J Med Assoc Thai 2012; 95 (12):1583

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How the Interpersonal and Attachment Styles of Therapists Impact Upon the Therapeutic Alliance and Therapeutic Outcomes
Wongpakaran T Mail, Wongpakaran N

Objective: Explore how therapist’s interpersonal and attachment styles have an impact upon both the therapeutic alliance formed and therapy outcomes.

Material and Method: One hundred twenty one outpatients attending for routine psychiatric services were monitored for symptom outcomes, comprising depression, anxiety, and interpersonal problems. Patients were also asked about the level of therapeutic alliance that had been formed, covering goals, tasks, and the bond developed, using the Working Alliance Inventory (WAI). At the same time, the participating therapists reported upon their interpersonal styles by categorizing them into domineering or submissive styles using the IIP-32 questionnaire and their attachment styles by categorizing them into secure or preoccupied styles using the ECR-R. To explore therapist factors such as interpersonal and attachment styles, as well as to establish the presence of gender matching, the working alliance was used as a dependent variable.

Results: Multivariate analysis revealed that neither the gender of the therapist nor the gender of the patient, or the therapists’ styles, had an effect on the Working alliance or working outcomes. The multivariate test for WAI-goal (Wilks’ Lambda F (3, 134) = 4.24, p = 0.007), interpersonal style (Wilks’ Lambda F (3, 134) = 2.77, p = 0.044), attachment style (Wilks’ Lambda F (3, 134) = 2.76, p = 0.045) and IIP-Style*Attachment Style (Wilks’ Lambda F (3, 134) = 3.13, p = 0.028) produced statistically significant results, while working alliance-goal was the only predictor of the level of anxiety and depression in patients (p = 0.014 and p = 0.002, respectively). Submissive style was positively correlated to anxiety (p = 0.011) and interpersonal difficulties (p = 0.006), whilst surprisingly, a secure attachment style was found to have a positive correlation with anxiety and depression. However, when both styles were combined, the resulting style negatively predicted anxiety (p = 0.002).

Conclusion: Therapist factors were found to have no effect on working alliance, as reported by the patients; however, it was reported that when the therapists employed a secure or submissive attachment style, this played a role in helping to reduce symptoms. The working alliance-goal element was found to be a predictor of a reduction in levels of both anxiety and depression among patients.

Keywords: Interpersonal style, Attachment style, Therapeutic alliance, Psychotherapy outcome


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