Attachment Theory & Therapeutic Alliance

By Ofer Zur, Ph.D.

A counter-trend to the emphasis on empirically supported and manualized psychotherapy is the resurgence of interest in the value and contribution of change in the therapeutic relationship. Attachment theory, with its emphasis on relationships, development, and personality, is making to important contributions to this area.

Below are some of the recommendations made by an APA Task Force (Division of Psychotherapy) based on their review of the evidence concerning the therapeutic relationship. For each recommendation, attachment theory and accompanying research can offer further details:

  • Clinicians should focus on building and nurturing the therapeutic relationship. Research shows that the therapeutic relationship consistently accounts for about 5-10% of therapeutic change. This effect is durable across clinical approaches – therapy with children, adolescents, or adults – and degree of professional training. Attachment-informed clinicians forge the alliance and also monitor the unfolding of attachment to the therapist, building a climate of security that propels collaborative work.Attachment Theory and The Therapeutic Alliance
  • Clinicians should consider customizing the therapeutic relationship to patient styles and preferences. Research shows that, for example, resistance (defined as actively opposing change efforts) impedes therapeutic process and that certain therapists behaviors can provoke resistance. Early research also suggests that less secure adults can have difficultly forming strong alliances and that expert therapist can make considerable efforts to adapt the treatment to them.
  • Clinicians should monitor the patients’ reactions to the therapeutic relationship and to the treatment. Ruptures in the therapy relationship can jeopardize treatment. Early research suggests that insecure adults may be more prone to ruptures.
Attachment Theory and the Therapeutic Alliance
    This online course teaches therapists to:

  • Define the alliance and summarize empirical findings that support its importance.
  • Describe the basics of attachment theory and its major findings.
  • Understand the empirical evidence showing that attachment security influences alliance formation and strength.
  • Appreciate how an alliance may develop into an attachment.
  • Create a therapeutic climate that facilitates change, identify and resolve therapeutic ruptures, and customize the therapeutic relationship to differences in attachment security.
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