Background: Individuals with different attachment classifications Secure, Avoidant and Preoccupied may experience emotional closeness differently, in their intimate relationships but also as clients in psychotherapy. However, evidence for this assumption almost exclusively comes from research with self-report questionnaires. Aims: In this paper, we use observer-rated measures to explore in depth how patients with different attachment classifications experience closeness and distance from the therapist in different phases of therapy.
Cases were chosen from a larger research project due to their different prototypical attachment classification on the PACS. The narratives were obtained from Relationship Anecdote Paradigm RAP interviews in which the patients and their therapists narrated separately about meaningful interactions with each other, at early, middle and late phases of therapy.
In addition, we followed patients self-report of the alliance and symptoms OQ This allowed the therapist to harness these feelings for the benefit of the therapy. The avoidant and the preoccupied patients both experienced the therapist as distant, but the avoidant patient prevented closeness by a minimal expression of feelings, and the preoccupied described strong frustration with the therapist in a one-sided manner that prevented collaborative processing and left the therapist confused. Discussion: It appears that patient discourse is a stable trait-like component of attachment, while the therapeutic-distance is a process state-like component that may change along therapy.
The relationship between patient and psychotherapist is considered a key component of psychotherapy, capable of bringing about change 1 β 3. Research has shown that the quality of the therapeutic relationship contributes to differences in therapy outcome to a significant degree 1 , 4 ; yet, our understanding of the mechanisms through which the therapeutic relationship can influence change remains incomplete and in search of sharper definition.
One of the most popular conceptualizations of the patientβtherapist relationship in psychotherapy is the one first proposed by Bowlby 5 in his attachment theory. Bowlby proposed that the patientβtherapist relationship could be considered an attachment relationship, given that it is one in which the patient seeks protection and support from the therapist.
