Therapeutic progress and symptom elevation in treating dismissive attachment: A case study

Abstract

A dismissive or avoidant attachment style can present clinical challenges in psychotherapy as the attachment style may interfere with the development of a constructive therapeutic alliance and impact the level of disclosure, expressions of distress, and risks for premature drop-out. This paper reports a naturalistic case study and offers an in-depth examination of a treatment with a client with dismissive attachment, including a detailed examination of relational interventions and countertransference struggles. Furthermore, this paper considers the notable differences between quantitative scores on a well-validated, practice-based clinical symptom inventory and the qualitative outcomes for this client to offer clinical and research implications in treatment with dismissive attachment.

Keywords:

• attachment
• avoidant
• dismissive
• case study
• psychodynamic therapy
• treatment monitoring

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Natasha L. Reynolds

Natasha L. Reynolds, Psy.D. is a licensed clinical psychologist in private practice, who primarily works with adults and adolescents in both psychotherapy and psychological assessment.  She also teaches and consults for psychotherapists living in China with the Psychoanalytic English Consultation for Chinese Psychotherapists, mentors at the Chicago Center for Psychoanalysis, and is an adjunct professor at The Chicago School of Professional Psychology. Her clinical and research interests include relational and psychodynamic approaches to psychotherapy, attachment theory, Asian and Asian American psychology, and psychoanalytic training in China.

David Rupert

David Rupert, PsyD, is the director of training at the Danielsen Institute, and a licensed psychologist in private practice. He has a doctorate in clinical psychology and master’s degrees in psychology and theology from Fuller Seminary. Dr. Rupert has been in full-time clinical practice since 1996. His areas of interest and specialization are relational approaches to psychotherapy;  spiritual, religious, and existential issues; cultural competence/humility and social justice; and formative approaches to training for psychotherapists.

Steven J. Sandage

Steven J. Sandage, PhD, LP, is the Albert and Jessie Danielsen Professor of Psychology of Religion and Theology at Boston University and research director for the Center for the Study of Religion and Psychology at the Danielsen Institute. He is also a visiting faculty in Psychology of Religion at MF Norwegian School of Theology. Sandage is co-author or co-editor of five books, To Forgive is Human, The Faces of Forgiveness, Transforming Spirituality, Forgiveness and Spirituality: A Relational Approach, and The Skillful soul of the Psychotherapist. He is a licensed psychologist in practice at the Danielsen Institute, where he specialises in couples therapy, multicultural therapy and spiritually integrative therapy.