Attachment as a framework to facilitate empowerment for people with severe mental illness

Cathelijn D. Tjaden*, Cornelis L. Mulder, Philippe A.E.G. Delespaul, Arnoud R. Arntz, Hans Kroon

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)


Objectives: Recovery and empowerment have evolved into key objectives in the treatment and care of people with severe mental illness (SMI), and interest has grown in the role of social relationships in recovery. This study is the first to explore whether attachment styles are related to levels of empowerment, and secondly, whether attachment anxiety and attachment avoidance are associated with lower empowerment levels, independently of quality and frequency of social contact. Design: We used a cross-sectional design. Methods: In a sample of 157 participants with SMI in outpatient care, associations between attachment (Revised Adult Attachment Scale), self-reported social functioning, and empowerment (Netherlands Empowerment List) were assessed. Results: Attachment anxiety and attachment avoidance were both associated with lower levels of empowerment. A stepwise multiple regression analysis showed that the prediction of empowerment was significantly improved by adding attachment anxiety and attachment avoidance to quality and frequency of social contact. Attachment anxiety, attachment avoidance, and quality of social contact were significant predictors; frequency of social contact was not. Conclusions: Although our design does not allow causal conclusions, our results highlight the importance of interpersonal processes and behaviours as routes to improving empowerment for people with SMI. A promising approach might thus consist of securing attachment bonds with significant others so that the self and the other are perceived as reliable resources. Our findings also feature the importance of reciprocity and equality in social relationships. Taken together, our study emphasizes the value of social, contextualized interventions in recovery work for people with SMI. Practitioner points: Working towards attachment safety in interpersonal relations may be important in recovery-oriented treatment and care for people with severe mental illness (SMI). Helping people with SMI to recognize and change how they tend to relate themselves to others may promote engagement and effectiveness of recovery-oriented treatment and care. Reciprocity and equality in social relationships as vital complements to the more one-sided nature of ‘standing alongside’ and offering support may be important requisites for empowerment.

Original languageEnglish
Pages (from-to)407-425
Number of pages19
JournalPsychology and Psychotherapy: Theory, Research and Practice
Issue number3
Publication statusPublished - Sept 2021

Bibliographical note

Funding Information:
The authors particularly wish to thank all of participants who took part in the study and the dedicated research team who conducted the interviews. This study was supported by a grant from the ‘Stichting tot Steun VCVGZ’ (project number: 243) and funding from participating mental health centres. The sponsors did not participate in any way in preparing or performing the study or in writing or reviewing the manuscript.

Publisher Copyright:
© 2020 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of British Psychological Society.


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