-42, 2018.

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“…The lead and co-therapists will also complete the WAI in relation to the service user and each family member/FSM at the end of session 3. The WAI has previously been used with key workers and therapists [74–76]. …”

Section: Data Collectionmentioning

confidence: 99%

Culturally-adapted Family Intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: a feasibility study protocol of implementation and acceptability

Edge

Degnan

Cotterill

et al. 2016

Pilot Feasibility Stud

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BackgroundAfrican-Caribbeans in the UK have the highest schizophrenia incidence and greatest inequity in access to mental health services of all ethnic groups. The National Institute for Health and Care Excellence (NICE) highlights this crisis in care and urgent need to improve evidence-based mental healthcare, experiences of services and outcomes for this group. Family intervention (FI) is clinically and cost-effective for the management of schizophrenia but it is rarely offered. Evidence for FI with minority ethnic groups generally, and African-Caribbeans in particular, is lacking. This study aims to test the feasibility and acceptability of delivering Culturally-adapted Family Intervention (CaFI) to African-Caribbean service users diagnosed with schizophrenia.Methods/DesignThis is a feasibility cohort design study. Over a 12-month intervention period, 30 service users and their families, recruited from hospital and community settings, will receive ten one-hourly sessions of CaFI. Where biological families are absent, access to the intervention will be optimised through ‘family support members’; trusted individuals nominated by service users or study volunteers.We shall collect data on eligibility, uptake, retention and attrition and assess the utility and feasibility of collecting various outcome measures including readmission, service engagement, working alliance, clinical symptoms and functioning, perceived criticism, psychosis knowledge, familial stress and economic costs. Measures will be collected at baseline, post-intervention and at 3-month follow-up using validated questionnaires and standardised interviews. Admission rates and change in care management will be rated by independent case note examination. Variability in the measures will inform sample size estimates for a future trial. Independent raters will assess fidelity to the intervention in 10 % of sessions. Feedback at the end of each session along with thematically-analysed qualitative interviews will examine CaFI’s acceptability to service users, families and healthcare professionals.DiscussionThis innovative response to inequalities in mental healthcare experienced by African-Caribbeans diagnosed with schizophrenia might improve engagement in services, access to evidence-based interventions and clinical outcomes. Successful implementation of CaFI in this group could pave the way for better engagement and provision across marginalised groups and therefore has potentially important implications for commissioning and service delivery in ethnically diverse populations. This study will demonstrate whether the approach is feasible and acceptable and can be implemented with fidelity in different settings.

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The Role of Therapist Attachment in Alliance and Outcome: A Systematic Literature Review

Cited by 84 publications

References 49 publications

Cognitive Attachment Model of Voices: Evidence Base and Future Implications

Cognitive Attachment Model of Voices: Evidence Base and Future Implications

A Systematic Review of the Effect of Therapists’ Internalized Models of Relationships on the Quality of the Therapeutic Relationship

Culturally-adapted Family Intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: a feasibility study protocol of implementation and acceptability

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