Client self rated adult attachment patterns and the therapeutic alliance: a systematic review.

As a perspective on close relationships, attachment theory has been meaningfully used to stimulate understanding of parent-child, romantic partner, and even psychotherapeutic relationships. But how useful is attachment theory in stimulating understanding of the psychotherapy supervision relationship? In this article, we examine that question by (1) reviewing the primary conceptual/practical works where an attachment-informed vision of supervision has been proposed; (2) reviewing the limited empirical studies that have in some way addressed attachment concepts in supervision; and (3) considering what implications might be drawn from those conceptual/practical and research works. Based on our study and reflection, we propose and offer some discussion of the following ideas: (1) the psychotherapy supervisee-supervisor relationship, while having the potential to develop into an attachment bond, might best be viewed as involving an affective component that leads to the evoking of attachment dynamics (rather th...

Psychotherapy Supervision and Attachment Theory: Review, Reflections, and Recommendations

Attachment theory provides a useful framework for understanding individual differences in pain patients, especially with insecure attachment shown to be more prevalent in chronic pain patients compared to the general population. Nevertheless, there is little evidence of attachment-informed treatment approaches for this population. The present study compares outcomes from two different attachment-informed treatment modalities for clinicians, with outcomes from treatment as usual (TAU). In both intervention groups (IG1 and IG2), clinicians received bi-monthly training sessions on attachment. Additionally, clinicians in IG1 had access to the attachment diagnostics of their patients. All treatments lasted for four weeks and included a 6-month follow up. A total of 374 chronic pain patients were recruited to participate in this study (TAU = 159/IG1 = 163/IG2 = 52). Analyses were carried out using multilevel modeling with pain intensity as the outcome variable. Additionally, working alliance was tested as a mediator of treatment efficacy. The study was registered under the trial number DRKS00008715 on the German Clinical Trials Register (DRKS). Findings show that while IG2 was efficient in enhancing treatment outcomes, IG1 did not outperform TAU. In IG2, working alliance was a mediator of outcome. Results of the present study indicate that attachment-informed treatment of chronic pain can enhance existing interdisciplinary pain therapies; however, caveats are discussed.

https://www.mdpi.com/2077-0383/8/3/364/pdf

Effectiveness of an attachment-informed working alliance in interdisciplinary pain therapy

There is a growing interest into how attachment theory can inform psychotherapeutic practice with adults. This study aimed to explore how a group of therapists with an interest in attachment theory use it in their work with adult clients. A cross-sectional qualitative design was adopted. Sampling, data collection and analysis procedures were guided by grounded theory principles. Semi-structured telephone interviews were conducted with 12 therapists from a variety of training backgrounds. Data were coded and developed into thematic categories. Six primary themes were identified to describe how attachment theory influenced the clinical practice of the sample through the following: (i) complementing other therapeutic models; (ii) providing a framework to understand the development of clients' mental health problems; (iii) working with different attachment styles; (iv) thinking about the therapeutic relationship as an attachment relationship; (iv) influencing the different stages of the therapeutic process; and (vi) influencing clinical service design and delivery. It is concluded that attachment theory can play a significant role in influencing the practice of therapists and can be usefully adopted to complement therapeutic processes irrespective of the therapist's dominant clinical orientation. Further research is needed to explore the views of clinicians from different theoretical orientations and to investigate the security of the client–therapist attachment within the context of therapeutic change processes. Copyright © 2015 John Wiley & Sons, Ltd.

Key Practitioner Message
Attachment theory may have implications for practice across a range of different types of therapy and may help therapists to bridge apparent differences between modality-specific formulation and techniques.
Attachment theory can be used to understand the development of mental health problems. Therapists should assess and formulate clients' attachment styles, and these formulations should guide therapeutic approaches.
Attachment theory provides a comprehensive framework for facilitating the therapist's attentiveness to relational issues and use of the therapeutic relationship as a fulcrum for change.
The principles of attachment theory can be used to inform all stages of the therapeutic process, as well as the design and delivery of mental health services.

A Qualitative Exploration of the Use of Attachment Theory in Adult Psychological Therapy

Approximately one in five patients drops out of treatment before its completion. Little is known about consistent predictors of dropout, and most studies focus on patients’ demographic characteristics. A mass of information is collected daily at intake in clinical practice. Based on psychodynamic theoretical conceptualizations and accumulative clinical experience, this information may help predict dropout, and thereby expand the empirically based predictors of dropout. Objective: The present study aims at bridging between scientific research and clinical practice by investigating potential predictors of unilateral termination collected at intake, before therapy, in addition to predictors already identified in the literature. Method: The study was based on data from 413 patients from a university consulting center. Each patient completed a pre-intake questionnaire collecting demographic information, and underwent an interview conducted by a professional intaker. Results: Results indicate that the c...

Patient demographics and psychological functioning as predictors of unilateral termination of psychodynamic therapy.

John Bowlby's Attachment Theory is being increasingly operationalised in the world of developmental research, but as yet its implications for clinical work are relatively less discussed. This paper addresses the issue of the measurement of attachment patterns and how knowledge of these can inform psychoanalysts’ work with their patients. It looks at the implications of Attachment Theory at all stages of the therapeutic process, but concentrates particularly on how it can help with the crucial phase of building the working alliance.

Tirril Harris

Papers

Implications of attachment theory for working in psychoanalytic psychotherapy