Psychotherapy, Vol 63(3), Sep 2026, 295-303; doi:10.1037/pst0000622
This study investigated whether clients’ pretreatment attachment insecurity predicted initial alliance and early alliance growth rate. Additionally, we examined whether clients’ early alliance growth rate predicted change in attachment insecurity following therapy. Data from 549 clients treated by 53 therapists in a primary care setting were analyzed using multilevel modeling. Associations between attachment styles (anxiety and avoidance), initial alliance, and alliance growth rate in the first four sessions were analyzed. Additionally, the associations between early alliance growth rate and the degree of improvement in anxious and avoidant attachment following treatment were examined. Higher attachment avoidance significantly predicted lower initial alliance levels and was marginally associated with steeper early alliance growth. Attachment anxiety showed no significant associations with alliance formation. Steeper early alliance growth predicted greater improvement in attachment avoidance following therapy. No associations were found between alliance growth and changes in attachment anxiety. The findings suggest that clients with higher attachment avoidance exhibit lower initial alliance levels but may demonstrate greater alliance strengthening during early sessions. Notably, early alliance growth was associated with reductions in avoidant attachment insecurity following treatment. These results underscore the importance of identifying attachment styles in treatment planning and prioritizing alliance formation in early sessions for clients presenting with avoidant attachment. (PsycInfo Database Record (c) 2026 APA, all rights reserved)