An examination of the relationship between clients' attachment experiences, their internal working models of self and others, and therapists' empathy in the outcome of process-experiential and cognitive-behavioural therapies

The literature has linked adult depression with maladaptive internal working models that have been influenced by negative childhood attachment experiences. Therapeutic empathy has been posited as one factor that helps change clients' personality structures and self-treatment. Although the relationship between therapeutic empathy and outcome is well established, no empirical studies have looked at the role that therapeutic empathy plays in changing clients' internal working models. The present study investigated the role that a therapeutic relationship characterized by empathy plays in changing models of self and other over the course of treatment and whether these changes are predictive of positive outcome.; The data for this study was drawn from a larger research project that used Cognitive Behavioural Therapy (CBT) and Process Experiential Therapy (PET) in a 16 week treatment for depression (Watson, Gordon, Stermac, Kalogerakos & Steckley, 2003). The sample was comprised of 52 DSM-IV diagnosed depressed clients. The present study tested a path model that combined clients across treatment groups and included the following variables: self-reported early attachment relations with mother, self-reported current attachment styles (pre & post therapy), observer-rated self-treatment in therapy (early & late in therapy), perceived therapists' empathy (mid therapy) and therapy outcome as it related to depressive symptoms, interpersonal problems, dysfunctional attitudes, and self-esteem. The path model accounted for moderate to large amounts of variance in the outcome measures. The data revealed that clients' perceived empathy positively impacts clients' self-treatment and their attachment styles over the course of therapy and these changes are associated with positive outcome. The results did not support the hypothesis that client-reported early attachment experiences are significantly related to clients' self-treatment or attachment styles at the beginning of therapy. The findings of the study underscore that perceived therapist empathy is an active ingredient of change in psychotherapy, which impacts various aspects of intrapsychic and interpersonal functioning. Implications for clinical work and future research are discussed.