The Relationship Between Adult Attachment Style and Therapeutic Alliance in Individual Psychotherapy

A Meta-Analytic Review

Diener, Marc J.
Monroe, Joel M.

¹American School of Professional Psychology, Argosy University

Marc J. Diener, PhD, American School of Professional Psychology, Clinical Psychology Program, Argosy University, Washington, DC, 1550 Wilson Boulevard, Suite 600, Arlington, VA 22209 [email protected]

Submission November 19, 2010. Accepted November 22, 2010.

Psychotherapy 48(3):p 237-248, September 2011. | DOI: 10.1037/a0022425

The present study examined the relationship between adult attachment style and therapeutic alliance in individual psychotherapy. Search procedures yielded 17 independent samples (total N = 886, average n = 52, standard deviation = 24) for inclusion in the meta-analysis. Results indicated that greater attachment security was associated with stronger therapeutic alliances, whereas greater attachment insecurity was associated with weaker therapeutic alliances, with an overall weighted effect size of r = .17, p < .001 (95% confidence interval = .10–.23). Publication bias analyses did not indicate any cause for concern regarding the results. The data were not demonstrably heterogeneous (Q = 6.10, df = 16, p = .99), and all between-study moderator analyses were nonsignificant (p values > .10) with the exception of the source of alliance ratings; results indicated that patient-rated alliance demonstrated a significantly larger relationship with attachment compared with therapist-rated alliance (Q_between = 3.95, df = 1, p = .047). Implications for clinical practice and future research are discussed.