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Psychopathology. 2013;46(3):192-200. doi: 10.1159/000341591. Epub 2012 Aug 31.

Attachment styles and outcome of psychoanalytic psychotherapy for children and adolescents.

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  • 1Department of Psychiatry, University Hospital Heidelberg, Heidelberg, Germany. annette.stefini@med.uni-heidelberg.de



Until now few studies have proven that an attachment style can be changed in the course of psychotherapy and that the attachment style has an impact on the therapy outcome. In particular, there is a lack of studies about these relationships in long-term psychoanalytic psychotherapy with children and adolescents.


Seventy-one children with mental disorders receiving long-term outpatient psychodynamic psychotherapy were assessed 4 times using the Heidelberg Attachment Style Rating for Children and Adolescents. The measurements were conducted at the beginning of treatment, at the 25th treatment session, at the end of treatment and 1 year after the completion of treatment.


The results showed a significant change in attachment style during treatment. The proportion of children and adolescents with a secure attachment style increased from 23% to 63%. There was no significant difference in the attachment style between patients with good and poor treatment outcome, but a significant relationship between secure attachment and the number of treatment sessions could be demonstrated.


A reorientation towards a secure main attachment style over the course of psychotherapy is possible. However, attachment style seems to be not a moderator but a mediator for the outcome of psychoanalytic psychotherapy in children and adolescents.

Copyright © 2012 S. Karger AG, Basel.

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