Attachment to therapist, the working alliance and emotional processing of traumatic material in session among veterans diagnosed with posttraumatic stress disorder

Abstract

Combat related posttraumatic stress (PTSD) continues to be a pervasive phenomenon, and world-wide PTSD rates are rising. Although a number of treatment approaches are utilized to address traumatic stress, veterans diagnosed with this disorder often have PTSD symptoms decades after the original combat trauma. Emotional processing appears to be a critical component in most effective treatments for PTSD. However, many veterans are unable to engage in this activity. Theory and research suggest that a secure attachment to the therapist and a strong working alliance will facilitate readiness to process emotional material in session. Sixty-eight self-selecting veterans diagnosed with combat-related PTSD were administered the Client Attachment to Therapist Scale (CATS), the Working Alliance Inventory-Short Form (WAI-SF), the Post-traumatic Checklist-Military Version (PCL-M), the University of Rhode Island Change Assessment scale (URICA), and a demographic questionnaire to examine the possible associations between adult attachment, the working alliance, and readiness to process traumatic material in session. Results suggest that fostering a strong, secure emotional bond may play a central role in working with veterans with posttraumatic stress. Veterans' attachment to their therapists appears to affect whether there will be agreement on the goals and tasks of therapy, as well as motivation to carry out these tasks. Motivational interviewing may be a useful tool to assist veterans in weighing the pros and cons of addressing their PTSD. Limitations of the study and future research were also discussed.