Working alliance as a mediator of client attachment dimensions and psychotherapy outcome.

Abstract

Studies that employ multidimensional attachment measures to explore the impact of attachment style on psychotherapy process and outcome are virtually absent in the literature. Further, the role of the working (therapeutic) alliance as a mediator of the influence of attachment on treatment outcome has not been formally investigated. In order to address these gaps in the research, archival data from 66 psychotherapy clients treated at a university graduate program training clinic were used to examine the influence of three adult attachment dimensions (Comfort with Closeness, Comfort Depending on Others, and Rejection Anxiety) on the therapeutic alliance and outcome, as well as to assess whether the alliance mediates the relationship between attachment and therapy outcome. Both Comfort with Closeness and Comfort Depending on Others were significantly related to alliance and outcome, whereas Rejection Anxiety was not significantly related to either variable. Alliance was a significant partial mediator of the effect of Comfort with Closeness on outcome. The results suggest that multidimensional measures of attachment capture important influences on alliance and psychotherapy and that Comfort with Closeness promotes successful outcome by virtue of its influence on alliance.

Adult attachment as a moderator of treatment outcome for generalized anxiety disorder: Comparison between cognitive–behavioral therapy (CBT) plus supportive listening and CBT plus interpersonal and emotional processing therapy.

“…For example, in university students with mixed diagnoses treated with interpersonal, cognitive– behavioral, psychodynamic, or eclectic therapies, avoidant attachment predicted poor outcome (Byrd et al, 2010). Similarly, Horowitz and colleagues (1993) found that patients with mixed diagnoses and avoidant attachment treated with brief psychodynamic therapy fared least well compared with other attachment styles.…”

“…At the same time, compared with those with secure attachment, avoidant attachment, with its associated dismissive style, has been found to predict greater rejection of treatment providers, less willingness to seek psychotherapy, less self-disclosure to therapists, and poorer compliance with and use of treatment (Dozier, 1990; Vogel & Wei, 2005). Avoidant attachment also predicts poor psychotherapy outcome (Byrd, Patterson, & Turchik, 2010; Horowitz, Rosenberg, & Bartholomew, 1993) as well as dropping out of therapy (Tasca et al, 2006; Tasca, Taylor, Bissada, Ritchie, & Balfour, 2004). In contrast, individuals with anxious attachment and associated over-emotional and dependent attachment style are more likely to seek help, admit their distress, and to be more compliant with treatment than those with avoidant attachment (Dozier, 1990; Vogel & Wei, 2005).…”

Emotional availability in psychotherapy: The usefulness and validity of the Emotional Availability Scales for analyzing the psychotherapeutic relationship

“…It has a significant impact on treatment outcome (Byrd, Patterson, Turchik, 2010;Falkenströ m, Granströ m & Holmqvist, 2013;Horvath, 2000Horvath, , 2005Horvath, Del Re, Fluckiger, & Symonds, 2011). Alliance is a conscious and goal-oriented process.…”

The role of attachment style, attachment to therapist, and working alliance in response to psychological therapy

“…Attachment representations may be related to improved therapy outcomes as a result of the relationship with greater WA. A number of studies have found that patterns of attachment predict therapy outcomes (Byrd, Patterson, & Turchik, 2010;Daniel, 2006;Forbes, Parslow, Fletcher, McHugh, & Creamer, 2010;Joyce, Ogrodniczuk, Piper, & Sheptycki, 2010;Saatsi, Hardy, & Cahill, 2007;Stalker, Gebotys, & Harper, 2005), although others have reported non-significant findings (Daniel, 2006;Kirchmann et al, 2009;Ravitz, Maunder, & McBride, 2008;Sauer et al, 2010;Strauss et al, 2006). Consequently, the relationship between attachment and therapy outcome remains currently unclear.…”