Clients’ Attachment Styles and Therapy Outcomes

Course materials are available as articles.

A growing body of research shows that clients’ attachment styles have an important effect on therapy outcome. Therapists who can recognize and adapt to the different kinds of attachment styles – and therapists who can recognize their own attachment styles – will have a better chance at cutting down on premature terminations. They will also be more adept and proactive at avoiding ruptures to the alliance and more quickly repairing them. Knowing each client’s attachment style and being able to respond empathically and strategically to it will help keep each client engaged in therapy.

This intermediate course for psychologists, social workers, and counselors who work with children, adolescents and adults has two sections. Section One provides a theoretical overview of how and why attachment styles affect the therapy relationship. Section Two presents research on the effect of different attachment styles on the therapeutic alliance. Additional resources and references are provided for further study, but they are not part of the course.


  • Gruenthal, R. (2010). A view of the “disengaged” patient as already engaged. Psychoanalytic Dialogues, 20 (1), 70-77.
  • Holmes, J. (2011). Attachment in the consulting room: towards a theory of therapeutic change. European Journal of Psychotherapy & Counselling, 13 (2), 97-114.
  • Rizq, R., & Target, M. (2010). “We had a constant battle”. The role of attachment status in counselling psychologists’ experiences of personal therapy: Some results from a mixed-methods study. Counselling Psychology Quarterly, 23 (4), 343-369.

Educational Objectives

  • Identify primary attachment styles.
  • Describe how attachment styles are developed.
  • Describe how different attachment styles affect the therapy alliance.
  • State how therapists’ attachment styles influence therapy.
  • Describe the Self-Confrontation Method as a measure of personality.


  • How early caregiver interactions determine attachment styles
    • Secure attachments defined and described
    • Insecure attachments defined and described
  • Clients’ attachment styles and the therapy alliance
    • Effect of attachment styles on clients’ expectations of therapy
    • Therapist strategies for connecting with various styles
  • The Self-Confrontation Method as a measure of personality
    • Personality dimensions measured by SCM
    • How emotional schema correspond to attachment styles
    • The use of SCM in counseling and research
  • How therapists’ attachment styles influence the alliance
    • Different client attachment styles fit or clash with therapists’ attachment styles
    • Therapists’ attachment styles can affect their own view of therapy