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Title: Therapist attachment styles and therapeutic alliance in family therapy
Author: Yusof, Yusmarhaini
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2012
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There is some evidence from individual psychotherapy that the ability to build therapeutic alliances with clients may be related to the therapist's adult attachment style. These are patterns of expectations, needs, emotions and social behaviour, learn from our history of attachment experiences with our caregivers (Fraley and Shaver in Mikulincer and Shaver, 2007). There are no published empirical studies of the association between therapist's attachment style and therapeutic alliance in family therapy. Aim The overall aim was to investigate family therapist's attachment styles and explore the association between the therapist's attachment style and therapeutic alliance in family therapy. Method Participants were registered UKCP family therapists. The research comprised three linked studies. Study 1 was a survey using two different self-report attachment measures, the Relationship Questionnaire (Bartholomew and Horowitz, 1991) and the Experiences in Close Relationships questionnaire (Brennan et al., 1998) to examine the variety of therapists' attachment styles; Study 2 sought to examine therapists' and families' perceptions of the therapeutic alliance using the System for Observing Family Therapy (SOFTA, Friedlander et al., 2006) and to examine their association with the therapists' attachment styles; and Study 3 explored therapists' (of different attachment styles) views on alliance and their therapeutic work using semi-structured interviews. Quantitative data derived from the survey of therapists' attachment styles (Study 1) and the survey of therapists' difficulties with Study 2 were analysed using descriptive, and where possible, inferential statistics. Open ended questions for Study 2 were analysed thematically. Digital recordings of the interviews with therapists (Study 3) were analysed using Interpretive Phenomenological Analysis (Smith, 1999) and a template analysis based on a conceptual model of the therapeutic alliance in family therapy, the System for Observing the Therapeutic Alliance (SOFTA, Friedlander et al., 2006). In addition, observational field notes and self- reflections on the interview process were analysed using the method of Interpretative Observational Analysis (Dallos and Vetere, 2005). Results Study 1 showed that therapists (N=82) tended to self-report as having a 'secure' attachment style (74.4%) when assessed using the RQ, a more obvious measure. However, only just over a quarter of them were assessed as having a 'secure' attachment style on the, less transparent, ECR measure. Attachment style, as measured by the ECR, was not associated with therapists' prior profession, 3. gender and preference for a model of therapy. The attempt to investigate the association between therapists' attachment styles and family members' and therapist's perceptions of the therapeutic alliance in family therapy (Study 2) was unsuccessful. In a follow up questionnaire, therapists (N = 13) who had agreed to participate reported that they were unable to carry this through for a number of reasons. These explanations included a feeling that they were overloaded with new paperwork, that they had no time beyond their regular work, and that they had no suitable new cases. The 'failure' of Study 2 showed the difficulty of engaging practitioners in research on their practice. The interviews with therapists (Study 3) showed differences between the 'secure' and 'insecure' therapists (N=13) in alliance building according to their attachment styles. The 'secure' therapists were able to be more reflexive and used richer explanations to guide their therapeutic work than their 'insecure' counterparts. In two cases there was a discrepancy between the therapists self- reported assessments of themselves as 'secure' and their interview presentations. Discussion and Conclusions It is assumed in the literature that effective family therapy requires a 'secure' base/strong therapeutic alliance and that family therapists should have a 'secure' adult attachment style. However this study indicates: 1. On what is probably the more reliable measure, the ECR, around three- quarters of family therapists in this study appeared to have 'insecure' attachment styles. 2. There are differences between participating 'secure' and 'insecure' family therapists in their accounts of therapeutic alliance in family therapy, suggesting that participating 'insecure' therapists have difficulty in some of the key elements of therapeutic alliance building. Nonetheless, this research cannot say for certain whether therapists' attachment styles influenced the formation of therapeutic alliance because this part of the study was unsuccessful. Consequently, it would be desirable to make another attempt to investigate the possible association and to explore whether it was associated with the outcomes of therapy. 4. Given that it would appear that a high proportion of family therapists in this study manifested 'insecure' attachment styles and may have unresolved attachment issues arising from family of origin experiences, personal development/therapy for family therapists would seem to be desirable, both as part of training and subsequently.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available