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Attachment Theory and the Therapeutic Alliance

Resources & Updates

This resource page is part of three Online Courses
Attachment Theory and the Therapeutic Alliance
Attachment Theory: Introduction to Infant Attachment
Clients' Attachment Styles and Therapy Outcomes

CE Credits for Psychologists. CE Credits (CEUs) for LMFTs, Social Workers, Counselors and Nurses.
CE Approvals by BBS-CA, ASWB, NBCC, NAADAC, CA-BRN & more.
Zur Institute is approved by the American Psychological Association to sponsor continuing education for psychologists. Zur Institute maintains responsibility for this program and its content.

 

 

 

Online Resources

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Books and Articles on the Therapeutic Alliance

  • The Website of Joseph H. Obegi, PsyD
    On my resources page I'll occasionally post articles I've written about the clinical application of attachment ideas. You'll also find a link to my recent book that I co-edited with Ety Berant, "Attachment Theory and Research in Clinical Work with Adults."
  • Ackerman, S. J., & Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23, 1-33.
  • Bedics, J. D., Atkins, D. C., Harned, M. S., & Linehan, M. M. (2015). The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder. Psychotherapy, 52(1), 67-77. http://dx.doi.org/10.1037/a0038457
  • Bernecker, S. L., Levy, K. N., & Ellison, W. D. (2014). A meta-analysis of the relation between patient adult attachment style and the working alliance. Psychotherapy Research, 24(1), 12-24. http://dx.doi.org/10.1080/10503307.2013.809561
  • Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16, 252-260.
  • Chambless, D. L., Crits-Christoph, P., Wampold, B. E., Norcross, J. C., Lambert, M. J., Bohart, A. C., et al. (2006). What Should Be Validated? In J. C. Norcross, L. E. Beutler, & R. F. Levant (Eds.), Evidence-based practices in mental health: Debate and dialogue on the fundamental questions. (pp. 191-256). American Psychological Association.
  • Dinger, U., Zimmermann, J., Masuhr, O., & Spitzer, C. (2017). Therapist effects on outcome and alliance in inpatient psychotherapy: The contribution of patients' symptom severity. Psychotherapy, 54(2), 167-174. http://dx.doi.org/10.1037/pst0000059
  • Falkenström, F., Granström, F., & Holmqvist, R. (2014). Working alliance predicts psychotherapy outcome even while controlling for prior symptom improvement. Psychotherapy Research, 24(2), 146-159. http://dx.doi.org/10.1080/10503307.2013.847985
  • Fitzpatrick, M. R., Janzen, J., Chamodraka, M., & Park, J. (2006). Client critical incidents in the process of early alliance development: A positive emotion-exploration spiral. Psychotherapy Research, 16, 486-498.
  • Gelso, C. J., & Carter, J. A. (1994). Components of the psychotherapy relationship: Their interaction and unfolding during treatment. Journal of Counseling Psychology, 296-306.
  • Greenson, R. R. (1967). The technique and practice of psychoanalysis. New York: International Universities Press.
  • Hatcher, R. L. (2010). Alliance theory and measurement. In J. C. Muran, & J. P. Barber (Eds.), The therapeutic alliance: An evidence-based guide to practice (pp. 7-28). New York: Guilford Press.
  • Hatcher, R., L (1), & Barends, A., W (1). (2006). How a return to theory could help alliance research. Psychotherapy: Theory, Research, Practice, Training, 43, 292-299.
  • Hill, C. E., & Knox, S. (2009). Processing the therapeutic relationship. Psychotherapy Research, Vol 19, 13-29.
  • Horvath, A. O., & Bedi, R. P. (2002). The alliance. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 37-69). New York: Oxford University Press.
  • Kivlighan Jr, D. M., Hill, C. E., Gelso, C. J., & Baumann, E. (2016). Working alliance, real relationship, session quality, and client improvement in psychodynamic psychotherapy: A longitudinal actor partner interdependence model. Journal of counseling psychology, 63(2), 149-161. http://dx.doi.org/10.1037/cou0000134
  • Koole, S. L., & Tschacher, W. (2016). Synchrony in Psychotherapy: A Review and an Integrative Framework for the Therapeutic Alliance. Frontiers in Psychology, 7. doi: 10.3389/fpsyg.2016.00862
  • Lilliengren, P., Falkenström, F., Sandell, R., Mothander, P. R., & Werbart, A. (2015). Secure attachment to therapist, alliance, and outcome in psychoanalytic psychotherapy with young adults. Journal of counseling psychology, 62(1), 1-13. http://dx.doi.org/10.1037/cou0000044
  • Lingiardi, V., & Colli, A. (2015). Therapeutic alliance and alliance ruptures and resolutions: Theoretical definitions, assessment issues, and research findings. In Psychotherapy Research (pp. 311-329). Springer Vienna.
  • Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438-450.
  • Muran, J. C., & Barber, J. P. (Eds.). (2010). The therapeutic alliance: An evidence-based guide to practice. New York: Guilford Press.
  • Norcross, J. C. (Ed.). (2002). Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients. New York: Oxford University Press.
  • Obegi, Joseph H. and Ety Berant (Eds.). (2008). Attachment Theory and Research in Clinical Work with Adults. New York: Guilford Press.
  • Orlinsky, D. E., Ronnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy process-outcome research: Continuity and change. In M. J. Lambert (Ed.), Bergin and Garfield's handbook of psychotherapy and behavior change (5th ed., pp. 307-389). New York: Wiley.
  • Safran, J. D., Muran, J. C., Samstag, L. W., & Stevens, C. (2002). Repairing alliance ruptures. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 235-254). New York: Oxford University Press.
  • Samstag, L. W., Muran, J. C., & Safran, J. D. (2004). Defining and identifying alliance ruptures. In D. P. Charman (Ed.), Core processes in brief psychodynamic psychotherapy: Advancing effective practice (pp. 187-214). New Jersey: Lawrence Erlbaum.
  • Shafran, N., Kivlighan, D. M., Gelso, C. J., Bhatia, A., & Hill, C. E. (2016). Therapist immediacy: The association with working alliance, real relationship, session quality, and time in psychotherapy. Psychotherapy Research, 1-12. http://dx.doi.org/10.1080/10503307.2016.1158884
  • Simpson, S. G., & Reid, C. L. (2014). Special Issue–Psychology in the Bush Original Research Therapeutic alliance in videoconferencing psychotherapy: A review. Aust. J. Rural Health, 22, 280-299.
  • Xu, H., & Tracey, T. J. (2015). Reciprocal influence model of working alliance and therapeutic outcome over individual therapy course. Journal of counseling psychology, 62(3), 351-359. http://dx.doi.org/10.1037/cou0000089
  • Zilcha-Mano, S., Dinger, U., McCarthy, K. S., & Barber, J. P. (2014). Does alliance predict symptoms throughout treatment, or is it the other way around?. Journal of consulting and clinical psychology, 82(6), 931-935. http://dx.doi.org/10.1037/a0035141

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Books and Articles on Attachment and the Therapeutic Relationship

  • Bar-Kalifa, E., Atzil-Slonim, D., Rafaeli, E., Peri, T., Rubel, J., & Lutz, W. (2016). Therapist–client agreement in assessments of clients' functioning. Journal of consulting and clinical psychology, 84(12), 1127-1134. http://dx.doi.org/10.1037/ccp0000157
  • Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. London: Routledge.
  • Bucci, S., Seymour‐Hyde, A., Harris, A., & Berry, K. (2016). Client and therapist attachment styles and working alliance. Clinical psychology & psychotherapy, 23(2), 155-165. DOI: 10.1002/cpp.1944
  • Daly, K. D., & Mallinckrodt, B. (2009). Experienced therapist's approach to psychotherapy for adults with attachment avoidance or attachment anxiety. Journal of Counseling Psychology, 56, 549-563.
  • Degnan, A., Seymour‐Hyde, A., Harris, A., & Berry, K. (2016). The role of therapist attachment in alliance and outcome: A systematic literature review. Clinical psychology & psychotherapy, 23(1), 47-65. DOI: 10.1002/cpp.1937
  • Dozier, M., & Tyrrell, C. (1998). The role of attachment in therapeutic relationships. In J. A. Simpson, & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 221-248). New York: Guilford Press.
  • Farber, B. A., & Metzger, J. A. (2009). The therapist as a secure base. In J. H. Obegi, & E. Berant (Eds.), Attachment theory and research in clinical work with adults (pp. 46-70). New York: Guilford Press.
  • Gnilka, P. B., Rice, K. G., Ashby, J. S., & Moate, R. M. (2016). Adult attachment, multidimensional perfectionism, and the alliances among counselor supervisees. Journal of Counseling & Development, 94(3), 285-296. DOI: 10.1002/jcad.12085
  • Holmes, J. (2009). Exploring in security: Towards an attachment-informed psychoanalytic psychotherapy. Hove, East Sussex ; New York, NY: Routledge.
  • Janzen, J., Fitzpatrick, M., & Drapeau, M. (2008). Processes involved in client-nominated relationship building incidents: Client attachment, attachment to therapist, and session impact. Psychotherapy: Theory, Research, Practice, Training, 45, 377-390.
  • Kivlighan Jr, D. M., & Marmarosh, C. L. (2016). Counselors’ attachment anxiety and avoidance and the congruence in clients’ and therapists’ working alliance ratings. Psychotherapy Research, 1-10. http://dx.doi.org/10.1080/10503307.2016.1198875
  • Mallinckrodt, B., Anderson, M. Z., Choi, G., Levy, K. N., Petrowski, K., Sauer, E. M., ... & Wiseman, H. (2016). Pseudosecure vs. individuated-secure client attachment to therapist: Implications for therapy process and outcome. Psychotherapy Research, 1-15. http://dx.doi.org/10.1080/10503307.2016.1152411
  • Mallinckrodt, B., Choi, G., & Daly, K. D. (2015). Pilot test of a measure to assess therapeutic distance and its association with client attachment and corrective experience in therapy. Psychotherapy Research, 25(5), 505-517. http://dx.doi.org/10.1080/10503307.2014.928755
  • Mallinckrodt, B., Gantt, D. L., & Coble, H. M. (1995). Attachment patterns in the psychotherapy relationship: Development of the client attachment to therapist scale. Journal of Counseling Psychology, 42, 307-317.
  • Mallinckrodt, B., & Jeong, J. (2015). Meta-analysis of client attachment to therapist: associations with working alliance and client pretherapy attachment. Psychotherapy (chicago, Ill.), 52(1), 134-139. DOI: 10.1037/a0036890
  • Marmarosh, C. L., Kivlighan Jr, D. M., Bieri, K., LaFauci Schutt, J. M., Barone, C., & Choi, J. (2014). The insecure psychotherapy base: Using client and therapist attachment styles to understand the early alliance. Psychotherapy, 51(3), 404. http://dx.doi.org/10.1037/a0031989
  • Mikulincer, M., Shaver, P. R., & Berant, E. (2013). An attachment perspective on therapeutic processes and outcomes. Journal of Personality, 81(6), 606-616. DOI: 10.1111/j.1467-6494.2012.00806.x
  • Obegi, J. H. (2008). The development of the client-therapist bond through the lens of attachment theory. Psychotherapy: Theory, Research, Practice, Training, 45, 431-446.
  • Obegi, J. H., & Berant, E. (Eds.). (2009). Attachment theory and research in clinical work with adults. New York: Guilford Press.
  • Owens, K. A., Haddock, G., & Berry, K. (2013). The role of the therapeutic alliance in the regulation of emotion in psychosis: an attachment perspective. Clinical psychology & psychotherapy, 20(6), 523-530. DOI: 10.1002/cpp.1793
  • Parish, M., & Eagle, M. N. (2003). Attachment to the therapist. Psychoanalytic Psychology, 20, 271-286.
  • Petrowski, K., Pokorny, D., Nowacki, K., & Buchheim, A. (2013). The therapist's attachment representation and the patient's attachment to the therapist. Psychotherapy Research, 23(1), 25-34. http://dx.doi.org/10.1080/10503307.2012.717307
  • Smith, A. E. M., Msetfi, R. M., & Golding, L. (2010). Client self rated adult attachment patterns and the therapeutic alliance: A systematic review. Clinical Psychology Review, 30, 326-337.
  • Taylor, P. J., Rietzschel, J., Danquah, A., & Berry, K. (2015). The role of attachment style, attachment to therapist, and working alliance in response to psychological therapy. Psychology and Psychotherapy: Theory, Research and Practice, 88(3), 240-253. DOI: 10.1111/papt.12045
  • Wallin, D. J. (2007). Attachment in psychotherapy. New York: Guilford Press.
  • Wiseman, H., & Tishby, O. (2014). Client attachment, attachment to the therapist and client-therapist attachment match: How do they relate to change in psychodynamic psychotherapy?. Psychotherapy Research, 24(3), 392-406. http://dx.doi.org/10.1080/10503307.2014.892646

References on Infant Attachment

  • Adam, K. S., Sheldon-Keller, A. E., & West, M. (1996). Attachment Organization and History of Suicidal Behavior in Clinical adolescents. Journal of Consulting and Clinical Psychology, 64(2), 264-272. Retrieved September 14, 2001, from PsycARTICLES database.
  • Ainsworth, M. D. S. (1979). Attachment as related to mother-infant interaction. Advances in the Study of Behavior. 9, 2-52.
  • Ainsworth, M. thibs4. “The Strange Situation.” YouTube. Web. 21 July 2011.
  • Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978) Patterns of attachment: Assessed in the strange situation and at home. Hillsdale, NY: Lawrence Erlbaum Associates.
  • Ainsworth, M. D. S., & Eichberg, C. G. (1991). Effects on infant-mother attachment of mother’s unresolved loss of an attachment figure, or other traumatic experience. In C. M. Parkes, J. Stevenson-Hinde, & P. Marris (Eds.), Attachment across the life cycle (pp. 160-183). London: Routledge.
  • Amani, R. (2016). Mother-infant attachment styles as a predictor of aggression. Journal of Midwifery and Reproductive Health, 4(1), 506-512. DOI: 10.22038/jmrh.2016.6076
  • Ammaniti, M., Speranza, A. M., & Candelori, C. (1996). Stabilita dell'attaccamento infantile e transmissione intergenerazionale dell'attaccamento [Stability of infant attachment and intergenerational transmission of attachment]. Psichiatria dell'Infanzia e dell'Adolescenza, 63, 313–332.
  • Bakermans-Kranenburg, M. J., & van Ijzendoorn, M. H. (1997). Stability of disorganized attachment in the second year of life. Unpublished manuscript, Leiden University.
  • Barach, Peter M. (1991). Multiple personality disorder as an attachment disorder. Dissociation: Progress in the Dissociative Disorders, 4(3), 117-123.
  • Barnett, D., Ganiban, J., & Cicchetti, D. (1997). Maltreatment, emotional reactivity, and the development of type D attachments from 12- to 24-months of age. Unpublished manuscript.
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  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory, 2nd ed. San Antonio, TX.: Psychological Corporation Boston: Harcourt Brace. /li>

  • Beeghly, M., Nelson, K. M., Olson, K. L., Kernan, H., Markov, Y., Weinberg, M. K., & Tronick, E. Z. (1997). Effects of maternal depression on infant attachment in a low risk sample. Paper presented at the Biennial Meeting of the Society for Research in Child Development, Washington, DC.
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  • Boldt, L. J., Kochanska, G., & Jonas, K. (2017). Infant Attachment Moderates Paths From Early Negativity to Preadolescent Outcomes for Children and Parents. Child development, 88(2), 584-596. DOI: 10.1111/cdev.12607
  • Boris, N. W., Wheeler, E.E., Heller, S.S. & Zeanah, C.H. (2000). Attachment and developmental psychopathology, Psychiatry, 63(1), 75-84. Retrieved March 25, 2002, from ProQuest Direct database.
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  • Cassibba, R., Castoro, G., Costantino, E., Sette, G., & Van Ijzendoorn, M. H. (2015). Enhancing maternal sensitivity and infant attachment security with video feedback: An exploratory study in Italy. Infant mental health journal, 36(1), 53-61. DOI: 10.1002/imhj.21486
  • Chong, S.F.C., Werker, J.F., Russell, J.A., & Carroll, J.M. (2003). Three facial expressions mothers direct to their infants. Infant and Child Development, 12, 211-232.
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  • Ekman, P. (1992). Are there basic emotions? Psychological Review, 99(3), 550-553. Retrieved January 18, 2004, from PsycARTICLES databases.
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  • Ekman, P., Friesen, W.V. & Hager, J.C. (2002). Facial Action Coding System: Investigator’s guide. Research Nexus, Salt Lake City, Utah.
  • Ekman, P., Irwin, W., & Rosenberg, E. (1994). EMFACS-8: Emotion Facial Action Coding System -8. Retrieved on October 19th 2004 directly from Dr. Paul Ekman and Dr. Joseph Hager.
  • Enlow, M. B., Egeland, B., Carlson, E., Blood, E., & Wright, R. J. (2014). Mother–infant attachment and the intergenerational transmission of posttraumatic stress disorder. Development and psychopathology, 26(1), 41-65. DOI: https://doi.org/10.1017/S0954579413000515
  • Fish, M., & Fish, S. E. (1998). Temperament, attachment, and heart rate variability: Comparisons of secure, avoidant, and disorganized infants. Poster presented at the Biennial Meeting of the International Society for Infant Studies, Atlanta, GA.
  • Fish, M., & Stifter, C. A. (1995). Patterns of mother infant interaction and attachment: A cluster-analytic approach. Infant Behavior and Development, 18, 435-446.
  • Fonagy, P., Steele, H. & Steele, M. (1991). Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age. Child Development, 62, 891-905.
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