The Role of Therapists' Attachment and Introject in Their Treatment Process and Outcome: A Systematic Review

Previous reviews have examined empirical evidence of the relationship between therapists' internalized relational models, including therapists' attachment styles and Sullivan's notion of introject, and the therapeutic relationship. This review expands upon previous reviews by examining the effect of therapists' internalized relational models on the treatment process (e.g., therapeutic alliance and countertransference) and treatment outcomes (e.g., symptoms and functioning) more broadly. Our systematic search identified 42 empirical studies measuring therapist's internalized relational models, defined as therapist attachment style (i.e., the way the therapist relates to others) and/or introject (i.e., the way the therapist relates to themselves), in relation to therapy process and outcome, including 35 studies on attachment, nine studies on introject and two that examined both constructs. A rigorous quality assessment was conducted; two studies were rated as 'moderate', and 40 were rated as 'weak' in quality. Based on the study findings, it appears that more securely attached therapists may have stronger working alliances and more positive therapeutic processes with their patients. Contrary to expectations, therapist attachment security does not appear to impact treatment outcomes. Therapists who relate to themselves in a more affirming way may have stronger working alliances and better treatment outcomes, but very few studies have addressed this question thus far. More rigorous research, especially on the effect of therapists' introject, is needed. Therapists may consider the potential impact of their internalized relational models on the working alliance and other treatment processes that influence therapeutic outcomes.

Development of the Psychotherapist Character Virtues (PCV) Interview

OBJECTIVE

To develop an interview-based rating method for assessing therapists' beneficial character traits and evaluate its reliability and validity.

METHOD

The semi-structured Psychotherapist Character Virtues (PCV) interview and evaluation method, based on Erik Erikson's and Heinz Kohut's writings on 16 virtues or abilities and achievements of an adult self, was administered to 68 psychodynamic and solution-focused therapists. Inter-rater reliability was assessed based on 20 videorecorded interviews, rated by two evaluators. In a mixed-methods design, validity was investigated against (i) therapist's questionnaire-based self-reported professional and personal background characteristics and (ii) a qualitative content analysis of emotional atmosphere in the interview.

RESULTS

Interrater reliability for individual 16 virtues was acceptable (median correlation .72). From individual virtues, three principal components (Creative Will, Empathy, and Love/Care) emerged with good/excellent internal consistency (component determinacies .95, .85, and .90, respectively) and criterion validity with self-reported professional and personal characteristics. Cluster analysis of therapists' component scores yielded six different therapist character profiles. In qualitative analysis, character profiles meaningfully differed in their impact on the interview's emotional atmosphere.

CONCLUSION

PCV appears promising for evaluating therapists' character virtues, posited to undergird therapists' sensitive attunement and responsiveness. Further research is needed on PCV's predictive validity for therapeutic relationships and outcomes.

Dispositional Empathy Among Psychotherapists: A Latent Profile Analysis

OBJECTIVE

This study examined therapists' dispositional empathy profiles and how they differ based on professional and personal characteristics.

METHOD

A total of 376 clinicians was recruited for this study. Dispositional empathy was assessed with the Interpersonal Reactivity Index (IRI). Profiles were generated using latent profile analysis. Predictors of profiles were assessed with multiple self-report questionnaires measuring demographic and professional characteristics, romantic attachment styles, five-factor personality traits and vulnerable narcissism.

RESULTS

A four-profile solution was retained with the following proportions: rational empathic (20%), disengaged/detached (10%), empathic immersion (35%) and insecure/self-absorbed (35%). Overall, few relationships were found regarding demographic and professional characteristics. In contrast, significant relationships were found between profile membership and personal characteristics, including avoidant and anxious attachment, agreeableness, conscientiousness, neuroticism, intellect/imagination and vulnerable narcissism.

CONCLUSION

The findings show that differences in therapists' empathic dispositions are linked to personality dimensions. Implications for psychotherapy research, practice and training are discussed.

How secure is the secure base? Romantic attachment, emotion regulation, and psychotherapists' role as secure base figures

In 1988, Bowlby posited that the emotional availability of psychotherapists in establishing a secure base environment is influenced by their personal relational history. Despite the acknowledged influence of the therapist's attachment on therapeutic processes and outcomes, the therapist's role as a secure base figure has received insufficient attention. This study delves into the connection between psychotherapists' attachment organization and their self-perceived roles as secure base figures within clinical contexts. Additionally, we explore the mediating role of emotion regulation processes in this context. The dataset comprises self-reports from 384 psychotherapists with diverse theoretical orientations. Our analysis reveals both direct and indirect effects of psychotherapists' attachment on the provision of a secure base. Emotion regulation, specifically through the dimension of clarity, emerges as a significant mediator in this relationship. This study offers a distinctive contribution to deepening our understanding of the relational dynamics inherent to psychotherapeutic practice. It sheds light on the nuanced relation between attachment and emotion regulation, influencing the psychotherapist's role as a secure base figure in psychotherapy. The discussion of the results additionally emphasizes key implications for clinical practice and therapists' training.

Trauma-Informed Care in Psychedelic Therapy Research: A Qualitative Literature Review of Evidence-Based Psychotherapy Interventions in PTSD and Psychedelic Therapy Across Conditions

Introduction

Post-traumatic stress disorder (PTSD) is associated with significant patient burden. While pharmacotherapies and evidence-based psychotherapy interventions (EBPI) are effective, studies consistently highlight inadequate outcomes and high treatment dropout. Psychedelic therapy (PT) has shown preliminary promise across difficult-to-treat conditions, including MDMA-assisted therapy for PTSD, however trials of classical psychedelics in PTSD are lacking. Understanding patients' experiences of EBPI could help promote safety in PT.

Aim

To systematically review qualitative research on patients' subjective experience of EBPI for PTSD, and of PT, and examine areas of overlap and divergence between them.

Methods

Systematic literature searches for studies published between 2010 and 2023 were conducted on OVID, PubMed, Web of Science, and PsycInfo. Included were original studies in English that presented qualitative data of patient experiences of EBPI in PTSD, or PT for any indication. Extracted data from included studies were analysed using thematic synthesis. Syntheses were completed separately for EBPI and PT, before similarities and differences between the therapies were identified.

Results

40 research articles were included for review: 26 studies on EBPI for PTSD, and 14 studies on PT. EBPI studied were CBT, EMDR, CPT and PE. Psychedelic compounds studied were psilocybin, ibogaine, LSD, MDMA and ketamine, for treatment of substance use disorders, anxiety relating to physical illness, depression, and PTSD. Core themes from patient experiences of EBPI: 1) patient burden in PTSD treatment; 2) readiness; 3) key mechanisms of change; 4) psychological safety and trust. Themes identified in the review of PT: 1) indirect trauma processing; 2) reorganisation of self-narratives via processes of relatedness and identification; 3) key treatment characteristics.

Conclusion

This study suggests overlap between patients' experience of EBPI and PT in terms of key mechanisms of change, the importance of psychological safety and readiness to engage in treatment. Trauma-informed care paradigms and practices may improve safety and acceptability of PT research.

Self-formulation in counselling psychology: The Power Threat Meaning Framework

This reflective report critically evaluates my developing professional identity as a counseling psychologist. Using the Power Threat Meaning Framework, I present a self-formulation to make sense of my experiences during the second stage of my training. To begin with, I consider how multiple forms of power were operating in the complex relationship between personal and professional spheres. As I appraise my professional development, I examine the threats posed by the negative use of power and the resulting challenges within my practice. Drawing from research, psychological theories, and relevant case examples, I explore the meaning I attached to my experiences while managing complex problems and professional issues. In my endeavor to act according to ethical and professional guidelines, I consider my threat responses to preserve my functioning within program learning and professional practice. By appreciating my access to power resources, I demonstrate my willingness and ability to engage with feedback and reflexivity as personal strengths that helped me navigate my ongoing training. Therefore, I integrate professional and ethical perspectives in the “meaning-making” of my development as a trainee counseling psychologist.

Entwicklung von Affiliation während der Psychotherapieausbildung

Fragestellung

Die Studie untersuchte die Entwicklung von Affiliation bei psychotherapeutischen Ausbildungskandidat:innen in Bezug auf ihr therapeutisches Handeln, ihre Selbstwahrnehmung und ihre Wahrnehmung von Klient:innen. Zudem wurde der Einfluss von Bindungsrepräsentationen und Selbsterfahrung auf die Affiliation betrachtet.

Material und Methode

In einem naturalistischen Prä-Post-Design bewerteten Ausbildungskandidat:innen unterschiedlicher therapeutischer Orientierungen (n = 126) verschiedene Affiliationsdimensionen in schwierigen Therapiesituationen (Intrex Questionnaire Short Form) über den Abstand von 3 Jahren. Bindungsangst und Bindungsvermeidung wurden zu Beginn (Experiences in Close Relationships, ECR-RD), Länge und Zufriedenheit der Selbsterfahrung am Ende des Erhebungszeitraums erfasst. Die Zusammenhangsanalysen wurden in Mehrebenenmodellen realisiert.

Ergebnisse

Die Affiliation im eigenen therapeutischen Verhalten und in der Wahrnehmung des Klient:innenverhaltens zeigte Steigerungen kleiner Effektgröße, wobei Bindungsvermeidung eine geringere Affiliation im eigenen Verhalten voraussagte. Die selbstbezogene Affiliation nahm mit einer mittleren Effektgröße ab; hierbei war Bindungsangst mit einer niedrigeren Affiliation assoziiert. Die Selbsterfahrungsdauer wies einen negativen Zusammenhang mit der Wahrnehmung des Klient:innenverhaltens auf; dieser Effekt kehrte sich bei hoher Bindungsvermeidung um. Die Zufriedenheit mit Selbsterfahrung hatte keinen Einfluss auf die Affiliationsentwicklung.

Schlussfolgerung

Die interpersonelle und intrapsychische Affiliation von angehenden Psychotherapeut:innen ist z. T. durch Bindungsrepräsentationen geprägt, unterliegt aber Entwicklungsprozessen. Die Abnahme selbstbezogener Affiliation zeigt die Notwendigkeit für kompensatorische und ressourcenstärkende Maßnahmen in der Psychotherapieausbildung.

Therapeutic distance in client-therapist narratives: client attachment, therapist attachment, and dyadic effects

Based on the attachment framework, therapeutic distance conceptualization focuses on closeness-distance dynamics in the therapeutic relationship. We aimed to evaluate the psychometric properties of the Therapeutic-Distance-Scale, Observer-version (TDS-O) and apply a dyadic approach to examine associations between attachment characteristics and therapeutic distance experiences of clients, therapists, and mutual effects. Sixty-six clients and their 29 therapists completed the ECR and relational narratives collected in RAP interviews at early, mid, and late psychodynamic-therapy were rated on TDS-O scales: too close, too distant, autonomy, and engagement. The TDS-O showed good IRR, internal reliability and content validity. Client anxiety was not associated with therapeutic distance but associated with autonomy. Client avoidance associated with clients' experiencing therapist as too close, and lower engagement only at early therapy, but was not associated with therapists' experience. Therapist anxiety was not related to closeness-distance at early therapy but related to gaps between client and therapist experiences at mid and late therapy. Therapist avoidance related to clients experiencing therapists as too close and granting less autonomy at early and mid-therapy, and to therapist experience of distance at late therapy. The findings underscore the importance of therapists' regulating therapeutic distance through attunement to client's interpersonal needs and therapy phase.

An exploration of the experience of trainee integrative psychotherapists on therapeutic alliance in the light of their attachment style

Therapeutic Relationship has been regarded as a profound element of the psychotherapeutic procedure and crucial for the outcome of therapy. Research evidence so far claims that both therapist’s and client’s personality can impact the Therapeutic Relationship. Based on the well-researched Attachment Theory there has been some research mostly focused on how clients’ attachment patterns can affect the Alliance. Limited research, though, on how therapists experience the Relationship in relation with their Attachment Styles do exist. The current study investigates trainee therapists’ experience of the Therapeutic Relationship in the light of their Attachment Style. A qualitative approach was used for this research to investigate in depth the experience of five trainee Integrative psychotherapists who were recruited to take part in semi-structured interviews. Interviews were transcribed and verbatim was divided into superordinate and subordinate themes and analyzed by Interpretative Phenomenological Analysis method. Four master themes were identified. Findings were then compared and discussed according to existing literature. All participants referred to the relevance of Attachment Theory in psychotherapy. They also agreed on the activation of their Attachment Styles during the therapeutic process. The securely attached therapist confirms previous studies on her capability to offer a secure base for her clients. On the other hand therapists with insecure Attachment Styles appeared sensitive in their collaboration mostly with insecure clients. Anxiously attached therapists proved to experience difficulty in the initial stages of the Therapeutic Relationship while the combination of avoidant therapist-avoidant client appeared to be the most demanding one, regarding the concept of trust and relationship ruptures. We suggest that the exploration of trainee therapists’ Attachment Styles as well as the study of the Attachment Theory should be added to all Counseling and Psychotherapy curricula regardless the therapeutic orientation because of its contribution to forming positive Therapeutic Relationships.

The supervisory relationship from an attachment perspective: Connections to burnout and sense of coherence in health professionals

Supervision is an essential part of the training and work environment of health professionals, especially of psychotherapists and clinical/health psychologists. However, although the supervisory process is always a relational one and may therefore be influenced by attachment dynamics, the importance of the supervisory relationship for the professional's performance and the well‐being of the supervisee has yet to be fully examined.

In this cross‐sectional observational study, the Experiences in Close Relationships‐Revised (ECR‐RD; avoidant and anxious attachment), the Supervisory Relationship Questionnaire (SRQ), the Maslach Burnout Inventory (MBI) and the Sense of Coherence Scale (SOC‐13) were analysed for 346 (81.8% female) health professionals.

Considering professional experience and number of supervision sessions as control variables, a better supervisory relationship negatively predicted burnout symptoms (β = −.31) but positively predicted sense of coherence (β = .31, both p < .01). The final model, including avoidant and anxious attachment as additional predictors, explained 30% of the variance in burnout symptoms and 41% of the variance in sense of coherence.

The results underline the importance of the supervisory relationship for the well‐being and the professional performance of health professionals. Interactions between the supervisory relationship and underlying attachment parameters should be further explored in future studies.

In-session interactive dynamics of the psychotherapy process between therapeutic alliance, therapist expertise, therapist technical intervention, patient metacognition and functioning

Empirical research has explored different dimensions of the therapy process and their associations, often showing bidirectional links: for example, metacognition may be favoured by a positive alliance with the clinician; on the other hand, metacognitive difficulties may be an obstacle for the alliance. However, little is still known about the overall relationship between multiple dimensions during the psychotherapy process. The aim of this study is to further explore the in-session interaction of therapeutic process variables, focusing on patient metacognition, therapeutic alliance, technical intervention, therapist expertise, and patient functioning. Participants included 45 patients involved in a psychodynamic weekly treatment in two clinical centres. Therapists were both in-training and experienced clinicians. Four instruments were applied on four psychotherapy sessions (178 verbatim transcripts): Metacognition Assessment Scale-Revised (MAS-R) assessing metacognition, Collaborative Interaction Scale (CIS) assessing therapeutic alliance, Psychodynamic Intervention Rating Scale (PIRS) assessing therapist technical interventions, and Shedler-Westen Assessment Procedure (SWAP)-200 assessing patient functioning. Sequential analyses revealed that specific therapist interventions co-occurred with three different levels of therapeutic alliance: a first one characterized by positive collaboration, the second one by neutral collaboration, and the third one by ruptures. Moreover, and critically, the patient metacognition, patient functioning, and therapist expertise were found to exert different effects in the three alliance levels. These findings suggest the existence of a specific interdependence between the variables involved in the research. These results further indicate that the therapist expertise is a key element in the therapeutic process, as it can drastically affect the in-session interactive dynamic.

Service users' first accounts of experiencing endings from a psychological service or therapy: A systematic review and meta-ethnographic synthesis

PURPOSE

To review and synthesize the qualitative literature on service users' experiences of endings from a psychological service or therapy.

METHODS

A systematic search of the peer-reviewed literature identified qualitative studies meeting specific inclusion criteria. A modified CASP tool was used to critically appraise their quality, and a meta-ethnographic approach was used to synthesize their findings.

RESULTS

Twelve papers met the inclusion criteria. The interpretation of findings suggested three key themes: anticipation of ending, service user control, and sense of responsibility. Although studies varied in geographical location and type of service, they were consistently of high quality.

CONCLUSIONS

The review highlights the importance of service users' perspectives in understanding the experiences of endings. The findings complement existing literature and provide new interpretations. Considerations for practice were limited; however, the review provides useful directions for future research.

PRACTITIONER POINTS

When ending therapy, clinicians should consider the dyadic nature of the therapeutic relationship and the emotional impact this may have upon both service users and staff. Further consideration should be given to how staff manage their responses to the ending. The time-limited structure of therapy may aid the ending process by relieving staff and service users of responsibility.

Detecting alliance ruptures: the effects of the therapist's experience, attachment, empathy and countertransference management skills

Accurate alliance rupture detection is a prerequisite to any successful repair process. Despite its importance, however, rupture detection remains a struggle for most therapists. Supporting the existence of a therapist effect on therapy outcomes, rupture detection skills may rely on certain therapists’ personal characteristics. The aim of this study was to verify whether alliance rupture detection performance is related to therapists’ personal characteristics. One hundred and eight undergraduates, trainees and mental health professionals participated in an experimental task assessing their alliance rupture detection ability. Participants also completed attachment, empathy and countertransference management self-reported measures. Participants with clinical experience (trainees and professionals) reported more alliance ruptures, accurate or not, than those with no clinical experience (undergraduates). Trainees reported more accurate ruptures and less inaccurate ones than the two other groups. Attachment anxiety was positively associated with accurate ruptures detection for undergraduates, while this association proved negative for trainees and therapists. Perspective-taking, a cognitive dimension of empathy, was negatively associated with accurate rupture detection, whereas personal distress, an affective dimension of empathy, was negatively associated with accurate ruptures detection for trainees, and positively associated for undergraduates. Self-insight, a component of countertransference management, revealed a negative association with accurate rupture detection for trainees. These findings suggest that therapists vary as to their rupture detection ability and that this ability is related to certain personal characteristics. They also highlight the importance of specific training and clinical supervision for both trainees and experienced therapists in order to improve their detection ability.

Exposure to attachment narratives dynamically modulates cortical arousal during the resting state in the listener

BACKGROUND

Affective stimulation entails changes in brain network patterns at rest, but it is unknown whether exogenous emotional stimulation has a prolonged effect on the temporal dynamics of endogenous cortical arousal. We therefore investigated differences in cortical arousal in the listener following stimulation with different attachment-related narratives.

METHODS

Resting-state EEG was recorded from sixteen healthy subjects for ten minutes each with eyes closed: first at baseline and then after passively listening to three affective narratives from strangers about their early childhood experiences (prototypical for insecure-dismissing, insecure-preoccupied, and secure attachment). Using the VIGALL 2.1 algorithm, low or high vigilance stages in consecutive EEG segments were classified, and their dynamic profile was analyzed. Questionnaires assessed the listeners' emotional response to the content of the narrative.

RESULTS

As a general effect of preceding affective stimulation, vigilance following the stimulation was significantly elevated compared to baseline rest, and carryover effects in dynamic vigilance profiles were observed. A difference between narrative conditions was revealed for the insecure-dismissing condition, in which the decrease in duration of high vigilance stages was fastest compared to the other two conditions. The behavioral data supported the observation that especially the insecure narratives induced a tendency in the listener to affectively disengage from the narrative content.

DISCUSSION

This study revealed carryover effects in endogenous cortical arousal evoked by preceding affective stimulation and provides evidence for attachment-specific dynamic alterations of brain states and individual differences in emotional reactivity.

Counselors' attachment anxiety and avoidance and the congruence in clients' and therapists' working alliance ratings

OBJECTIVE

To determine how counselors' attachment anxiety and avoidance related to congruence between counselors' and clients' Working alliance (WA) ratings. Congruence strength was defined as the regression coefficient for clients' WA ratings predicting counselors' WA ratings. Directional bias was defined as the difference in level between counselors' and clients' WA ratings.

METHOD

Twenty-seven graduate student counselors completed an attachment measure and they and their 64 clients completed a measure of WA early in therapy. The truth-and-bias analysis was adapted to analyze the data.

RESULTS

As hypothesized counselors' WA ratings were significantly and positively related to clients' WA ratings. Also as hypothesized, counselors' WA ratings were significantly lower than their clients' WA ratings (directional bias). Increasing counselor attachment anxiety was related to increasing negative directional bias; as counselors' attachment anxiety increased the difference between counselors and clients WA ratings became more negative. There was a significant interaction between counselor attachment anxiety and congruence strength in predicting counselor WA ratings. There was a stronger relationship between client WA ratings and counselor WA ratings for counselors low versus high in attachment anxiety.

CONCLUSION

Counselors' attachment anxiety is realted to their ability to accurately percieve their clients' WA.

The relevance of professionals' attachment style, expectations and job attitudes for therapeutic relationships with young people who experience psychosis

BACKGROUND

Therapeutic relationships are a central component of community treatment for psychosis and thought to influence clinical and social outcomes, yet there is limited research regarding the potential influence of professional characteristics on positive therapeutic relationships in community care. It was hypothesised that professionals' relating style and attitudes toward their work might be important, and thus this exploratory study modelled associations between these characteristics and therapeutic relationships developed in community psychosis treatment.

METHODS

Dyads of professionals and young patients with psychosis rated their therapeutic relationships with each other. Professionals also completed measures of attachment style, therapeutic optimism, outcome expectancy, and job attitudes regarding working with psychosis.

RESULTS

Professionals' anxious attachment predicted less positive professional therapeutic relationship ratings. In exploratory directed path analysis, data also supported indirect effects, whereby anxious professional attachment predicts less positive therapeutic relationships through reduced professional therapeutic optimism and less positive job attitudes.

CONCLUSIONS

Professional anxious attachment style is directly associated with the therapeutic relationship in psychosis, and indirectly associated through therapeutic optimism and job attitudes. Thus, intervening in professional characteristics could offer an opportunity to limit the impact of insecure attachment on therapeutic relationships in psychosis.

Experiences Learning Interpersonal Neurobiology: An Interpretative Phenomenological Analysis

Neuroscience is increasingly part of the national dialogue regarding mental health and yet little is known about the experiences of mental health professionals learning and integrating neuroscience into their work. In this study, the authors explored mental health professionals' experiences learning Interpersonal Neurobiology (IPNB). Four super-ordinate themes emerged from an interpretative phenomenological analysis: (1) learning process as dynamic and engaging, (2) deepening knowledge and understanding of self and others, (3) personal and professional growth, and (4) impact on therapeutic practice. Three higher-order constructs appeared embedded within and across themes: learning as ongoing, person of the participant, and person of the instructor. These findings suggest learning IPNB through experiential-based means had a profound impact on participants' personal and professional development, specifically in areas related to characteristics of effective counselors. Implications for future research and mental health practice are discussed.

Pilot test of a measure to assess therapeutic distance and its association with client attachment and corrective experience in therapy

OBJECTIVES

The Therapeutic Distance Scale (TDS) was developed in this project to assesse clients' experiences of distance versus engagement with their therapist.

METHOD

In a survey study of 47 university clients at the "mid-stage" and 34 of these clients at termination, four TDS subscales were identified: Too Close, Too Distant, Growing Autonomy, and Growing Engagement.

RESULTS

TDS subscales were correlated as expected with working alliance and Client Attachment to Therapist. As hypothesized, (i) pre-therapy attachment Avoidance was significantly correlated with perceptions of therapists as Too Close (but not Too Distant), (ii) pre-therapy Anxiety was significantly correlated with Too Distant (but not Too Close); furthermore, among clients who developed a secure attachment to their therapist, (iii) pretherapy Avoidance was significantly correlated with Growing Engagement; however, (iv) contrary to expectations, pre-therapy anxiety was not significantly associated with Growing Autonomy.

CONCLUSIONS

The TDS is a promising measure for assessing the in-therapy corrective emotional experiences of clients with hyperactivating attachment (i.e. increasing autonomy) and deactivating attachment (i.e. increasing engagement).

Therapists' professional and personal characteristics as predictors of outcome in long-term psychodynamic psychotherapy and psychoanalysis

BACKGROUND

Whether long-term psychodynamic therapy (LPP) and psychoanalysis (PA) differ from each other and require different therapist qualities has been debated extensively, but rarely investigated empirically.

METHODS

In a quasi-experimental design, LPP was provided for 128 and PA for 41 outpatients, aged 20-46 years and suffering from mood or anxiety disorder, with a 5-year follow-up from start of treatment. Therapies were provided by 58 experienced therapists. Therapist characteristics, measured pre-treatment, were assessed with the Development of Psychotherapists Common Core Questionnaire (DPCCQ). General psychiatric symptoms were assessed as the main outcome measure at baseline and yearly after start of treatment with the Symptom Check List, Global Severity Index (SCL-90-GSI).

RESULTS

Professionally less affirming and personally more forceful and less aloof therapists predicted less symptoms in PA than in LPP at the end of the follow-up. A faster symptom reduction in LPP was predicted by a more moderate relational style and work experiences of both skillfulness and difficulties, indicating differences between PA and LPP in the therapy process.

CONCLUSIONS

Results challenge the benefit of a classically "neutral" psychoanalyst in PA. They also indicate closer examinations of therapy processes within and between the two treatments, which may benefit training and supervision of therapists.

The therapist's attachment representation and the patient's attachment to the therapist

This study examines the relationship between the therapist's own attachment representation (Adult Attachment Interview, AAI) and the patient's attachment relationship to the therapist (client's attachment to the therapist, CATS). The attachment representations of n=22 psychotherapists who treated n=429 patients were assessed. A general effect of the secure/insecure therapist attachment status on the attachment of the patient to the therapist was not found whereas the more specific effects expected could be confirmed: The more preoccupied the therapist's attachment status was, the more the patient experienced a preoccupied-merger attachment to the therapist. The more dismissing the therapist's attachment status was, the more the patient experienced an avoidant-fearful attachment to the therapist. In summary, not the general security/insecurity of the therapist's attachment representation but rather the type of the insecurity is associated with the subjective patient's attachment-related experience of the therapeutic dyad.

Exploring the influence of the attachment organizations of novice therapists on their delivery of emotionally focused therapy for couples

Clinicians' own internal resources for understanding relationships--that is, their attachment organizations--have been found to influence the process and outcome of treatment. The current study addressed whether the attachment organizations of novice couple and family therapists were associated with couples' experiences of their therapists, therapeutic alliance, session impact, and emotionally focused couple therapy (EFT) fidelity (i.e., especially as related to targeting and working with attachment needs and overt and underlying emotions). Novice couple and family therapists delivered EFT, an attachment-based approach, to couples in a simulated session and an embedded multicase study design guided a cross-case analysis. Findings indicated that secure therapists, when compared to their insecure peers, were more competent at working with attachment needs, as well as the overt and underlying emotions of their clients. Secure therapists perceived themselves as being more skilled in emotion regulation, which may have contributed to their abilities to remain attuned to their clients' attachment needs and emotional expression, even in the face of emotional arousal in session. Couples of insecure therapists also reported greater alliance splits. Future research is needed to further explore the dyadic influences of both therapists' and clients' attachment organizations, as well as the training and supervision practices these findings implicate.

Pet in the therapy room: an attachment perspective on Animal-Assisted Therapy

John Bowlby's ( 1973, 1980, 1982) attachment theory is one of the most influential theories in personality and developmental psychology and provides insights into adjustment and psychopathology across the lifespan. The theory is also helpful in defining the target of change in psychotherapy, understanding the processes by which change occurs, and conceptualizing cases and planning treatment (Daniel, 2006; Obegi & Berant, 2008; Sable, 2004 ; Wallin, 2007). Here, we propose a model of Animal-Assisted Therapy (AAT) based on attachment theory and on the unique characteristics of human-pet relationships. The model includes clients' unmet attachment needs, individual differences in attachment insecurity, coping, and responsiveness to therapy. It also suggests ways to foster the development of more adaptive patterns of attachment and healthier modes of relating to others.

Adult attachment patterns and individual psychotherapy: A review

Attachment theory provides an empirically grounded framework for understanding important aspects of interpersonal functioning in children as well as adults. Recently attachment theory has found increasing use within the field of individual psychotherapy with adults. This article outlines the theory and measurement of individual differences in adult attachment, and the relevance of such adult attachment patterns to psychotherapy. It then offers a review and discussion of empirical findings regarding the effects of client and therapist attachment patterns on process and outcome in individual psychotherapy with adults. Empirical studies have linked adult attachment patterns to differences in client and therapist in-treatment behaviour, to differences in the quality and development of the therapeutic alliance, and to differences in therapeutic outcome. Although empirical studies on the subject are still few in number, evidence is emerging for the importance of adult attachment patterns in the therapeutic relationship.

Self-reported attachment styles and therapeutic orientation of therapists and their relationship with reported general alliance quality and problems in therapy

The aims of this study were to explore the relationship between therapists' self-reported attachment styles and therapeutic orientation with the self-reported general therapeutic alliance and therapist-reported problems in psychological therapy.A sample of 491 psychotherapists from differing therapeutic orientations responded to a postal questionnaire. The questionnaire contained standardized measures of therapeutic alliance quality, attachment behaviours, a checklist of problems in therapy, and a brief personality inventory.Therapist-reported attachment styles generally explained a significant additional proportion of the variance in alliance and problems in therapy, over and above variance explained by general personality variables. Self-reported secure attachment style was significantly positively correlated with therapist-reported general good alliance. Self-reported anxious attachment styles were significantly negatively correlated with good alliance, and significantly positively correlated with the number of therapist-reported problems in therapy. Therapeutic orientation independently predicted a small but significant amount of the variance in reported general alliance quality in addition to that explained by attachment behaviours.

Psychoanalysis--with whom, for what, and how? Comparisons with psychotherapy

If psychoanalytic treatment is to survive in the era of evidence-based medicine and managed care systems, empirical evidence is needed to demonstrate its unique nature and effectiveness. To address this need, comprehensive analyses were conducted of data from the Menninger Psychotherapy Research Project (Wallerstein 1986). These analyses addressed three questions: (1) What are the differences in outcome between psychoanalysis (PSA) and supportive-expressive psychotherapy (SEP)? (2) With what types of patient, and in what ways, are these two psychodynamic treatments differentially effective? (3) Are these differences in outcome the consequence of possibly different mechanisms of therapeutic action? PSA was found to contribute significantly to the development of adaptive interpersonal capacities and to the reduction of maladaptive interpersonal tendencies, especially with more ruminative, self-reflective, introjective patients, possibly by extending their associative capacities. SEP, by contrast, was effective only in reducing maladaptive interpersonal tendencies and only with dependent, unreflective, more affectively labile anaclitic patients, possibly by containing or limiting their associative capacities.