Date of Award


Document Type


Degree Name

Doctor of Philosophy in Clinical Psychology



First Advisor

Lisa Samstag

Committee Chair and Members

Lisa Samstag, Chari

Nicholas Papouchis

Kevin Meehan


Attachment, Cognitive processing, Therapist effects, Therapist skills


The wounded healer concept suggests that one's therapeutic ability is rooted in one's own experiences of pain and suffering. The present study used this concept as a theoretical framework from which to explore issues related to therapist insecure attachment and therapist skill. It examined the role of therapist cognitive flexibility in the relationship between therapist attachment insecurity and therapist mentalization capacity. Participants were 158 therapists from different clinical fields of study and varying levels of clinical experience who completed an online protocol. Results indicated that avoidant attachment negatively predicted mentalization capacity, validating in a therapist sample what previous studies have demonstrated with non-therapist samples. Additionally, results showed that when therapists’ self-reported cognitive flexibility was high, the relationship between attachment anxiety and mentalization was negative, such that as attachment anxiety increased, mentalization capacity decreased. This was contrary to expectations. Finally, correlations revealed no relationships among a self-report, a neuropsychological, and an observer-rated measure of cognitive flexibility. This study was the first to validate the use of the Emotion Card Sort Test (ECST; Deveney & Deldin, 2006) (a modified version of the Wisconsin Card Sorting Test using emotional stimulus words) to assess cognitive flexibility in therapists. Additionally, it was the first to validate the use of the Reflective Functioning Scale (RFS; Fonagy et al., 1998) to code the Five-Minute Speech Sample (FMSS; Gottschalk & Gleser, 1969) in a therapist population. Implications for psychotherapy and psychotherapy training as well as study limitations and future directions for research are discussed.