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

Kathryn Lewis-Ginebaugh, Ph.D.


Attachment, outcome, process, psychotherapy, TASc, therapist


Researchers have demonstrated that therapist attachment is associated with therapeutic relationships and client outcomes (Steel et al., 2018). Yet, results have varied and, at times, seemed contradictory. This study explores how therapist attachment might influence the working alliance and symptom change throughout psychotherapy and uses the recently validated, transcript-based Therapist Attunement Scales (TASc; Talia & Muzi, 2017). The TASc was developed to measure in-session attachment-related verbal behavior. The third session from each pair of 23 therapists-in-training and their clients was transcribed and coded. Clients completed the OQ-45.2 and the Working Alliance Inventory prior to each session.

Growth curve modeling was used to examine changes over time. Overall, client distress levels reduced over time and the quality of the working alliance improved as therapy progressed. Therapist avoidant attachment was significantly associated with change in OQ scores. Therapists high in avoidance were associated with clients who increased in distress over time; whereas therapists low in avoidance had clients who decreased in distress over time. There were no significant effects of therapist attachment on working alliance ratings.

Access Setting

Dissertation-Open Access