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Secure attachment to therapist, alliance, and outcome in psychoanalytic psychotherapy with young adults
Stockholm University, Faculty of Social Sciences, Department of Psychology.
Stockholm University, Faculty of Social Sciences, Department of Psychology.
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2015 (English)In: Journal of counseling psychology, ISSN 0022-0167, E-ISSN 1939-2168, Vol. 62, no 1, 1-13 p.Article in journal (Refereed) Published
Abstract [en]

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. While 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 post-treatment 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.

Place, publisher, year, edition, pages
2015. Vol. 62, no 1, 1-13 p.
Keyword [en]
attachment to therapist, therapeutic alliance, outcome, psychoanalytic, psychodynamic, psychotherapy, young adults
National Category
Applied Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-106500DOI: 10.1037/cou0000044ISI: 000348049200001OAI: oai:DiVA.org:su-106500DiVA: diva2:736774
Available from: 2014-08-08 Created: 2014-08-08 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Exploring therapeutic action in psychoanalytic psychotherapy: Attachment to therapist and change
Open this publication in new window or tab >>Exploring therapeutic action in psychoanalytic psychotherapy: Attachment to therapist and change
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to explore therapeutic action in psychoanalytic psychotherapy from different perspectives (patient, therapist, observer), using different methodological approaches (qualitative and quantitative). Study I explores patients’ views of therapeutic action with grounded theory methodology. The results indicated that talking openly in a safe therapeutic relationship led to new relational experiences and expanding self-awareness. Hindering factors included difficulties “opening up” and experiencing something missing in treatment. Study II investigates experienced therapists’ views of therapeutic action. The development of a close and trusting relationship was perceived as the core curative factor. Patients’ fear of closeness hindered treatment from the therapists’ perspective. Study III involves the development and psychometric examination of a new rating scale for patient-therapist attachment (Patient Attachment to Therapist Rating Scale; PAT-RS). Inter-rater reliability was good for three of the subscales (Security, Deactivation, Disorganization), but poor for one (Hyperactivation). Patterns of correlations with other measures suggest construct validity for the reliable subscales. Study IV examines the relationships between secure attachment to therapist, alliance, and outcome. Linear mixed-effects models, controlling for therapist effects, treatment length and patient-rated alliance, indicated that secure attachment to therapist relates to outcome. Further, the unique variance associated with secure attachment to therapist predicted continued gains in functioning during follow-up. The results of this thesis suggest that the development of a secure attachment to the therapist is a central mechanism of therapeutic change. The results are discussed in relation to established notions of therapeutic action in psychoanalytic psychotherapy. Two tentative process models that may be useful for clinical practice and future research are proposed. 

Place, publisher, year, edition, pages
Stockholm: Department of Psychology, Stockholm University, 2014. 73 p.
Keyword
Therapeutic action, mechanisms of change, psychoanalytic, psychodynamic, psychotherapy, young adults, attachment to therapist, therapeutic alliance, process, outcome, grounded theory, linear mixed models
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-106501 (URN)978-91-7447-988-1 (ISBN)
Public defence
2014-11-21, David Magnussonsalen (U31), Frescati hagväg 8, Stocksholm, 13:00 (English)
Opponent
Supervisors
Note

At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: Epub ahead of print.

Available from: 2014-10-30 Created: 2014-08-08 Last updated: 2014-11-21Bibliographically approved

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