The therapeutic relationship.

Contemporary attachment theory is inspiring a burgeoning literature on adult attachment. This literature offers counseling psychology a compelling framework for understanding the healthy and effective self. In this article, the authors review studies probing the cognitive processes, affect self-regulatory dynamics. and relationship behaviors associated with secure (primary) and insecure (secondary) adult attachment strategies. They then offer a portrait of the healthy, effective personality that is consistent with theory and research on adult attachment. Finally, in an effort to understand key characteristics of successful movement toward the healthy and effective self, the authors review empirical extensions of attachment theory to the therapeutic context.

Dynamic processes underlying adult attachment organization: Toward an attachment theoretical perspective on the healthy and effective self.

The stages of change proposed by Prochaska and DiClemente have been applied to change efforts within and outside of formal treatment and in relation to virtually any problem behavior. This model has gained widespread popularity in health psychology and addictions and is being used to guide interventions and allocate treatment resources in several fields. In this article, the authors review 87 studies on the stages of change across problem behaviors. Research findings suggest that the proposed stages are not mutually exclusive and that there is scant evidence of sequential movement through discrete stages in studies of specific problem behaviors, such as smoking and substance abuse. Although the stage model may have considerable heuristic value, its practical utility is limited by concerns about the validity of stage assessments. The model's underlying concepts and alternative views of readiness for change are considered, along with directions for future research.

Stages of Change: A Critique

https://focus.psychiatryonline.org/doi/pdf/10.1176/foc.8.1.foc127

Adult attachment patterns and individual psychotherapy: A review

The authors hypothesized that level of experience and selected personal characteristics of therapists would predict clients' perceptions of the working alliance early in treatment. Therapists (N = 73) in university settings completed measures that assessed level of self-directed hostility, perceived social supports, and degree of comfort with attachment, and their clients completed a measure that estimated the working alliance between the 3rd and 5th sessions of therapy. As predicted, level of self-directed hostility, perceived social support, and degree of comfort with closeness in interpersonal relationships were significantly predictive of the bond component of the working alliance. Contrary to predictions, experience level was not uniquely predictive of clients' alliance ratings on the goal and task components of the alliance.

Contribution of Therapist Experience and Personal Characteristics to the Working Alliance.

The relationships among 3 dimensions of client attachment (depend, anxiety, and close) and client ratings of the working alliance were examined in a sample of first-time clients (N = 60) seeking services through a university-based counseling clinic. Working alliance ratings were collected from all participants immediately after their 3rd counseling session with a counselor-in-training. A significant association was found between the depend dimension of attachment and client working alliance ratings

Client Attachment and Perceptions of the Working Alliance with Counselor Trainees

The relation between client stages of change and client expectations about counseling was examined in a sample of 88 clients seeking services from a university-based outpatient clinic. Results of a canonical correlation indicated that the composite of the contemplation, action, and maintenance stages of change was significantly related to the expectation factors of Personal Commitment and Facilitative Conditions. The composite of the contemplation and maintenance stages of change accounted for additional variance in expectations for Facilitative Conditions, Counselor Expertise, and Nurturance. The significance and implications of these findings for counseling are briefly discussed.

Client Stages of Change and Expectations About Counseling

The relation between client working models of attachment and therapist type of change assessments (first- vs. second-order) was examined in a sample of first-time clients (N=46) seeking services through a university-based outpatient clinic. Results indicated that the problems and goals of clients who exhibited relatively secure working models of attachment were assessed by their therapists as being of a first-order nature, whereas the problems and goals of clients with more insecure working models of the world were assessed as being congruent with second-order conceptualizations. Implications for clinical research and the practice of cognitive psychotherapy are discussed. An important distinction in cognitive psychotherapy - particularly among adherents to constructivist approaches - is that made between first- and second-order change (Guidano, 1987; Lyddon, 1990; Mahoney, 1991; Watzlawick, Weakland, & Fisch, 1974). In brief, first-order change is essentially "change without change," or any change that does not lead to a change in the fundamental structure of the system (Watzlawick et al., 1974). From a clinical standpoint, first-order change typically involves immediate symptom relief and/or the reestablishment of a relatively stable sense of equilibrium in the client's experience of self and world. Second-order change, on the other hand, is "change of change," a type of change that entails the alteration of the structure of the system. Clinically speaking, construedvists consider secondorder problems as "deep" (Guidano, 1987) or "core" (Mahoney, 1980) and suggest that working with such issues often challenges a client's most basic assumptions about self and world. Second-order change is rarely easy or rapid and is often accompanied by intense and sometimes painful emotional experiences (Lyddon, 1990). Following from the significant interest given to attachment constructs in the cognitive psychotherapy literature (cf. Guidano, 1987, 1991; Liotti, 1988, 1991; Mahoney, 1991; Safran & Segal, 1990; Young, 1990), Lyddon and Alford (1993) have recently suggested a link between the level of security in a persons' interpersonal schemata (or working models of attachment) and the type of change that may be indicated in a clinical context (first- vs. secondorder). In particular, they suggest that because securely attached clients are relatively comfortable with their core assumptions about self and world, they tend to require only first-order adjustments in their personal systems. In these cases, the client's impetus for entering therapy often stems from the effects of an adverse current life situation or stressor (e.g., loss of job, end of intimate relationship, inconsiderate co-worker, etc.). As a result, the aim of therapy is to help the client refine the skills necessary to more effectively cope with the current problem and reestablish a personal sense of equilibrium. By way of contrast, Lyddon and Alford (1993) suggest that clients who exhibit insecure working models of attachment most often require significant second-order revisions in these schemata. In these instances, clients' core beliefs about self and world are no longer adaptive and their presenting problems are more pervasive (e.g., a pattern of unproductive relationships, chronic depression, low self-esteem, generalized anxiety, etc.). In such cases, therapy tends to involve (a) a developmentally focused reconstruction of the history and patterning of the problem, (b) a gradual elaboration of the client's tacit cognitive models of self and world that are no longer viable, (c) a full exploration of the feelings related to this newly accessed experiential information, and (d) therapist support for the client's construction of new meaning structures (Lyddon, 1990, p. 125). The purpose of this study is to examine the relation between clients' working models of attachment and therapists' assessments of the type of change that may be clinically indicated. …

William A. Satterfield

Papers

Client Attachment and Perceptions of the Working Alliance with Counselor Trainees

Client Stages of Change and Expectations About Counseling

Relation of Client Attachment to Therapist First- and Second-Order Assessments