Patients' Individual Differences in Implicit and Explicit Expectations From the Therapist as a Function of Attachment Orientation

Patients' attachment orientation was found to be an important predictor of the process and outcome of psychotherapy. The present study is the first to examine whether patients' attachment orientation toward significant others predicts their implicit and explicit expectations from the therapist, and whether this effect is moderated by the extent to which the therapist has become an attachment figure. In two studies (N = 308), we developed measures of implicit (lexical decision task) and explicit expectations from therapist, and tested the presence of individual differences in expectations as a function of the patients' attachment orientation, early and late in treatment. Whereas individuals higher on attachment anxiety did not report having fewer positive expectations from therapist early in treatment, they showed lower accessibility of positive expectations when measured implicitly. As treatment progressed, the extent to which the therapist has become an attachment figure may mitigate the adverse effects of pretreatment attachment anxiety. Public Significance Statement The article demonstrates how expectations from the therapist can be assessed using both explicit and implicit measures. Findings suggest that pretreatment attachment orientation can predict implicit and explicit expectations from the therapist, and suggest that potential adverse effects of insecure attachment can be mitigated when the therapist becomes an attachment figure.