How Attachment Styles Influence Therapy Outcomes:
A Summary of My PhD Research
Introduction
As part of my PhD at the University of Wollongong (completed in 2008), I conducted research examining “how therapy works”. Specifically, I sought to better understand why some people experience a rapid improvement in therapy whereas others progress more gradually.
At the time, researchers were largely focused on comparing therapies using symptom data—trying to prove their modality was superior. But this didn’t explain why therapy was effective or why it sometimes didn’t work at all.
My research took things deeper: I analysed what was happening inside sessions, between clients and therapists. I also explored the role of attachment and other interpersonal patterns, and how these influenced both the speed and depth of recovery.
This involved analysing transcripts from a group of participants who received a 16-session course of a manualised therapy.
Key Findings
- Around one-third of participants showed major improvement by Session 6 (a “rapid response”).
- Therapy transcripts revealed that people who experienced a rapid response tended to be more willing to own and process strong emotions earlier in therapy.
- People who progressed more slowly often presented with fears and defensiveness which was evident in the interactions between them an their therapists, and their pre-therapy scores on measures of attachment predicted the speed of their response via these interactions.
- Early differences in the therapy transcripts (as early as Session 3) reflected these patterns, even when the therapeutic relationship appeared strong.
- In other words, despite high therapeutic alliance ratings (from themselves, their therapists, and independent observers) people who progressed more slowly had a characteristic style of emotional avoidance evident in the therapy transcripts that differed significantly from people who responded rapidly.
- It appeared that some people are not able to ‘make as much use’ of the therapeutic alliance, even when that bond is extremely positive.
Why This Matters
Although these findings came from a structured research setting (not clinical work with my clients), they build on decades of attachment research and continue to shape my approach today. These insights help me tailor therapy to each person’s attachment style and relational needs.
This guides my attention to the patterns and processes unfolding within therapy itself—what’s happening moment-to-moment in the relationship, how emotional states are stored and expressed in the body, and how early trauma can shape brain processing in ways that leave people stuck in reactive, protective responses.
Good therapy can help bring awareness to these processes and support change at both the relational and neurobiological level.
Understanding how we relate to others—including our therapist—can allow us to better understand ourselves and work towards making relationships feel safer and (especially when it comes to therapeutic relationships, more effective, and tailored appropriately to our individual needs).
From Research to Hope
My PhD research aligns with both earlier findings and the direction of many of today’s most transformative therapies. What’s promising is that we now have approaches that don’t just manage symptoms—they work on healing from the inside out.
Through awareness of our internalised attachment systems, we can begin to offer ourselves the kind of safety, compassion, and reassurance that a secure caregiver would provide—even if those experiences were missing in childhood. These are not fixed traits; they are skills and practices that can be learned.
A key concept here is the idea of an introject—a mental representation of someone else (often a caregiver) that becomes internalised and then shapes how we treat ourselves. It’s not just about how we relate to others; it’s also about how we relate to ourselves.
These internal working models can become critical, harsh, or neglectful, especially if our early experiences were unsafe or inconsistent. Much of my work involves helping people recognise and shift these patterns—cultivating a more supportive, compassionate relationship with themselves.
Healing from the Inside-Out
Although we can’t change the past, we can change the way it impacts us—including healing how we relate to ourselves. Many of the latest therapies and interventions are designed to do exactly this. These include:
- EMDR (Eye Movement and Desensitisation Therapy)
- Compassion Focused Therapy (CFT) & Compassionate Mind Training
- DBR (Deep Brain Reorienting)
- Ego State Therapy
These approaches support us working with our internal parts, our inner relational patterns, and in healing emotional wounds that are often carried silently from early life. They provide pathways to healing that are experiential, relational, and deeply reparative.
You can read more about these therapies here.
Learn More
If you’d like to explore the findings in more detail or request a copy of the research abstract, you’re welcome to get in touch or mention it during our work together.
I’ve also written self-help articles related to this research, including:
These insights are aimed at helping you shape a personalised, attachment-informed approach to care that meets you where you are, and supports meaningful, lasting change.
Ready to Take the Next Step ?
Andreas is currently accepting new clients for online therapy.
Get in touch to discuss your goals.
Andreas will respond personally and guide you through the next steps.
Self-Help Tools:
Practical articles designed to help you better understand & address common challenges.
Evidenced-based tools to support your psychological wellbeing.
Explore Self-Help Tools:
Request an Appointment:
Appointment Enquiries
