The Therapeutic Attachment Scale: A validation study

The first aim of this study was to develop an observer-rated coding scale to assess narrative styles, consistent with the literature on adult attachment, for the purpose of exploring the role of attachment in psychotherapy relationships. This study was conducted to establish the psychometric properties of this measure. To develop this instrument, a survey of the literature was conducted and items related to indices of narrative coherence and adult attachment were compiled. Items were organized into subscales (Integrative-Collaborative, Defensive Exclusion, Defensive Over-Inclusion, and Unresolved) and the Therapeutic Attachment Scale (TAS) was created. Subsequently, a coding manual was written for the purpose of instructing coders in interpreting and applying TAS items. Participants were 22 patients who completed a 30-session treatment at the Brief Psychotherapy Research Program (BPRP) at Beth Israel Medical Center and who participated in a semi-structured interview about one month post termination of treatment. This interview, the Patient-Therapist Relationship Interview (PTRI) (Diamond, et al. 2000), is an adaptation of the Adult Attachment Interview (George, Kaplan & Main, 1996). PTRI interview and questions focus on patients' thoughts and feelings about their relationship with their therapist. TAS coders were 6 research assistants for the BPRP program who underwent extensive training in the literature on adult attachment and applying items from the TAS. Coders scored 22 PTRI interview using the TAS and rendered subscale scores for each patient participant in the study. Interrater reliability and internal consistency for the measure was established. To begin establishing the psychometric properties of this measure, average TAS subscale scores were correlated with other established psychotherapy process and outcome measures and a measure that taps a construct related to the TAS. Specifically, analyses attempted to establish predictive and concurrent validity hypotheses. Preliminary validation results suggest that the integrated-collaborative subscale of the TAS is related to patient ratings of tension and resolution; however, this subscale appears unrelated to ratings of the Working Alliance Inventory. Implications for the findings and future directions are discussed.