This thesis explores the associations between therapist and client attachment styles and the working alliance. It is presented as three papers: a literature review, a report of the empirical research study, and a critical reflection of the research process. In the first paper, the author provides a systematic review of studies that have investigated the association between therapist attachment and the working alliance and therapist attachment and clinical outcome. A total of nine research studies met the inclusion criteria and were included in the final review. The studies varied considerably in terms of their design and methodology, as well as, the different tools used to measure the therapeutic alliance, attachment style and outcome. The findings were then organized in terms of the relationship between therapist attachment and client-rated therapeutic alliance; the relationship between therapist attachment and therapist-rated alliance; the relationship between therapist attachment and alliance as rated by an observer and finally, the relationship between therapist attachment and outcome. The key findings were that therapist attachment security was associated with client-rated and therapist-rated working alliance. However, the overall association between therapist attachment and alliance was not straight forward. There was evidence to suggest that the attachment style of therapist and the client interact to produce a combined effect on perceptions of the working alliance and outcome. The empirical research paper examined the extent to which client and therapist self-reported attachment styles were related to the working alliance. The study also investigated any role for client attachment to therapist and psychological mindedness. Both these variables were included as exploratory. It was hypothesised that psychological mindedness may be related to secure attachment and the alliance. Specifically, we investigated the extent to which self-reported attachment styles were related to the working alliance and assessed the relative contribution of psychological mindedness to attachment security and the quality of the working alliance. Thirty clients and 42 therapists from primary care services were recruited. Participants completed measures of anxiety and depression, attachment style, working alliance and psychological mindedness. Therapist attachment security was not related to the alliance. No significant relationships were found between client attachment style and the working alliance. However, therapists and clients with oppositional attachment styles had more favourable alliances. The clinical implications and future research directions is then discussed.The final paper provides a critical reflection of the research process. It begins by outlining the rationale for the development of the literature review and the empirical research paper, and goes on to discuss some of the methodological considerations of the research paper. The implications for therapeutic practice are then suggested, followed by the wider service-related issues. Attachment theory is then critiqued, and the clinical implications discussed. Finally recommendations are made for future research.

The effectiveness of psychological therapies has received increasing attention in recent years with a confidant optimism building in the strong research evidence for its efficacy. However, criticism comes from the study of attrition from therapy in routine clinical practice, which studies show can reach from 30 to 60%. Searches for the causes of attrition have uncovered a multitude of correlations but only socio-economic variables emerge as significant predictors of attrition. This present study proposes and tests a theoretical model with clear implications for practice and research. In reviewing three broad literatures on health service use the concept of the Decision Action Pathway Interactive Network (DAPIN) began to emerge. Health decisions are seen as taking place within an emerging decision/action pathway that is subject to a dynamic interaction network. Decisions are made by individuals based on rational calculations, with network interactions providing the mechanism by which the social factors influence the decision/action pathway. Empirical testing of DAPIN consisted of the construction of a patient self-report cost attached to therapy attendance (CATA) measure that could be used to determine whether people of low SES do in fact have higher network costs attached to attending therapy and whether this is related to higher attrition. A small sample of patients attending their first appointment completed CATA and those who unilaterally terminated in the first four sessions compared with those who continued therapy. Weak support was obtained for the DAPIN model. The Demand sub-scale of CAT A proved to be a powerful predictor of unilateral termination from therapy (attrition) at the early stage of therapy attendance and provides a useful short tool for routine clinical practice. The small and idiosyncratic sample used meant that the DAPIN model could not be adequately tested. However, the evidence accumulated suggests that the model is worthy of more extensive testing.

The thesis agrees that there can be interpreted within conscious life, the influence of the past. The past can influence the intersubjective style of an ego, a person in some of their relations with others. But Freud held an unclear position on how to interpret 'unconscious intentionality'. He preferred theory about senses that never appear and natural scientific science. It is argued that concepts such as transference, countertransference and unconscious communication should be contextualised within intersubjectivity in the strong sense of a potential manifold of interpretable perspectives on any single cultural object. The answer is to show that Freud's key ideas are situated within metaphysical commitments to natural science and material cause overall in an unclear relation to conscious psychological life. Husserl's apriori analysis of intersubjectivity is argued to explain any psychological event in relation to the past and the current therapeutic situation. Consequently, Freud's key ideas need to be abandoned in preference for a rationalisation about meaning, empathy and intersubjectivity as more adequate explanations of the conditions for the psychological meaningfulness of any psychological cultural object.

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This thesis explores the relatively unknown area of female stalkers. Throughout the thesis the newly defined term ‘Socially Intrusive Behaviours’ (SIBs) is used to unify previous stalking definitions. Chapter One provides an introduction to the topic of females who display SIBs. Chapter Two includes a Thematic Analysis and explores the motives and justifications for SIBs and examines the personality traits, attachment styles and experiences of anger with female patients. Results indicate that SIBs are a maladaptive coping strategy that benefit the perpetrator, provide feelings of safety, are a response to perceived threats of abandonment and require over-control of emotional arousal. Assessment of personality, anger and attachment are also examined and treatment recommendations are discussed. An interesting finding was that SIBs are a maladaptive coping strategy to manipulate the perpetrators’ feelings rather than the feelings or actions of others. Dialectical Behavioural Therapy (DBT) is a recognised treatment which targets a range of maladaptive coping strategies. Chapter Three provides a systematic review of the effectiveness of DBT with female-only populations in Randomised Control Trials. Results found DBT was superior at reducing a range of maladaptive coping behaviours including self-harm, substance misuse and binge/purge eating. It was therefore considered a potentially useful intervention for females whose maladaptive coping strategies are SIBs. Whether DBT could effectively target an adult female patient’s SIBs was tested by a single case study in Chapter Four. The results indicated that DBT reduced her SIBs and improved her anger management skills. Chapter Five is a critique of the State Trait Anger Expression Inventory (Spielberger, 1999) as used in Chapter Two and Four. Chapter Six discusses the clinical and theoretical implications of this thesis, explores its limitations, and provides recommendations for future research.

Objectives: The evidence base for Acceptance and Commitment Therapy’s (ACT) overall effectiveness is highly promising. However, the extent to which the six processes comprising ACT have been investigated is extremely variable. In particular, the process regarding the self and therapeutic change is in need of validation, having never been subjected to empirical investigation The objective of the present study was to achieve this by testing whether the predictions ACT makes regarding the self and therapeutic change are supported by quantitative data. The specific prediction to be tested were that a) those with a fixed sense of self and low psychological flexibility will display high therapeutic resistance and b) those with a fluid sense of self and high psychological flexibility will display a strong tendency towards value-based behaviour. Method: Data from 171 non-clinical participants was subjected to a two-way between subjects ANCOVA, with self-theory and psychological flexibility as independent variables and therapeutic reactance as the dependent variable, co-varying out the effects of gender. Results: A significant interaction effect between psychological flexibility and sense of self was found. Post-hoc tests revealed two specific findings: Firstly, people with low psychological flexibility and a fixed sense of self displayed therapeutic reactance that was likely to impede therapeutic change. Secondly, people with high psychological flexibility and a fluid sense of self displayed therapeutic reactance that was more likely to be consistent with value-driven, goal-oriented behaviour. Conclusions: These findings are consistent with ACT’s theorised process regarding the self and therapeutic change. Thus, ACT’s predictions regarding the self and therapeutic change have received their first empirical validation. Clinically, the overarching psychotherapeutic focus is on the client’s process of relating to their self-concept, rather than altering its contents.

Introduction: Empathy is considered to be an important therapist offered condition. Historically the exploration of empathy has employed quantitative methodologies. It is argued that these methodologies cannot capture the socially constructed nature of psychological concepts and instead regard empathy as problematic due to its inconsistently applied definition. Objectives: This study aimed to explore therapists' discourse around empathy by employing a qualitative methodology and acknowledging the importance of context. A further objective was to encourage a theoretical and methodological shift in the way that psychological concepts are conceptualised and investigated. Design: A discursive psychological approach was taken in the analysis of data from discussion groups. Method: Discourse was collected from two discussion groups conducted at an NHS Primary Care Trust: the first with a group of clinical psychologists and the second with a group of cognitive behaviour therapists. In addition some documentary information was collected from the research site in order to contextualise the service. Results: In both discussion groups, empathy was considered fundamental to the therapeutic relationship between the client and therapist. Therapists constructed empathy in two ways: as a limited therapist experience and as a quality that might develop over time. Further patterns emerged in the data; the clinical psychologists made frequent use of case studies whereas the cognitive behavioural therapists cited research evidence and made use of theoretical models. Discussion: The results are discussed with reference to a particular model of discursive psychology where the activity done through discourse is emphasised. It is argued that through particular constructions of empathy, therapists were working up their professional accountability. It is suggested that therapists work up their constructions of empathy as factual and therefore indisputable through discursive devices, identified as the use of case studies and research evidence.

There has been much anecdotal and theoretical material concerning the impact of `race' on therapy in Britain, especially with regards to therapeutic outcomes. The three studies presented in this thesis empirically investigated the notion that premature termination in counselling, and apparently shorter duration of therapeutic treatment, amongst British Black clients is a function of lack of ethnic matching with a Black counsellor; and that racial identity attitudes may help provide some light on this attendance pattern of Black people. Results from SGlindicated that Black people had an appropriate appreciation of the uses and benefits of counselling; that over two-thirds of Black individuals would consider receiving counselling for their problems; and, when asked directly, a statistically significant amount of Black respondents stated that if they were to see a counsellor, they would prefer to see a racially similar counsellor. However, when `race' was not mentioned, this preference was not significant. Analysis of archival material of former clients ('SG2'), did not find a significant difference between Black and White samples in teens of premature termination of counselling or with regards to length of treatment. Similarly, no significant difference was found in terms of dropout rates between those Black clients who were ethnically matched with a Black counsellor and those who were not. The RIAS revealed low item reliability for the British sample in SG3. It was concluded that counsellors should take account of the heterogeneous nature of `Black' people as a group and not automatically presume that a Black client will prefer a Black counsellor, but to explore this with each Black client. Other implications for therapists are considered and recommendations for further research are made.

The aim of this study is to explicate the concepts transference and countertransference from the psychoanalytic, interpersonal and cybernetic perspectives. Commonalities and differences in definition are described. The notion that transference and countertransference provide the therapist with objective interpersonal information concerning the patient or client system is explored. It is pointed out that whilst, according to the tenets of second-order cybernetics, objective interpersonal information is not possible, transference and countertransference analysis, nevertheless, according to this viewpoint, provide the therapist with a double description. Such a description may influence the therapist's interpretation or understanding of the system at hand and be a component then also of the coconstructed, therapeutic reality of the therapist and patient or client. / Psychology / M.A. (Clinical Psychology)

Text in Afrikaans / The development of the person of the therapist is increasingly being highlighted in systemic therapeutic training. This emphasis on the person of the therapist can be traced back to the rise of constructivism. Constructivism represents the viewpoint that reality is created rather than discovered. As a result the therapist's contribution to the therapeutic process is considered cardinal. The personal style of the therapist is once more placed under the limelight. Exactly how this variable must be handled to ensure optimal efficiency is still unclear. Suggestions in this regard are mostly related to some therapeutic model. The objective of this study, on the contrary, is to determine the value of a more general approach. A procedure developed by the University of South Africa, accentuating the person of the therapist, has been evaluated. / Opleiding in sistemiese terapie word al hoe meer gekenmerk deur die ontwikkeling van die persoon van die terapeut. Die beklemtoning van die persoon van die terapeut kan veral na die opkoms van die onstruktivisme teruggevoer word. Hierdie denkrigting verteenwoordig die standpunt dat die werklikheid eerder geskep as ontdek word. Gevolglik word die terapeut se bydrae tot die terapeutiese proses as van deurslaggewend beskou. Die persoonlike styl van die terapeut word dus opnuut onder die soeklig geplaas. Hoedat hierdie veranderlike egter hanteer moet word om optimale effektiwiteit te verseker, is egter nie duidelik nie. Meeste voorstelle hou direk verband met een of ander terapeutiese model. Met hierdie studie is daar egter gepoog om die waarde van 'n meer algemene benadering te peil. 'n Prosedure wat met verloop van tyd aan die Universiteit van Suid-Afrika ontwikkel is, is gevolglik verder - en wei vanuit die gesigshoek van die terapeut - ondersoek. / M.A. (Voorligtingsielkunde)