• social difficulties;
  • group therapy;
  • adherence;
  • attachment;
  • abused and suicidal African American women


The social brain model emphasizes improving our understanding of the relational factors that influence treatment adherence. Consistent with this framework, which has been applied to medical adherence, it was hypothesized that insecure attachment styles, interpersonal hassles, and low levels of social support would explain group psychotherapy attendance. Results from 51 abused and suicidal low-income, African American women who attended at least 1 session of an empowerment group psychotherapy indicated that lower attendance was related to (a) insecure attachment styles (fearful) and (b) interpersonal hassles (perceived social differences, lack of social acceptability, social victimization). Perceived social support did not predict group therapy attendance. The value of addressing attachment styles and interpersonal factors to enhance treatment participation is underscored. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1–12, 2009.