Processes involved in client-nominated relationship building incidents: Client attachment, attachment to therapist, and session impact.

Thirty volunteer clients of trainee therapists nominated an incident that was critical in the development of their therapeutic relationship. Clients completed the Client Attachment to Therapist Scale (CATS), the Experiences in Close Relationships Scale (ECRS), and the Session Impacts Scale (SIS). Clients reported an increase in attachment security with their therapists, along with perceptions of support and relief and increasing exploration following the relationship building incident. While clients' avoidant attachment was unrelated to attachment to the therapist prior to the incidents, in subsequent sessions avoidance was related to a change in secure attachment to therapist. Finally, client attachment to therapist but not general attachment was significantly related to in-session exploration. Findings are discussed in light of attachment theory and convergence with findings from the field of social psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experienced therapists’ approach to psychotherapy for adults with attachment avoidance or attachment anxiety.

Interviews were conducted with therapists (N = 12) nominated by peers as especially effective in working with clients with adult interpersonal problems. Open-ended questions asked how these therapists would approach 2 adult clients described in brief vignettes as having high attachment avoidance or anxiety. A coding team used a grounded theory approach to identify 8 higher order themes in the interviews: Conceptualization, Client Defenses, Managing Boundaries, Markers of Progress, Therapist Reactions, Targeted Interventions, Corrective Relational Patterns, and Internal Representations and Models. These themes were integrated into an inclusive theoretical model based on the core concept of therapists’ strategic management of therapeutic distance. The distance necessary to engage clients initially is adjusted later in therapy to create a corrective attachment in the psychotherapy relationship that facilitates change. Therapists described how, after engagement, they gradually increase therapeutic distance for clients with attachment anxiety who must then manage resulting frustration while learning to function more autonomously. Therapists gradually insist on decreased therapeutic distance to help clients with attachment avoidance overcome their fears of intimacy. Therapists discussed the specific techniques they use to manage therapeutic distance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of the client-therapist bond through the lens of attachment theory.

The bond between client and therapist, a component of the global alliance, is widely believed to play a crucial role in supporting the work of therapy. However, we know little about how the client-therapist bond becomes established and have few theoretical tools to conceptualize its development. Attachment theory, with its focus on the development and dynamics of intimate relationships, is a lens through which we can expand our understanding of the client-therapist bond. I argue that the therapeutic bond may be usefully viewed as an in-progress attachment to therapists. Using Bowlby (1969/1982) and Ainsworth's (Ainsworth et al., 1978) ideas about normative attachment development, I present a phase model of attachment to the therapist and include behavioral, cognitive, emotional, and physiological markers of each phase. I draw empirical support from the psychotherapy process and alliance literatures and discuss research considerations and clinical implications of the model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internalized homophobia and adult attachment: Implications for clinical practice.

Two hundred eighty-six men and women who identified as lesbian, gay, or bisexual (LGB) were surveyed using measures of attachment, internalized homophobia, shame, and guilt. Results indicated that secure attachment was negatively correlated with internalized homophobia, shame, and guilt. Fearful and preoccupied attachments were positively correlated with these constructs, accounting for 36.9% of the variance in scores. Results are discussed in terms of the therapeutic relationship, with the therapist serving as a secure base for LGB clients working through issues of internalized homophobia and social isolation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dynamics of attachment and systems-centered group psychotherapy.

In this article, links are made between 2 theoretical paradigms, 1 that primarily describes the dynamics of dyads (attachment theory) and another that primarily although not exclusively describes the dynamics of groups (the theory of living human systems). The ideas presented are based on research into empathic attunement in adult psychotherapy, clinical material from a group psychotherapy session, and research in the field of attachment. It is suggested that systems-centered group psychotherapy provides the environment for changing members' attachment status through its attention to emotional resonance, authentic affect, and empathic attunement. These ideas are presented with a view toward encouraging research into the links between attachment theory, affect attunement, and group psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An index of relationship quality based on attachment theory.

Two measures are reported of the nature or quality of a mother-offspring (MO) relationship during development using brown capuchin monkeys (Cebus apella) as models. One is a qualitative classification of MO relationships as secure, resistant, or avoidant attachments. The other is an empirical ratio of relative affiliation to agonism called the MO relationship quality, or MORQ, Index. The two methods tapped similar relationship features so relationships high or low of a median split of MORQ values were heuristically labeled secure (n = 22) or insecure (n = 16), respectively. A comparison revealed extensive behavioral differences between secure and insecure MO relationships and suggested MORQ provided an objective, continuous measure of attachment security. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability of attachment representations: The transition to marriage.

This study examined the stability of adult attachment representations across the transition to marriage. One hundred fifty-seven couples were assessed using the Adult Attachment Interview (AAI; C. George, N. Kaplan, & M. Main, 1985), the Current Relationship Interview (J. A. Crowell & G. Owens, 1996), and measures describing relationship functioning and life events 3 months prior to their weddings and 18 months into their marriages. The authors tested the hypotheses that attachment classifications are stable and that change is related to experiences in the relationship and/or life events; 78% of the sample received the same primary AAI classification (secure, preoccupied, and dismissing) at both times. Change was toward increased security and was associated with feelings and cognitions about the relationship. Only 46% of participants initially classified as unresolved retained the classification. Stability of the unresolved classification was associated with stressful life events and relationship aggression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of adult attachment styles in psychopathology and psychotherapy outcomes.

Attachment theory provides a model for understanding how the attachment styles formed in infancy systematically affect subsequent psychological functioning across the life span. Attachment styles provide the cognitive schemas, or working models, through which individuals perceive and relate to their worlds. In turn, these schemas predispose the development of psychopathologies and influence outcomes when people undergo psychotherapy. After reviewing recent empirical findings, the authors conclude that an understanding of attachment theory facilitates the conceptualization of clients' problems and the selection of appropriate interventions. Accordingly, attachment styles should be assessed as a standard part of treatment planning. Furthermore, the authors propose that attachment styles should be assessed as individual difference variables in psychotherapy outcome research because adult attachment styles dictate how people perceive and respond to their environments and, therefore, how clients respond differentially to various treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between attachment scales and group therapy alliance growth differs by treatment type for women with binge-eating disorder.

The impact of the treatment context in influencing the relationship between attachment anxiety/avoidance and group therapy alliance growth was examined. Sixty-five women treatment completers with binge-eating disorder received 16 sessions of group cognitive behavioral therapy (GCBT) or group psychodynamic interpersonal psychotherapy (GPIP). Attachment scales were completed before treatment, and a group therapy alliance measure was completed after each therapy session. Growth curve modeling indicated an increasing linear growth in group therapy alliance for both treatments. For GPIP, higher attachment anxiety and lower attachment avoidance were each associated with alliance growth. These relationships were not evident for GCBT. The context of therapy likely activated (in the case of GPIP) or did not activate (in the case of GCBT) defensive attachment strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists’ attachment, patients’ interpersonal problems and alliance development over time in inpatient psychotherapy.

The focus of this study is the investigation of the relation between patients’ interpersonal problems, therapists’ attachment representations, and the development of the therapeutic alliance over time. The authors investigated weekly alliance ratings of 281 psychotherapy inpatients, treated by 12 psychotherapists. Alliance quality was measured with the Inpatient Experience Scale. Multilevel regression models showed that patients’ interpersonal problems were associated with the level of alliance quality. Therapists’ attachment security was not related to alliance development, but higher attachment preoccupation of therapists was associated with lower levels of alliance quality. In addition, an interaction effect between therapists’ degree of attachment preoccupation and patients’ interpersonal problems explained variations of the alliance development curve over time. Limitations of the study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client attachment to therapist: Relation to client personality and symptomatology, and their contributions to the therapeutic alliance.

This study examined the relation of client attachment to the therapist to diverse facets of the therapeutic alliance, client personality, and psychopathological symptoms, as well as the relative importance of therapeutic attachments, personality, and symptomatology in predicting the alliance. Eighty clients in ongoing therapy completed measures of client attachment to therapist (CATS), personality (6FPQ), psychopathological symptoms (BSI), and therapeutic alliance (WAI–Short, CALPAS, HAQ). Secure and Avoidant–Fearful attachment to the therapist correlated positively and negatively, respectively, with total and subscale alliance scores. Preoccupied-Merger therapeutic attachment was unrelated to the alliance. Exploratory analyses suggested however that the relationship between Preoccupied–Merger attachment and the alliance was moderated by the extent to which clients were distressed. Clients' therapeutic attachments were unrelated to basic personality dimensions. Preoccupied–Merger attachment to the therapist correlated significantly with several symptom dimensions. Clients' therapeutic attachments emerged as superior and more consistent predictors, relative to client personality and symptomatology, of the therapeutic alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The secure-base hypothesis: Global attachment, attachment to counselor, and session exploration in psychotherapy.

This study explored J. Bowlby's (1988) secure-base hypothesis, which predicts that a client's secure attachment to the therapist, as well as the client's and the therapist's global attachment security, will facilitate in-session exploration. Volunteer clients (N = 59) and trainee counselors (N = 59) in short-term therapy completed the Experiences in Close Relationship Scale (K. A. Brennan, C. L. Clark, & P. R. Shaver, 1998) as a measure of adult global romantic and peer attachment orientations; the Client Attachment to Therapist Scale (B. Mallinckrodt, D. L. Gantt, & H. M. Coble, 1995) as a measure of attachment to counselor; the Working Alliance Inventory (A. O. Horvath & L. Greenberg, 1989) as a measure of working alliance; and the Session Evaluation Questionnaire-Depth Subscale (W. B. Stiles & J. S. Snow, 1984) as a measure of session depth. In line with Bowlby's hypothesis, the findings suggest that session depth is related to the client's experience of attachment security with the counselor and that counselor global attachment moderates the relationship between client global attachment and session exploration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clarifying links between attachment and relationship quality: Hostile conflict and mindfulness as moderators.

In this study we examined self-reported hostile conflict and mindfulness as potential moderators of the links between attachment and relationship quality over time in a sample of 1,702 online respondents. The analyses revealed that both attachment anxiety and avoidance were associated with lower levels of current relationship quality and attachment avoidance was linked with lower relationship satisfaction over time. The results offered partial support for the moderation hypotheses with attachment anxiety but failed to support moderation of attachment avoidance. Specifically, when predicting relationship satisfaction, hostile conflict moderated the effect of attachment anxiety such that high hostile conflict and high attachment anxiety were associated with particularly low current satisfaction. Shifts in hostile conflict over time also exacerbated the longitudinal associations between attachment anxiety and relationship satisfaction. Furthermore, mindfulness moderated the effects of attachment anxiety on stability such that high levels of mindfulness seemed to buffer relationships from the increased risk of breakup associated with high levels of attachment anxiety. Implications for research and treatment are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The client-counselor match and the corrective emotional experience: Evidence from interpersonal and attachment research.

Models of brief psychodynamic therapy posit the corrective emotional experience as a key factor in therapeutic change. Although widely taught and used, these models do not have strong empirical support. This article proposes the client-counselor match as a facilitating condition for a corrective emotional experience and reviews the relevant evidence from attachment and interpersonal research. Overall, the notion of the corrective emotional experience has received some support from attachment research, which looks at complementarity of styles at the personality level. Interpersonal research, rather, considers complementarity of actual exchanges in therapy and has yielded mixed results. It thus appears that the validity of the corrective experience has yet to be established, notably through the use of a more fine-grained approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Theraplay: Child therapy for attachment fostering.

Many adults enter psychotherapy complaining of problems with self-esteem. As we come to understand better the origins of this sense of vulnerability it becomes increasingly clear that the quality of early parent-child relationships can range from esteem-enhancing to esteem-jeopardizing. This paper describes two techniques: one, the Marschak Interaction Method (MIM) for clinical assessment of the parent-child relationship and two, Theraplay, for therapeutic intervention into these relationships which are at risk for generating low self-esteem in the child. A sample case is presented and the kinds of cases for which Theraplay is appropriate or inappropriate are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood emotional abuse and attachment processes in the dyadic adjustment of dating couples.

In an effort to improve understanding of the mechanisms that link early maltreatment to later outcomes, this study investigated the mediation effects of adult attachment processes on the association between childhood emotional abuse and later romantic relationships among heterosexual couples. College students and their dating partners (N = 310; 155 couples) completed the Childhood Trauma Questionnaire, Experiences in Close Relationship Scale, and Dyadic Adjustment Scale. Using the Actor–Partner Interdependence Model (Kenny, Kashy, & Cook, 2006), multilevel modeling results indicated that memories of childhood emotional abuse reported by both students and their partners were significantly associated with attachment strategies, as well as romantic relationship quality. Findings supported hypothesized mediation effects of attachment anxiety and avoidance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intergenerational transmission of aggression in romantic relationships: The moderating role of attachment security.

This prospective study used longitudinal, multi-reporter data to examine the influence of parents’ marital relationship functioning on subsequent adolescent romantic relationships. Consistent with Bryant and Conger’s (2002) model for the Development of Early Adult Romantic Relationships (DEARR), we found that interactional styles, more specifically paternal aggression and satisfaction, exhibited in parents’ marital relationship when their adolescents were age 13 were predictive of qualities of the adolescent’s romantic relationships 5 years later. Continuities were domain specific: paternal satisfaction predicted adolescent satisfaction and paternal aggression predicted adolescent aggression. Attachment security moderated the link between paternal aggression and subsequent adolescent aggression, with continuities between negative conflictual styles across relationships reduced for secure adolescents. Results are interpreted as suggesting that attachment may help attenuated the transmission of destructive conflict strategies across generations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The attachment system in fledgling relationships: An activating role for attachment anxiety.

Is it sensible to study attachment dynamics between potential romantic partners before they share a full-fledged attachment bond? The present data indicate that such an approach may reveal novel insights about initial attraction processes. Four studies suggest that the state-like experience of attachment anxiety has functional implications within fledgling (i.e., desired or undeveloped) romantic relationships, well before the formation of an attachment bond. Studies 1 and 3 reveal that attachment anxiety directed toward a particular romantic interest is elevated before (in comparison with after) participants report being in an established relationship. Studies 2 and 3 demonstrate that such partner-specific attachment anxiety predicts attachment-relevant outcomes in fledgling relationships, including proximity seeking, safe haven, secure base, passionate love, and other approach behaviors. These associations were reliable above and beyond (and were typically as strong as or stronger than) the effect of sexual desire. Finally, Study 4 presents evidence that partner-specific attachment anxiety may cause several of these attachment-relevant outcomes. Attachment anxiety seems to be a normative experience and may signal the activation of the attachment system during the earliest stages of romantic relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The overlapping contributions of attachment orientation and social support in predicting life-events distress.

Attachment anxiety, attachment avoidance, and perceived social support are examined as predictors of life-events distress. Clients at initial intake to an addiction treatment centre and university students in their graduating year were administered measures of attachment orientation, social support, and the experience of distressing life events. Hypotheses were tested across different categories of distressing life events (overall distress, bereavement, relationship dissolution, crime victimization, and severe accidents). We found that attachment anxiety and attachment avoidance have varying predictive utility for distress, depending on the type of event. Social support did not account for variance beyond attachment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult attachment and the transition to parenthood.

This study examined how a major life stressor—the transition to parenthood—affects marital satisfaction and functioning among persons with different attachment orientations. As hypothesized, the interaction between women's degree of attachment ambivalence and their perceptions of spousal support (assessed 6 weeks prior to childbirth) predicted systematic changes in men's and women's marital satisfaction and related factors over time (6 months postpartum). Specifically, if highly ambivalent (preoccupied) women entered parenthood perceiving lower levels of support from their husbands, they experienced declines in marital satisfaction. Women's ambivalence also predicted their own as well as their husbands' marital satisfaction and functioning concurrently. The degree of attachment avoidance did not significantly predict marital changes, although women's avoidance did correlate with some of the concurrent marital measures. These findings are discussed in terms of attachment theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)