Attachment and Older Adults in Psychotherapy: A Latent Profile Analysis of Psychological Distress across Treatment
Date of Award
Doctor of Philosophy
Counselor Education and Counseling Psychology
Eric Sauer, Ph.D.
Kelly McDonnell, Ph.D.
Janet Hahn, Ph.D.
Attachment theory, latent profile analysis, older adults, psychotherapy, socioemotional selectivity theory
Older adults have been largely underrepresented within the psychotherapy literature. Given the unique social and emotional changes associated with older age (Carstensen et al., 1999) and the perceived gap in training that trainees report in working with older adults (Woodhead et al., 2015), there is a pressing need for research that can aid mental health practitioners in the conceptualization, treatment planning, and treatment of their older adult clients.
In the first part of this manuscript, an integrated theoretical model, consisting of socioemotional selectivity theory (SEST; Carstensen et al., 1999) and attachment theory (Bowlby 1969), was developed to provide psychotherapists with a more complete conceptualization of older adult clients. This integrated model combined the normative emotional and social network patterns in older adults predicted by SEST with attachment theory’s prototypical attachment styles of secure, anxious, avoidant, and disorganized attachment. SEST’s perspective of normative social aging was used to help inform and adjust if certain social behaviors should be viewed as pathological or not. Stemming from the consolidation of these theories, specific recommendations to clinicians, supervisors, and training programs regarding client conceptualization, treatment planning, and progress tracking were provided.
In the second part of this manuscript, an archival study was conducted that sought to aid researchers and clinicians in the conceptualization and treatment of older adult clients through the development of clinical profiles. To establish the number of valid profiles, their characteristics, and how they differ in treatment outcomes across the first six sessions of psychotherapy, a latent profile analysis (LPA) and subsequent analysis of covariates (ANCOVA) were conducted. Because attachment theory’s potential application to the unique social experiences of older adults and the transdiagnostic nature of psychological distress, the subscales of the Experiences of Close Relationship scale and Outcome Questionnaire 45.2 were used as the LPA’s indicator variables. With a sample of 172 clients who are 55 years or older, a three-profile model was identified, and each participant was assigned to a profile. Each profile was characterized based on mean scores of each indicator variable: Profile 1 was identified as “Secure Attachment and Low Psychological Distress”; Profile 2 was identified as “High Attachment Anxiety and Psychological Distress”; and Profile 3 was identified as “High Attachment Avoidance and Moderate Attachment Anxiety and Psychological Distress.” Next, ANCOVAs were conducted to evaluate differences in change in psychological distress across the first six sessions of therapy. Results suggested that while Profile 2 experienced the greatest change in psychological distress across the first six session of therapy, they were also the only profile to remain within the clinically significant range of distress. Further clinical and research applications were explored. Overall, the development of the three-profile model and examination of profile differences in treatment outcomes provides a novel and potentially useful tool in the psychological treatment of the largely under-studied population of older adults.
Stran, Brian Michael, "Attachment and Older Adults in Psychotherapy: A Latent Profile Analysis of Psychological Distress across Treatment" (2022). Dissertations. 3880.