Broaden-and-Build Cycles of Attachment Security in Therapy: Antecedents, Consequences, and Trajectory of Therapeutic Exploration

This study expanded the scope of research into clients’ self-disclosure in therapy, using an attachment theory perspective. Attachment theory views the therapist as a secure base and safe haven who helps the client to reflect on attachment experiences and their influence. I present a new measure of self-disclosure, the Client Therapeutic Exploration scales (CTE-4), that incorporates Bowlby’s (1988) conceptualization of self-disclosure as attachment-supported exploratory behavior. In this study, client speech was scored for its depth, emotional involvement (versus distance), freedom (versus inhibition), and spontaneity (versus preparedness) in video-recorded therapy sessions of 36 patients from five points in time over the course of therapy. This exploratory study investigated client self-disclosure in the naturalistic context of the dynamically evolving therapeutic relationship proposing that the features of client speech and their patterns of change over time in treatment are associated with characteristics of the client and the therapeutic relationship. I suggest, that via broaden-and-build cycles of attachment, therapeutic exploration leads to treatment outcomes. Specifically, I analyzed the relationship of therapeutic exploration to client attachment security, mentalizing, working alliance, level of symptoms (depression, anxiety, and stress), self-esteem, and motivation in therapy. While results connecting CTE-4 scores to clinical and alliance variables were mixed, each scale was consistently inversely related to attachment anxiety but not to attachment avoidance. That is, higher attachment anxiety was associated with less therapeutic exploration. Based on the results, I offer clinical recommendations and present pathways for future research. https://icc-idc.primo.exlibrisgroup.com/permalink/972ICC_IDC/5451oa/alma992003174403105