Therapeutic distance in client-therapist narratives: client attachment, therapist attachment, and dyadic effects

Sharon Egozi, Orya Tishby, Hadas Wiseman

Research output: Contribution to journalArticlepeer-review


Based on the attachment framework, therapeutic distance conceptualization focuses on closeness–distance dynamics in the therapeutic relationship. We aimed to evaluate the psychometric properties of the Therapeutic-Distance-Scale, Observer-version (TDS-O) and apply a dyadic approach to examine associations between attachment characteristics and therapeutic distance experiences of clients, therapists, and mutual effects. Sixty-six clients and their 29 therapists completed the ECR and relational narratives collected in RAP interviews at early, mid, and late psychodynamic-therapy were rated on TDS-O scales: too close, too distant, autonomy, and engagement. The TDS-O showed good IRR, internal reliability and content validity. Client anxiety was not associated with therapeutic distance but associated with autonomy. Client avoidance associated with clients’ experiencing therapist as too close, and lower engagement only at early therapy, but was not associated with therapists’ experience. Therapist anxiety was not related to closeness–distance at early therapy but related to gaps between client and therapist experiences at mid and late therapy. Therapist avoidance related to clients experiencing therapists as too close and granting less autonomy at early and mid-therapy, and to therapist experience of distance at late therapy. The findings underscore the importance of therapists’ regulating therapeutic distance through attunement to client’s interpersonal needs and therapy phase.

Original languageEnglish
Pages (from-to)963-976
Number of pages14
JournalPsychotherapy Research
Issue number8
StatePublished - 17 Nov 2021

Bibliographical note

Funding Information:
This article is based in part on research supported by Small Research Grants Program, Society for Psychotherapy Research (SPR) to Sharon Egozi and by the Israel Science Foundation (ISF) [grant number 178/07] to Hadas Wiseman and Orya Tishby. The authors express their deep gratitude to the RAP interviewers and TDS-O observer for their dedicated and helpful work; to Prof. Ruth Sharabany for her significant contribution to this research; Dr. Gabi Liberman for providing invaluable statistical assistance; and the Student Psychological Services at the Hebrew University for their co-operation. This paper is partly based on Wiseman, H., Egozi, S., Tishby, O., & Sharabany, R. (2018). Evolving Attachment Patterns in the Therapeutic Relationship: Associations with global attachment and attachment to therapist. 49th Annual International Meeting of the Society for Psychotherapy Research, Amsterdam, Netherlands, June 2018.

Publisher Copyright:
© 2021 Society for Psychotherapy Research.


  • Relationship Anecdotes Paradigm
  • attachment style
  • dyadic analytical framework
  • therapeutic distance
  • therapeutic relationship

ASJC Scopus subject areas

  • Clinical Psychology


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