The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: A meta-analytic review.
Abstract
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 (Qbetween = 3.95, df = 1, p = .047). Implications for clinical practice and future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
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The therapeutic alliance is a significant transdiagnostic predictor of therapy outcomes, and it is closely related to attachment style.
“The therapeutic alliance is a significant transdiagnostic predictor of therapy outcomes, and it is closely related to attachment style (Diener & Monroe, 2011).”
From A preliminary investigation of the relationships between attachment insecurity, fear of compassion, and <scp>OCD</scp> severity (2025) · cites this paper as Diener & Monroe, 2011
Therapeutic alliance depends on the patient's attachment security: more secure attachment is related to stronger therapeutic alliance and vice-versa.
“and depends on the patient's attachment security: more secure attachment is related to stronger therapeutic alliance and vice-versa (see Diener and Monroe, 2011 for a metaanalysis).”
From Intranasal oxytocin administration dampens amygdala reactivity towards emotional faces in male and female PTSD patients (2016) · cites this paper as Diener and Monroe, 2011
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- Authors
- Diener, M. J., & Monroe, J. M.
- Affiliations
- Argosy University (US)
- ORCID
- Diener, Marc J.
- Venue
- Psychotherapy
- Published
- 2011
- Volume
- 48
- Issue
- 3
- Pages
- 237-248
- ISSN
- 0033-3204 (ISSN-L)
- 1939-1536
- OpenAlex
- W1993917807
- Cited by
- 260
- References
- 69
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 14 · 2023: 29 · 2022: 17 · 2021: 16 · 2020: 32 · 2019: 1 · 2018: 26 · 2017: 16 · 2016: 17 · 2015: 19 · 2014: 23 · 2013: 17 · 2012: 11
- FWCI
- 18.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- adult attachment styles, therapeutic relationship, individual psychotherapy, attachment security, insecure attachment
- MeSH terms
- Adult, Mental Disorders, Cooperative Behavior, Humans, Object Attachment, Professional-Patient Relations, Psychological Theory, Psychotherapy, Transference, Psychology, Treatment Outcome
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