Date of Award


Degree Name

Doctor of Philosophy


Counselor Education and Counseling Psychology

First Advisor

Eric M. Sauer, Ph.D.

Second Advisor

Mary Z. Anderson, Ph.D.

Third Advisor

Ya Zhang, Ph.D.


Alliance, attachment, epistemic trust, mentalizing, outcome research, process research


Although psychotherapy researchers have gleaned greater understanding about how client attachment classifications influence the outcome of psychotherapy, relatively few studies have investigated therapists’ effects and have yielded inconclusive results (Steel et al., 2018). In the current study, we investigated how therapist attachment affects changes in the working alliance and client psychological distress over a course of psychotherapy treatment. We evaluated attachment in a sample of 23 therapist trainees from a university-based training clinic in the U.S. with the recently validated, transcript-based Therapist Attunement Scales (TASc; Talia & Muzi, 2017), which measures attunement by moment-to-moment discursive markers from a single psychotherapy session. Therapist trainees also completed the Reflective Functioning Questionnaire (RFQ; Fonagy, Luyten, Moulton-Perkins, et al., 2016) to assess mentalizing. Client outcome data were obtained from archival measures consisting of a weekly client-rated working alliance and a measure of psychological distress. Multilevel modeling analyses revealed that client psychological distress reduced and the working alliance improved over 11 sessions of psychotherapy, but contrary to our hypothesis, not as a function of therapist trainees’ markers of security (i.e., Balanced). However, low Detaching therapist trainees’ clients demonstrated a clinically significant reduction in psychological distress over time with a drop of 14 points from baseline. Furthermore, results suggest that there was no correlation between secure attachment (i.e., Balance classification) and ineffective mentalizing (i.e., high scores on Certainty and Uncertainty). Implications of this study build on the foundation of psychotherapy research, practice, and training.

Access Setting

Dissertation-Open Access