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  • Publicado : 25 de abril de 2011
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1. Introduction
The therapeutic alliance refers to the interpersonal processes that occur in the relationship between a therapist and client. The importance of understanding the therapeutic alliance is illustrated through research that has found that a good quality alliance is related to a better therapeutic outcome (Horvath & Symonds, 1991). It has been suggested that attachment theory canprovide a framework within which to explore the therapeutic alliance (Bowlby, 1988a). Although there has been considerable research on the relationship between client attachment patterns and the therapeutic alliance, at present there is a lack of synthesis of findings in this area. This paper therefore systematically reviews the empirical studies that have examined the relationship betweenclients' self reported attachment patterns and the therapeutic alliance. The intention is to evaluate whether assessing clients' attachment patterns would be beneficial to therapists and service providers. The concepts of therapeutic alliance and attachment will be discussed separately before exploring how they may fit together.
1.1. The therapeutic alliance
The concept of the therapeutic alliance wasoriginally developed within the psychodynamic tradition (for a detailed description of its origins see Horvath & Luborsky, 1993). However, over time research has consistently indicated that the strength of the therapist–client relationship is an important variable in determining therapeutic success, independently of the type of therapy delivered (Martin, Garske, & Davis, 2000). Thus theconcept has been adopted across therapeutic orientations and has emerged as an important common factor in the efficacy of the adult psychotherapeutic process (Norcross, 2002). Differences in the way that researchers conceptualise and term the therapeutic alliance (e.g. working or helping alliance, therapeutic relationship) have led to the call for a clarification of the concepts underlying alliancein order to provide a cohesive definition (Elvins & Green, 2008). Bordin (1979) was the first to present a generic synthesis of alliance constructs and conceptualised it as a purposeful collaborative relationshipwhich involves a blend of three features. These features are; (a) an agreement between the therapist and client on the goals of therapy, (b) an agreement of a task/s that can be doneto achieve these goals, and (c) the development of bonds, that is the development of enough trust, respect, confidence and personal attachment between the therapist and the client to achieve the goals and take part in the tasks. This conceptualisation was consistent with the idea that the alliance is a common factor across therapeutic orientations and modalities. As a result, Bordin'sconceptualisation began to dominate the literature and validated measurement scales were developed based on this theory. Two examples are the Working Alliance Inventory (WAI; Horvath & Greenberg, 1989) and the Family Therapy Alliance Scale (FTAS; Pinsof & Catherall, 1986). TheWAI has become the mostwidely used measure in alliance research (Martin et al., 2000). According to Bordin's (1979) theory, theprocess of building and repairing a strong alliance is the key mechanism underlying therapeutic change. In order for change to occur, therapists and clients need to monitor and repair any ruptures that may happen as a result of a disagreement or misunderstanding in relation to the above three components of the alliance (Safran & Muran, 2000). The alliance is viewed as dyadic and mutual withthe therapist and client as active coconstructors, constantly negotiating and renegotiating the alliance in order for successful work to take place (Bordin, 1994). Research studies have focussed on identifying the factors that influence this relationship, in particular client pre-treatment individual differences (e.g. motivation, ability to form social relationships; Horvath, 1994). It is thought...
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