Safety in psychotherapy: further steps toward an attachment-informed transtheoretical model of change

The role of safety in psychotherapy has gained increasing attention, particularly in relation to attachment theory. Scholars have suggested that attachment theory may provide the ground to explain psychotherapy change across theoretical orientations. This paper aims to contribute to this strand by proposing an attachment-informed transtheoretical model of change based on a relational-developmental view of safety informed by different disciplinary sources. A relational-developmental view of safety is first summarized, followed by an overview of empirical findings on safety and psychotherapy change. These are then used to propose a transtheoretical model of therapeutic change organized around the concept of the safety zone (SZ) that identifies a sequence of four common change principles (attend the client’s SZ, move toward the boundaries of the client’s SZ, expand the client’s SZ, and consolidate the expansion of the client’s SZ). The paper concludes by discussing future research and its implications for psychotherapy practice, training, and research.