Adult Attachment and the Psychotherapy Alliance
Bowlbys attachment theory
Attachment theory was invented in 1950 by John Bowldy who was a child psychiatrist and Mary Ainsworth who was also a psychologist. Their work was inspired by childrens response to loss. They started studying the aspects of attachment and bonding. Attachment is defined as a special emotional relationship that involves an exchange of comfort, care, and pleasure (Bowlby, 1997). The research on attachment started with Freuds theories about love, but Bowlby is normally accredited as the founder of the theory. John Bowlby did much research on the concept of attachment and defined as a lasting psychological connection between humans. He shared the psychoanalytic view that early experiences in childhood greatly affect the development and behavior later in life. Early attachment styles are developed in childhood via the infantcaregiver relationship (Ainsworth, Blehar, Waters, Wall, 1978).
Bowlby went further to state that attachment is an evolutionary component which helps in survival. The tendency to develop strong emotional attachment to particular individual is an inherent part of human nature. Bowlby maintains that healthy beings are dependent on attachments relationships in dangerous situations, when vulnerable, or ill. Attachment is therefore defined as a mutual connection to another individual who cannot be replaced by others, but there can be several such relationships. Such relationships are characterized by need to maintain closeness with the people we are attached to, distress in situations of separation and joy in reunion, and sadness at loss. The distinction between attachment relationships to other close relationships is the regard of the attachment figure as a safe place from where one can discover the world and also as a safe place to run to in situations of danger (Bartholomew Horowitz, 1991).
The ability to form attachment relationship is believed to develop biologically because it has survival value to the human evolution. There is attachment behavioral system in children where they get close to caregivers even though they may not be providing security and comfort which is needed by the child. If the caregiver does not love and does not provide the security and comfort sought for, the child is likely to adjust and transform its attachment behavior with the aim of obtaining security from the relationship (Diamond, Clarkin, Levine, Levy, Foelsch, Yeomans, 1999).
Attachment scales
The principle of attachment pattern is closely related to the measurement methods. In infant attachment, the strange situation has been the model used while in the field of adult attachment, two powerful methods of inquiry and measurements have been developed concurrently since 1980s. The two methods share some concepts, but they are applied differently and also in different fields, and researchers who are not well acquainted with the two can misinterpret the research findings in the area. To enhance understanding of research findings on adult attachment patterns in individual psychology, there has been development of different measures of adult attachment that have been used in psychotherapy research (Bernier Dozier, 2002).
The first attachment measure in adulthood is referred to as adult attachment interview. This is a semi structured interview carried out within time span of one hour and it is aimed at investigating attachment relationships and their impacts (Bartholomew Horowitz, 1991). The interview evaluates the states of mind in relation to attachment which are thought to be functioning partly outside conscious awareness. It results in three key classifications which are autonomous which is coinciding with the attachment in infants, dismissing, related to insecure avoidant attachment in infants, and preoccupied, corresponding to insecure ambivalent attachment in infants (Bartholomew Horowitz, 1991).
Interviews can also be classified as unresolved in relation to trauma or loss and it foresees insecure disorganized attachment in infants. An interview which is categorized as unresolved is always secondarily placed as the best fitting of other categories. When AAI is applied in clinical samples, majority of the interviews became difficult to group within the original four groups. As a result, a fifth class has been added and it is referred to as cannot classify. This is where interviews which show high levels of both dismissing and preoccupied speech or those that appear globally incoherent are classified. The coding system of AAI is highly dependent on the manner in which a person describes his childhood instead of the content of the information (Bartholomew Horowitz, 1991).
Autonomous interview is distinguished by coherence, collaboration with the interview process, and steadiness in describing both favorable and unfavorable situations. Dismissing interview on the other hand is characterized by internal disagreement between general positive descriptions and absence of concrete evidences supporting these, insistence on the inability to recall childhood experience, and attempts to avoid the topic of attachment. Preoccupied interview is marked by being long and confused as if the interviewee is confused with the subject of attachment. The interviewee most of the times confuses people by mixing discussions of the past and the present, and dwells mostly on the present anger at parents or vague and childish speech. Unresolved interviews results if the speaker speaks in an odd manner or shows mysterious thinking in discussions on loss or trauma. Because the classification is based on form, people with traumatic childhoods who are able to tell their tale in a coherent and collaborative manner can be classified as autonomous. This is a demonstration that their children will be attached to them (Ainsworth, Blehar, Waters, Wall, 1978).
Attachment styles
Quite often, people experiencing relationship problems always blame it on their parents. Before resorting to blame game, it is very important to realize that attachment styles developed during childhood are not necessarily similar to those demonstrated in adult romantic attachment. Since much time has elapsed between infancy and adulthood, intervening experiences are very vital in adult attachment (Bernier Dozier, 2002). Those people who were described as ambivalent or avoidant when were young can developed secure attachments in adulthood, while those who demonstrated secure relationships while young can end up with insecure relationships in adulthood. Basic temperament is also thought to play a role in attachment.
Research carried out in this field does not show that relationship patterns demonstrated in adulthood has an impact on adulthood relationships. According to Hazen and Shaver (1987), there are various beliefs about relationships amongst adults with varied attachment styles. Adults who are securely attached tend to believe that romantic relationship is long lasting. Adults who are ambivalently attached frequently fall in love while those who are avoidant perceive love to be scarce and temporary (Bowlby, 1998).
Although it is not possible to link childhood relationship with adult romantic relationships, researches have indicated that childhood relationships can be used to predict future relationships. The secure attachment style is characterized by comfort and dependence when people attached are close and absence of fear and abandonment. Adults who are in a secure relationship tend to have trust and relationships which last longer. These individuals are also characterized by high self esteem, enjoying intimate relationships, search of social support, and are able to share their feelings with other people. A study has indicated that women in a secure attached relationship tend to have more positive feelings about their romantic relationships as compared to those women with insecure attachment styles (Ainsworth, Blehar, Waters, Wall, 1978).
The avoidant style on the other hand is distinguished by show of discomfort in situations of closeness and dependence. People with this kind of relationship style have a feeling of others want to be too close to them and this makes them uncomfortable. These adults experience difficulty in intimacy and close relationships. These individuals do not invest many emotions in relationships and do not feel much pain whenever a relationship comes to an end. They tend to avoid intimacy at all costs by giving excuses like long working hours or even fantasize about other people during sex (Bartholomew Horowitz, 1991).
The ambivalent style of is marked with fear of being left alone and urge to be closer to other people than they would want to. Adults with this kind of attachment mostly feel reluctant in on becoming close to others and always worry that their partner may not reciprocate their feelings. As a result of fear, frequent break ups are always observed because the relationship is cold and not close. These people always feel distressed after the relationship has ended. There is tendency of these adults to get attached to young children as a source of security (Bartholomew Horowitz, 1991).
Impact of adult attachment on therapeutic alliance
Studies conducted on working alliances have showed that it is a strong predictor of psychotherapy client outcome. The manner in which the alliance unfolds has been found to be associated with the clients outcome. A relationship which experiences a rupture that is then repaired is likely to end up with a positive outcome as compared to that devoid of rapture or that with raptures which are not repaired (Bowlby, 1997).
Therapeutic alliance which is also called therapeutic relationship or working alliance in psychotherapy is defined as the partnership and effective bond between the therapist and the client. It can also be defined as the personal bond between the client and therapist where goals for therapy and the procedure to achieve the set goals are established. It the way through which the professional hopes to involve with the client and bring some change to the life of the client. The bond created between the patient and therapists has been found to predict treatment adherence and concordance and outcome across different patient diagnoses ands treatment (Bartholomew Horowitz, 1991).
If clients with varied attachment patterns handle interpersonal relationship differently, their attachment patterns can impact the therapeutic alliance they form with their therapists. The alliance formed is determined by quality and recovery over time. Client attachment pattern is also inquired because it is practically found that there is a relation between alliances and the final therapeutic outcome. The link between client attachment pattern and alliance can be attributed to different outcomes between clients who have different attachment patterns (Ainsworth, Blehar, Waters Wall, 1978).
Initial studies on alliance and attachment patterns resulted in measures on comfort with intimacy, ability to depend on others, and fear of abandonment. Comfort with intimacy is found to correlate positively with alliance while fear resulted in negative correlation. Comfort with intimacy and ability to trust others predicts better therapeutic relationships (Dunkle Friedlander, 1996). Other studies found a significant relation between ability to depend on others and positive alliance. Comfort with intimacy and ability to rely on other people associate moderately with each other and are both linked to secure attachment. From the studies above, we can therefore conclude that clients with secure attachment patterns results in more positive therapeutic relationship as compared to those with insecure attachment patterns and this is in accordance with the attachment theory (Hesse,1996).
Other studies conducted revealed that preoccupied individuals demonstrate a strong emotional involvement in treatment displaying both positive and negative reactions. The most recent research on attachment patterns and therapeutic alliance was done with the use of hierarchical linear modeling to discover the effects of clients attachment styles and the therapist attachment pattern on the quality of the working alliance. In this study attachment patterns were measured by the use of Simpsons adult attachment inventory. The results indicated that there is no effect of client avoidance or even anxiety on the working alliance. The study also indicated that a client with a secure attachment is likely to end up with a positive working relationship with the therapist than those with insecure attachments. It is also indicated that the alliance is likely to deteriorate more in preoccupied clients as compared to other clients groups. This indicates that therapeutic work with preoccupied clients is likely to require more rupture repair work than the work with other clients (Bernier Dozier, 2002).
The other question which needs to be handled is the differential reliability of reports of therapeutic alliance by clients of different attachment styles. Studies have also showed that secure clients are likely to be more reliable in their portrayal of the quality of the relationship. Dismissing clients on the other hand are likely to report good relationships but in denial of their difficulty and readiness to engage in treatment emotionally (Bartholomew Horowitz, 1991).
Effects of the therapists attachment
The attachment pattern of the therapist is also important in determining the working alliance between the client and the therapist just like that of the client. Attachment pattern of the client is very important in determining their ability to develop a secure working relationship with the client. On the side of the therapist, secure attachment is highly desired and this is attachment is quite common in therapists than in patients. A study conducted to investigate attachment patterns of various therapists indicated that those who had insecure attachment style experienced more professional problems (Diamond, Clarkin, Stovall-McClough, Levy, Cortina Marrone, 2000). However, the study demonstrated further that even those therapists who had secure attachment had variations in degrees of attachment anxiety and avoidance which could also affect the working alliance (Ainsworth, Blehar, Waters, Wall, 1978).
Conclusion
Despite the fact that research on adult attachment patterns in individual psychotherapy is not conclusively done, the increasing numbers of practical studies clearly support the importance of adult attachment to psychotherapy process and outcome. From the studies it has become evident that people with secure attachment patterns are easy to treat and benefit more from the treatment as compared to those with other attachment pattern. To the clinicians, this is not good because a large number of patients are insecurely attached. To improve in the field of psychotherapy, more research should be done on how to handle patients with insecure attachment since they form the majority of the patients.
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