The Relationship Between Attachment Needs, Earned Secure Therapeutic Attachment and Outcome in Adult Psychotherapy

• Published in: Journal of consulting and clinical psychology 2024-07, Vol.92 (7), p.410-421
• Main Authors: Jacobsen, C. F., Falkenström, F., Castonguay, L., Nielsen, J., Lunn, S., Lauritzen, L., Poulsen, S.
• Format: Article
• Language: English
• Subjects: Adult; adult attachment; Anxiety; Attachment Behavior; Attachment style; Autonomy; Avoidance behavior; client attachment to therapist; Client Treatment Matching; Clients; Closeness; Female; Human; Humans; Individual psychotherapy; Insecurity; Interpersonal problems; Interpersonal Relations; Male; Measures; Mental Disorders - psychology; Mental Disorders - therapy; Middle Aged; Object Attachment; process-outcome research; Professional-Patient Relations; Psychology; Psychotherapeutic Processes; Psychotherapy; Psychotherapy - methods; Psykologi; therapeutic distance; Therapists; Therapy; Treatment Outcome; Treatment Outcomes
• ISSN: 0022-006X; 1939-2117; 1939-2117
• DOI: 10.1037/ccp0000900

Objective: The aim of this study was to investigate a sequence of associations between clients' pretreatment attachment style, the development of individuated-secure attachment to the therapist (i.e., therapeutic attachment), and the experience of increased comfort with emotional closeness (growing engagement) or independence (growing autonomy) in therapy. Moreover, the study explored whether clients' experience of growing engagement or growing autonomy was associated with a change in interpersonal problems at the end of therapy. Method: Three hundred thirty adult clients (mean age 40.2, 75% female) were seen by 44 therapists in individual psychotherapy. The associations between pretreatment attachment insecurity measured on the Experiences in Close Relationships scale, repeated measures of therapeutic attachment measured on the Client Attachment to Therapist Scale, repeated measures of a growing engagement or growing autonomy measured on the Therapeutic Distance Scale, and pre-post measures of interpersonal problems measured on the Inventory for Interpersonal Problems were analyzed using multilevel modeling. Two types of therapeutic attachment were estimated, one controlling for anxious attachment characteristics and one for avoidant. Results: Significant associations between higher levels of therapeutic attachment controlled for avoidant attachment characteristics and lower levels of growing autonomy in therapy were found. Moreover, higher levels of growing engagement in therapy and higher levels of therapeutic attachment controlled for anxious attachment characteristics were associated with a decrease in interpersonal problems at the end of therapy. Conclusions: Distinct types of therapeutic attachment may exert different influences on the process and outcome of therapy. Furthermore, therapists' attunement to clients' specific attachment needs in therapy may enhance interpersonal outcomes of treatment. What is the public health significance of this article? This study highlights the clinical relevance of applying attachment-theoretical principles to the process of therapy to enhance therapeutic outcomes. The study suggests that for certain clients, increases in the attachment between the client and therapist may be associated with a decrease in the client's experience of autonomy in therapy. The study also indicates that the client's experience of increased comfort with emotional closeness in therapy, as well as the development of therapeutic attachment