Bell, Sally; (2024) Childhood Trauma Experiences, Epistemic Stance, And Social Relationships in Adolescents Receiving Therapy. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

INTRODUCTION: This systematic literature review and meta-analysis explored the relationship between attachment style and therapeutic alliance, updating research conducted over a decade ago. METHODS: This review encompassed English-language, peer-reviewed studies of adolescent and adult patient groups aged 12 and above, receiving psychological intervention, which reported a correlation between early therapy patient-rated therapeutic alliance and attachment traits as measured by the Experiences of Close Relationships Scale (ECR) and Relationships Questionnaire/Relationships Scales Questionnaire (RQ/RSQ). The databases searched from inception to 27/11/23 included PsycINFO, Medline, Embase, CINAHL, and Scopus PubMed. Longitudinal studies were appraised using the Newcastle Ottawa Scale and cross-sectional studies with the Joanna Brigg’s Institute critical appraisal tool. Correlational data was extracted from included papers and categorised by attachment style: Secure, Anxious/Preoccupied, Avoidant/Dismissive, and Fearful/Disorganised. Four meta-analyses were conducted to investigate the relationship between each category and therapeutic alliance, reporting a pooled effect size. Moderator analyses were conducted for age, gender, and ethnicity of the included samples. RESULTS: The review included 22 studies in the Anxious/Preoccupied category (N = 2574), 21 in the Avoidant/Dismissive category (N = 2528), 6 in the Fearful/Preoccupied category (N = 276), and 5 in the Secure category (N = 227). The average age of participants in the studies ranged from 27.39 to 45.98. The percentage of female participants ranged from 52.7% to 100%, and the percentage of white participants ranged from 58.33% to 100%. A small yet significant positive effect size was observed between secure attachment and alliance (r = .22, CI [.12, .32], p < .05). A small yet significant negative effect was observed in all insecure categories – Anxious/Preoccupied (r = - .18, CI [-.25, -.11], p < .05), Avoidant/Dismissive (r = -.09, CI [-.13, -.05], p < .05), and Fearful/Disorganised (r = -.17, CI [-.37, .04], p < .05). No significant moderators were observed in any category. DISCUSSION: This study compared only two commonly used measures of attachment, which limits the generalisability of these results. The statistical differences between the reported effect sizes were not explored, and moderator analysis for different diagnostic groups or treatment types was not investigated due to the heterogeneity within the study samples. The results of this study support the notion that attachment style may influence an individual's ability to form a therapeutic alliance. However, due to small effect sizes, the results should be interpreted with caution, considering other confounding variables. Nonetheless, understanding a client’s attachment tendencies could support clinicians in sensitively adapting therapeutic engagement techniques to meet the needs of the client and promote favourable therapeutic outcomes.

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