Effects of adult inpatient group psychotherapy on attachment characteristics: An observational study comparing routine care to an untreated comparison group

Abstract

This study investigated the changes in attachment characteristics of patients undergoing inpatient group psychotherapy in routine care. We collected data from 265 consecutively recruited patients and 260 non-clinical control persons using self-report measures of attachment, depression, and socio-demographic characteristics. The effects of treatment on patients were analyzed using propensity score techniques (propensity strata and logit-transformed propensity scores) in combination with a generalized analysis of covariance. A moderate increase of attachment security was found which could be attributed to a decrease both in attachment anxiety and avoidance. Pre-post improvements in attachment with regard to romantic partnerships were stable after a 1-year follow-up. Furthermore, we found significant treatment-covariate interactions indicating that subjects with particularly high treatment propensities (propensities were highly correlated with depression and attachment anxiety) improved the most in terms of attachment security. Our results are encouraging for psychotherapeutic practice in that they provide evidence that long-term attachment improvements can be reached via psychotherapy. Our results will also provide a sound basis for future studies in the field of clinical attachment research, e.g., studies examining whether improved attachment security is correlated to symptom improvements in different psychological disorders.

Changes in attachment representations during psychological therapy

“…Lawson and Bossart (2009) used two dimensions from a measure that was originally designed to assess more whilst Muller and Rosenkranz (2009) used composite scores of the RSQ and RQ, without a rationale. For those studies that used categorization (Kirchmann et al, 2012;Lawson et al, 2006;Travis et al, 2001), precision of measurement may have been an issue (Fraley & Waller, 1998). Attrition rates were considered problematic (> 40%) for one study during therapy (Levy et al, 2006) and for two studies during follow-up (Kilmann et al, 1999;Kirchmann et al, 2012).…”

“…For those studies that used categorization (Kirchmann et al, 2012;Lawson et al, 2006;Travis et al, 2001), precision of measurement may have been an issue (Fraley & Waller, 1998). Attrition rates were considered problematic (> 40%) for one study during therapy (Levy et al, 2006) and for two studies during follow-up (Kilmann et al, 1999;Kirchmann et al, 2012). Muller and Rosenkranz (2009) did not provide a follow-up of a control group and so was also rated weak for attrition at follow-up.…”

“…Six studies computed the two-dimensional factors recommended by Brennan, Clark, and Shaver (1998), whereas four studies computed four variables (Kilmann et al, 1999;Muller & Rosenkranz, 2009;Tasca, Balfour, Ritchie, & Bissada, 2007;Travis, Biner, Bliwise, & HorneMoyer, 2001) and one study computed only one dimension (Butler et al, 2011). In addition, three studies transformed participants' scores into categories (Kirchmann et al, 2012;Lawson et al, 2006;Travis et al, 2001).…”

“…Non-randomized studies were automatically rated "weak" with regard to their control over confounding variables, except for Kirchmann et al (2012), who used statistical analyses to control for confounders. Three RCTs were also rated weak in this domain because they did not report whether differences existed between groups.…”

Attachment theory within clinical supervision: application of the conceptual to the empirical

“…Similar studies of attachment in psychotherapy that have found the need for longer periods of time to impact a client's internal working model (IWM) (Fonagy et al, 1996;Kinley & Reyno, 2013;Kirchmann et al, 2012;Tasca, Balfour, Ritchie, & Bissada, 2007), a period of a year, rather than a semester might have allowed for meaningful patterns to surface. However, the structure of the supervision model in this training clinic did not easily facilitate a full year data collection; sample size restrictions would have likely been even more concerning.…”