Secure attachment to therapist, alliance, and outcome in psychoanalytic psychotherapy with young adults.

Abstract

Using a novel approach to assess attachment to therapist from patient narratives (Patient Attachment to Therapist Rating Scale; PAT-RS), we investigated the relationships between secure attachment to therapist, patient-rated alliance, and outcome in a sample of 70 young adults treated with psychoanalytic psychotherapy. A series of linear mixed-effects models, controlling for length of therapy and therapist effects, indicated that secure attachment to therapist at termination was associated with improvement in symptoms, global functioning, and interpersonal problems. After controlling for the alliance, these relationships were maintained in terms of symptoms and global functioning. Further, for the follow-up period, we found a suppression effect indicating that secure attachment to therapist predicted continued improvement in global functioning, whereas the alliance predicted deterioration when both variables were modeled together. Although limited by the correlational design, this study suggests that the development of a secure attachment to therapist is associated with treatment gains as well as predictive of posttreatment improvement in functioning. Future research should investigate the temporal development of attachment to therapist and its interaction with alliance and outcome more closely. To ensure differentiation from patient-rated alliance, observer-based measurement of attachment to therapist should be considered.

Using Attachment to Better Understand the Therapy Alliance: The Attachment Based Alliance Questionnaire

“…While, another meta‐analysis of 14 studies found that the stronger the client's attachment security, the stronger the therapeutic alliance (Mallinckrodt & Jeong, ) and that a secure attachment to the therapist is positively correlated with outcomes (Diener & Monroe, ; Marmarosh et al., ). Finally, Lilliengren, Falkenström, Sandell, Mothander, and Werbart () found that a client's attachment to the therapist was predictive of both immediate and posttreatment outcomes. The authors also controlled for the alliance ratings and found results were still significantly related, indicating that attachment was related to outcome and not merely an artifact of the alliance.…”

Estudos clínicos em psicoterapia psicodinâmica: uma revisão do follow-up das intervenções

“…As modalidades de psicoterapia avaliadas foram: psicoterapia psicodinâmica -PP (Lilliengren et al, 2015;Berghout e Zevalkink, 2009); psicoterapia psicodinâmica de curto prazo -PPCP (Leichsenring et al, 2014;Amianto et al, 2011); psicoterapia psicodinâ-mica de longo prazo -PPLP (Leichsenring et al, 2014;Arvidsson et al, 2011); psicoterapia psicodinâmica intensiva e curto prazo -PPI-CP (Solbakken e Abbass, 2015); psicoterapia psicodinâmica intensiva -PPI (Abass et al, 2015); psicoterapia psicodinâmica de apoio -PPA (Driessen et al, 2013); psicoterapia psicodinâmica breve -PPB (Amianto et al, 2011); psicoterapia psicodinâmica focal -PPF (Zipfel et al, 2014); tratamento comunitário de foco psicodinâmico -TCFP (Vinnars et al, 2009); psicoterapia psicodinâmica interpessoal -PIT (Sattel et al, 2012); psicoterapia psicodinâmica pela internet -PPIN (Johansson et al, 2013); psicanálise -PA (Grande et al, 2009); psicaná-lise com predomínio de interpretações transferências -PAT e sem interpretações transferenciais -PAST (Høglend et al, 2008) e terapia cognitivo comportamental -TCC; (Levi et al, 2015;Zipfel et al, 2014); terapia cognitivo comportamental pela internet -TCCI (Johansson et al, 2013); terapia do esquema -TE (Gude e Hoffart., 2008); terapia de apoio -TA (Vinnars et al, 2009); e, terapia focal -TF (Heinonen et al, 2012). Foram encontradas também intervenções com medicamentos como a fluoxetina (Sørensen et al, 2011), sozinhos ou combinados com psicoterapia psicodinâmica (Koppers et al, 2011); e também intervenções combinadas com outros tratamentos multidisciplinares, tais como dieta alimentar e acompanhamento familiar (Abba-te Daga et al, 2015).…”

“…Outro método utilizado para complementar os questionários foram entrevistas presenciais semiestruturadas desenvolvidas para o próprio estudo, ou entrevistas estruturadas, por exemplo: Operationalized Psychodynamic Diagnosis -OPD Task Force (Levi et al,2015;Vinnars et al, 2009;Marttunen et al, 2008;Johansson et al, 2013;Kronström et al, 2009;Koppers et al, 2011;Høglend et al, 2008;Gude e Hoffart, 2008;Abbate-Daga et al, 2015;Berghout e Zevalkink, 2009;Lilliengren et al, 2015;Grande et al, 2009;Arvidson et al, 2011;Leichsenring et al, 2014). O estudo que avaliou custo-efetividade dos serviços de saúde também utilizou, além dos questionários, os registros nacionais de verificação para compor as medidas de follow-up (Abass et al, 2015).…”

“…Em oito deles, foram comparadas intervenções psicanalíticas com tratamentos "as usual" (TAU), ou com grupo controle (GC). Em cinco estudos, a PP foi superior (Sattel et al, 2012;Amianto et al, 2011;Hasse et al, 2008;Zipfel et al, 2014;Lilliengren et al, 2015), e em dois, pacientes de ambos os estudos melhoraram e os resultados se mantiveram no follow-up (Scheidt et al, 2013;Vinnars et al, 2009).…”

The Complexity of Loss During a Forced Termination: A Case Illustration

“…At its best, the therapeutic relationship offers a new attachment experience that is imbued with meaning and empathic connection, and contributes to positive treatment outcome [see Lilliengren et al . () for an empirical example of the positive effect of patient attachment to the therapist on alliance and treatment outcome]. Successfully working through termination entails a transformation process in which patients internalize the therapeutic relationship, and ultimately develop new ways to view themselves and others.…”