Healing attachment trauma in adult psychotherapy: The role of limited reparenting

ABSTRACT

Bowlby was the first scholar who conceptualised the therapeutic relationship as an attachment. A wide range of therapeutic approaches have adopted his ideas and have focused on the importance of the therapeutic relationship in healing relational trauma. The present paper focuses on limited reparenting, an attachment informed approach employed in the context of schema therapy, and explores its potential in producing beneficial therapeutic outcomes by meeting the client’s attachment needs and thus reconstructing their relational schemas. In support of this claim empirical evidence is drawn from two seemingly different areas of research: attachment security priming and imagery rescripting. Implications for clinical practice and research are discussed.

ABSTRAKT

Bowlby war der erste Wissenschaftler, der die therapeutische Beziehung als Bindung konzeptualisierte. Eine breite Palette von therapeutischen Ansätzen hat seine Ideen übernommen und sich auf die Bedeutung der therapeutischen Beziehung bei der Heilung von Beziehungstrauma konzentriert. Der vorliegende Beitrag konzentriert sich auf limitierte Neubeelternung, einen bindungsinformierten Ansatz, der im Kontext der Schematherapie eingesetzt wird, und untersucht sein Potenzial, vorteilhafte therapeutische Ergebnisse zu erzielen, indem die Bindungsbedürfnisse des Klienten erfüllt und so seine Beziehungsschemata rekonstruiert werden. Zur Unterstützung dieser Behauptung werden empirische Beweise aus zwei scheinbar unterschiedlichen Forschungsbereichen gezogen: dem Priming der Bindungssicherheit und dem Rescripting von Bildern. Implikationen für klinische Praxis und Forschung werden diskutiert.

Resumen

Bowlby fue el primer erudito que conceptualizó la relación terapéutica como un apego. Una amplia gama de enfoques terapéuticos han adoptado sus ideas y se han centrado en la importancia de la relación terapéutica en la curación del trauma relacional. El presente artículo se centra en la reparentación limitada, un enfoque informado del apego empleado en el contexto de la terapia de esquema, y explora su potencial para producir resultados terapéuticos beneficiosos al satisfacer las necesidades de apego del cliente y, por lo tanto, reconstruir sus esquemas relacionales. En apoyo de esta afirmación, la evidencia empírica se extrae de dos áreas de investigación aparentemente diferentes: el cebado de seguridad de apego y la reescritura de imágenes. Se discuten las implicaciones para la práctica clínica y la investigación.

ABSTRAIT

Bowlby fut le premier intellectuel à conceptualiser la relation thérapeutique comme un attachement. Des approches thérapeutiques variées ont adopté ses idées et se sont centrées sur l’importance de la relation thérapeutique dans la prise en charge du trauma relationnel. Cet article traite du reparentage limité, une approche inspirée par la théorie de l’attachement utilisée dans un contexte de thérapie des schémas, et explore son potentiel de résultats positifs lorsqu’on respond aux besoins d’attachement des clients favorisant la reconstruction de leurs schémas relationnels. Pour soutenir cette assertion, des données empiriques sont extraites de deux zones de recherche différentes: amorce à l’attachement sécurisant (attachment security priming) et le recodage des informations par imagerie mentale (imagery rescripting). Les implications pour la clinique et la recherche sont discutées.

ΠΕΡΊΛΗΨΗ

Ο Bowlby ήταν ο πρώτος που θεώρησε τη θεραπευτική σχέση ως δεσμό. Ένα ευρύ φάσμα θεραπευτικών προσεγγίσεων έχει υιοθετήσει τις ιδέες του και έχει επικεντρωθεί στη σημασία της θεραπευτικής σχέσης στη θεραπεία των σχεσιακών τραυμάτων. Η παρούσα εργασία επικεντρώνεται στη διορθωτική γονεϊκή στάση (Limited reparenting), μια προσέγγιση που βασίζεται στη θεωρία του δεσμού, και χρησιμοποιείται στο πλαίσιο της θεραπείας σχημάτων, και διερευνά τις δυνατότητές της ως προς την παραγωγή ευεργετικών θεραπευτικών αποτελεσμάτων ικανοποιώντας τις ανάγκες δεσμού του πελάτη ανακατασκευάζοντας έτσι τα σχέσιακά του σχήματα. Προς στήριξη αυτού του ισχυρισμού αντλούνται εμπειρικά δεδομένα από δύο φαινομενικά διαφορετικούς τομείς έρευνας: τη γνωστική ενεργοποίηση της ασφάλειας δεσμού (attachment security priming) και την φαντασιακή επανεγγραφή (imagery rescripting). Συζητούνται οι επιπτώσεις για την κλινική πρακτική και την έρευνα.

KEYWORDS:

• Attachment needs
• attachment trauma
• limited reparenting
• schema therapy
• security priming
• therapeutic relationship

SCHLÜSSELWÖRTER:

• Bindungsbedürfnisse
• Bindungstrauma
• eingeschränkte Neubeelternung
• Schematherapie
• Security Priming
• therapeutische Beziehung

PALABRAS CLAVE:

• necesidades de apego
• trauma de apego
• reparenting limitado
• terapia de esquema
• cebado de seguridad
• relación terapéutica

MOTS-CLÉS:

• besoins d’attachement
• trauma lié à l’attachement
• reparentage limité
• thérapie des schémas
• amorce de sécurité
• relation thérapeutique

ΛΈΞΕΙΣ-ΚΛΕΙΔΙΆ:

• ανάγκες σχετικά με το δεσμό
• τραύμα δεσμού
• διορθωτική γονεϊκή στάση στη θεραπευτική σχέση
• θεραπεία σχημάτων
• θεραπευτική σχέση
• γνωστική ενεργοποίηση του σχήματος ασφαλούς βάσης

The efficacy of the therapeutic relationship in producing positive outcomes for a wide range of mental health conditions has been extensively recognised and supported by empirical evidence (e.g. Cronin et al., 2014; Falkenström et al., 2013; Flückiger et al., 2018).

In his seminal book on the clinical applications of attachment theory, Bowlby (1988) was the first to conceptualise the therapeutic relationship as an attachment bond between the therapist and the client. Since then, several therapeutic approaches, such as attachment therapy (Heard et al., 2018), schema therapy (Young et al., 2003), and emotionally focused therapy (Greenberg et al., 1993), have adopted his ideas and have placed them at the centre of the therapeutic process. In developing a schema-focused approach for personality disorders, Young (1999) advocated for a limited reparenting role for the therapist who similarly to a security-providing attachment figure is attuned to the unmet emotional needs of the client and endeavours to fulfil them in a limited way without violating the boundaries of the therapeutic relationship.

In the present article, the potential of limited reparenting to produce beneficial therapeutic outcomes by healing attachment trauma is discussed drawing upon empirical evidence from two seemingly different areas of research: attachment security priming and imagery rescripting.

Attachment theory: Basic concepts

According to attachment theory (Bowlby, 1982) human babies are born with an innate neurobiological system, the attachment system, which promotes their survival through the development of affective bonds with significant others who provide protection, reassurance and comfort (Mikulincer & Shaver, 2016). Those significant others, or attachment figures, serve a number of functions that characterise attachment bonds: (a) they are the target of proximity seeking especially in times of need; (b) they provide a safe haven when the child feels threatened by providing comfort and support thus helping the child to regulate his/her distress; and (c) they provide a secure base from which the child can explore the physical and social environment trusting that the attachment figure will be available and responsive in the face of threat, adversity, illness, or fatigue (Mikulincer & Shaver, 2016). When attachment figures fulfil their role of meeting the child’s attachment needs (secure emotional connection, attunement, regulation, protection) in an optimal way, a secure bond is developed and the child forms positive mental representations (internal working models: IWMs) of themselves (‘I am worthy of love and care’) and others (‘Others will be there when I need them and will respond to my needs’). Contrarily, infants whose attachment figures have been unresponsive or unavailable develop insecure attachment patterns or styles. Children whose attachment figures are completely indifferent towards their attachment needs develop an avoidant attachment style that leads them to avoid intimacy and engage in compulsive self-reliance in times of need in an attempt to deactivate the attachment system (they employ deactivating defensive strategies). In turn, when the attachment figure is inconsistently available children develop an ambivalent (or ‘resistant’) attachment style leading them to engage in hyperactivating strategies such as hypervigilance towards threats, intensification of their distress and over-reliance on the attachment figures when at the same time they cannot be comforted by them (Mikulincer & Shaver, 2016).

The three patterns described above arose from the Ainsworth et al.’s (1978) original classifications of infants based on the Strange Situation procedure. Later, Main and Salomon (1990) introduced a fourth pattern, the disorganised (or disoriented) attachment, to describe the lack of a consistent attachment strategy. The infants in this category appear apprehensive and fearful, alternating between approach and avoidance towards their attachment figures who seem to be both a source of comfort and at the same time a source of fright (‘fright without solution’; Main & Hesse, 1990).

Bowlby (1982) posited that the attachment patterns and their related IWMs formed in childhood are stable throughout an individual’s life, ‘from cradle to grave’, influencing cognitions, emotions, behaviours and ways of relating. This view was first supported by a decisive study carried out by Hazan and Shaver (1987) where romantic love was conceptualised as an attachment relationship. Research into adult attachment has proliferated as a result of this study revealing that adult attachment relationships share similar patterns, characteristics and functions with childhood attachment relationships (Mikulincer & Shaver, 2016). Contemporary adult attachment scholars conceptualise attachment as a bidimensional construct with two orthogonal dimensions: attachment anxiety (which reflects the ambivalent pattern of attachment observed in childhood) and attachment avoidance. Those individuals who score low on both dimensions have a secure attachment style and those who score high on both dimensions have a fearful (or disorganised based on childhood classifications) attachment style (Brennan et al., 1998). Based on Mikulincer and Shaver's (2003) model and on hundreds of studies that support it (see Mikulincer & Shaver, 2016 for a comprehensive review), the attachment system in adulthood is an emotion regulation device which is activated by threats and stressors, and one of its main functions is to seek proximity to attachment figures who will provide support and comfort. Although, in childhood proximity seeking (primary attachment strategy) translates into actual behaviour, in adulthood even the activation of mental representations (symbolic proximity) of security-providing attachment figures can be sufficient in creating a sense of safety and security which allows the person to successfully deal with stressors and regulate dysphoric emotions (Mikulincer & Shaver, 2003). Insecure individuals who experience their attachment figures as unavailable or unresponsive employ secondary strategies to attain a sense of security which will deactivate the attachment system. Avoidantly attached individuals will rely on deactivating strategies denying their attachment needs in an attempt to deactivate the attachment system and regulate emotion. Contrarily, anxious individuals will employ hyperactivating strategies engaging in frantic efforts to engage their attachment figure, and thus attain attachment security, by exaggerating their attachment needs. Finally, similarly to disorganised infants who exhibit a confused behaviour of approach and avoidance towards their attachment figures, adults with a fearful (or disorganised) attachment ‘may enact both strategies [hyperactivating and deactivating] in a haphazard, confused, and chaotic manner … their behaviour under stress may be an incoherent blend of contradictory, abortive approach/avoidance behaviours or perhaps paralyzed inaction or withdrawal’ (Simpson & Rholes, 2002, p. 224). This attachment style is common to persons who have experienced severe attachment trauma, such as severe neglect and abuse, and has been linked to a number of clinical conditions such as borderline personality disorder (Liotti, 2013).

The psychotherapeutic relationship as attachment

According to attachment theory (Bowlby, 1982), although in infancy it is mainly the primary caregivers (most often the parents) who serve as attachment figures, in adulthood a wide range of relationships, including those with romantic partners, close friends, teachers, mentors, supervisors, and therapists can be considered attachment relationships as long as they serve the attachment figure functions outlined at the beginning of the previous section. Bowlby (1988) was the first to claim that psychotherapeutic relationships exhibit the three essential elements that characterise attachment bonds. Accordingly, the therapist like a ‘good enough parent’ (a termed that derived from the work of Winnicott, 1953) is attuned to the client’s emotional experience and is responsive to their needs creating in this way a safe space, a secure base, within which the client feels safe to explore and work on traumatic memories and reflect on their experiences and emotions. Therapists can also serve as a safe haven and be the target of proximity seeking especially in times of emotional turmoil or in crisis situations (Mallinckrodt, 2010).

A growing body of empirical studies has provided evidence for the secure base and safe haven qualities of the psychotherapeutic relationship. Thus, Mallinckrodt et al. (2005) found that a secure attachment to the therapist facilitates deeper psychological exploration in sessions and that this association could not be explained by the clients’ dispositional attachment or the quality of the working alliance. These findings have also been confirmed by two subsequent studies (Janzen et al., 2008; Romano et al., 2008). Similarly, a therapist can serve as a safe haven for comfort and reassurance in times of distress (Mallinckrodt & Jeong, 2015; Parish & Eagle, 2003).

Expectedly, not all psychotherapeutic relationships have the characteristics of attachment bonds (Mallinckrodt, 2010; Mikulincer et al., 2013). According to Mallinckrodt (2010), although many relationships have the potential to fulfil the main characteristics of an attachment bond, not all therapists apply attachment concepts in their clinical practice. In addition, even when some therapeutic relationships meet these criteria at later stages of therapy, this is rarely the case at the beginning of the therapy process. Most importantly, research has shown that both the clients’ and the therapists’ global insecure attachment styles can limit their capacity to build a strong therapeutic relationship (Mikulincer et al., 2013).

Clients who have experienced attachment trauma and therefore hold insecure IWMs struggle to build a strong therapeutic alliance with their therapist and benefit the least from the therapeutic process. As stated by Mallinckrodt (2010), anxious individuals might depend excessively on the therapist experiencing high levels of anxiety especially when the therapist seems unavailable (e.g. during holidays) whereas avoidant individuals might engage in compulsive self-reliance avoiding proximity to the therapist. In accordance with this line of reasoning, evidence has shown that high levels of attachment avoidance and attachment anxiety are predictive, to a similar degree, of a poorer working alliance (Bernecker et al., 2014; Folke et al., 2016), can interfere with psychotherapy outcome (Shorey & Snyder, 2006) and result in higher dropouts (Tasca et al., 2004). Contrarily, securely attached individuals seem to be able to establish a strong alliance with the therapist and benefit more from psychotherapy (Byrd et al., 2010). Consequently, it seems that insecure individuals who potentially need psychotherapy the most might not be benefiting adequately from it, which calls for approaches that focus on the attachment security enhancing qualities of the therapeutic relationship.

Schema therapy and the concept of limited reparenting

Schema therapy is an integrative model of psychotherapy drawing on cognitive-behavioural, attachment, psychodynamic (particularly object relations theory), and humanistic (particularly Gestalt) approaches, initially developed for the treatment of personality disorders (Young et al., 2003). Young et al. (2003) found that some clients with personality disorder characteristics did not respond well to cognitive-behavioural therapy as they held more rigid and maladaptive cognitive structures which were deeply rooted in a traumatic childhood and were harder to engage in a productive therapeutic alliance due to repeated painful interactions with attachment figures. Drawing from the approaches mentioned above, schema therapy, places emphasis on the consequences of developmental trauma in the formation and maintenance of psychological difficulties, the maladaptive long-lasting patterns of relating and behaving arising from ingrained cognitive schemas and their associated coping styles, and the importance of an empathic and nurturing therapeutic relationship (Martin & Young, 2010).

Limited reparenting is at the heart of schema therapy and is considered the first of the four core mechanisms of healing (the other three being cognitive restructuring, experiential techniques, and behavioural pattern breaking). One of the main assumptions of schema therapy is that dysfunctional schemas develop as a consequence of toxic frustration of the core emotional needs in childhood which according to Young et al. (2003) are the need for: (1) secure attachments to others; (2) autonomy, competence, and sense of identity; (3) freedom to express valid needs and emotions; (4) spontaneity and play; and (5) realistic limits and self-control. In the course of therapy, the therapist seeks to identify the emotional needs that were not fulfilled by significant others (or attachment figures), and as a ‘good enough’ parent will venture to meet those needs by establishing a secure nurturing attachment bond while at the same time maintaining the ethical and professional boundaries (Kellogg & Young, 2006). Namely, the therapist will become a security-promoting attachment figure who will provide a secure base and a safe haven within the framework of which the client’s attachment needs will be satisfied (Mallinckrodt, 2010).

The reparenting qualities of the therapeutic relationship are of particular importance for the more traumatised clients whose emotional needs might have been frustrated very early on in life and might be manifested in a more childlike manner in therapy (Young et al., 2003).

Schema therapy is a lengthy and complex treatment, and it would be difficult to clearly delineate the mechanisms of change and distinguish the differential effects of the techniques employed (e.g. cognitive techniques, experiential techniques, limited reparenting) in bringing about change. Nevertheless, indirect evidence for the effectiveness of limited reparenting comes from two seemingly distinctive lines of research. The first research line comes from the fields of social psychology and social cognition and relates to the exploration of the effects of attachment security priming (Gillath & Karantzas, 2019). Security priming involves the experimental activation of secure IWMs in memory subliminally (e.g. exposure to security related words or the names of security-providing attachment figures) or supraliminally (with the use of guided imagery where the attachment system is activated by a threat and then the participants bring to memory a sensitive and responsive attachment figure who provides love and care). The guided imagery task was developed by Mikulincer and Shaver (2001). Participants are given the following instructions, and are then asked to visualise the face of the attachment figure for 2 minutes and write down about their experience and related thoughts on a sheet of paper.

Imagine yourself in a problematic situation that you cannot solve on your own, and imagine that you are surrounded by people who are sensitive and responsive to your distress, want to help you only because they love you, and set aside other activities in order to assist you. (Mikulincer & Shaver, 2001).

This security priming technique has been used in a number of studies and has been found to produce a number of benefits (that cannot be explained by the induction of positive affect) such as lower levels of depressed and anxious moods postprime (Carnelley et al., 2016), an increase in the cognitive openness to counterarguments towards previously held beliefs (Jarvinen & Paulus, 2017), an increase in positive affect for participants with dependency depression (Liao et al., 2017), easier recovery from negative affect triggered by thinking about upsetting autobiographical memories (Selcuk et al., 2012), and a decrease in children’s physiological responses to threat (Stupica et al., 2019). These are only some examples of studies demonstrating the beneficial effects of attachment security priming. Two recent comprehensive systematic reviews have summarised the findings of research exploring the influence of attachment security priming on a broad array of outcomes (Gillath & Karantzas, 2019; Rowe et al., 2020).

It has to be highlighted that especially repeated security priming can have cumulative and long-lasting beneficial effects for insecurely attached individuals leading them to adopt emotion regulation strategies similar to those of their dispositionally secure counterparts (Rowe et al., 2020). Interestingly, laboratory-based repeated security priming has been found to be bringing about changes in dispositional attachment (Gillath et al., 2008; Mikulincer & Shaver, 2020) indicating that relational schemas are malleable and can respond to intervention.

The second line of research, that could provide evidence for the effectiveness of limited re-parenting, comes from the field of clinical psychology and psychotherapy and the study of the Imagery Rescripting technique (Edwards, 2007), a core technique of schema therapy. In the context of this technique, patients are asked to bring to memory childhood images of traumatic interactions with their significant others, without being exposed to the most traumatic aspects of the experience to avoid re-traumatisation, and then the therapist enters the image and re-parents the child by providing validation of feelings, protection, comfort, and safety offering in this way a corrective attachment experience (Hayes & van der Wijngaart, 2020). The evidence base for the effectiveness of imagery rescripting is rapidly growing revealing important beneficial repercussions for a variety of clinical conditions such as voice hearing (Paulik et al., 2019), obsessive compulsive disorder (Maloney et al., 2019), social anxiety disorder (Norton & Abbott, 2016), and borderline personality disorder (Schaich et al., 2020). It has to be noted that all the studies mentioned above have employed the procedure outlined by Arntz (2014) within which the therapist enters the image meets the emotional needs and protects the client who at the end of the image feels calm and safe (the attachment system is deactivated in attachment terms).

The attachment security priming method, described above, involves the activation (or repeated activation) of IWMs of security in an attempt to strengthen them and make them more salient. It is however possible, that individuals who have experienced severe attachment trauma, such as adults with a personality disorder diagnosis, might not hold mental representations of security (Stupica et al., 2019). Imagery rescripting might then be more beneficial for these adults, not only because it allows the development of a new security base script with the therapist being the sensitive and responsive attachment figure but also by altering the meaning of the insecure IWMs. As Arntz and Jacob (2012) have postulated, imagery rescripting offers a more favourable ending that is attuned to the needs of the child.

Both procedures share similar features in that they (a) both start with the activation of the attachment system by bringing traumatic or threatening events to the surface, and (b) both end with the deactivation of the attachment system as the individual’s needs are met by either an available and responsive attachment figure (security priming) or by a comforting and protective therapist who acts as a security-providing attachment figure offering consequently a corrective attachment experience. These two processes are continuously at play in psychotherapeutic approaches, such as schema therapy, where the focus is on the exploration and reflection on painful experiences (which contributed to the development of maladaptive schemas) through experiential techniques (e.g. imagery, chair work, mode dialogues) and on the acknowledgement and fulfilment of the clients’ emotional needs through limited reparenting.

Implications for practice and research

As it becomes apparent from the brief review above pertaining to the effectiveness of the two procedures (security priming and imagery rescripting) the provision of attachment security through limited reparenting is of utmost importance in therapeutic practice, especially when implemented via mental imagery, as it allows for powerful changes for the clients. It is therefore important for therapists to be able to be skilfully attuned to the attachment needs of the client and have the ability to provide a secure base for them.

Nevertheless, according to evidence from studies on attachment, insecure attachment interferes with individuals’ capacity for caregiving (Mikulincer & Shaver, 2016). It may therefore be inferred that the therapist’s ability to provide sensitive caregiving is influenced by their own attachment orientation. Indeed, research has demonstrated that anxious (preoccupied) and fearful attachment styles in therapists have been associated with lower level of alliance quality especially with clients who experience interpersonal difficulties pretherapy (Bucci et al., 2016; Degnan et al., 2016; Dinger et al., 2009). In addition, therapists’ insecure attachment orientations were associated with poorer client-reported therapy outcomes (Degnan et al., 2016). Consequently, therapists’ training and supervision should be focusing more on helping therapists develop an understanding of how their own attachment experiences might be influencing their ability to build a strong therapeutic relationship and provide limited reparenting. Most importantly, this line of evidence clearly indicates that therapists’ personal therapy is essential (especially for those with an insecure dispositional attachment style) in enabling them to provide a secure base for their clients. Thus, therapists’ earned security (Roisman, Padrón, Sroufe, & Egeland) through therapy would allow them to better meet their clients’ attachment needs and facilitate their attachment security.

As mentioned in previous sections the clients’ attachment orientations have also been shown to impact the strength of the therapeutic alliance and outcome (Folke et al., 2016; Shorey & Snyder, 2006). However, in many studies security priming has been found to have a beneficial effect irrespective of participants’ chronic attachment insecurities (Gillath et al., 2008). It is therefore possible that the development of a strong attachment bond could bear significant implications for therapy outcomes for individuals who have experienced attachment trauma. This idea is supported by evidence indicating that schema therapy, an attachment-informed approach, is effective for clients with personality disorders and complex clinical presentations (Bamelis, Spinhoven, & Arntz, 2014; Videler et al., 2018). Similarly, evidence shows that imagery rescripting reduces severity of borderline symptoms and leads to an improvement of emotion regulation strategies in patients with a borderline personality diagnosis (Schaitz et al., 2020). Collectively, these findings indicate that enhancement of security early on in therapy, potentially with the use of imagery techniques, might be beneficial for retention and treatment outcomes (Millings et al., 2019). This hypothesis could be the focus of further research. A fruitful avenue for research would also be to explore the therapists’ ability to provide limited reparenting and how this ability could be influenced by their own attachment orientations. More research is also needed on the potential effects of security-providing therapeutic relationships on healing attachment trauma and moving clients towards attachment security. Finally, the potential differential effects of imagery rescripting depending on participants’ individual variations in attachment could be explored.

Concluding remarks

Therapeutic relationships and processes are extremely complex and therefore distinguishing the differential effects of the various techniques employed remains a challenging endeavour. The present paper has utilised attachment theory as a conceptual framework and has drawn upon evidence from two seemingly distinctive areas of research to argue for the effectiveness of limited reparenting in healing relational trauma. The evidence reviewed here adds to our understanding of attachment processes and limited reparenting in the context of therapeutic relationships. Further research is essential in enhancing our comprehension of the mechanisms of change and the characteristics of therapeutic figures who can provide a secure base.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Panoraia Andriopoulou

Dr Panoraia Andriopoulou, BSc, MSc, PhD, CPsychol, FHEA is a HCPC registered Clinical & Counselling Psychologist and Lecturer in Psychology at Manchester Metropolitan University. She is fully trained in CBT, Schema Therapy, and Systemic Family Therapy and has worked as a practitioner psychologist for more than 15 years both in private practice and in the public sector gaining extensive experience in the assessment and treatment of adolescents and adults with anxiety, depressive, and personality disorders. Her research interests lie within the areas of clinical/counselling psychology and psychotherapy, psychopathology, psychological well-being, and the therapeutic properties of close relationships with a special focus on attachment.