Matching the patient to the therapist: the roles of the attachment status and the helping alliance.

The helping alliance between patient and therapist is essential in the psychotherapeutic relationship. Recently, the links between patients' attachment and therapeutic alliance were examined. So far, there has been no published study that matched the patients and the patients' attachment representation to examine its role on the therapeutic relationship. Working along Bowlby's assumptions, a dissimilar matching of the attachment status to both was assumed to positively effect the helping alliance. In our study, the attachment representations of 19 psychotherapists and 59 anxiety patients (Structured Clinical Interview for DSM Axis I Disorders) were measured using the Adult Attachment Interview, using the dimensional scales by Waters et al. (Scoring secure versus insecure and dismissing versus preoccupied attachment as continuous variables: Discriminant analysis using AAI state of mind scales; unpublished manuscript). The helping alliance was assessed using the Helping Alliance Questionnaire. As expected, anxiety patients with a more insecure attachment with highly preoccupied and disorganized features evaluated the relationship with a more dismissing therapist as more helpful than that with a more preoccupied therapist. The results indicate the importance of a matching attachment status to a fruitful helping alliance in psychotherapy.