The Patient Attachment Coding System (PACS) and the process and outcome of psychotherapy
Previous attachment research has been based on interviews and self-reports, with little emphasis on how attachment processes unfold during the process of psychotherapy. With the introduction of the Patient Attachment Coding System (PACS, Talia, Miller-Bottome, Daniel, 2015), the first clinical measure of attachment validated with the AAI, we can now assess attachment by monitoring the patient’s moment-to-moment communications with the therapist. Thanks to the PACS, we want to further the study of attachment in psychotherapy from a pre-treatment client factor to a process that unfolds in the therapeutic interaction. In our large and diverse sample of transcribed sessions (which come from four different countries and are in different therapeutic modalities), we code patients’ discourse to investigate associations between the unfolding of the patient-therapist relationship and other process variables of psychotherapy: the therapeutic alliance and its ruptures, the development of the therapist countetransference, and many others. We also want to investigate if patients’ attachment is a predictor or a mediator of outcome, how a shift to more secure attachments can be facilitated, and how therapists can adapt to their patients’ attachment to improve their interventions. Finally, we are interested in exploring how therapists’ attachment impact their activity in psychotherapy. At our institute, we also offer trainings on coding and scoring with the PACS twice a year.
PI: Alessandro Talia
Funding: state funded
Talia, A., Daniel, S. ,Miller-Bottome, M., Brambilla, D., Miccoli, D., Safran, J. & Lingiardi, V. (2014). AAI predicts patients’ in‐session interpersonal behavior and discourse: A “move to the level of the relation” for attachment‐informed psychotherapy research. Attachment & Human development, 16(2), 192-¬‐209.
Talia, A., Miller¬‐Bottome, M., Daniel, S. I. F. (2015). Assessing Attachment in Psychotherapy: Validation of the Patient Attachment Coding System (PACS). Clinical Psychology and Psychotherapy. Article first published online: 24 NOV 2015 doi: 10.1002/cpp.1990
Talia, A., Taubner, S., Folke, S., Katznelson, H., Bremer, L., Lunn, S., Poulsen, S., Daniel, S.(2015). Observer‐based assessment of in‐session attachment with the Patient Attachment Coding System and the process and outcome of psychotherapy.
Miller‐Bottome, M., Talia, A., Safran, J. D., Muran, C. (2017) Resolving Alliance Ruptures from an Attachment-Informed Perspective. Psychoanalytic Psychology. Article first published online 6 JUL 2017 doi:
Talia, A., Miller-Bottome, M. Katznelson, H., Pedersen, S. H., Steele, H., Schröder, P., Scharff, F., Giovanardi, G., Andersson, M., Lingiardi, V., Safran, J., Lunn, S., Poulsen, S., Taubner, S. (2018). Mentalizing in the presence of another: Measuring Reflective functioning and Attachment in the therapeutic Process. Advance online publication. Psychotherapy research.