Attachment, Complex Trauma and Psychotherapy: A Clinical Study of the Significance of Attachment in Adult Arabic-speaking Refugees with PTSD

​1. Title: 

Attachment, Complex Trauma and Psychotherapy: A Clinical Study of the Significance of Attachment in Adult Arabic-speaking Refugees with PTSD 

(This project is linked to Stress Management versus Cognitive Restructuring: a randomised clinical study on traumatised refugees (PTF2)

2. Project period: 

June 2011 – June 2014 

3. Investigator: 

Karin Riber, MSc, PhD 

4. Supervisors 

  • Prof. Susanne Lunn (University of Copenhagen) 
  • Prof. Ask Elklit (University of Southern Denmark) 
  • Prof. Simo Køppe (University of Copenhagen) 

5. Background 

Findings within psychotherapy research concludes that the outcome of therapy is consistently connected to procedural circumstances, and the therapeutic alliance is described both as the most central change-mediating process variable in psychotherapy, and as one of the most robust predictors of therapeutic effect. Secure attachment appears to promote a positive therapeutic alliance and more beneficial therapy, and one pilot study points to reflective function being a possible predictor of therapeutic success. According to Fonagy and colleagues, reflective function is thought to develop in a secure attachment relation, to be related to the identification and regulating affect, and to play a role as a protective mechanism against traumatic events. 

6. Aims

  • To examine the attachment patterns and reflective function in traumatised refugees in Denmark and explore to what extent these factors predict psychotherapeutic alliance and treatment effect. 
  • To get a better insight into the development and personality-psychological upbringing and accompanying development-psychopathological factors, and examine whether and how these individual differences inhibit or promote the recovery, for the sake of developing the psychotherapeutic treatment in accordance with the patients’ needs. 

7. Methods 

7.1 Number of participants: 


7.2 Population: 

Adult, PTSD-diagnosed and Arabic-speaking refugees referred to treatment at CTP and included in PTF2 

7.3 Description of data and data collection 

This process-effect study examines attachment patterns and reflective function in the Arabicspeaking patients included in PTF2 and illustrates the importance hereof for psychotherapeutic process and treatment efficacy using the measuring instruments Adult Attachment Interview (AAI), Revised Adult Attachment Scale (RAAS), Reflective Functioning (RF) Working Alliance Inventory (WAI), Harvard Trauma Questionnaire (HTQ) and the Hopkins Symptom Checklist-25 (HSCL-25). Finally, this study discusses the meaning of the results in relation to the future development of psychotherapeutic treatment. 

8. Dissemination of results 

Three papers have been finalised and are currently in review: 

  • Attachment organisation in Arabic-speaking refugees with post-traumatic stress disorder 
  • Attachment, reflective functioning, alliance and change mechanism in Arabic-speaking refugees with PTSD 
  • The effects of child abuse on adult refugees: a qualitative analysis of trauma complexity in a clinical sample
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