Therapeutic alliance and childhood interpersonal trauma: The role of attachment, cultural humility, and therapeutic presence

Abstract

This study aimed to assess the role of insecure attachment style, cultural humility, and therapeutic presence in the development of therapeutic alliance in a sample of adults with a history of childhood interpersonal trauma (N = 251). Multiple regression analyses indicated that cultural humility, therapeutic presence, and lower levels of attachment anxiety together accounted for 66.6% of the variance in therapeutic alliance. Implications for counselors, limitations, and directions for future research are provided.

A discourse analysis of cultural humility within counseling dyads

“…First, the examples involving positioning support how the CIT asking the client for explanation and clarification can be part of an ongoing self-examination of not only their clinical judgments but also of their cultural understandings. In this way, the use of positioning within session as part of cultural teachability could reflect both therapeutic process and goals, echoing the previous research linking CH to strengthened therapeutic alliance (Davis et al, 2016;Grad, 2022). Although Gaete and Strong (2017) discussed how conversationally transacted or deliberate discursive actions in session can be part of treatment or intervention, CITs in this study may have also engaged in and evidence positioning of self as a learner in a variety of valuable ways outside of the session.…”

“…Extant research has explored the role of CH in counseling. Counselor CH is significantly associated with client‐perceived positive working alliance (Grad, 2022; Hook et al., 2013; Zhu et al., 2022), positive treatment outcomes (Hook et al., 2013; Owen et al., 2014, 2016), and greater therapist competence (DeBlaere et al., 2019). Grad (2022) found that CH is significantly correlated with therapeutic alliance among individuals who have experienced childhood interpersonal trauma where it accounted for over 61% of the variance in therapeutic alliance.…”

“…Counselor CH is significantly associated with client‐perceived positive working alliance (Grad, 2022; Hook et al., 2013; Zhu et al., 2022), positive treatment outcomes (Hook et al., 2013; Owen et al., 2014, 2016), and greater therapist competence (DeBlaere et al., 2019). Grad (2022) found that CH is significantly correlated with therapeutic alliance among individuals who have experienced childhood interpersonal trauma where it accounted for over 61% of the variance in therapeutic alliance. Because CH can foster therapeutic alliance and other positive outcomes in the counseling process, it is of paramount significance to be able to clearly identify when CH is enacted in a session.…”

Cultural humility, counseling alliance, and counseling outcome among LGBTQ+ clients

“…The result that cultural humility, counseling alliance, and counseling outcome were positively correlated was in line with previous literature. Higher cultural humility was associated with higher counseling alliance in LGBTQ+ participants in this study, which is similar to previous literature (Grad, 2022;Zhang et al, 2021), particularly literature on LGB clients (Jennings & Sprankle, 2023;Kangos & Pieterse, 2021). This study's results also showed that higher cultural humility is associated with higher counseling outcome among LGBTQ+ participants, which resonated with previous literature indicating that cultural humility predicted counseling outcomes in racially diverse clients (Hook et al, 2013;Scott, 2022) and sexually diverse clients (Kangos & Pieterse, 2021).…”

Porges, S. W. (2021). Polyvagal safety: Attachment, communication, and self‐regulation. WW Norton, Incorporated, 320 pp., $45.00

“…First, the book lacks recognition of any systemic or contextual factors that may influence one's ability to assess or attain safety. The absence of examining the numerous systemic and contextual factors, like the impacts of trauma and systemic and interpersonal discrimination, that impact one's safety is limiting for those working through a socially just framework (Grad, 2021; Lawson et al, 2020). Overall, the book provides solid guidance in conceptualizing various topics through the lens of Polyvagal theory, but it did not consistently extend this understanding to application.…”