Attachment Theory and The Therapeutic Alliance

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Developed by Joseph H. Obegi, Psy.D.

General Course Description

The recent focus on empirically supported therapies, albeit valuable, elevates procedure and uniformity over adaptation to patient preferences and over what all psychotherapies are at their root: an intimate and interpersonal process. In contrast, the therapeutic alliance offers a view of treatment that is a balanced mix of humanism and science. Alliance explains how patients become invested in the work of therapy, and researchers have established that alliance strength accounts for as much change as the treatment method.

Attachment theory and research can further augment our understanding of the therapeutic relationship by describing how the bond between patient and therapist unfolds, how insecurity impinges upon the formation and strength of alliances, and how a sense of security in psychotherapy promotes change.

The purpose of this intermediate course is three-fold: to introduce alliance theory and research, to show how an attachment-informed view deepens and broadens our understanding of the therapeutic relationship, and to describe how attachment ideas can help clinicians nurture and customize the therapeutic relationship in ways that can foster change. The course consists of an audio slide show that introduces basic concepts and 4 readings, by researchers and clinicians in the attachment field, that elaborate lecture points. Additional resources and references are provided for further study, but they are not part of the course.

Educational Objectives

    This course will teach the participant to

  • Define the alliance and summarize empirical findings that support its importance.
  • Describe the basics of attachment theory and its major findings.
  • Summarize the empirical evidence showing that attachment security influences alliance formation and strength.
  • Describe how an alliance may develop into an attachment.
  • Create a therapeutic climate that facilitates change.
  • Identify and resolve therapeutic ruptures.
  • Construct the therapeutic relationship based on attachment security.


  • Farber, A. & Metzger, J. (2009). The therapist as 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.
  • Shaver, P. R., & Mikulincer, M. (2009). An overviewof adult attachment theory. In J. H. Obegi, & E. Berant (Eds.),Attachment theory and research in clinical work with adults(pp. 17–45). New York: Guilford Press.
  • 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.

Course Syllabus:

Alliance Theory and Research

  • Historical background
  • Essential concepts
  • Major clinical findings regarding therapeutic outcome

Attachment Theory

  • Major concepts and research findings

Alliance and Insecurity

  • Characteristics of avoidant attachment
  • Characteristics of anxious attachment
  • How insecurity can undermine alliance building

Alliance or Attachment?

  • Shortcomings of alliance theory
  • Qualities of attachment that overlap with therapeutic relationships
  • Phases of client-therapist attachment
  • Translating alliance into attachment terms

Exploring in Security

  • Creating a climate of security
  • Triggering the cognitive and emotional benefits of felt security
  • Therapeutic ruptures and their repair
  • Customizing the therapeutic relationship based on attachment security
CE Badge Created with Sketch. 7 CE

Cost: $69.00

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