Fearful attachment, working alliance and treatment response for individuals with major depression

Abstract

The present research examines links between adult attachment styles, working alliance, and treatment response in men and women receiving 16 sessions of supportive-expressive dynamic psychotherapy for major depression. 58 clients were assessed using the Relationship Questionnaire and the Hamilton Rating Scale for Depression (HRSD) prior to commencement of psychotherapy. The Working Alliance Inventory was completed in session 3, and the HRSD was readministered after six and 16 sessions. Results indicated that a high proportion (39%) of the sample reported 'fearful-avoidant' attachment at intake. Fearful avoidance also longitudinally predicted significantly more negative outcomes (particularly over the initial six sessions), but was unrelated to working alliance. Working alliance was unrelated to treatment response. Findings highlight the negative impact of fearful attachment on treatment response, but indicate that this occurs independent of the working alliance. The avoidance of intimacy for fear of rejection appears to impede successful psychotherapy, and treatment should be tailored for these clients.

The influence of interpersonal factors on the speed of recovery from major depression

“…McLeod et al's findings are compelling because, although the etiology of depression has genetic, biological, shared, and nonshared familial origins (Barlow, 2002;Bierut et al, 1999;Plomin, 1990), others (Klerman, Weissman, Rounsaville, & Chevron, 1984;Weissman, Markowitz, & Klerman, 2000) also view vulnerability to psychopathology as resulting from interpersonal problems. Indeed, research suggests that lower perceived social support (Roberson & Lichtenberg, 2003), the avoidance of intimacy for fear of rejection (Reis & Grenyer, 2004a, 2004b, and a greater amount of interpersonal conflicts (Grenyer, 2002) may jointly precipitate depression and influence recovery.…”

Emotional availability in psychotherapy: The usefulness and validity of the Emotional Availability Scales for analyzing the psychotherapeutic relationship

“…Several studies have explored the relations between alliance in psychotherapy and self-rated attachment style (Diener & Monroe, 2011). Results seem to indicate that secure attachment predicts better alliance (Eames & Roth, 2000;Reis & Grenyer, 2004;Satterfield & Lyddon, 1998;Smith et al, 2010), whereas research results about the relation between attachment avoidance (implying a reduced need of close relationships) or attachment anxiety (implying a fear of being emotionally abandoned) and alliance are less conclusive (Diener & Monroe, 2011;Smith et al, 2010).…”

Mindfulness and emotional regulation as sequential mediators in the relationship between attachment security and depression

“…The authors attribute this association to the 'negative self' model characteristic of these attachment styles (Bartholomew & Horowitz, 1991). Conversely, a dismissive style, associated with a 'positive self' model was not found to be significantly related to depression (Reis & Grenyer, 2004). The significant impact on mental wellbeing, health and social outcomes behoves us to identify variables that may alter attachment styles and/or their impact.…”