Moderating effects of attachment anxiety and avoidance on the relationship between working alliance subscales and therapy outcome.

This study investigated the moderating effects of client attachment anxiety and avoidance on how client-rated working alliance subscales (goal, task, and bond) in one session predicted the client functioning the following week. The sample included 137 clients working with 17 therapists in a university clinic for a total of 5,356 psychodynamic psychotherapy sessions. The client attachment was measured before the first session. Each week, clients rated their overall functioning in the past week as therapy outcome and rated working alliance for each session. Across all sessions, the attachment anxiety level had a significant moderating effect on how agreement on goals in one session predicted client functioning in the following week. For clients with high attachment anxiety, when they perceived high goal agreement in a session, they reported poor functioning the following week. This counterintuitive result has important implications for practice and research: (a) Practitioners should assess and consider client's attachment anxiety levels in the goal-setting process and not simply strive for verbal goal agreement for clients with high attachment anxiety. (b) The goal agreement measurement in the working alliance subscale is limited. The goal-setting theories are reviewed to discuss the "what" (goals) and "how" (to set goals) for goal setting in therapy. No other significant moderating effects were found for attachment anxiety and avoidance on the relationships between working alliance subscales and therapy outcome. The meaning of these nonsignificant results was also discussed within the context of sample characteristics in this study. (PsycInfo Database Record (c) 2026 APA, all rights reserved).