Meta-analysis of client attachment to therapist: associations with working alliance and client pretherapy attachment.

A review was conducted of 14 studies published from 1995 to 2013 and 2 thus far unpublished studies that have used the Client Attachment to Therapist Scale (CATS) in research with help-seeking clients. Of these, meta-analyses were conducted for studies that examined the CATS subscales (Secure, Avoidant, Preoccupied) as correlates of client-rated working alliance, client pretherapy general adult attachment, or both (Total k = 13; k = 9 for each specific analysis). With regard to pretherapy adult attachment, CATS Secure was negatively associated with client Anxiety and Avoidance. For CATS Avoidant, clients' attachment avoidance and anxiety were positively associated. For CATS Preoccupied, client adult attachment Anxiety was significantly positively associated. CATS Secure was strongly positively correlated with total working alliance, CATS Avoidant was negatively correlated with total working alliance, and CATS Preoccupied was not significantly associated with working alliance. Implications for models of therapeutic change based on client gains in social competencies and capacity for secure attachment are discussed.