Siefert Caleb J, Hilsenroth Mark J
Behavioral Sciences, University of Michigan-Dearborn, Dearborn, MI, USA.
Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA.
Clin Psychol Psychother. 2015 Nov-Dec;22(6):677-86. doi: 10.1002/cpp.1927. Epub 2014 Oct 16.
Several studies have examined associations between client attachment status and therapeutic alliance. Most, however, measure alliance at a single time point only. This study is among the first to examine how client attachment relates to changes in the therapeutic alliance early in treatment. Forty-six outpatients from a university-based community clinic participated. Attachment status was assessed with the Relationship Questionnaire (Bartholomew & Horowitz, 1991) prior to beginning treatment. Participants rated therapeutic alliance after an evaluation feedback session and again early in psychotherapy. Fearful insecurity was associated with declines in therapeutic alliance, while attachment security was associated with increasing client-therapist bonds. Although unrelated to global alliance, preoccupied insecurity was associated with greater confident collaboration at both time points and declines in idealized relationship from the evaluation to the early therapy time point. Results are discussed in light of prior theoretical formulations and previous research. Limitations of the study are reviewed, implications for clinical practice are noted, and suggestions for future research are made.
Assessing client attachment status can provide clinicians with information that helps them identify clients at risk for difficulties establishing a therapeutic alliance. Clients high in attachment security are more likely to develop strong bonds with therapists during the early portion of treatment. Clients high in fearful insecurity are at risk for developing weaker alliances early in treatment. Such clients appear more likely to experience declines in client-therapist bond, goal-task agreement and overall alliance early in the treatment process. Clients high in preoccupied insecurity may enter therapy with great confidence in the therapist and willing to engage in therapy but report more conflicts with therapists in the early phase of treatment.
多项研究探讨了来访者依恋状态与治疗联盟之间的关联。然而，大多数研究仅在单一时间点测量联盟。本研究是首批考察来访者依恋如何与治疗早期治疗联盟变化相关的研究之一。来自一所大学社区诊所的46名门诊患者参与了研究。在治疗开始前，使用关系问卷（Bartholomew & Horowitz，1991）评估依恋状态。参与者在评估反馈 session 后以及心理治疗早期再次对治疗联盟进行评分。恐惧不安全与治疗联盟的下降相关，而依恋安全与来访者 - 治疗师关系的增强相关。尽管与整体联盟无关，但痴迷不安全在两个时间点都与更高的自信合作相关，并且从评估到治疗早期时间点理想化关系下降。根据先前的理论表述和以往研究对结果进行了讨论。回顾了研究的局限性，指出了对临床实践的启示，并提出了未来研究的建议。
评估来访者依恋状态可以为临床医生提供信息，帮助他们识别在建立治疗联盟时面临困难风险的来访者。依恋安全性高的来访者在治疗早期更有可能与治疗师建立紧密的关系。恐惧不安全程度高的来访者在治疗早期有形成较弱联盟的风险。这类来访者在治疗过程早期似乎更有可能经历来访者 - 治疗师关系、目标 - 任务一致性和整体联盟的下降。痴迷不安全程度高的来访者可能在进入治疗时对治疗师充满信心并愿意参与治疗，但在治疗早期报告与治疗师有更多冲突。
