Aim: This research explores the therapeutic contact with clients with substance misuse disorders as experienced by therapists and whether attachment theory can provide explanatory value for the common factors of therapeutic change.
Methods: Ten therapists (psychologists, counselors and psychotherapists) of whom three worked in Private Practice and seven worked for addiction agencies, were interviewed. Interviews were tape-recorded, transcribed in full and analysed using IPA. Assertions of attachment theory were compared with the themes that were extracted from the analysed interviews.
Results and Discussion: The assertions of attachment theory were found either explicitly or implicitly to correlate with the main themes highlighted in the data and especially matched the seeking of a secure base provision. Many therapists appeared to use a model of attachment theory as means of making sense of the therapeutic relationship with substance users.
Similar relational difficulties were found to apply to clients that were viewed by therapists as 'working well' and to those 'not working well'.
The clients seen as gaining positive outcomes were viewed as being more able to establish and make use of the therapeutic relationship and accordingly, therapists viewed themselves as impacting those clients positively. The qualities of the therapist were seen to impact this process and these were subject to change depending on the qualities of the client.
Clients appear to have a greater capacity for exploring their external worlds than their internal worlds. The clients' ability to explore their internal worlds, as well as difficulties with narrative competence as experienced by their therapists, appear to correlate with their level of psychological-mindedness.
Empathy was used as a tool by therapists to engage their clients whilst promoting a sense of understanding of the clients' process. Ruptures within the therapeutic relationship were viewed as an opportunity to facilitate their clients' learning about relationships through the use of the therapeutic relationship.
Conclusions: This research supports the view that the qualities of the therapeutic alliance in psychotherapy is of most importance to the outcome. Findings of this research suggest the usefulness of applying a model of attachment theory to this population. They also increase our understanding of the significance of the therapeutic relationship at the level of engagement in therapy.