Exploring the relationship between attachment, work-related distress, and Emotionally Focused Individual Therapy (EFIT) as a potential treatment: a realist review and evaluation

Thesis

In this thesis, I explore the link between attachment and work-related distress and assess Emotionally Focused Individual Therapy (EFIT) as a potential treatment. This work was inspired by my experiences as a psychotherapist, executive coach, and former Fortune 50 executive, where many leaders expressed distress due to feeling that ‘no one had their back.’ This reminded me of what I learned about attachment theory during my therapist training, sparked my interest, and led to the research questions in this thesis.

I adopted a realist approach for this thesis, combining a narrative review, a realist review, and a realist evaluation. The narrative review provided insight from existing literature into the relationship between attachment and distress at work. Leaders can act as attachment figures, serving as safe havens during stressful times and secure bases for taking risks. When they fail to perform these roles, they may become sources of distress. The realist review then explored the potential of attachment-based therapy, Emotionally Focused Individual Therapy (EFIT), as a treatment for work-related distress. Lastly, I conducted a realist evaluation with ten participants experiencing workplace distress to test the program theory from the realist review. Over the course of twelve sessions with each participant, I gathered and analyzed transcripts, clinical notes, assessments, and participant feedback. Results suggest that EFIT may help participants reduce work-related distress; however, specific micro-interventions may be required to overcome hyper- and hypo- arousal during sessions, which can impede progress.

This thesis aims to improve understanding of the role of attachment at work and attachment-based EFIT as a potential treatment for work-related distress. Its strengths include being the first study on EFIT for work-related distress and utilizing realist approaches; its limitations include the small, exploratory, and geographically limited sample. My dual role as therapist and researcher was both helpful and challenging: it allowed for practitioner-led insights, reflexivity, and real-time adjustments, but also risked bias and may restrict the generalizability of the findings to other settings. Future research should examine EFIT with larger, more diverse groups and explore how leaders and organizations can apply attachment-based principles to create healthier workplaces.

Authors: McConnell, D

• DOI: 10.5287/ora-qrny1k4r6
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: attachment; work; psychology; stress; burnout; occupational health; leadership
• Subjects: Management; Leadership; Occupational health libraries; Clinical health psychology