THE CLIENT COUNSELOR MATCH AND THE CORRECTIVE EMOTIONAL EXPERIENCE: EVIDENCE FROM INTERPERSONAL AND ATTACHMENT RESEARCH

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1 PROD #: Psychotherapy: Theory/Research/Practice/Training Copyright 2002 by the Educational Publishing Foundation 2002, Vol. 39, No. 1, /02/$5.00 DOI // THE CLIENT COUNSELOR MATCH AND THE CORRECTIVE EMOTIONAL EXPERIENCE: EVIDENCE FROM INTERPERSONAL AND ATTACHMENT RESEARCH ANNIE BERNIER AND MARY DOZIER University of Delaware Models of brief psychodynamic therapy posit the corrective emotional experience as a key factor in therapeutic change. Although widely taught and used, these models do not have strong empirical support. This article proposes the client counselor match as a facilitating condition for a corrective emotional experience and reviews the relevant evidence from attachment and interpersonal research. Overall, the notion of the corrective emotional experience has received some support from attachment research, which looks at complementarity of styles at the personality level. Interpersonal research, rather, considers complementarity of actual exchanges in therapy and has yielded mixed results. It thus appears that the validity of the corrective experience has yet to be established, notably through the use of a more fine-grained approach. Annie Bernier and Mary Dozier, Department of Psychology, University of Delaware. This study was funded by a postdoctoral fellowship from the Social Sciences and Humanities Research Council of Canada. Correspondence regarding this article should be addressed to Annie Bernier, PhD, who is now at the Department of Psychology, University of Montreal, C. P. 6128, succursale Centre-Ville, Montreal, Quebec H3C 3J7, Canada. abernier@udel.edu One of the most famous yet controversial claims ever made in the psychotherapy literature is that of Luborsky, Singer, and Luborsky (1975), who suggested that all psychotherapies produce somewhat equivalent outcomes. Empirical research has since repeatedly tried to challenge this assertion; a host of studies have searched for individual dispositions of both client and therapist that may have contributed to Luborsky et al. s null findings. At least 175 categories of client characteristics and 40 therapist traits have been studied as potential predictors of treatment effectiveness (Beutler, 1991), and it has been suggested that the client counselor match accounts for a greater portion of the outcome than does any single characteristic of the client or of the counselor. The interaction between the two partners personal characteristics has thus become a focus in recent counseling literature (Beutler, 1991; Nelson & Neufeldt, 1996; Reis & Brown, 1999; Talley, Strupp, & Morey, 1990). The basic assumptions of at least two major theoretical fields converge to suggest that the interpersonal orientation of each partner is the key to understanding the client counselor match: attachment theory (Bowlby, 1973, 1980, 1982, 1988) and interpersonal theory (Kiesler, 1982a, 1996; Sullivan, 1953a, 1953b). Both these theories assert that opposite or contrasting interpersonal orientations in the therapist and client are optimal for the process and the outcome of the treatment relationship, by virtue of the corrective emotional experience (Alexander & French, 1946, p. 294) they provide to the client. A corrective emotional experience is an experiential relearning through which the client can safely alter his or her rigid relational patterns by being exposed to new interpersonal experiences with the therapist (Teyber, 2000). This is consistent with the core propositions of short-term psycho- 32

2 Attachment and Interpersonal Research dynamic models of therapy, notably those developed at Vanderbilt University (Strupp & Binder, 1984) and at the Beth Israel Medical Center (Pollack & Horner, 1985). Although widely taught and used in clinical settings and despite encouraging results, these models have not been thoroughly supported by empirical data (Bein et al., 2000; Pollack, Winston, McCullough, Flegenheimer, & Winston, 1990; Strupp & Hadley, 1979; Winston et al., 1991). The goal of this article is to explore the validity of the notion of the corrective emotional experience by drawing evidence from attachment and interpersonal research regarding the implications of contrasting relational styles in counseling. The Corrective Emotional Experience as a Result of the Interpersonal Match It is generally recognized that the client counselor match is an important predictor of successful therapeutic relationships (Berzins, 1977; Beutler, 1991; Reis & Brown, 1999). In a review of variables contributing to therapy outcomes, Beutler (1989) concluded that the therapist client match is the strongest predictor of outcome. The match on demographic variables such as ethnicity, gender, and native language has received the most attention, with the general conclusion that similarity on such variables is related to successful treatment (Berzins, 1977; Beutler, Clarkin, Crago, & Bergan, 1991; Flaskerud, 1990; Nelson & Neufeldt, 1996). Counselor and client similarities on attitudes, beliefs and personal values, coping styles (Beutler, Crago, & Arizmendi, 1986; Nelson & Neufeldt, 1996), perspectives and expectations toward counseling (Reis & Brown, 1999), and self-concept (Talley et al., 1990) have also been associated with positive treatment outcomes. One might therefore conclude that similarities between client and therapist are related to positive outcomes. However, numerous empirical studies have found that dissimilarities on interpersonal characteristics are related to better process and outcomes in therapy. For example, Beutler, Pollack, and Jobe (1978) observed that, although therapist client similarity on general values related to religion and philosophy was associated with positive process and outcome, dissimilarity on values related to interpersonal security and sexual relationships was maximally facilitative of therapeutic gains. Arizmendi, Beutler, Shanfield, Crago, and Hagaman (1985) found that both therapists and clients ratings of outcome were enhanced by pretreatment similarities in values related to general philosophical and humanistic concerns, whereas dissimilarities on values pertaining to social ascendance, independence, and social attachment favored positive outcomes. There is also some evidence that dissimilarity between therapist and client on interpersonal style dimensions such as relatedness and autonomy can be beneficial to the treatment relationship: Berzins (1977) observed that counselors who valued autonomy at the cost of closeness were more effective with clients showing dependent tendencies, whereas counselors with connection-oriented styles worked better with clients who valued personal autonomy. Therefore, there is some empirical evidence that dissimilarity between the two partners interpersonal orientations enhances the process and the outcomes of therapy. Two of the most widely accepted theoretical frameworks to systematize the concept of interpersonal orientation in adulthood are attachment theory (Bowlby, 1973, 1980, 1982) and interpersonal theory (Kiesler, 1996; Leary, 1957; Sullivan, 1953a, 1953b). Researchers interested in the clinical applications of both theories propose that therapist client dyads in which the partners have dissimilar or contrasting relational styles should have optimal processes and outcomes; the therapist s natural stance helps him or her resist the pull to adopt a reinforcing position in response to the client s rigid and maladaptive relational patterns. This view is strikingly similar to the central tenets of several clinical models that posit the corrective emotional experience as a core mechanism of therapeutic change (e.g., Pollack & Horner, 1985; Strupp & Binder, 1984; Teyber, 2000), a proposition that has yet to be validated despite some encouraging results (Bein et al., 2000; Pollack et al., 1990; Strupp & Hadley, 1979; Winston et al., 1991). Interpersonal and attachment theories have given rise to more empirical data likely to shed light on the issues of the client therapist match and of the corrective emotional experience. We review the conceptual bases of these two theoretical fields and the empirical evidence that each has provided with regard to these issues. Interpersonal Theory Contemporary interpersonal theory and research rely heavily on the classic work of Harry 33

3 A. Bernier and M. Dozier Stack Sullivan. A basic tenet of interpersonal theory is that personality is developed, maintained, and best understood within the context of interpersonal transactions (Carson, 1969; Sullivan, 1953a, 1953b). A person s actions can thus be understood only in relation to the historical and current interpersonal transactions in which they are embedded. Personality is therefore defined as the relatively enduring pattern of recurrent interpersonal situations which characterize a human life (Sullivan, 1953a, p. 52). Sullivan (1953a, 1953b) considered interpersonal anxiety to be basic in human development. He proposed that individuals strive to minimize anxiety by reducing the disapproval of significant others. A major learning experience in childhood thus involves the discovery that some behaviors reduce or eliminate the intensity of interpersonal anxiety, whereas other behaviors increase or exacerbate anxiety. The child learns to adjust his or her behavior to decrease the experience of interpersonal anxiety (Sullivan, 1953b). One of Sullivan s (1953a, 1953b) central theoretical propositions is that self-esteem is ultimately an interpersonal phenomenon; individuals feel good about themselves when they have the impression that others are satisfied with them. Self-esteem is thus the inverse of anxiety. All interpersonal behaviors are attempts by a person to avoid anxiety or to establish and maintain selfesteem (Leary, 1957). In keeping with the Sullivanian tradition, Leary (1957) defined personality as the pattern of interpersonal processes employed to reduce anxiety, ward off disapproval, and maintain self-esteem (p. 119). Sullivan s (1953b) theorem of reciprocal emotion and Leary s (1957) principle of reciprocal interpersonal relations both assert that any interpersonal act is designed to elicit from other people reactions that confirm or validate the individual s perceptions and expectations, thus making it more likely that the individual will continue to emit similar interpersonal acts. The selffulfilling prophecy (Merton, 1948) mechanism asserts that a person brings about the very consequences of his or her expectation simply by virtue of the effects of the expectation itself. The result is a self-perpetuating cycle (Carson, 1982) that has received considerable empirical support (Darley & Fazio, 1980; Jussim, 1986; Rosenthal & Rubin, 1978). The underlying theory is that to establish comfortable relationships that protect against anxiety and threats to self-esteem, it is necessary that we elicit relational positions that are complementary to or reinforcing of the positions we are adopting (Kiesler, 1996). In short, our interpersonal actions are designed to invite, pull, elicit, draw, entice, or evoke restricted classes of reactions from persons with whom we interact, especially from significant others (Kiesler, 1983, p. 198). The principle of complementarity implies that others reactions to our acts are not random, nor are they likely to include the entire range of possible reactions. Instead, reactions to each of us tend to be restricted to a relatively narrow range of interpersonal responses (Kiesler, 1996). An interpersonal behavior and its most probable interpersonal reaction are said to be complementary and are characterized by their capacity to reduce anxiety. Interpersonal transactions that incorporate complementary behaviors reduce or eliminate interpersonal anxiety, whereas transactions that include noncomplementary behaviors may maximize anxiety (Kiesler, 1996). Minimization of interpersonal anxiety (and thus of threats to self-esteem) may hence be the underlying cause of the maintenance of the self-perpetuating cycles of interpersonal behaviors. In interpersonal theory, complementarity is operationalized through a two-dimensional interpersonal circle. Interpersonal circles are taxonomies of interpersonal behaviors that specify trigonometric relations among the categories of behaviors (Carson, 1969; Kiesler, 1983; Leary, 1957; Lorr & McNair, 1963; Wiggins, 1985). All interpersonal circles reflect the assumption that human interpersonal behaviors represent blends of two basic motivations: the need for control (power, dominance) and the need for affiliation (love, friendliness). Individuals interacting with each other continually negotiate two major relationship issues: how friendly (vs. hostile) they will be with each other and how much in charge or in control (vs. submissive) each will be. The interpersonal circle operationalizes this assumption by placing control (dominance submission) and affiliation (friendliness hostility) along its vertical and horizontal axes, respectively (Kiesler, 1996). Complementarity, which occurs when two participants interpersonal behaviors endorse and confirm each other s self-presentation, occurs on the basis of (a) reciprocity with respect to the control dimension (dominance pulls for submission, submission pulls for dominance) and (b) correspondence in regard to the 34

4 Attachment and Interpersonal Research affiliation dimension (hostility pulls for hostility, friendliness pulls for friendliness; Kiesler, 1983). A most impressive body of literature has examined the phenomenon of interpersonal complementarity (see Kiesler, 1996, pp , for an exhaustive list). The empirical evidence thus far is mixed, with reviews of the literature yielding contradictory conclusions. Whereas Kiesler (1983) interpreted available studies as supporting the complementarity principle, Orford (1986) concluded that the complementarity hypothesis is essentially unsupported by empirical data and called for a reexamination of the principle. More recently, Kiesler (1996) conceded that the research evidence is far from conclusive and suggested that future studies look at the issue with a more fine-grained approach by differentiating complementarity occurring on the friendly versus the hostile half of the circle, by taking into account which interpersonal circle is used to assess complementarity, and by examining the influence of contextual factors such as the nature of the relationship between the participants, the gender match, and the setting. Overall, then, more research is needed on the validity of the complementarity hypothesis. Nonetheless, interpersonal complementarity and the related principles have been examined with regard to their implications for psychotherapy. Clinical Applications of Interpersonal Theory According to Kiesler (1996), to the extent that the therapist represents a significant person to the client, he or she will experience complementary inner responses similar to those experienced by other persons in the client s life. The therapist s responses to the client, then, represent vital cues for targeting the client s self-defeating patterns of rigid relational behaviors (Kiesler, 1996). Furthermore, the therapist s use of his or her inner responses is proposed as a key therapeutic tool. Because the client is expert in his or her distinctive relational pattern, the therapist is likely to be hooked temporarily into providing the complementary response to the client. In fact, getting hooked may be necessary for the establishment of a working alliance. The rationale is that the client needs to experience some level of acceptance and endorsement of his or her selfpresentation by the therapist as a prerequisite for alliance formation (Kiesler, 1996). Studies by Kiesler and Watkins (1989) as well as Weinstock-Savoy (1986) have provided empirical support for this claim by showing positive relations between complementarity of responses early in therapy and both quality of the working alliance as reported by client and therapist (Kiesler & Watkins, 1989) and outcomes assessed by client, therapist, and external raters (Weinstock-Savoy, 1986). Carson (1969) and Kiesler (1996), however, proposed that the first therapeutic priority is for the treatment provider to disengage from the complementary responses so as to interact with the client differently than do other significant individuals in the client s life. This corrective interpersonal experience allows the client to experience a different way of relating to others, providing him or her with the opportunity to gradually develop a more flexible and diverse repertoire of interpersonal behaviors. The only study to have clearly supported this idea so far (Andrews, 1991) has indicated that high levels of noncomplementary responses between client and therapist were associated not only with positive outcomes but also with the experience of more positive mood states by both partners during the sessions at several stages of therapy. Studies by Dietzel and Abeles (1975) and Tracey and colleagues (Tracey, 1987; Tracey & Ray, 1984) have also provided some support for the hypothesis that noncomplementarity is facilitative of therapeutic gains, although their results are especially clear in showing that a cycle of complementarity is optimal for treatment: The most successful therapy dyads are typically involved in complementary exchanges early in therapy, then switch to a working stage wherein noncomplementary interactions are more frequent, and finally revert to mostly complementary transactions by the end of the therapy. As outlined by Tracey (1993), however, more recent work on the complementarity principle indicates that this three-stage model needs to be refined. Coulter (1993), for example, argued that very frequent noncomplementary exchanges, even in the working phase of therapy, would likely result in angering and confusing the client. Tasca and Mc- Mullen (1993) have indeed observed that high levels of noncomplementarity throughout the therapy were characteristic of unsuccessful treatment dyads, further supporting the idea that noncomplementarity must be used with caution and clinical judgment. Overall, then, interpersonal research suggests 35

5 A. Bernier and M. Dozier that both complementarity and noncomplementarity can be useful therapeutic tools, although probably at different stages of therapy. Furthermore, it appears that harmonious and gentle switches between complementary and noncomplementary exchanges over the course of treatment may maximize therapeutic gains, presumably by providing the client with a safe and confirming environment along with appropriate challenges likely to induce change and growth. Thus, interpersonal research has provided moderate support for the concept of the corrective experience proposed by brief psychodynamic models; the evidence suggests that noncomplementarity can at times be useful, if used with parsimony in the context of prior complementary exchanges. One might therefore argue that therapists who are flexible and open maximize the likelihood of a corrective emotional experience for the client by being able to choose and adopt the relational stance that will be most effective with a given client at a given stage of therapy. We also propose that there are substantial interindividual differences among clients in how they react to the therapist s attempts to provide noncomplementary responses and that these differences are likely to be closely linked to the client s natural relational style. It is surprising that there has been little research on how therapists and clients natural relational styles, in isolation or in combination, affect the process and the outcome of the therapeutic enterprise. Studies using interpersonal theory constructs have almost exclusively looked at interpersonal complementarity as a momentary behavioral phenomenon characterizing exchanges taking place at specific stages of the treatment relationship. Interpersonal theory, however, proposes that individuals interpersonal style is a central part of their personality, and inventories to assess an individual s typical relational style have been developed (e.g., Benjamin, 1974; Leary, 1957; Wiggins, Trapnell, & Phillips, 1988). It thus appears that researchers should also study interpersonal complementarity in treatment relationships at the personality level by looking at clients and therapists dominant interpersonal style prior to the treatment and at matches of styles most likely to produce effective treatment relationships. Attachment research, because it focuses on individual differences in attachment status as an integral part of the individual s personality, has helped researchers understand how the match of prior relational styles contributes to treatment relationships. Such research has thus yielded evidence relevant to the concept of the corrective emotional experience. Attachment in Infancy and Childhood John Bowlby (1973, 1980, 1982) developed the basic tenets of attachment theory, with Mary Ainsworth (1967) developing methods to systematically assess attachment quality. Their work and the work of others (e.g., Sroufe, 1983) revealed that a key developmental task of infancy is the formation of a relationship with a primary caregiver. From an ethological perspective, reliance on a caregiver is critical to survival. When the infant experiences threat, moving toward the caregiver maximizes the likelihood of survival. Ainsworth (1967) initially expected that all children would show the pattern of seeking out the caregiver when distressed. Indeed, she found that the babies of responsive, sensitive caregivers did seek out caregivers when distressed. These babies were said to be securely attached to their caregivers (Ainsworth, Blehar, Waters, & Wall, 1978). In contrast, babies who had rejecting or inconsistently responsive caregivers did not actively seek the caregivers out to relieve their distress. Instead, babies of rejecting caregivers tended to turn away from them, giving the impression that they were not in need, and babies of inconsistent caregivers tended to respond to them with angry resistance. These babies were said to have avoidant and resistant attachments, respectively (Ainsworth et al., 1978). Still other babies, those with caregivers who responded to them in either frightening or frightened ways (including abuse, in some cases), appeared to have no strategy for dealing with their caregivers. They seemed to be distressed without solution and were said to present a disorganized pattern of attachment (Main & Solomon, 1990). Attachment status has been found to play an important role in later socioemotional development, notably interpersonal relationships with same-age peers. In preschool, children with a secure attachment history initiate more play activities with their peers and are more empathic, more effective at conflict management, and better at interpreting social clues than are other children (Grossmann & Grossmann, 1991; Kestenbaum, Farber, & Sroufe, 1989). Children with histories 36

6 Attachment and Interpersonal Research of avoidant attachment display more hostility, scapegoating, and bullying behaviors compared with other children, whereas children with resistant attachment histories tend to be victimized by their peers (Suess, Grossmann, & Sroufe, 1992; Troy & Sroufe, 1987). There is also evidence suggesting that disorganized attachment in infancy is associated with aggression toward peers in preschool and throughout childhood (Lyons- Ruth, Alpern, & Repacholi, 1993; Shaw, Owens, Vondra, Keenan, & Winslow, 1996). Later on in development, children with secure attachment histories tend to have more friends in middle childhood than do children with avoidant or resistant histories (Elicker, Englund, & Sroufe, 1992; Grossmann & Scheuerer-Englisch, 1991; Lewis & Feiring, 1989), and children with insecure histories are ridiculed, exploited, or excluded by their peers more often than are secure children (Grossmann & Grossmann, 1991). The more optimal peer relationships found in the school setting for children with secure attachment seem to generalize across settings and developmental periods: Adolescents with secure histories are rated by summer camp counselors as more socially competent in general and within mixedgender groups especially (Weinfield, Ogawa, & Sroufe, 1997), are rated as presenting better leadership skills, and are more likely to be elected as spokespersons for their group (Englund, Levy, & Hyson, 1997). This pattern might also extend into adulthood and romantic relationships. Grossmann, Grossmann, Winter, and Zimmermann (in press) observed that children with secure attachment histories were likely to show a pattern of responses to imagined separations from their parents considered as secure at age 6, which in turn predicted the quality of their discourse about their current romantic relationship at age 22. Children who were securely attached at ages 1 and 6 are thus likely to become adults who value attachment relationships and are sensitive to their romantic partner s attachment needs. Thus, there is fairly compelling evidence suggesting that the quality of the attachment bond between an infant and his or her attachment figures may predict the quality of the relationships subsequently established with same-age peers across several developmental periods. The generally agreed-on explanation for such findings is that early relationships with parents enable children to develop mental representations of themselves, of others, and of interpersonal relationships, referred to as internal working models. One of attachment theory s key premises is that these internal working models guide expectations, appraisals, feelings, and behaviors in subsequent relationships, throughout childhood, and into adolescence and adulthood (Bretherton, 1985). Attachment in Adulthood The study of attachment working models in adolescence and adulthood has been made possible by the development of the Adult Attachment Interview (AAI) by Mary Main and her colleagues (George, Kaplan, & Main, 1996; Hesse, 1999; Main & Goldwyn, 1998). The AAI assesses state of mind with respect to attachment (Main, Kaplan, & Cassidy, 1985, p. 68), which is presumed to reflect the organization of internal working models. It consists of an hour-long semistructured interview focusing on the individual s early relationships with his or her parents. The AAI yields classification into one of four primary categories of attachment state of mind. An autonomous state of mind is indicated by a coherent, well-balanced, and credible discourse regarding one s relationships with parents along with valuing of attachment. A dismissing state of mind is characterized by minimization of the importance of attachment relationships and insistence on personal strength, often accompanied by idealization of the relationship with the parents and a striking lack of recall for attachment experiences. A preoccupied state of mind is indicated by current enmeshment in the relationship with the parents, as evidenced by the expression of current anger toward the parents or by a passive and confusing style of discourse. Finally, an unresolved state of mind is characterized by lapses in reasoning or discourse when recounting a loss or a trauma (Main & Goldwyn, 1998). An autonomous state of mind is considered secure, whereas dismissing, preoccupied, and unresolved states of mind are said to be insecure. One of the most robust findings in the attachment literature is that an individual s AAI classification predicts the attachment strategies of his or her infant: Autonomous adults tend to have babies who are securely attached to them, dismissing adults tend to have babies who are avoidant, preoccupied adults often have resistant babies, and adults showing unresolved attachment typically have babies showing a disorganized pat- 37

7 A. Bernier and M. Dozier tern of attachment (van IJzendoorn, 1995). Although longitudinal studies are still relatively few, there is also preliminary evidence that attachment status in infancy can be modestly predictive of the same individual s attachment status in adulthood under stable life circumstances (Hamilton, 2000; Waters, Merrick, Treboux, Crowell & Albersheim, 2000). It has been proposed that attachment state of mind lies on a continuum of autonomy relatedness, with autonomous attachment representing a balance between dismissing and preoccupied attachments (Kobak, Cole, Ferenz-Gillies, Fleming, & Gamble, 1993). Dismissing attachment is characterized by self-reliance, emotional restriction, mistrust in others, and denial of personal distress, whereas preoccupied attachment is associated with dependency, exaggeration of personal distress, and a great need for support and closeness (Dozier & Lee, 1995; Main & Goldwyn, 1998). Clinical Applications of Adult Attachment There is a growing body of evidence suggesting that attachment state of mind is associated with the individual s response to a variety of intervention modalities. Individuals presenting dismissing features are evaluated by treatment providers as disclosing less about personal issues, as being more rejecting of the treatment, as being less cooperative, and as seeking less support (Dozier, 1990; Dozier, Lomax, Tyrrell, & Lee, 2001). Dismissing mothers gain little benefit from an intervention based on discussions of their attachment experiences (Bakermans-Kranenburg, Juffer, & van IJzendoorn, 1998) and were evaluated as less invested than were others in an intervention program focusing on maternal sensitivity (Korfmacher, Adam, Ogawa, & Egeland, 1997). Adults presenting a preoccupied state of mind benefit less from inpatient treatment in a mental institution than do other individuals (Fonagy et al., 1995). In contrast, autonomous mothers are evaluated by treatment providers as more emotionally invested, as more interested, as more likeable, and as using fewer roadblocks to the intervention than are mothers with dismissing and unresolved states of mind (Korfmacher et al., 1997). They also make more use of problem solving and personal support components of interventions, whereas individuals with an unresolved state of mind use crisis intervention more than the others (Korfmacher et al., 1997). Consistent with the propositions of interpersonal theorists, Bowlby (1988) suggested that the major task of the therapist is to help clients recognize and change their insecure working models or maladaptive relational patterns. He suggested that the therapist needs to challenge the client s beliefs about relationships by flexibly adopting a stance that is in contrast (i.e., noncomplementary) to the client s rigid expectations. Dozier and Tyrrell (1998) argued that to provide such a corrective experience, the therapist s challenge is to resist the natural pull to respond to the client s attachment working models in a complementary fashion. For instance, the therapist needs to resist the first natural inclination to respond to the dismissing individual s avoidance of intimate topics by respectfully going along engaging on superficial, nonthreatening issues; instead, the therapist needs to gently challenge the client s strategies by promoting gradual exploration of emotional issues. In contrast, when working with a preoccupied individual who is overwhelmed by emotional turmoil, the therapist needs to disconfirm the individual s expectations by slowly encouraging autonomy. One factor likely to help the therapist respond to the client in such a noncomplementary manner is the security of his or her own attachment state of mind. Dozier, Cue, and Barnett (1994) have shown that clinicians presenting an autonomous state of mind were more effective at providing noncomplementary responses than were nonautonomous clinicians. That is, autonomous clinicians worked in greater depth with clients presenting dismissing features than with preoccupied clients, whereas nonautonomous clinicians provided complementary responses, working in greater depth with preoccupied clients. Another factor that may help therapists resist the pull to respond to clients in a complementary manner is their natural bias on the autonomyrelatedness continuum, operationalized in attachment research through the dismissing preoccupied dimension. It has been observed that whereas clinicians largely tend to present secure attachment models, they differ substantially in terms of their reliance on preoccupied versus dismissing strategies (Dozier et al., 1994). According to Tyrrell, Dozier, Teague, and Fallot (1999), even among dyads in which the therapist presents secure attachment models, clients and therapists showing dissimilar attachment tendencies on the dismissing preoccupied dimension have the most 38

8 Attachment and Interpersonal Research productive relationships. In such dyads, the natural style of the therapist makes him or her more likely to adopt an interpersonal stance that is contrary to what the client pulls for, thereby disconfirming the client s rigid perceptions and strategies. These propositions have received support from two empirical studies. Tyrrell et al. (1999) observed that, when working with severely impaired psychiatric patients, case managers were most effective with patients showing attachment states of mind in contrast to their own (e.g., dismissing vs. preoccupied). In such dyads, clinicians rated their patients as presenting higher global functioning according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria, and the patients reported better life satisfaction as well as stronger working alliances with their case managers than did clients and clinicians with similar attachment states of mind. The authors attributed their findings to case managers state of mind influencing their interpersonal styles, thereby facilitating (or impeding) their task of challenging their clients rigid and maladaptive interpersonal strategies. This hypothesis was supported by Bernier, Larose, and Soucy (2001) with college students and volunteer professors involved in academic counseling dyads. The students were administered the AAI to assess their attachment state of mind, whereas the professors were asked to complete a relational style questionnaire focusing on behaviors and feelings in relationships; beliefs about self, others, and relationships; attitudes toward the importance of achievement versus relatedness; and valuing of intimacy and help seeking. The most effective counseling dyads were those in which the professor s relational style was likely to challenge the student s state of mind. Hence, students presenting dismissing attachment tendencies worked better with counselors who reported valuing connectedness, interdependence, and relationships, whereas students with preoccupied attachment features had better relationships with professors valuing independence, autonomous problem solving, and achievement. In such dyads, students were more open to selfdisclosure, were more comfortable (according to both professor and student reports), were more satisfied with their counseling experience, and reported higher relational quality with the professor, and their grades improved more over the course of the counseling experience than in dyads in which the professor s relational style was consistent with the student s attachment state of mind. These two studies yielded similar patterns of results, providing support for the interpersonal complementarity hypothesis. Given that the population, the treatment context, and the methodology used to tap the treatment providers interpersonal predispositions (i.e., attachment state of mind vs. self-reported relational style) differed considerably, the similar patterns of findings obtained by the two studies suggest that the results may represent a lawful phenomenon that is robust to different settings, methodologies, and populations. Because those findings are consistent with observations made in psychotherapy (e.g., Berzins, 1977), the phenomenon could be thought as likely to arise in a variety of dyadic relationships in which one participant attempts to offer assistance to the other. Hence, in a range of treatment situations, it is possible that dyads in which the client and the treatment provider present dissimilar interpersonal orientations function better and enjoy better outcomes than do dyads composed of individuals showing similar interpersonal orientations. This could tentatively be interpreted as a spontaneous occurrence of a corrective experience, brought about by the natural relational styles of the two partners. It thus appears that the attachment research focus on attachment status as a prior personality characteristic of both client and provider, by allowing researchers to examine interpersonal complementarity from a different angle, may add to the knowledge yielded through the interpersonal field s reliance on behavioral reports or observations of actual complementary exchanges. In contrast to interpersonal research, however, attachment research has not often been conducted with psychotherapy dyads. It is unclear at this point whether the findings of attachment studies lending support to the concept of the corrective emotional experience would also be found true in psychotherapy dyads. One might argue that the extensive clinical training and supervision that professional therapists receive allow them to use their natural style flexibly and competently, overshadowing the effects of natural relational styles that have been observed in dyads involving a less intensively trained helper. However, results from the Vanderbilt University studies have shown that even experienced therapists trained to under- 39

9 A. Bernier and M. Dozier stand and resist the eliciting power of clients maladaptive relational patterns still tend to respond to clients in a complementary manner (Henry, Strupp, Butler, Schacht, & Binder, 1993). This suggests that the interpersonal complementarity phenomenon may override deliberate and informed efforts to resist it. Nonetheless, the results of attachment studies need to be replicated with psychotherapy dyads before one can assert that they apply to trained therapists as well. A most puzzling aspect of this issue is the apparent discrepancy between findings from attachment and interpersonal research. Whereas the few attachment studies pertaining to complementarity have suggested that contrasting (or noncomplementary) relational styles are optimal for treatment (Bernier et al., 2001; Tyrrell et al., 1999), interpersonal research mostly supports the view that either complementary exchanges (Kiesler & Watkins, 1989; Weinstock-Savoy, 1986) or some noncomplementarity in the context of prior and subsequent complementary exchanges (Dietzel & Abeles, 1975; Tracey, 1987; Tracey & Ray, 1984) is optimal. One might expect that dyads involving individuals with contrasting relational styles naturally engage in noncomplementary exchanges, as a result of each partner s natural tendencies. If this is so, findings from attachment research are in sharp contrast with those of the interpersonal tradition, with the exception of one interpersonal study that has found clear benefits for noncomplementary exchanges (Andrews, 1991). One possible explanation for the apparently discrepant results is that complementary and noncomplementary exchanges may have different degrees of usefulness depending on the specific outcome under study. Attachment and psychotherapy research have different traditions and aims and typically focus on different variables to operationalize process and outcomes. Thus, the usefulness of complementarity and noncomplementarity might be outcome specific. It is not clear, however, that dyads composed of individuals presenting dissimilar relational styles do indeed engage in the noncomplementary exchanges that would be expected. Although Dozier et al. (1994) have shown that clinicians with secure attachment organizations are more adept at responding to clients in a noncomplementary manner, it has yet to be determined whether the same holds for dyads with dissimilar attachment tendencies (e.g., dismissing client with preoccupied clinician). To examine this issue, attachment research would benefit from using tools developed within the interpersonal field to better operationalize the processes taking place in counseling or therapy. For example, Kiesler (1982a) proposed that no single client s or therapist s behavioral unit is meaningful when looked at in isolation and that the basic behavioral unit of analysis should be the interpersonal transactions between the partners. Therefore, the use of systems such as the structural analysis of social behaviors (Benjamin, 1974) or the interpersonal circle (Kiesler, 1982b), which capture the interactional nature of dyadic therapeutic exchanges, could provide a unique window into the nature and the flow of interpersonal processes taking place in counseling. These could in turn be studied in relation to the attachment status of each partner to verify the hypothesis that treatment dyads engage in more noncomplementary exchanges when they are composed of individuals with contrasting relational styles. Finally, it should be kept in mind that attachment research conceptualizes contrasting attachment predispositions according to their dissimilarity on the autonomy-relatedness dimension, with a dismissing state of mind representing self-reliance and independence and a preoccupied state of mind representing dependence and need for support. Interpersonal theory, however, identifies complementarity as dissimilarity on the control axis and similarity on the affiliation axis. The two fields therefore use different interpersonal issues in characterizing certain relational styles as contrasting or complementary to one another. Although possibly contributing to the apparently diverging findings, this also gives a more complete picture of the phenomenon under study, with each field addressing a different set of interpersonal features. Conclusion In line with brief psychodynamic models, attachment and interpersonal theories both suggest that a central task of the therapist is to resist the pull to respond to the client s interpersonal orientation in a complementary manner, so as not to reinforce the client s rigid way of approaching relationships. Empirical studies from both fields have provided some support for these claims, suggesting that providing the client with a contrasting relational orientation can be beneficial in 40

10 Attachment and Interpersonal Research psychotherapy (Andrews, 1991), case management (Tyrrell et al., 1999), and academic counseling (Bernier et al., 2001). There is also, however, contradictory evidence suggesting that complementary exchanges are optimal (Kiesler & Watkins, 1989; Weinstock-Savoy, 1986) or even that noncomplementary exchanges may be detrimental to the treatment relationship (Tasca & McMullen, 1993). We propose that the apparently inconsistent findings might partially be accounted for by interindividual differences in how clients react to and how therapists provide noncomplementary exchanges. Just as clients may vary in their receptivity to challenges to their current style of functioning, therapists may also vary in their ability to provide the trust and security that are necessary for a corrective emotional experience to take place. A host of reasons could be evoked to explain such differences, including the rigidity and extremity of the client s maladaptive relational style and the sensitivity, experience, and clinical skills of the therapist. The security of each partner s attachment status might also be an intervening factor. Regardless of position on the dismissing preoccupied (or autonomy relatedness) axis, clients and therapists showing relatively high degrees of security might be more receptive to and more skilled at providing a corrective interpersonal experience. A more finegrained approach thus seems warranted, replacing the conceptualization of complementarity and noncomplementarity as universal phenomena with an increased attention to individual and contextual factors likely to enhance the benefits of complementarity and noncomplementarity. 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