Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Counseling and Psychological Services

First Advisor

Melissa Zeligman

Second Advisor

Franco Dispenza

Third Advisor

Catharina Chang

Fourth Advisor

Jonathan Orr


Despite decades of prevention campaigns and research, childhood interpersonal trauma remains a critical mental health problem in the United States with longstanding and harmful negative effects on adult psycho-relational functioning (Dugal, Bigras, Godbout, & Belanger, 2016). In the United States, 678,810 children were found to be victims of childhood abuse in one year (U.S. Department of Health & Human Services, 2013). Estimated prevalence rates of childhood trauma in American adults older than 55 years were 13.5% for verbal abuse, 9.6% for physical abuse and 9.3% for sexual abuse (Bynum et al., 2010). Childhood interpersonal trauma may have a damaging impact on a child’s development (Dodge, 2010; Schury & Kolassa, 2012), and in the long run may lead to high rates of suicidality and low levels of social functioning (Stansfeld et al., 2010). Extended interdisciplinary common factor research has identified the therapeutic alliance as a consistent factor influencing therapeutic outcomes (Flückiger, Del Re, Wampold, Koole & Tschacher, 2016; Symonds & Horvath, 2012). Cultural humility (Hook, Davis, Worthington, & Utsey, 2013; Owen et al., 2014), therapeutic presence (Colosimo & Pos, 2015; Geller & Porges, 2014), and attachment style (Byrd, Patterson, & Turchik, 2010; Marmarosh et al., 2009) have all been found to significantly contribute to the development of the therapeutic alliance. However, these factors have not been investigated together in the context of working with individuals with a history of childhood interpersonal trauma. These variables are of particular importance looking at interpersonal trauma survivors, as healing relationships that provide quietness, safety, presence, protection, and empowerment are integral to their recovery process (Herman, 1992; Levine, 1997). This study investigated the relationships among cultural humility, therapeutic presence, attachment style, and therapeutic alliance when working with childhood interpersonal trauma survivors. Correlation analyses indicated that cultural humility and therapeutic presence were both significantly correlated with therapeutic alliance. Regression analyses revealed that together cultural humility, therapeutic presence and attachment anxiety were the strongest predictors of the therapeutic alliance. Implications and recommendations for professional counselors and counselor educators are provided.

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