Lisa J. Milone, Psy.D., is a 2019 graduate of the Psy.D. Program in Clinical Psychology at Antioch University, New England

Dissertation Committee:

  • Martha B. Straus, PhD, Committee Chair
  • Gina Pasquale, PsyD, Committee Member
  • Cara Bonuso, PsyD, Committee Member


attachment theory, therapeutic relationship, psychotherapy, adolescent residential treatment, grounded theory, constructivist grounded theory, complex trauma

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This qualitative study explores therapist views of the therapeutic relationship in adolescent residential treatment from an attachment perspective. The therapeutic relationship is a strong predictor of outcomes in adult psychotherapy and a significant body of research has relied on the attachment literature to understand its importance. Research yields comparable results when examining the significance of the therapeutic relationship with children and adolescents; however, there is virtually no literature exploring it from the attachment lens. This is particularly notable for children and adolescents in residential treatment. As treatment intensity increases from outpatient to inpatient to residential, challenges and opportunities within the therapeutic relationship increase, too: therapists form uniquely intense and intimate connections with children and adolescents they may see every day. This study employed constructivist grounded theory data analysis of semi-structured interviews with residential therapists exploring their views of the role of attachment in the therapeutic relationship with their adolescent clients. Key findings include role differences in therapists in adolescent residential treatment; the importance of affect management, attunement, and self-awareness within the therapeutic relationship in adolescent residential treatment; the healing nature of relationship, connection, and feelings of safety with adolescents in residential treatment; and the concept of attachment as fundamental in adolescent residential treatment. Implications for practice and training, limitations, and suggestions for future inquiry are also discussed.


Lisa J. Milone

ORCID Scholar ID# 0000-0001-5359-4445