Implications of attachment theory for working in psychoanalytic psychotherapy
01 Sep 2004-International Forum of Psychoanalysis (Taylor & Francis Group)-Vol. 13, Iss: 3, pp 147-156
TL;DR: In this article, the authors address the issue of the measurement of attachment patterns and how knowledge of these can inform psychoanalysts' work with their patients, focusing particularly on how it can help with the crucial phase of building the working alliance.
Abstract: 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.
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TL;DR: Evidence suggests that clients who rate themselves as having a more secure attachment pattern are likely to rate the alliance as stronger, and the implications for therapeutic practice are discussed.
135 citations
TL;DR: In this article, 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.
Abstract: 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...
32 citations
Cites background from "Implications of attachment theory f..."
...The IWM tends to be thought of as durable and enduring, though not entirely intransigent and immutable (Bowlby, 1977b; Harris, 2004)....
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TL;DR: Results of the present study indicate that attachment-informed treatment of chronic pain can enhance existing interdisciplinary pain therapies; however, caveats are discussed.
Abstract: 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.
17 citations
Cites background from "Implications of attachment theory f..."
...Examples of attachmen -informed therapies can be fou d within family therapy [28,29], psychoanalytic therapy [30], therapy for personality disorders [31], and within psychotherapy in ge eral [32]....
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...Examples of attachmentinformed therapies can be found within family therapy [28,29], psychoanalytic therapy [30], therapy for personality disorders [31], and within psychotherapy in general [32]....
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TL;DR: 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.
Abstract: 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.
16 citations
Cites methods from "Implications of attachment theory f..."
...Consistent with existing descriptions of practice, formal assessment of attachment style was uncommon, and therapists relied instead on history-taking and clinical judgement (Harris, 2004; Shilkret, 2005)....
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TL;DR: This finding attests to the unique value of professional evaluations of patients’ intrapsychic functionality, frequently conducted in clinical practice, to detect patients at risk of unilateral termination of treatment.
Abstract: 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...
16 citations
Cites background from "Implications of attachment theory f..."
...Based on psychodynamic theoretical conceptualizations, as described above, on cumulative clinical experience (e.g., Harris, 2004; Waska, 2002), and on the few available empirical studies (Karterud et al., 2003; Ogrodniczuk et al., 2008; Piper et al., 1999), we hypothesize that higher psychological…...
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...Therefore, currently most of the information about the association between these three patient characteristics collected at intake and dropout from therapy is based mainly on clinical experience (e.g., Harris, 2004; Waska, 2002), and has scarcely been investigated empirically....
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...Accumulating clinical experience suggests that low intrapsychic functionality is related to low emotional bond with the therapist (Harris, 2004), discomfort in the therapy situation, and with a tendency to act out the patient’s problem with the therapist—elements that can, consecutively, result in…...
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...Accumulating clinical experience suggests that low intrapsychic functionality is related to low emotional bond with the therapist (Harris, 2004), discomfort in the therapy situation, and with a tendency to act out the patient’s problem with the therapist—elements that can, consecutively, result in the patient unilaterally terminating the therapy (Waska, 2002)....
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...Such patients may also have difficulty forming a sustained relationship with their therapist (Harris, 2004), which may become another reason for dropping out (Sharf et al....
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References
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TL;DR: The proposed model was shown to be applicable to representations of family relations; Ss' attachment styles with peers were correlated with family attachment ratings.
Abstract: A new 4-group model of attachment styles in adulthood is proposed. Four prototypic attachment patterns are defined using combinations of a person's self-image (positive or negative) and image of others (positive or negative). In Study 1, an interview was developed to yield continuous and categorical ratings of the 4 attachment styles. Intercorrelations of the attachment ratings were consistent with the proposed model. Attachment ratings were validated by self-report measures of self-concept and interpersonal functioning. Each style was associated with a distinct profile of interpersonal problems, according to both self- and friend-reports. In Study 2, attachment styles within the family of origin and with peers were assessed independently. Results of Study 1 were replicated. The proposed model was shown to be applicable to representations of family relations; Ss' attachment styles with peers were correlated with family attachment ratings.
6,610 citations
TL;DR: Dimensions of attachment style were strongly related to how each partner perceived the relationship, although the dimension of attachment that best predicted quality differed for men and women.
Abstract: Three studies were conducted to examine the correlates of adult attachment. In Study 1, an 18-item scale to measure adult attachment style dimensions was developed based on Kazan and Shaver's (1987) categorical measure. Factor analyses revealed three dimensions underlying this measure: the extent to which an individual is comfortable with closeness, feels he or she can depend on others, and is anxious or fearful about such things as being abandoned or unloved. Study 2 explored the relation between these attachment dimensions and working models of self and others. Attachment dimensions were found to be related to self-esteem, expressiveness, instrumentality, trust in others, beliefs about human nature, and styles of loving. Study 3 explored the role of attachment style dimensions in three aspects of ongoing dating relationships: partner matching on attachment dimensions; similarity between the attachment of one's partner and caregiving style of one's parents; and relationship quality, including communication, trust, and satisfaction. Evidence was obtained for partner matching and for similarity between one's partner and one's parents, particularly for one's opposite-sex parent. Dimensions of attachment style were strongly related to how each partner perceived the relationship, although the dimension of attachment that best predicted quality differed for men and women. For women, the extent to which their partner was comfortable with closeness was the best predictor of relationship quality, whereas the best predictor for men was the extent to which their partner was anxious about being abandoned or unloved. It is generally believed that the nature and quality of one's close relationships in adulthood are strongly influenced by affective events that took place during childhood, particularly within the child-caretaker relationship. Yet, only recently have social psychologists begun to integrate work on adult love relationships with developmental theory and research on the nature and functioning of parent-child relations (Hartup & Rubin, 1986; Kazan & Shaver, 1987;Hinde, 1979;HindeS Shaver & Hazan, 1988; Shaver, Hazan, & Bradshaw, 1988; Shaver R Weiss, 1982,1986). Of particular interest has been the extent to which a child's early attachment relationships with caretakers shape important beliefs about the self and social world, which then guide relationships in adulthood. Recently, Hazan and Shaver (1987) have used infant attachment theory (Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby, 1982,1973,1980) as a framework for examining how adult love relationships are related to early parent-child interactions. The
3,499 citations
TL;DR: In this article, the quality of the working alliance (WA) was most predictive of treatment outcomes based on clients' assessments, less so of therapists' assessments and least predictive of observers' report, and a moderate but reliable association between good WA and positive therapy outcome was found.
Abstract: Results of 24 studies (based on 20 distinct data sets) relating the quality of the working alliance (WA) to therapy outcome were synthesized using meta-analytic procedures. A moderate but reliable association between good WA and positive therapy outcome was found. Overall, the quality of the WA was most predictive of treatment outcomes based on clients' assessments, less so of therapists' assessments, and least predictive of observers' report
2,642 citations
"Implications of attachment theory f..." refers background in this paper
...Yet there is now increasing agreement that one of the best predictors of the overall success of a therapy is the quality of the working alliance (21) which requires skill to build, and that it can be premature to venture into deeper waters until such an alliance is securely developed, usually after some three months or so....
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Book•
25 Aug 1998
TL;DR: Holmes, this article, Preface to the Routledge Classics edition, The Role of Attachment in Personality and Development, Attachment, Communication, and the Therapeutic Process.
Abstract: Holmes, Preface to the Routledge Classics Edition. Preface. Caring for Children. The Origins of Attachment Theory. Psychoanalysis as Art and Science. Psychoanalysis as a Natural Science. Violence in the Family. On Knowing What You Are Not Supposed To Know and Feeling What You Are Not Supposed To Feel. The Role of Attachment in Personality and Development. Attachment, Communication, and the Therapeutic Process.
2,176 citations