Attachment style and clinical outcome within a DBT-informed Therapeutic Community

Purpose – There is evidence that attachment style and clinical outcomes are related within Therapeutic Communities (TCs). This study sought to examine any possible relationships between self-reported adult attachment style, therapy programme engagement and measures of psychological distress and dissociation on admission and discharge within a residential TC. Design/methodology/approach – Ex-clients of the TC were contacted by post and invited to take part in this service evaluation. Additional data was sourced from a database of routinely collected outcome measures. Of 281 ex-clients, the final sample in this study was N=32. Findings – When attachment style is conceptualised dimensionally, participants identified most strongly with a fearful attachment style, and least with a preoccupied or secure style. A range of attachment styles were reported. A significant association was apparent between self-reported secure attachment and reduced levels of psychological distress upon discharge from the TC. The potential for changes in client attachment patterns following TC membership is discussed. Originality – To date, this is the first known study to report on the relationship between self-reported adult attachment style and psychological outcomes specifically for women with self-defeating behaviours within a TC. Research limitations/implications – The small sample size and correlational nature of this study means that results should be interpreted cautiously. Nevertheless, results are of clinical relevance for inpatient or residential therapy programmes (including TCs). Such programmes should routinely assess client attachment style to ensure appropriate interventions and adaptions are implemented.