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Client/Therapist Matching Based on Attachment Style

General Description

Attachment theory is one of the most widely accepted systems for analyzing and understanding human relationships (Slade, 1999). According to this theory, individuals relate to other important individuals in their lives in one of three ways: with secure attachment (sometimes called autonomous), with avoidant attachment (sometimes called dismissing), or with ambivalent attachment (sometimes called preoccupied). Avoidant people are overly self-reliant, have minimal expressions of affect, deny desires for love and support, are distrustful of affection, keep a safe distance from others, and avoid passionate relationships. They have difficulty remembering their life stories. Ambivalent people are the opposite. They are overly dependent on attachment figures, are afraid to let them go, and have strong yearnings for love, support, and affection, although they don't trust the permanence of these things. They have little regulation of feelings related to attachments, and their life stories tend to be rambling and incoherent. Securely attached people are in the middle. They are able to trust relationships, ask for support when needed, and give and accept love and dependency. Their affects are well regulated, and they are optimistic about attachments.

According to Holmes (1997), therapists have their own styles, and some will be better than others at different methods. Holmes suggests that avoidant patients need an attuned, following, warm, flexible "holding" type of therapy. Ambivalent patients, on the other hand, need a firm, consistent therapy with clear boundaries. Holmes specifically suggests that therapists who are better at attunement and empathy would be more suited to treating avoidant patients, and therapists who are better at structures and boundaries would be better matched with ambivalent patients. Slade (1999) recommends that for avoidant clients, therapy should help them experience, or get more in touch with, their emotions. Therapists should also find ways to connect emotionally with these clients. In contrast, Slade suggests that for ambivalent clients, therapy should concentrate on structures for organizing and containing overwhelming feelings. Slade also suggests that avoidant clients do not do well in short-term therapy, and ambivalent clients do not do well in therapy in general. For TMatch, these suggestions were combined into three specific recommendations:

  1. Avoidant clients should be matched with attuned, following, warm, flexible "holding" type of therapy; ambivalent clients should be matched with firm, consistent therapy with clear boundaries.
  2. Avoidant clients should be matched with therapy that gets them more in touch with their emotions, and with therapists who emphasize connecting emotionally with clients; ambivalent clients should be matched to therapy with more structure.
  3. Avoidant clients should be matched with longer term therapy; ambivalent clients should be matched with shorter term therapy.

For more information, or to give feedback, email Kenneth Frankel, Ph.D.

References

Dolan, R., Arnkoff, D., & Glass, C. (1993). Client attachment style and the psychotherapist's interpersonal stance. Psychotherapy: Theory, Research and Practice, 30, 408-412.

Holmes, J. (1997). Too early, too late: Endings in psychotherapy - an attachment perspective. British Journal of Psychotherapy, 14(2), 159-171.

Slade, A. (1999). Attachment theory and research: Implications for the theory and practice of individual psychotherapy with adults. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 575-594). New York: Guilford Press.