The Role of the Therapeutic Alliance in the Regulation of Emotion in Psychosis: An Attachment Perspective

Authors

  • Karen Annette Owens,

    Corresponding author
    1. School of Psychological Sciences, The University of Manchester, Manchester, UK
    2. Department of Psychological Medicine, L Block, Royal Oldham Hospital, Oldham, UK
    • Correspondence to: Karen Annette Owens, School of Psychological Sciences, University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL UK.

      E-mail: owens_ka@hotmail.com

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  • Gillian Haddock,

    1. School of Psychological Sciences, The University of Manchester, Manchester, UK
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  • Katherine Berry

    1. School of Psychological Sciences, The University of Manchester, Manchester, UK
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Abstract

Objectives: This article aims to explore the value of attachment theory as a framework for understanding the ways in which the staff–patient relationship is associated with different methods of regulating emotion in individuals with a diagnosis of psychosis. Method: Patient participants with a diagnosis of schizophrenia, schizoaffective disorder or psychosis not otherwise specified and mental health workers were recruited from 24-hour rehabilitation teams. Patient participants completed questionnaires assessing emotion regulation, attachment, therapeutic alliance and symptomatology. The therapeutic alliance was also assessed from mental workers' perspective. Results: Insecure attachment was significantly associated with greater difficulties in regulating emotions. A strong therapeutic alliance was associated with fewer difficulties in regulating emotions. Conclusions: Attachment is a useful theoretical construct for understanding psychosis, with evidence for a link between a positive staff–patient relationship and enhanced emotion regulation. Clinical implications of these findings are discussed. Copyright © 2012 John Wiley & Sons, Ltd.

Key Practitioner Message

  • The study supports a link between attachment organisation and psychosis, characterised by difficulties in emotion regulation.
  • A positive patient-key worker relationship may facilitate the development of emotion regulation in this client group.
  • A key implication of these findings is the training of MDT staff in the implementation of attachment-informed interventions.

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