Adult Attachment and Psychotherapy

  • Julia Rietzschel

Student thesis: Doctor of Clinical Psychology


This thesis explores the association between adult attachment and psychological therapy by examining attachment as an outcome variable of therapy, as well as a predictor of therapy outcome. The literature review systematically explores research that has examined changes in attachment representations during psychological therapy. The purpose of the review is to enhance understanding of change processes in adult attachment and to provide empirical support to the premises of attachment theory. In spite of inconsistencies with regards to measurement and conceptualisation of attachment, the evidence suggests that attachment security increases during therapy, whereas insecurity decreases.The aim of the empirical paper was to examine the association between global adult attachment representations, specific attachment to the therapist, working alliance and response to individual Cognitive-Behaviour Therapy (CBT). The study also investigated changes in global attachment representations and their relationship with outcome. The results indicated that clients with greater secure attachment to the therapist showed greater improvements in symptoms, whereas clients with higher avoidant-fearful attachment to the therapist demonstrated less improvement. Significant improvements in attachment avoidance and anxiety were also associated with improvements in psychological symptoms, as was working alliance. No associations between adult global attachment and outcome were found. In paper 3, the approaches used within the current thesis are evaluated in terms of their strengths and weaknesses. Clinical implications of the findings are discussed and ideas for future research are outlined.
Date of Award31 Dec 2012
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorKatherine Berry (Supervisor)

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