Therapist attachment, emotion regulation and working alliance within psychotherapy for personality disorder

Personality disorder is characterised by intense emotional experiences, unstable patterns of relating to self and others, and risky behaviour. Alliance ruptures and premature drop-out is common within psychotherapy for personality disorder, which frequently limits the effectiveness of treatment. Research has shown that some clinicians are better able to facilitate the development of a therapeutic alliance than others. However, there is a clear lack of research exploring therapist factors which influence the alliance. The present study examined the relationship between therapist attachment style, therapist emotion regulation and working alliance within psychotherapy for personality disorder. Psychological therapists (N = 44) were recruited from specialist personality disorder services and a personality disorder conference. Participants were asked to complete three questionnaire measures of their personal attachment style (on the dimensions of attachment anxiety and attachment avoidance), their emotion regulation capacity, and their alliance with one of their clients with a primary diagnosis of personality disorder. Results showed that neither therapist attachment anxiety nor attachment avoidance were significant predictors of working alliance. However, therapist emotion regulation was a significant predictor of working alliance, explaining 13.2% of the variance in alliance scores. As hypothesised, higher levels of emotional dysregulation were associated with poorer working alliance. The findings are discussed in relation to relevant theory, previous research and models of psychotherapy for personality disorder. Since the current study is the first to investigate these therapist factors within psychotherapy for personality disorder, directions for further research and potential clinical implications are discussed.