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This meta-analysis synthesizes research on the relation between patient adult attachment style and patient-rated working alliance. A random-effects model was used to calculate the mean weighted product-moment correlation (r) for 24 studies (12 published in peer-reviewed journals and 12 unpublished doctoral dissertations) of individual outpatient therapy with adults. The mean weighted r for attachment avoidance and alliance was −.137, p<.001, and the mean weighted r for attachment anxiety and alliance was −.121, p<.001. These findings suggest that therapists should attend to attachment in order to foster alliance and have additional implications for theory and future research. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted to analyze and compare attachment status and mentalization of the comorboid narcissistic personality disorder (NPD) and borderline personality disorder (BPD) patients with the BPD and non-NPD patients following their psychotherapy with transference work. It informs that two randomized clinical trials were used for the treatment of the patients with BPD. The results show significant difference between the patients in terms of attachment.

Attachment theory, developed by Bowlby to explain human bonding, has profound implications for conducting and adapting psychotherapy. We summarize the prevailing definitions and measures of attachment style. We review the results of three meta-analyses examining the association between attachment anxiety, avoidance, and security and psychotherapy outcome. Fourteen studies were synthesized, which included 19 separate therapy cohorts with a combined sample size of 1,467. Attachment anxiety showed a d of −.46 with posttherapy outcome, while attachment security showed a d of.37 association with outcome. Attachment avoidance was uncorrelated with outcome. The age and gender composition of the samples moderated the relation between attachment security and outcome: samples with a higher proportion of female clients and a higher mean age showed a smaller relation between security and outcome. We discuss the practice implications of these findings and related research on the link between attachment and the therapy relationship. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 67:193-203, 2011. [ABSTRACT FROM AUTHOR]

Attachment theory provides a framework for understanding and predicting critical aspects of aggression in the personality disorders. An association between borderline personality disorder (BPD) and insecure forms of adult attachment marked by high relationship anxiety has been repeatedly observed in the empirical literature. Aggression also has been linked to insecure attachment. The present study extends previous work by exploring the degree to which the underlying attachment dimensions of relationship anxiety and avoidance are associated in BPD with the following forms of hostility: (a) direct aggression (verbal or physical) initiated towards others, (b) expectation/perception of aggression from others (including “reactive” counteraggression when/if provoked), (c) aggression directed towards the self in the form of suicidality or parasuicidality, and (d) affective experience of irritability or anger. The issue was studied in a sample of 92 patients diagnosed with BPD. Results show significant association between more fearful forms of attachment (simultaneous presence of relationship anxiety and avoidance) and the more reactive form of aggression involving expectation of hostility from others. Self-harm was significantly associated only with relational avoidance while anger and irritability were associated only with relational anxiety. Implications for understanding relational aspects of BPD aggression in research and clinical work are discussed. © 2007 Wiley Periodicals, Inc., J Clin Psychol 64: 67–82, 2008. [ABSTRACT FROM AUTHOR]

Changes in attachment organization and reflective function (RF) were assessed as putative mechanisms of change in 1 of 3 year-long psychotherapy treatments for patients with borderline personality disorder (BPD). Ninety patients reliably diagnosed with BPID were randomized to transference-focused psychotherapy (TFP), dialectical behavior therapy, or a modified psychodynamic supportive psychotherapy. Attachment organization was assessed with the Adult Attachment Interview and the RF coding scale. After 12 months of treatment, participants showed a significant increase in the number classified secure with respect to attachment state of mind for TFP but not for the other 2 treatments. Significant changes in narrative coherence and RF were found as a function of treatment, with TFP showing increases in both constructs during treatment. No changes in resolution of loss or trauma were observed across treatments. Findings suggest that 1 year of intensive TFP can increase patients' narrative coherence and RF. Future research should establish the relationship between these 2 constructs and relevant psychopathology, identify treatment components responsible for effecting these changes, and examine the long-term outcome of these changes. [ABSTRACT FROM AUTHOR]

In this introduction to the special section on attachment theory and psychotherapy, the editors briefly describe the key points of attachment theory (J. Bowlby, 1969, 1973, 1980) and its relevance to psychotherapy. They then outline their criteria for the selection of papers and briefly describe their emphasis. The aim of this section is to present novel and thought-provoking research that highlights the ways attachment theory principles contribute to understanding psychotherapy practice and outcome. It was the editors' goal to ensure breadth of coverage in terms of specific problems, range of populations, and types of treatments represented and to emphasize attachment-based treatments and outcomes. [ABSTRACT FROM AUTHOR]

Abstract: The Borderline Psychotherapy Research Project at New York Presbyterian Hospital-Weill Cornell Medical Center, headed by Drs Otto Kernberg and John Clarkin has developed and tested a treatment for Borderline Personality Disorder called Transference Focused Psychotherapy. The theory, development and empirical research for the treatment are discussed. A pre-post study and a comparison to treatment as usual both showed promising results. The structure of the randomized controlled trial that is currently underway is also discussed. [Copyright &y& Elsevier]

Most people will experience a traumatic event in their lifetime, but only a subset (<10%) will develop posttraumatic stress disorder (PTSD). To facilitate prevention and intervention of PTSD, it is important to understand how risk and resilience factors interact with one another to explain individual differences in risk for PTSD, especially in underprivileged groups, who often experience greater burden of trauma and PTSD. The current study utilized multiple and moderated regression to examine the relation between childhood maltreatment and adulthood PTSD risk in the context of various attachment patterns and emotion dysregulation in a sample (n = 856) of mostly low-income, African American participants. Moderation analysis indicated that the strongest association between self-reported childhood maltreatment and PTSD symptoms was manifest in participants reporting the highest levels of both attachment anxiety and attachment avoidance (b = 0.22, 95% CI [0.15, 0.29], p <.001), whereas, among those low on both these dimensions (i.e., more securely attached participants), there was no significant association between childhood maltreatment and current PTSD (b = 0.07, 95% CI [−0.01, 0.14], p =.07). Separately, multiple regression predicting current PTSD symptoms revealed an effect size for the two attachment dimensions similar to that of emotion dysregulation, while controlling for childhood maltreatment. These findings suggest more secure attachment may buffer against the deleterious effects of childhood maltreatment, and both attachment difficulties and emotion dysregulation serve as robust correlates of adulthood PTSD. [ABSTRACT FROM AUTHOR]

In this introduction to the JCLP: In Session 69(11) issue on attachment theory and psychotherapy, the key points of attachment theory (Bowlby, , , 1981) and its relevance to psychotherapy are briefly described. The aim of this issue is to provide case illustrations of how an attachment theory perspective and principles can expand our understanding of psychotherapy practice. [ABSTRACT FROM AUTHOR]