The relationship between adult attachment styles and work-related self-perceptions for Australian paediatric occupational therapists.
Abstract: Introduction: An attachment framework has been increasingly employed to inform our understanding of the ways in which early childhood relationships have an impact upon people's adaptation to the workplace. Evidence supports the presence of four attachment-related work orientations in adulthood (secure, cautious, support-seeking and self-reliant), which correspond to a secure and three insecure attachment patterns in early childhood. Although these work orientations have been investigated in several working populations, they have not yet been considered within a sample of occupational therapists.

Method: The present exploratory study considered the results of a nationwide survey of 486 paediatric occupational therapists, and investigated the associations between attachment styles and a range of demographic variables and work-related self-perceptions.

Results: Consistent with hypotheses, those with a secure attachment style reported a high investment of skill and energy in their job and low levels of overcommitment. Conversely, cautious attachment and, to a lesser extent, support-seeking attachment were linked with feeling overcommitted and perceiving low returns in terms of recognition and prestige from their work.

Conclusion: Understanding how practitioners' predominant attachment style is associated with work-related self-perceptions may offer insights into their behaviours and needs. This, in turn, can inform the provision of appropriate supports, with potential benefits for staff satisfaction, retention, health, wellbeing and, ultimately, client care.

Keywords: Attachment theory, work, occupational therapy.
Article Type: Survey
Subject: Occupational therapists (Beliefs, opinions and attitudes)
Occupational therapists (Practice)
Occupational therapists (Psychological aspects)
Attachment behavior (Analysis)
Self-perception (Analysis)
Authors: Meredith, Pamela
Poulsen, Anne
Khan, Asad
Henderson, Julie
Castrisos, Veronica
Pub Date: 04/01/2011
Publication: Name: British Journal of Occupational Therapy Publisher: College of Occupational Therapists Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 College of Occupational Therapists Ltd. ISSN: 0308-0226
Issue: Date: April, 2011 Source Volume: 74 Source Issue: 4
Topic: Event Code: 200 Management dynamics
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 254827347
Full Text: Introduction

Attachment theory (Bowlby 1969/1997), a theory of interpersonal development, posits that the earliest interactions between infants and caregivers form the foundations of personality throughout life. Depending on caregiver accessibility and responsivity in childhood, individuals form cognitive maps, or internal working models, of their worthiness as care recipients and of the trustworthiness of others. The long-term implications of these early experiences for exploration, development and relationships are well established, with a secure attachment (positive internal working models of both self and others) proving a source of resilience throughout the lifespan (see Karen 1998 for a summary). Hazan and Shaver (1990) have further highlighted ways in which a secure attachment in adulthood supports work activity, drawing a parallel between exploration in childhood and work in adulthood. Literature addressing the associations between attachment style and work-related factors, including demographics and self-perceptions of work, is briefly reviewed, and new evidence within a sample of paediatric occupational therapists is presented.

Literature review

The attachment construct is widely understood to contain two main dimensions: avoidance of relationships (negative working model of others) and anxiety about relationships (negative working model of self) (Schirmer and Lopez 2001). Relationship avoidance develops following caregiver unavailability, resulting in staunch self-reliance. Relationship anxiety emerges when caregivers are inconsistently available, and is associated with increased dependency on others. These two dimensions combine to produce four attachment styles:

1. Secure attachment (low levels of avoidance and relationship anxiety)

2. Support-seeking (or preoccupied) attachment (low avoidance and high relationship anxiety)

3. Self-reliant (or dismissing) attachment (high avoidance and low relationship anxiety)

4. Cautious (or fearful) attachment (high avoidance and high relationship anxiety) (see Fig. 1) (Bartholomew and Horowitz 1991, Ciechanowski et al 2002).

While 'secure attachment' is always known by this term, the latter three categories are known collectively as insecure attachment styles.

By 18 months of age, a child displays clear patterns of attachment in relationships, which remain largely consistent throughout life (Hamilton 2000, Lewis et al 2000, Moss et al 2005). Nevertheless, there is evidence that these patterns can change, particularly in response to changed circumstances, such as the introduction of a supportive, consistent carer or therapeutic relationship. Adults who are aware of their insecure behaviours may also be able to engage in corrective relationship experiences, develop self-management strategies and facilitate progress towards attachment security (Pearson et al 1994).

Attachment styles and work-related factors

Consistent with the tenets of occupational therapy, Hazan and Shaver (1990, p271) argued that work, like play in childhood, '... provides one of the major opportunities for exploration and mastery ... satisfaction and a sense of accomplishment' in adulthood. These authors were the first to investigate the implications of attachment styles in the workplace, uncovering evidence that individuals with secure attachment styles experience high levels of work success and satisfaction, approach work with confidence, report few work-related fears, such as fear of failure, and have few concerns about performance and evaluation by co-workers. While work is valued, work habits do not jeopardise health or interfere with relationships. Adults with secure attachment styles are more confident in seeking and gaining support from others in times of stress, and are less likely to experience burnout at work (Pines 2004).

Although the attachment styles of practising occupational therapists have not been studied previously, the proportion of attachment styles among undergraduate occupational therapy students has been found to reflect both the general population and other undergraduate populations (Mickelson et al 1997, Roney et al 2004). Roney et al (2004) found that occupational therapy students with an insecure attachment style were less satisfied with their choice of career compared with those with a secure style. It is not known whether choice of specialty area within the profession, such as working in paediatric settings with children and their families, may also be linked with any particular attachment style.

The application of adult attachment theory to a range of work-related situations offers insights for occupational therapists' practice (see Meredith 2009 for summary). For example, Pines' (2004) evidence of associations between insecure attachment and burnout is consistent with Hazan's and Shaver's (1990) description of those with an anxious attachment work orientation (support-seeking and cautious attachment) as feeling overly obligated and underappreciated. These workers feared rejection, failure and loss of esteem, and had difficulty meeting deadlines. Hardy and Barkham (1994) identified significant links between anxious attachment and anxiety about both work performance and relationships at work, while Schirmer and Lopez (2001) found that attachment anxiety uniquely predicted perceptions of higher work-related stress intensity and psychological symptom levels. Attachment anxiety has been conceptualised as a source of vulnerability in the workplace, with these individuals requiring higher levels of supervisory support (Schirmer and Lopez 2001). Theoretically, occupational therapists with anxious attachment styles may be particularly vulnerable to work-related stress if supervisory or collegial support is perceived to be inadequate or unsafe.

Hazan and Shaver (1990) further described an avoidant work orientation (self-reliant and cautious attachment), where work is seen as a way to reduce anxiety and avoid social interactions. Individuals with an avoidant attachment pattern prefer to work alone, are reluctant to take vacations and feel nervous when not working. They will work at the expense of health, relationships and their home life; however, they are less satisfied with their jobs. This behaviour has implications for functioning in teams and interpersonal relationships at work (Boatwright et al 2010).

According to the Effort-Reward Imbalance model (Siegrist 2002), which is based on the notion of social reciprocity, the working situation is conceptualised as an exchange between worker effort (workload and job demands) and job rewards (financial remuneration, interpersonal recognition, job prestige and promotion prospects). Although not previously investigated in relation to attachment theory, the Effort-Reward Imbalance model promotes understanding of worker coping, support needs, absenteeism and turnover. Of particular interest in relation to attachment theory is the concept of overcommitment, described by Siegrist (2002) as part of the Effort-Reward Imbalance model. Overcommitment is regarded as a work-related coping style occurring when practitioners misjudge the balance between work demands and their own resources for coping. Workers who invest high effort in their work when there is a low likelihood of rewards are susceptible to burnout and ill health (Kuper et al 2002). Although not previously investigated, there is theoretical support for a link between overcommitment and the characteristics of insecure attachment (attachment anxiety and avoidance) in workers described earlier.

Taken together, this evidence suggests that an understanding of attachment theory and work-related perceptions about effort, reward and overcommitment may assist occupational therapists to understand and manage their working lives effectively. Meredith (2009, p289) noted ' .that awareness of individual attachment needs may encourage more suitable support and early intervention approaches in the workplace, and matching of jobs to individual strengths, with possible implications for staff retention'. For example, self-awareness and an understanding of individual strengths, as well as vulnerabilities, may offer protective benefits for burnout. Knowledge of attachment patterns may further guide supervisors in providing optimal working environments.

In order to further this argument, the relevance of attachment theory to work-adjustment variables among occupational therapists must be demonstrated. The study reported here investigated the distribution of attachment styles, and associations between these and a range of work-related variables, within a sample of paediatric occupational therapists. It was hypothesised that:

1. Secure attachment would be associated with more adaptive levels of work effort (that is, low overcommitment and high investment of effort) and perceived work reward (that is, high perceived returns from work) compared with those with anxious attachment styles

2. Individuals with either support-seeking or cautious (that is, anxious) attachment styles would report more work overcommitment and less perceived rewards relative to secure or self-reliant individuals.



The participants were 486 of the 1018 Australian paediatric occupational therapists surveyed (response rate 48%). They were predominantly married, female and working in the public health care sector (Table 1).


Ethical clearance was obtained from the Behavioural and Social Sciences Ethical Review Committee at The University of Queensland (Ethical Clearance Number: 2008000407). Occupational Therapy Australia Limited state offices posted 928 surveys with covering letters, information sheets and prepaid return envelopes to members listed on their databases as paediatric practitioners. An additional 90 surveys were distributed to non-Occupational Therapy Australia Limited members working with paediatric caseloads. Participants were informed that survey return implied consent to participate. The surveys contained no identifying information.

Data collection

Five sections of a larger questionnaire are reported in this paper. Information about demographics (including gender, age, postgraduate qualifications, relationship status, children and income) and working situation (including participant employment status, years of experience and work context) was collected.

The Relationship Questionnaire (RQ, Bartholomew and Horowitz 1991) identifies the individual as secure, support-seeking, cautious or self-reliant. Participants completed two sections: (1) identify which of four descriptive paragraphs best describes the self ('attachment style choice'), and (2) indicate on four seven-point rating scales (1 = not at all like me to 7 = very much like me) the extent to which they believe they resemble each of the four described attachment styles ('extent of attachment style'). The RQ is a widely used measure of attachment, showing adequate predictive validity and test-retest reliability (Scharfe and Bartholomew 1994, Herzberg et al 1999).

The Overcommitment Scale--Short Version (OCS-SV, Siegrist et al 2004) is a 6-item self-report version of the 29-item original scale (Siegrist 2002). Overcommitment represents one of three components of the Effort-Reward Imbalance model (Siegrist et al 2004), and focuses on an individual's self-perceptions regarding inability to withdraw from work obligations after work and to distance oneself from job requirements (Siegrist et al 2004). The OCS-SV is scored on a four-point Likert scale (1 = strongly disagree to 4 = strongly agree), with the summed score ranging from 6 to 24 (higher scores indicate more overcommitment). Sample items include: 'People close to me say I sacrifice too much for my job' and 'Work rarely lets me go, it is still on my mind when I go to bed'. Siegrist et al (2004) reported acceptable reliabilities and appropriate internal consistency for the short version across multiple samples.

The Effort-Reward Imbalance Scale: Abridged (ERIS, Kouvonen et al 2006) measures effort with one item: 'How much do you feel you invest in your job in terms of skill and energy?' Reward is measured by two items: 'How much return do you get from the work you do in terms of: (i) income and job benefits, and (ii) recognition and prestige?' Responses are made on a five-point Likert scale (1 = very little to 5 = very much) and the three items are analysed individually. The shorter version was chosen to decrease participant response burden, with evidence from the work-related literature indicating that single-item measures for narrowly defined constructs are as effective as summated, multiple-item scales (for example, Wanous et al 1997).

Data analysis

To investigate whether sociodemographic variables (age, postgraduate qualification, marital status, children and employment) were significantly associated with the attachment styles, a series of chi-square tests was conducted. Assumption of expected cell frequencies of [greater than or equal to] 5 was examined for a valid chi-square test, and this assumption was obtained in all analyses.

To examine relationships between the four 'extent of attachment style' variables (secure, cautious, support-seeking and self-reliant) and the OCS-SV, Pearson's correlation coefficients (r) were computed. A correlation coefficient value of 0 implies that there is no linear correlation between the variables. A value of 1 implies perfect positive correlation, while a value of -1 implies a perfect negative correlation. Analysis of variance (ANOVA) was carried out to investigate whether there were significant mean differences between the OCS-SV and the three ERIS variables for the different attachment styles.

For statistically significant differences between attachment styles, a post-hoc comparison, using Bonferroni adjustment, was planned to investigate pair-wise comparisons. Bonferroni adjustment was applied to control for multiple testing by keeping the experiment-wise error rate (the probability of making at least one Type I error when performing the series of comparisons) to a specified level (a = 0.05). This adjustment decreases the chance of making a Type I error to very acceptable levels. Independent sample t-tests were performed to examine the group differences between the 'extent of attachment style' variables. The t-test assesses whether the means of two groups are statistically different from each other under the assumption that two independent random samples were taken from two normal populations with equal variances. Cronbach's alpha was used to measure internal consistency; that is, how closely related items are within a set of items. A high value of alpha (for example, 0.7-0.8) is often used as evidence that the items measure an underlying (or latent) construct. Because of the ratio imbalance, with 97.7% of the sample being female, gender was not incorporated into analyses.


Associations between 'attachment style choice' and other variables (OCS-SV, ERIS and demographic variables)

A Cronbach's alpha of 0.82 was obtained for the OCS-SV, suggesting high internal consistency. This is consistent with previous findings (Siegrist et al 2004). A statistically significant ANOVA ([F.sub.3461] = 4.51, p = 0.004) revealed that the level of overcommitment was significantly different for the various attachment styles (secure, cautious, support-seeking and self-reliant), with Bonferroni post-hoc analyses revealing a significant difference between the secure (mean = 14.40) and cautious (mean = 15.87, p = 0.01) attachment styles.

Perceived 'reward from job' in terms of recognition and prestige was significantly associated with choice of attachment style (p<0.0001). As shown in Table 2, more occupational therapists with secure (41%) or self-reliant (29%) attachment styles reported obtaining high amounts of recognition and prestige from work compared with cautious (11%) or support-seeking styles (19%). In addition, as perceived job returns of recognition and prestige increased, so did the rate of choosing a secure attachment style, with only 16% of those selecting this style reporting very little reward, whereas 41% felt that they obtained high levels of recognition and prestige from their position. A reverse trend was evident in those choosing cautious attachment styles, with the majority (34%) perceiving very little reward and few (17%) perceiving very high levels of reward.

Significant associations between attachment style choice and age (p = 0.03) were found, with the rate of choosing a secure attachment style increasing with older age: 45% of those under 25 years of age chose the secure attachment category compared with 72% of those over 45 years. The reverse trend was evident in choosing cautious attachment, with 23% of those under 25 years choosing this style, whereas only 7% of those over 45 years selected the cautious style.

Chi-square analysis of attachment style choice and years of experience was significant (p = 0.006), with 44% of occupational therapists with less than 5 years of experience choosing the secure style compared with 72% of occupational therapists who had over 20 years of experience. On the other hand, 22% of therapists with 5 years or less of experience chose cautious attachment compared with only 5% of their counterparts who had over 20 years of experience.

Achievement of a postgraduate qualification, marital status, having children and current employment context were also significantly associated with choice of attachment style, using chi-square tests. Occupational therapists choosing secure (40.6%) or self-reliant (41.3%) attachment styles were more likely (p = 0.03) to have postgraduate qualifications than those choosing support-seeking (22%) or cautious (25%) styles. Securely attached therapists were less likely to be single (17%) and more likely to be married (77%) compared with their insecure counterparts (p = 0.008), and were more likely (p = 0.03) to have children (61%) than therapists selecting the cautious style (43%) (p = 0.01). Part-time occupational therapists were more likely to be securely attached (70% vs 56%) and were less likely to choose self-reliant attachment (13% vs 21%) than their full-time counterparts.

Associations between 'extent of attachment style' variables and other variables (OCS-SV, ERIS and demographic variables)

Pearson's correlations between the four 'extent of attachment style' variables and the OCS-SV revealed significant negative associations between secure attachment and overcommitment (r = -0.14, p<0.01), while cautious and support-seeking attachment styles showed significant positive associations with overcommitment at work (r = 0.17, p<0.01 and r = 0.14, p<0.01 respectively).

Occupational therapists who reported high job effort in terms of skill and energy reported significantly higher levels of secure attachment compared with those investing low levels of skill and energy (mean = 5.21 vs 4.83; [t.sub.480] = 2.51, p = 0.01). The reverse pattern was identified for cautious attachment. Those investing high levels of skill and energy in their job scored significantly lower on cautious attachment compared with those investing less effort (mean = 2.42 vs 2.88; [t.sub.480] = 2.93, p = 0.004). Occupational therapists in the public sector scored higher on the cautious dimension compared with those in the private sector (mean = 2.81 vs 2.45; [t.sub.480] = 2.28, p = 0.02).

Recognition and prestige was significantly associated with average extents of secure ([F.sub.(3477)] = 6.93, p<0.0001), cautious ([F.sub.(3477)] = 11.87, p<0.0001) and support-seeking ([F.sub.(3477)] = 5.14, p = 0.002) attachment, but not self-reliant attachment. Post-hoc analysis revealed that those reporting high recognition and prestige from work obtained significantly higher security scores (mean = 5.47) compared with those perceiving 'very little' (mean = 4.82, p = 0.01), 'little' (mean = 4.71, p = 0.001) or 'neutral' (mean = 4.78, p = 0.003) amounts of recognition and prestige from their work. Those with higher ratings on cautious attachment were more likely to perceive 'very little' (mean = 3.32, p<0.001), 'little' (mean = 2.85, p = 0.002) or 'neutral' (mean = 2.81, p = 0.002) amounts of recognition and prestige from their work compared with 'very much' (mean = 2.09) recognition and prestige. A final post-hoc analysis revealed that those with higher ratings on support-seeking attachment were more likely to perceive 'little' (mean = 2.72, p = 0.001) recognition and prestige from their work than 'very much' recognition and prestige (mean = 2.03).

A summary of the characteristics associated with each of the attachment styles is provided in Table 3.


The present study investigated associations between the four adult attachment styles and a range of sociodemographic and work-related variables in a sample of Australian paediatric occupational therapists. It was hypothesised that (1) secure attachment would be associated with a high investment of skill and energy in work, low overcommitment and high perceived rewards from work, while (2) support-seeking and cautious attachment styles would be linked with overcommitment and fewer work rewards. As discussed below, the pattern of findings was consistent with these expectations.

Consistent with the first hypothesis, secure attachment was associated with investing more skill and energy at work, feeling less overcommitted (particularly compared with the cautious group) and perceiving a higher return from work in terms of recognition and prestige than other attachments styles. Of all the attachment styles, securely attached participants were most likely to be married, to be older, to have more years of clinical experience, to have children and to work part time. Secure participants, along with their self-reliant counterparts, were also more likely to have postgraduate qualifications than those with support-seeking and cautious styles. This pattern of findings is consistent with existing literature, which suggests associations between attachment security and older age, likelihood of marrying, having children (Mickelson et al 1997, Magai et al 2001) and attaining higher levels of academic achievement (Bergin and Bergin 2009).

In contrast, cautious participants were more likely to be younger and to have fewer years (5 years or less) of clinical experience. With newly qualified occupational therapists already identified as vulnerable and in need of strategies to assist their transition from student to therapist (Morley 2009), this finding suggests that such strategies and supports for new therapists may be strengthened by insights from attachment theory. Cautious participants were also less likely to be married, to have children or to have postgraduate qualifications. At work, they reported feeling more overcommitted, with work being experienced as overwhelming and spilling over into after-work hours. This was associated with being unable to 'switch off' after work and feeling overwhelmed by time pressures during working hours. Cautious attachment was also associated with a sense of investing less skill and energy in the job, and with work providing low returns in terms of recognition and prestige. When employment history was analysed, an increased likelihood of practitioners with cautious attachment styles to work in the public (Government-funded) workforce was identified.

Support-seeking attachment was associated with feeling overcommitted at work, and with work providing limited returns in terms of recognition and prestige. Thus, consistent with expectations, both support-seeking and cautious (anxious) attachment styles were linked more strongly with feelings of overcommitment and dissatisfaction about low occupational prestige. According to the Effort-Reward Imbalance model, this makes those with an anxious attachment pattern more vulnerable to burnout and ill health (Siegrist 2002), which is, in turn, associated with decreased job performance and satisfaction (Jahrami 2009). Anxious attachment has also been linked with feelings of low self-esteem and more negative affect (Ciechanowski et al 2002), and with less adaptive functioning, than those with secure or avoidant patterns (Mikulincer and Shaver 2007).

Interestingly, like the securely attached participants with whom they share low levels of attachment anxiety, those with a self-reliant attachment style perceived high levels of recognition and prestige from their work, and were more likely to have postgraduate qualifications than the cautious and support-seeking participants. As opposed to the secure group, however, they were less likely to be married and more likely to work full time. This result is consistent with the portrayal of self-reliant individuals as more task-focused and less relationship-focused than people with secure attachment styles (Boatwright et al 2010). Boatwright et al (2010) described self-reliantly attached employees as avoiding face-to-face interactions with colleagues, preferring to communicate via email, and avoiding interpersonal closeness.

Some additional comments about demographic associations are warranted, as earlier studies of attachment and work have not considered demographic factors. One exception is the study by Schirmer and Lopez (2001), which found that avoidant attachment was associated with longer job tenure; however, no associations between attachment and other demographic variables were found. These researchers proposed that younger workers, who have fewer benefits and advancement opportunities, may identify with insecure attachment styles, particularly anxious attachment. It is, therefore, interesting to see associations between attachment and age, marital status, having children and having postgraduate qualifications in the present study. Although the findings are consistent with theoretical predictions and evidence from the wider attachment literature (Mickelson et al 1997, Magai et al 2001), their implications in the workplace require more detailed theoretical and empirical consideration. While it may be tempting to conclude that, with age, one becomes more securely attached, and more likely to marry and have children, this cannot be concluded from these cross-sectional data. Indeed, attachment insecurity is considered to be self-perpetuating and, therefore, stable without intervention (Hamilton 2000); thus, these changes appear unlikely to occur simply in association with age.

This study extends the evidence in the field of attachment and work, with findings that more anxiously attached individuals (cautious and, to a lesser extent, support-seeking attachment styles) reported feeling overcommitted and less rewarded at work than their colleagues with low relationship anxiety. Evidence of work challenges for practitioners who had self-reliant attachment styles was less clear. The implications for functioning in teams and working in close interpersonal relationships for self-reliant therapists, who avoid interpersonal closeness, limit their support-seeking strategies and distance themselves from others, have been previously noted (Boatwright et al 2010). Hardy and Barkham (1994) demonstrated that psychological interventions can modify insecure attachment patterns, with associated improvements in job satisfaction.

Study limitations and recommendations

The results of this study should be interpreted cautiously, and the results should not be generalised. The sample was a self-selecting group of paediatric occupational therapists, largely sourced through Occupational Therapy Australia Limited. Nevertheless, it is interesting to observe the similarity in the distribution of attachment styles compared with a nationally representative American sample (Mikelson et al 1997), a work sample (Schirmer and Lopez 2001) and a sample of first and fourth year Australian occupational therapy students (Roney et al 2004). Almost 62% of the sample was securely attached, compared with the 59% found by Mickelson et al (1997) and the 55% identified by Roney et al (2004). The distribution of insecure attachment patterns in this study (self-reliant 16.5%, cautious 13.2% and support-seeking 7.6%) reflects the student findings (self-reliant 22%, cautious 17.8%, and support-seeking 5.1%) of Roney et al (2004).

The attachment worker profiles obtained in this study were restricted by the measures employed. Further studies in this field might include measures of perceived and preferred levels of social support in the workplace, extent of sick and recreation leave, work satisfaction, work performance and work-life balance. The use of a dimensional measure of attachment would also offer valuable information. Finally, a qualitative project investigating practitioners' reports about their attachment, work, and work-related behaviours would be of interest.

Although the findings of this study are largely consistent with expectations, the magnitude of findings was generally in the low to moderate range. Because it is known that the attachment behavioural system is activated during times of illness, threat and distress (Berman and Sperling 1994), this conservative outcome with a sample of employed professionals was anticipated. Nevertheless, it is a testament to the relationships between these variables that significant patterns in the expected directions emerged in this sample. It would be advantageous to investigate these associations further with samples of occupational therapists identified as experiencing distress or receiving support for work-related concerns.


The present study adds to the growing body of evidence that links attachment styles with characteristics relevant to the workplace. Further, it extends these findings to the profession of occupational therapy. Understanding the ways in which individual differences in work-related thoughts, feelings and behaviours may be explained within the comprehensive developmental framework of attachment theory may provide the foundation for improved self-awareness and for understanding practitioners' work-related self-perceptions, behaviours and needs. Such insights can inform personal growth and provision of appropriate supports, with potential benefits for practitioner health and wellbeing, work satisfaction, retention and, ultimately, client care.


This project was supported by a grant from The Occupational Therapists Board of Queensland. The contribution of Occupational Therapy Australia Limited state offices, who distributed the surveys, is gratefully acknowledged, as is the collegial support of fellow paediatric occupational therapists who completed the surveys. Conflict of interest: None declared.

Key findings

* Securely attached occupational therapists reported more adaptive personal and work characteristics.

* Anxiously attached therapists reported feeling overcommitted at work, and perceived limited prestige and recognition for their work.

What the study has added

This study was the first to consider the implications of attachment work orientations among occupational therapists. The results demonstrate links between anxious attachment (cautious/support-seeking) and both burnout and work-related distress.


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Pamela Meredith, (1) Anne Poulsen, (2) Asad Khan, (3) Julie Henderson (4) and Veronica Castrisos (5)

(1) Lecturer, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.

(2) Senior Research Officer, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.

(3) Senior Lecturer in Statistics, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.

(4) Clinical Occupational Therapist, Occupational Therapy for Children Private Practice, Graceville, Queensland, Australia.

(5) Clinical Occupational Therapist, Association for Preschool Education of Deaf Children Inc., Taigum, Queensland, Australia.

Corresponding author: Dr Pamela Meredith, Lecturer, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland 4072, Australia. Email:

Reference: Meredith P, Poulsen A, Khan A, Henderson J, Castrisos V (2011) The relationship between adult attachment styles and work-related self-perceptions for Australian paediatric occupational therapists. British Journal of Occupational Therapy, 74(4), 160-167.

DOI: 10.4276/03080221 1X13021048723138

Submitted: 7 April 2010.

Accepted: 1 February 2011.
Table 1. Summary of descriptive details of demographic, work
and attachment variables
Variable           Category                  (N = 489)     %

Age                <25 years                     41       8.4
                   25-35 years                  176      36.0
                   35-45 years                  142      29.0
                   >45 years                    126      25.8
                   Missing                        4       0.8

Gender             Male                          10       2.1
                   Female                       475      97.7
                   Missing                        1       0.2

Postgraduate       No                           304      62.2
qualifications     Yes                          181      37.0
                   Missing                        4       0.8

Relationship       Never married                103      21.1
status             Married/cohabiting           359      73.4
                   Not currently married         22       4.5
                   Missing                        5       1.0

Children           No                           213      43.6
                   Yes                          272      55.6
                   Missing                        4       0.8

Income per         <$30 000                     132      27.0
annum              $30-60 000                   177      36.2
                   >$60 000                     161      32.9
                   Missing                       19       3.9

Employment         Full-time                    245      50.1
status             Part-time                    218      44.6
                   Missing                       26       5.3

Occupational       < 5 years                    115      23.5
therapy            5-10 years                    89      18.2
experience         10-20 years                  142      29.0
                   > 20 years                   140      28.6
                   Missing                        3       0.6

Work context (a)   Multidisciplinary team       339      69.3
                   Sole practitioner            140      28.6
                   Missing                       10       2.0

Work context (b)   Public sector                310      63.4
                   Private sector               176      36.0
                   Missing                        3       0.6

State of           Northern Territory             6       1.2
practice           New South Wales              158      32.4
                   Victoria                     101      20.7
                   Queensland                   122      25.0
                   South Australia               35       7.2
                   Western Australia             33       6.8
                   Tasmania                       4       0.8
                   Multiple states               27       5.5
                   Missing                        2       0.4

Attachment         Secure                       294      61.9
                   Cautious                      64      13.2
                   Support-seeking               37       7.6
                   Self-reliant                  80      16.5
                   Missing                       11       2.3

Table 2. Results of chi-square analysis of association between choice
of attachment style and perceived job reward in terms of recognition
and prestige

Perceived reward                     Attachment style choice

                             Secure       Cautious       seeking

                                n (%)         n (%)         n (%)
Very little reward          45 (15.6)     21 (33.9)      5 (13.9)
Little reward               63 (21.8)     17 (27.4)     15 (41.7)
Neutral                     63 (21.8)     17 (27.4)      9 (25.0)
A lot/very much reward     118 (40.8)      7 (11.3)      7 (19.4)
Total                       289 (100)      62 (100)      36 (100)

Perceived reward            Attachment style choice

                             reliant        Total

                                n (%)         n (%)
Very little reward          18 (22.5)     89 (19.1)
Little reward               12 (15.0)    107 (22.9)
Neutral                     27 (33.8)    116 (24.8)
A lot/very much reward      23 (28.8)    116 (24.8)
Total                        80 (100)     467 (100)

Table 3. Descriptions of work characteristics identified
for four attachment styles

Secure            Cautious          Support-seeking   Self-reliant

Less              More              More              Not related to
overcommitted     overcommitted     overcommitted     overcommitment
at work.          at work.          at work.          at work.

Perceive more     Perceive less     Perceive less     Perceive more
return from       return from       return from       return from
job in terms      work in terms     job in terms      job in terms
of recognition    of recognition    of recognition    of recognition
and prestige.     and prestige.     and prestige.     and prestige.
Invest more       Invest less       Less likely to    More likely to
skill and         skill and         have              have
energy in         energy in         postgraduate      post graduate
work.             work.             qualifications.   qualifications.

Associated        Associated        Less likely to    Less likely to
with being        with being        be married.       work part
older and         younger and                         time.
having more       having less
years of          experience.
experience.       Less likely to
More likely to    have
have              postgraduate
postgraduate      qualifications.

More likely to    Less likely to                      Less likely to
be married.       be married.                         be married.

More likely to    Less likely to
have children.    have children.

More likely to    More evident
work part         in the public
time.             sector.

Fig. 1. Four-category conceptualisation of adult attachment styles
(adapted from Bartholomew and Horowitz 1991).

                         Low relationship      High relationship
                             anxiety                anxiety

  Low relationship            Secure            Support-seeking
     avoidance                                   (preoccupied)

 High relationship         Self-reliant             Cautious
     avoidance             (dismissing)            (fearful)
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