The Role of the Therapeutic Alliance in the Regulation of Emotion in Psychosis: An Attachment Perspective

Abstract

This article aims to explore the value of attachment theory as a framework for understanding the ways in which the staff-patient relationship is associated with different methods of regulating emotion in individuals with a diagnosis of psychosis. Patient participants with a diagnosis of schizophrenia, schizoaffective disorder or psychosis not otherwise specified and mental health workers were recruited from 24-hour rehabilitation teams. Patient participants completed questionnaires assessing emotion regulation, attachment, therapeutic alliance and symptomatology. The therapeutic alliance was also assessed from mental workers' perspective. Insecure attachment was significantly associated with greater difficulties in regulating emotions. A strong therapeutic alliance was associated with fewer difficulties in regulating emotions. Attachment is a useful theoretical construct for understanding psychosis, with evidence for a link between a positive staff-patient relationship and enhanced emotion regulation. Clinical implications of these findings are discussed. The study supports a link between attachment organisation and psychosis, characterised by difficulties in emotion regulation. A positive patient-key worker relationship may facilitate the development of emotion regulation in this client group. A key implication of these findings is the training of MDT staff in the implementation of attachment-informed interventions.