Client Attachment and Change in Mental Health During Psychotherapy

In the current study, we used a naturalistic design to examine how client attachment orientations affect changes in client mental health over the course of treatment. We evaluated session-by-session changes in overall maladjustment levels (derived from the Outcome Questionnaire 45.2) in a sample of 105 adult clients who were seeking therapy at a large, university-based, outpatient psychology training clinic. The primary goal of this study was to investigate how client attachment orientations affected patterns of change in client overall maladjustment scores across time. Because previous findings have suggested that client attachment orientations may be associated with different patterns or differential rates of change. beyond linear changes, we also extended previous research by testing more complex models involving quadratic and cubic changes over the course of therapy. Multilevel modeling analysis revealed that client overall maladjustment scores significantly improved throughout therapy. Results further indicated that client attachment anxiety predicted change in maladjustment during therapy. Attachment avoidance did not predict change in symptoms. With respect to attachment anxiety, we found different patterns of recovery or symptom change throughout therapy for clients with high versus low attachment anxiety. Clients low in attachment anxiety showed consistent improvements and those high in attachment anxiety exhibited low levels of therapeutic change throughout the middle of therapy despite their overall improvements.