Attachment theory, developed by Bowlby to explain human bonding, has profound implications for conducting and adapting psychotherapy. This chapter summarizes the prevailing definitions and measures of attachment style. This chapter reviews the results of three meta-analyses examining the association between attachment anxiety, avoidance, and security and psychotherapy outcome. Fourteen studies were synthesized, which included nineteen separate therapy cohorts with a combined sample size of 1,467. Attachment anxiety showed a d of (.46 with posttherapy outcome, while attachment security showed a d of .37 association with outcome. Attachment avoidance was uncorrelated with outcome. The age and gender composition of the samples moderated the relation between attachment security and outcome; a higher proportion of female clients and a higher mean age showed a smaller relation between security and outcome. This chapter discusses the practice implications of these findings and related research on the link between attachment and the therapy relationship.
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