Towards developing strong early therapeutic relationships : client attachment and therapist responsiveness in relationship building incidents

The goal of the present research was to provide a structure for understanding the combinations of client attachment concerns, therapist interventions, and therapist interpersonal qualities that facilitate the development of strong therapeutic relationships by drawing upon the propositions of attachment theory and interpersonal theory.The first study supported the hypothesis that relationship incidents provide the relational information required for the client to feel secure enough with their therapist to explore in session. Following their third session, thirty volunteer clients seen by therapist trainees nominated an incident they felt was important to the development of their therapeutic relationship. General attachment was associated with the developing relationship with therapist, and this relationship was associated with exploration in-session. As expected, following a relationship building event, the client experienced the therapist as a safe haven from which to explore. The client's ability to attach to the therapist in the relationship building incident was related to avoidant attachment. Client in-session exploration, conceptualized as cognitive openness, was associated with the attachment-related relationship with the therapist, but not general attachment orientation.Within a framework that explicitly bridges attachment and interpersonal theory; the results of the second study offer differential support for the suggestions of interpersonal theory and attachment theory depending upon the attachment dimension in question. The predictions of interpersonal theory were generally supported in regards to clients with attachment anxiety; in relationship building incidents, therapists allowed themselves to be hooked by client interpersonal schemas however, they also refrained from eliciting emotions with these clients in early sessions. For clients high on avoidance, the results support suggestions from the attachment literature. Therapists met client distancing with proximity---seeking interventions unhooking from client interpersonal expectations; however while doing so, therapists provided the client with a containing framework. Together these studies highlight the importance of client attachment in the development of the therapeutic relationship and extend the findings from attachment research in social psychology to the therapeutic situation. This work adds to the growing literature that supports the clinical utility of Bowlby's attachment framework in assessment and intervention with adults, particularly in regards to the therapeutic relationship