Fearful attachment, working alliance and treatment response for individuals with major depression

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Abstract
The present research examines links between adult attachment styles, working alliance, and treatment response in men and women receiving 16 sessions of supportive–expressive dynamic psychotherapy for major depression. 58 clients were assessed using the Relationship Questionnaire and the Hamilton Rating Scale for Depression (HRSD) prior to commencement of psychotherapy. The Working Alliance Inventory was completed in session 3, and the HRSD was readmi‐nistered after six and 16 sessions. Results indicated that a high proportion (39%) of the sample reported ‘fearful–avoidant’ attachment at intake. Fearful avoidance also longitudinally predicted significantly more negative outcomes (particularly over the initial six sessions), but was unrelated to working alliance. Working alliance was unrelated to treatment response. Findings highlight the negative impact of fearful attachment on treatment response, but indicate that this occurs independent of the working alliance. The avoidance of intimacy for fear of rejection appears to impede successful psychotherapy, and treatment should be tailored for these clients. Copyright © 2004 John Wiley & Sons, Ltd.

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