The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: A meta-analytic review.

Abstract

The present study examined the relationship between adult attachment style and therapeutic alliance in individual psychotherapy. Search procedures yielded 17 independent samples (total N = 886, average n = 52, standard deviation = 24) for inclusion in the meta-analysis. Results indicated that greater attachment security was associated with stronger therapeutic alliances, whereas greater attachment insecurity was associated with weaker therapeutic alliances, with an overall weighted effect size of r = .17, p < .001 (95% confidence interval = .10-.23). Publication bias analyses did not indicate any cause for concern regarding the results. The data were not demonstrably heterogeneous (Q = 6.10, df = 16, p = .99), and all between-study moderator analyses were nonsignificant (p values > .10) with the exception of the source of alliance ratings; results indicated that patient-rated alliance demonstrated a significantly larger relationship with attachment compared with therapist-rated alliance (Qbetween = 3.95, df = 1, p = .047). Implications for clinical practice and future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Intranasal Oxytocin Administration Dampens Amygdala Reactivity towards Emotional Faces in Male and Female PTSD Patients

“…This way, OT could potentially enhance motivation for treatment, as well as the therapeutic alliance (Olff et al, 2010). Strength of therapeutic alliance, defined as the affective bond between the therapist and patient, is an important and consistent predictor of treatment success (Ormhaug et al, 2014) and depends on the patient's attachment security: more secure attachment is related to stronger therapeutic alliance and vice-versa (see Diener and Monroe, 2011 for a metaanalysis). Attachment style may be particularly relevant in PTSD: insecure attachment, has been associated with higher PTSD symptom severity in trauma-exposed individuals (see Woodhouse et al, 2015 a meta-analysis).…”

Attachment as a Predictor of the Therapeutic Alliance in Couple Therapy

“…These findings are consistent with research on the association between avoidant attachment and the therapeutic alliance in individual therapy, where many of the studies did not differentiate between anxious and avoidant attachment. For example, the meta-analysis that examined attachment and alliance in individual therapy (Deiner & Monroe, 2011) lumped these two types of attachment into the single category: insecure attachment. However, studies that have differentiated between the two types of insecure attachment, have generally found a lack of association between anxious attachment and the therapeutic alliance.…”

Therapist–client relationships in a psychological therapy trial for psychosis and substance misuse

“…One consistent finding in the general psychotherapy literature is that the quality of clients' current or past attachment relationships predicts the quality of therapeutic relationships. A number of studies have found that clients who have secure attachment styles and are comfortable with close emotional relationships develop better alliances (Diener and Monroe, 2011;Smith et al, 2010). Attachment styles may be related to improved therapy outcomes as a result of their associations with therapeutic alliance; a recent study involving people with early psychosis found associations between insecure attachment and poorer recovery from symptoms 12 months later (Gumley et al, 2014).…”