Razi Journal of Medical Sciences

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Background & Aims: Some researchers believe that an effective therapeutic relationship should have a stimulating potential that allows the client to maintain a joint effort with the therapist to overcome problems. It is a therapeutic alliance. This process refers to the concept of the alliance which can begin with the client or therapist's feelings before the first contact, is the center of gravity of psychotherapy's effectiveness. According to Rogers, the therapist - clients' relationship as an essential element of treatment is effective in response to successful treatment. He suggested that the relationship itself is, in fact, healing. According to Rogers, all humans have an inner need for warmth, respect, and acceptance (positive attention) from others. It seems that attachment is a vital element in establishing a therapeutic alliance. In attachment theory, attachment is defined as a human tendency to build strong emotional bonds with a particular person that has a decisive role in mental health. According to attachment theory, establishing an emotional and close bond is a general need of every human. This theory introduces attachment behavior's functions as a vital balance mechanism to moderate helplessness in adulthood and childhood. According to this theory, during the repetition of experiences related to the attachment object, the child creates mental representation, or "an internal working model." Once these models are formed, if the attachment system is activated, these models will also be activated and guide the individual's behavior. Lack of responsive caregivers causes children to see relationships as insecure and perceive others as unreliable and unlovable sources, leading to shape insecure attachments. Psychological well-being seems to be a variable that can predict therapeutic alliance in a psychotherapist. Theorists related to positive psychology have considered mental health equivalent to positive psychological function and have conceptualized it in psychological well-being. They do not know the absence of disease to be sufficient for feeling healthy and believe that having a sense of life satisfaction, adequate progress, effective interaction with the world, and positive development are healthy people's characteristics. Ryff considers psychological well-being as an attempt to realize one's potential and an essential criterion of health, which is the awareness of the integrity of all aspects of existence. Accordingly, the present study investigates the mediating role of psychological well-being in the relationship between attachment styles and psychotherapists' therapeutic alliance.
Methods: This study is descriptive-correlation in terms of applied purpose and descriptive-correlational data collection method and structural equation modeling. The statistical population of the present study consists of all psychotherapists and counselors with employment licenses from the Organization of Psychology and Counseling of the country who are active in 1398. In this descriptive-correlation study Two hundred fifty-five people were selected through a purposive sampling method based on inclusion and exclusion criteria. Criteria for entering the research were: activity in the profession of psychotherapy and counseling, being in the age group of 27-65 years, a history of at least one year of professional training. Exclusion criteria were: being under certain conditions such as a medical condition or surgery that makes a person eligible to participate in the study, suffering from acute mental or physical disorders and illnesses, unwillingness to continue research. In this study, the Adult Attachment Questionnaire, Psychological Well-Being Scale (short form), and Short Form Therapy Alliance Questionnaire were used to collect data. All analyzes were performed at a 95% confidence level using SPSS 19 and AMOS software.
Results: According to the results, the secure attachment style (0.48**) has a significant positive relationship with therapeutic alliance. The insecure attachment style (0.39**) has a meaningful negative association with the therapeutic alliance at the level of 0.01. Psychological well-being had a significant positive relationship with the therapeutic alliance at the level of 0.01 (0.27**).
The fit of the proposed model with the data based on the fit indices was appropriate. GFI, AGFI, IFI, TLI, CFI, and NFI indices indicated the model's fit. The total path coefficient between secure attachment style and therapeutic alliance is significant at the level of 0.01. Also, the coefficient of determination of this path was 0.29, which in other words, the style of secure attachment and psychological well-being explain 29% of the therapeutic alliance variance. The total path coefficient between insecure attachment style and therapeutic alliance is significant at the level of 0.01. The coefficient of determination of this path was equal to 0.26, which in other words, insecure attachment style and psychological well-being explain 26% of the therapeutic alliance variance.
Conclusion: This study aimed to investigate the mediating role of psychological well-being in the relationship between attachment and therapeutic alliance in psychotherapists. According to the results of the present study, psychological well-being had a positive relationship with therapeutic alliance. Psychological well-being is an upbeat assessment of the quality of experiences, knowledge, communication, and life values. It is a vital variable in interpersonal communication and can determine its nature. Psychological well-being plays a crucial role in people's lives, such as social acceptance, contact with others, intimacy, and a sense of efficiency that are the critical factors in mental health. Because the feeling of well-being has both emotional and cognitive components, people with high well-being mainly experience positive emotions and positively evaluate events. People with low well-being consider their life events undesirable and experience negative emotions that can disrupt their interpersonal relationships. This study's other results were the positive relationship between secure attachment with therapist therapy alliance and the negative relationship between insecure therapist attachment and therapeutic alliance. Explaining this finding, it should be stated that a secure attachment style can lead a person to be more adaptable to adverse events and establish stable and secure relationships with people. People with secure attachment in adulthood have the practical ability to develop desirable interpersonal relationships because the trust created in attachment development helps the person accept his strengths and weaknesses and strive to achieve his goals without anxiety. People with secure attachments are better equipped to manage stressful situations such as psychotherapy.

Keywords: Attachment, Therapist, Well Being, Therapeutic Alliance, Psychotherapy process

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