Objectives. The empirical qualitative study explored Older People’s (over 65 years of age) perceptions of psychological change and the processes by which these occurred. It also aimed to add to understanding of the barriers to therapeutic change. Subsequently, a systematic review of the current literature pertaining to older people’s attachment styles, and how attachment is measured within this population, was conducted. This scrutinised the literature regarding role of attachment (as a trans-diagnostic construct) in old age, as this may influence their change processes. Design. As the empirical study was exploratory, it adopted a Grounded Theory methodology, influenced by the constructivist perspective as described in Charmaz (2014). Data was obtained via semi-structured interviews, with the later interview schedule grounded in emergent codes and memos of earlier interviews. Literature pertaining to older people, attachment, and how attachment is measured, was obtained from a systematic review. Method. Twelve participants were interviewed using a semi-structured interview, following discharge from an Older Peoples Psychological Therapy Service, for the empirical project. Participants were aged 65 years or over and had received varying models of therapy over varying durations. Those reporting improvement, or no change, as a result of receiving psychological therapy, were approached to participate. Through detailed analysis, a tentative model of older people’s psychological change processes was constructed. This model was further checked by some participants for quality control. Subsequently the systematic review explored a key theme of attachment (as suggested by the categories highlighted in the empirical project). Literature regarding attachment, older people and how attachment is measured within this population, was obtained through a systematic search through major databases, compared against a checklist, constructed for this review, with all analysis prorated by qualified clinical psychologists supervising this study. Results. Interview transcriptions were analysed in line with a constructivist perspective of grounded theory. A non-linear model of psychological change, grounded in the data, was constructed. The main concepts of the model were Age as Context, Seeking Help and Entering the Therapeutic Environment, Building a Therapeutic Relationship, Developing a New Understanding, Therapeutic Changes and Post Therapy Reflections and Commitments of Continuation. In addition, some similar processes were highlighted across different therapeutic modalities, thus supporting trans-theoretical models of psychological change. In addition, the model highlighted a theme of models of relationships having continuity through the lifespan (as evidenced in the concepts of Seeking Help and Building a Therapeutic Relationship). This echoed the trans-therapeutic concept of attachment. Therefore, a systematic review of attachment in older people was conducted. Overall the quality of the literature pertaining to attachment, older people and how attachment is measured within this population was poor. There was a paucity of evidence of minimisation of bias reported in either design or analysis. Conclusions. The empirical project demonstrated the process of psychological change in older people is non-linear in nature. Some constructs of change were similar to those found in the adult literature, but there were also some constructs relating specifically to ageing, and the theoretical developmental stage of old age. This supports suggestions that age specific constructs should be held in mind when working therapeutically with older people. The systematic review found research exploring attachment in older people is a growing field of research, but one which is still in its infancy compared to other clinical populations. In addition, several studies had serious methodological issues and therefore readers are encouraged to interpret their results with caution.

Emotionally Focused Couple Therapy (EFT; Johnson, 2004) addresses relationship distress by facilitating the development of new patterns of interaction between partners. These new patterns of interaction are based on partners' vulnerable acknowledgement and expression of attachment needs. Partners' engagement in these new patterns of interaction is thought to improve their relationship-specific attachment bond. Although previous studies have shown EFT to result in excellent relationship satisfaction outcomes (Johnson, Hunsley, Greenberg & Schindler, 1999), research had yet clearly to demonstrate if and how EFT facilitates increases in partners' relationship-specific models attachment security over the course of therapy. To address this research gap, the current study employed Hierarchical Linear Modelling (HLM; Singer & Willet, 2003) to investigate the pattern of change in couples' (n=32) self-reported relationship satisfaction and relationship-specific attachment over the course of EFT. Couples reported significant linear increases in their relationship satisfaction and significant linear decreases in their relationship-specific attachment avoidance over the course of therapy. Couples who completed the blamer-softening therapeutic change event (n=16) demonstrated significant linear decreases in their relationship-specific attachment anxiety after completing this event. Decreases in relationship-specific attachment anxiety predicted increases in couples' relationship satisfaction over the course of therapy. Couples also demonstrated significant increases in the security of their pre-post-therapy relationship-specific attachment behaviour, as coded Secure Base Scoring System (Crowell, Treboux, Gao, Fyffe, Pan & Waters, 2002). The current study also used HLM (Singer & Willet, 2003) to examine how the completion of blamer-softening impacted softened couples' relationship-specific attachment anxiety, and whether the completion of blamer-softening had a similar impact on softened couples' relationship-specific attachment avoidance and relationship satisfaction. Softened couples reported an immediate increase in relationship satisfaction and immediate decrease relationship-specific attachment avoidance at the softening session. Further, softened couples' post-softening decreases in relationship-specific attachment anxiety were initially preceded by an increase at the softening session. These results provided an understanding of how EFT leads to increases in couples' relationship-specific attachment security. These results provide support for the use of attachment theory in the treatment of relationship distress, and also provide an illustration of how attachment can shift over the course of a therapeutic intervention.

Emotionally Focused Couple Therapy (EFT; Johnson, 2004) addresses relationship distress by facilitating the development of new patterns of interaction between partners. These new patterns of interaction are based on partners' vulnerable acknowledgement and expression of attachment needs. Partners' engagement in these new patterns of interaction is thought to improve their relationship-specific attachment bond. Although previous studies have shown EFT to result in excellent relationship satisfaction outcomes (Johnson, Hunsley, Greenberg & Schindler, 1999), research had yet clearly to demonstrate if and how EFT facilitates increases in partners' relationship-specific models attachment security over the course of therapy. To address this research gap, the current study employed Hierarchical Linear Modelling (HLM; Singer & Willet, 2003) to investigate the pattern of change in couples' (n=32) self-reported relationship satisfaction and relationship-specific attachment over the course of EFT. Couples reported significant linear increases in their relationship satisfaction and significant linear decreases in their relationship-specific attachment avoidance over the course of therapy. Couples who completed the blamer-softening therapeutic change event (n=16) demonstrated significant linear decreases in their relationship-specific attachment anxiety after completing this event. Decreases in relationship-specific attachment anxiety predicted increases in couples' relationship satisfaction over the course of therapy. Couples also demonstrated significant increases in the security of their pre-post-therapy relationship-specific attachment behaviour, as coded Secure Base Scoring System (Crowell, Treboux, Gao, Fyffe, Pan & Waters, 2002). The current study also used HLM (Singer & Willet, 2003) to examine how the completion of blamer-softening impacted softened couples' relationship-specific attachment anxiety, and whether the completion of blamer-softening had a similar impact on softened couples' relationship-specific attachment avoidance and relationship satisfaction. Softened couples reported an immediate increase in relationship satisfaction and immediate decrease relationship-specific attachment avoidance at the softening session. Further, softened couples' post-softening decreases in relationship-specific attachment anxiety were initially preceded by an increase at the softening session. These results provided an understanding of how EFT leads to increases in couples' relationship-specific attachment security. These results provide support for the use of attachment theory in the treatment of relationship distress, and also provide an illustration of how attachment can shift over the course of a therapeutic intervention.

Emotionally Focused Couple Therapy (EFT; Johnson, 2004) addresses relationship distress by facilitating the development of new patterns of interaction between partners. These new patterns of interaction are based on partners' vulnerable acknowledgement and expression of attachment needs. Partners' engagement in these new patterns of interaction is thought to improve their relationship-specific attachment bond. Although previous studies have shown EFT to result in excellent relationship satisfaction outcomes (Johnson, Hunsley, Greenberg & Schindler, 1999), research had yet clearly to demonstrate if and how EFT facilitates increases in partners' relationship-specific models attachment security over the course of therapy. To address this research gap, the current study employed Hierarchical Linear Modelling (HLM; Singer & Willet, 2003) to investigate the pattern of change in couples' (n=32) self-reported relationship satisfaction and relationship-specific attachment over the course of EFT. Couples reported significant linear increases in their relationship satisfaction and significant linear decreases in their relationship-specific attachment avoidance over the course of therapy. Couples who completed the blamer-softening therapeutic change event (n=16) demonstrated significant linear decreases in their relationship-specific attachment anxiety after completing this event. Decreases in relationship-specific attachment anxiety predicted increases in couples' relationship satisfaction over the course of therapy. Couples also demonstrated significant increases in the security of their pre-post-therapy relationship-specific attachment behaviour, as coded Secure Base Scoring System (Crowell, Treboux, Gao, Fyffe, Pan & Waters, 2002). The current study also used HLM (Singer & Willet, 2003) to examine how the completion of blamer-softening impacted softened couples' relationship-specific attachment anxiety, and whether the completion of blamer-softening had a similar impact on softened couples' relationship-specific attachment avoidance and relationship satisfaction. Softened couples reported an immediate increase in relationship satisfaction and immediate decrease relationship-specific attachment avoidance at the softening session. Further, softened couples' post-softening decreases in relationship-specific attachment anxiety were initially preceded by an increase at the softening session. These results provided an understanding of how EFT leads to increases in couples' relationship-specific attachment security. These results provide support for the use of attachment theory in the treatment of relationship distress, and also provide an illustration of how attachment can shift over the course of a therapeutic intervention.