Client attachment to therapist: Relation to client personality and symptomatology, and their contributions to the therapeutic alliance

Psychotherapy (Chic). 2010 Dec;47(4):454-68. doi: 10.1037/a0022079.


This study examined the relation of client attachment to the therapist to diverse facets of the therapeutic alliance, client personality, and psychopathological symptoms, as well as the relative importance of therapeutic attachments, personality, and symptomatology in predicting the alliance. Eighty clients in ongoing therapy completed measures of client attachment to therapist (CATS), personality (6FPQ), psychopathological symptoms (BSI), and therapeutic alliance (WAI-Short, CALPAS, HAQ). Secure and Avoidant-Fearful attachment to the therapist correlated positively and negatively, respectively, with total and subscale alliance scores. Preoccupied-Merger therapeutic attachment was unrelated to the alliance. Exploratory analyses suggested however that the relationship between Preoccupied-Merger attachment and the alliance was moderated by the extent to which clients were distressed. Clients' therapeutic attachments were unrelated to basic personality dimensions. Preoccupied-Merger attachment to the therapist correlated significantly with several symptom dimensions. Clients' therapeutic attachments emerged as superior and more consistent predictors, relative to client personality and symptomatology, of the therapeutic alliance.

MeSH terms

  • Adjustment Disorders / psychology
  • Adjustment Disorders / therapy
  • Adolescent
  • Adult
  • Aged
  • Anorexia Nervosa / psychology
  • Anorexia Nervosa / therapy
  • Anxiety Disorders / psychology
  • Anxiety Disorders / therapy
  • Character*
  • Cooperative Behavior*
  • Female
  • Humans
  • Interpersonal Relations
  • Male
  • Mental Disorders / psychology*
  • Mental Disorders / therapy*
  • Middle Aged
  • Mood Disorders / psychology
  • Mood Disorders / therapy
  • Object Attachment*
  • Personality Disorders / psychology
  • Personality Disorders / therapy
  • Personality Inventory / statistics & numerical data
  • Professional-Patient Relations*
  • Psychometrics
  • Psychotherapy*
  • Treatment Outcome
  • Young Adult