The role of the therapeutic alliance in the regulation of emotion in psychosis: An attachment perspective

Objectives: This article aims to explore the value of attachment theory as a framework for understanding the ways in which the staff-patient relationship is associated with different methods of regulating emotion in individuals with a diagnosis of psychosis. Method: Patient participants with a diagnosis of schizophrenia, schizoaffective disorder or psychosis not otherwise specified and mental health workers were recruited from 24-hour rehabilitation teams. Patient participants completed questionnaires assessing emotion regulation, attachment, therapeutic alliance and symptomatology. The therapeutic alliance was also assessed from mental workers' perspective. Results: Insecure attachment was significantly associated with greater difficulties in regulating emotions. A strong therapeutic alliance was associated with fewer difficulties in regulating emotions. Conclusions: Attachment is a useful theoretical construct for understanding psychosis, with evidence for a link between a positive staff-patient relationship and enhanced emotion regulation. Clinical implications of these findings are discussed. © 2012 John Wiley & Sons, Ltd.