Academic journal article Journal of Cognitive Psychotherapy

Relation of Client Attachment to Therapist First- and Second-Order Assessments

Academic journal article Journal of Cognitive Psychotherapy

Relation of Client Attachment to Therapist First- and Second-Order Assessments

Article excerpt

The relation between client working models of attachment and therapist type of change assessments (first- vs. second-order) was examined in a sample of first-time clients (N=46) seeking services through a university-based outpatient clinic. Results indicated that the problems and goals of clients who exhibited relatively secure working models of attachment were assessed by their therapists as being of a first-order nature, whereas the problems and goals of clients with more insecure working models of the world were assessed as being congruent with second-order conceptualizations. Implications for clinical research and the practice of cognitive psychotherapy are discussed.

An important distinction in cognitive psychotherapy - particularly among adherents to constructivist approaches - is that made between first- and second-order change (Guidano, 1987; Lyddon, 1990; Mahoney, 1991; Watzlawick, Weakland, & Fisch, 1974). In brief, first-order change is essentially "change without change," or any change that does not lead to a change in the fundamental structure of the system (Watzlawick et al., 1974). From a clinical standpoint, first-order change typically involves immediate symptom relief and/or the reestablishment of a relatively stable sense of equilibrium in the client's experience of self and world. Second-order change, on the other hand, is "change of change," a type of change that entails the alteration of the structure of the system. Clinically speaking, construedvists consider secondorder problems as "deep" (Guidano, 1987) or "core" (Mahoney, 1980) and suggest that working with such issues often challenges a client's most basic assumptions about self and world. Second-order change is rarely easy or rapid and is often accompanied by intense and sometimes painful emotional experiences (Lyddon, 1990).

Following from the significant interest given to attachment constructs in the cognitive psychotherapy literature (cf. Guidano, 1987, 1991; Liotti, 1988, 1991; Mahoney, 1991; Safran & Segal, 1990; Young, 1990), Lyddon and Alford (1993) have recently suggested a link between the level of security in a persons' interpersonal schemata (or working models of attachment) and the type of change that may be indicated in a clinical context (first- vs. secondorder). In particular, they suggest that because securely attached clients are relatively comfortable with their core assumptions about self and world, they tend to require only first-order adjustments in their personal systems. In these cases, the client's impetus for entering therapy often stems from the effects of an adverse current life situation or stressor (e.g., loss of job, end of intimate relationship, inconsiderate co-worker, etc.). As a result, the aim of therapy is to help the client refine the skills necessary to more effectively cope with the current problem and reestablish a personal sense of equilibrium.

By way of contrast, Lyddon and Alford (1993) suggest that clients who exhibit insecure working models of attachment most often require significant second-order revisions in these schemata. In these instances, clients' core beliefs about self and world are no longer adaptive and their presenting problems are more pervasive (e.g., a pattern of unproductive relationships, chronic depression, low self-esteem, generalized anxiety, etc.). In such cases, therapy tends to involve

(a) a developmentally focused reconstruction of the history and patterning of the problem, (b) a gradual elaboration of the client's tacit cognitive models of self and world that are no longer viable, (c) a full exploration of the feelings related to this newly accessed experiential information, and (d) therapist support for the client's construction of new meaning structures (Lyddon, 1990, p. 125).

The purpose of this study is to examine the relation between clients' working models of attachment and therapists' assessments of the type of change that may be clinically indicated. …

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