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

Objectives: 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. Method: 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. Results: Insecure attachment was significantly associated with greater difficulties in regulating emotions. A strong therapeutic alliance was associated with fewer difficulties in regulating emotions. Conclusions: 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. Copyright (c) 2012 John Wiley & Sons, Ltd. Key Practitioner Message 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.