Client attachment to therapist has been long considered a prominent process variable in psychotherapy research. The purpose of this study was to translate in Greek and evaluate the structure, reliability, convergent and discriminant validity of the well-known and widely administered Client Attachment to Therapist Scale (CATS) with exploratory and confirmatory factor analysis in a clinical sample of 153 clients of different treatment modalities and at different agencies. The results indicated that the EFA resulted in a model almost identical to the Mallinckrodt, Gantt and Coble’s [1] original model after the deletion of six items. Moreover, the findings indicated adequate internal consistency, test-retest reliability, convergent and discriminant validity of the three factors. Normalized scores were provided to help mental health professionals interpret the scale scores. In conclusion, CATS is a valid and reliable tool to measure client attachment to therapist, whose use can promote psychotherapeutic process and outcome. Thus, more validation studies should be conducted in several cultural contexts to better understand its structure and psychometric characteristics.
References
[1]
Mallinckrodt, B., Gantt, D.L. and Coble, H.M. (1995) Attachment Patterns in the Psychotherapy Relationship: Development of the Client Attachment to Therapist Scale. Journal of Counseling Psychology, 42, 307-317. https://doi.org/10.1037/0022-0167.42.3.307
[2]
Bowlby, J. (1969) Attachment and Loss: Vol. 1 Attachment. Basic Books, New York.
[3]
Bowlby, J. (1980) Attachment and Loss: Vol. 3 Loss. Basic Books, New York.
[4]
Bowlby, J. (1988) A Secure Base. Basic Books, New York.
[5]
Wallin, D.J. (2007) Attachment in Psychotherapy. Guilford Press, New York.
[6]
Farber, B.A., Lippert, R.A. and Nevas, D.B. (1995) The Therapist as Attachment Figure. Psychotherapy, 32, 204-212. https://doi.org/10.1037/0033-3204.32.2.204
[7]
Obegi, J. (2008) The Development of the Client-Therapist Bond through the Lens of Attachment Theory. Psychotherapy: Theory, Research, Practice, Training, 45, 431-446. https://doi.org/10.1037/a0014330
[8]
Shane, M.G. and Shane, M. (2001) The Attachment Motivational System as a Guide to an Effective Therapeutic Process. Psychoanalytic Inquiry, 21, 675-687. https://doi.org/10.1080/07351692109348967
[9]
Skourteli, M.C. and Lennie, C. (2011) The Therapeutic Relationship from an Attachment Theory Perspective. Counselling Psychology Review, 26, 20-33.
[10]
Daly, K.D. and Mallinckrodt, B. (2009) Expert Therapists’ Approaches to Psychotherapy with Adult Clients Who Present with Attachment Avoidance or Anxiety. Journal of Counseling Psychology, 56, 549-563. https://doi.org/10.1037/a0016695
[11]
Parish, M. and Eagle, M.N. (2003) Attachment to the Therapist. Psychoanalytic Psychology, 20, 271-286. https://doi.org/10.1037/0736-9735.20.2.271
[12]
Mikulincer, M. and Shaver, P.R. (2007) Attachment in Adulthood: Structure, Dynamics, and Change. Guilford Press, New York, NY.
[13]
Mallinckrodt, B. (2010) The Psychotherapy Relationship as Attachment: Evidence and Implications. Journal of Social and Personal Relationships, 27, 262-270. https://doi.org/10.1177/0265407509360905
[14]
Ainsworth, M.D.S., Blehar, M.C., Waters, E. and Wall, S. (1978) Patterns of Attachment: A Psychological Study of the Strange Situation. Erlbaum, Hillsdale, NJ.
[15]
Bartholomew, K. and Horowitz, L.M. (1991) Attachment Styles among Young Adults: A Test of a Four-Category Model. Journal of Personality and Social Psychology, 61, 226-244. https://doi.org/10.1037/0022-3514.61.2.226
[16]
Griffin, D. and Bartholomew, K. (1994) Models of the Self and Other: Fundamental Dimensions Underlying Measures of Adult Attachment. Journal of Personality and Social Psychology, 67, 430-445. https://doi.org/10.1037/0022-3514.67.3.430
[17]
Hazan, C. and Shaver, P.R. (1987) Romantic Love Conceptualized as an Attachment Process. Journal of Personality and Social Psychology, 52, 511-524. https://doi.org/10.1037/0022-3514.52.3.511
[18]
Main, M. and Goldwyn, R. (1998) Adult Attachment Scoring and Classification Systems. University of California, Berkeley.
[19]
Mallinckrodt, B. and Jeong, J. (2015) Meta-Analysis of Client Attachment to Therapist: Associations with Working Alliance and Client Pretherapy Attachment. Psychotherapy, 52, 134-139. https://doi.org/10.1037/a0036890
[20]
Brennan, K.A., Clark, C.L. and Shaver, P.R. (1998) Self-Report Measurement of Adult Attachment: An Integrative Overview. In: Simpson, J.A. and Rholes, W.S., Eds., Attachment Theory and Close Relationships, Guilford Press, New York, 46-76.
[21]
Mallinckrodt, B. and Chen, E.C. (2004) Attachment and Interpersonal Impact Perceptions of Group Members: A Social Relations Model Analysis of Transference. Psychotherapy Research, 14, 210-230. https://doi.org/10.1093/ptr/kph018
[22]
Mallinckrodt, B., Choi, G. and Daly, K.D. (2014) Pilot Test of a Measure to Assess Therapeutic Distance and Its Association with Client Attachment and Corrective Experience in Therapy. Psychotherapy Research, 25, 505-517. https://doi.org/10.1080/10503307.2014.928755
[23]
Robbins, S.B. (1995) Attachment Perspectives on the Counseling Relationship: Comment on Mallinckrodt, Gantt, and Coble. Journal of Counseling Psychology, 42, 318-319. https://doi.org/10.1037/0022-0167.42.3.318
[24]
Mallinckrodt, B., Anderson, M.Z., Choi, G., Levy, K.N., Petrowski, K., Sauer, E.M., Tishby, O. and Wiseman, H. (2017) Pseudosecure vs. Individuated-Secure Client Attachment to Therapist: Implications for Therapy Process and Outcome. Psychotherapy Research, 27, 677-691. https://doi.org/10.1080/10503307.2016.1152411
[25]
Parish, M. (2000) The Nature of the Patient’s Tie to the Therapist (Doctoral Dissertation, Adelphi University, 1999). Dissertation Abstracts International, 60, 6378-B.
[26]
Lilliengren, P., Werbart, A., Mothander, P.R., Ekström, A., Sjögren, S. and Ögren M.L. (2013) Patient Attachment to Therapist Rating Scale: Development and Psychometric Properties. Psychotherapy Research, 24, 184-201. https://doi.org/10.1080/10503307.2013.867462
[27]
Talia, A., Miller-Bottome, M. and Daniel, S.I. (2017) Assessing Attachment in Psychotherapy: Validation of the Patient Attachment Coding System (PACS). Clinical Psychology and Psychotherapy, 24, 149-161. https://doi.org/10.1002/cpp.1990
[28]
Láng, A., Péleya, B., Barlaya, L.M. and Bernáth, L. (2012) Measuring Patients’ Attachment Avoidance in Psychotherapy: Development of the Attachment Avoidance in Therapy Scale (AATS). Europe’s Journal of Psychology, 8, 620-631. https://doi.org/10.5964/ejop.v8i4.485
[29]
Daniel, S.I.F. (2006) Adult Attachment Patterns and Individual Psychotherapy: A Review. Clinical Psychology Review, 26, 968-984. https://doi.org/10.1016/j.cpr.2006.02.001
[30]
Mallinckrodt, B., Porter, M.J. and Kivlighan, D.M. (2005) Client Attachment to Therapist, Depth of In-Session Exploration and Object Relations in Brief Psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 42, 85-100. https://doi.org/10.1037/0033-3204.42.1.85
[31]
Romano, V., Fitzpatrick, M. and Janzen, J. (2008) The Secure-Base Hypothesis: Global Attachment, Attachment to Counselor, and Session Exploration in Psychotherapy. Journal of Counseling Psychology, 55, 495-504. https://doi.org/10.1037/a0013721
[32]
Janzen, J., Fitzpatrick, M. and Drapeau, M. (2008) Processes Involved in Client-Nominated Relationship Building Incidents: Client Attachment, Attachment to Therapist, and Session Impact. Psychotherapy, 45, 377-390. https://doi.org/10.1037/a0013310
[33]
Saypol, E. and Farber, B.A. (2010) Attachment Style and Patient Disclosure in Psychotherapy. Psychotherapy Research, 20, 462-471. https://doi.org/10.1080/10503301003796821
[34]
Woodhouse, S.S., Schlosser, L.Z., Crook, R.E., Ligiéro, D.P. and Gelso, C.J. (2003) Client Attachment to Therapist: Relations to Transference and Client Recollections of Parental Caregiving. Journal of Counseling Psychology, 50, 395-408. https://doi.org/10.1037/0022-0167.50.4.395
[35]
Bachelor, A., Meunier, G., Laverdiére, O. and Gamache, D. (2010) Client Attachment to Therapist: Relation to Client Personality and Symptomatology, and Their Contributions to the Therapeutic Alliance. Psychotherapy: Theory, Research, Practice, Training, 47, 454-468. https://doi.org/10.1037/a0022079
[36]
Crook, R.E., Gelso, C.J., Fischer, L. and Silva, L.R. (2007) Therapist Attachment, Client Attachment to Therapist, and Expected Working Alliance: An Analogue Study. Issues in Religion and Psychotherapy, 31, 36-45.
[37]
Diener, M.J. and Monroe, J.M. (2011) The Relationship between Adult Attachment Style and Therapeutic Alliance in Individual Psychotherapy: A Meta-Analytic Review. Psychotherapy, 48, 237-248. https://doi.org/10.1037/a0022425
[38]
Taylor, P.J., Rietzschel, J., Danquah, A. and Berry, K. (2015) The Role of Attachment Style, Attachment to Therapist, and Working Alliance in Response to Psychological Therapy. Psychology and Psychotherapy: Theory, Research and Practice, 88, 240-253. https://doi.org/10.1111/papt.12045
[39]
Meyer, B. and Pilkonis, P.A. (2001) Attachment Style. Psychotherapy, 38, 466-472. https://doi.org/10.1037/0033-3204.38.4.466
[40]
Sauer, E.M., Anderson, M.Z., Gormley, B., Richmond, C.J. and Preacco, L. (2010) Client Attachment Orientations, Working Alliances, and Responses to Therapy: A Psychology Training Clinic Study. Psychotherapy Research, 20, 702-711. https://doi.org/10.1080/10503307.2010.518635
[41]
Wiseman, H. and Tishby, O. (2015) Client Attachment, Attachment to the Therapist and Client-Therapist Attachment Match: How Do They Relate to Change in Psychodynamic Psychotherapy? Psychotherapy Research, 24, 392-406. https://doi.org/10.1080/10503307.2014.892646
[42]
Fuertes, J.N., Mislowack, A., Brown, S., Gur-Arie, S., Wilkinson, S. and Gelso, C.J. (2007) Correlates of the Real Relationship in Psychotherapy: A Study of Dyads. Psychotherapy Research, 17, 423-430. https://doi.org/10.1080/10503300600789189
[43]
Moore, S.R. and Gelso, C.J. (2011) Recollections of a Secure Base in Psychotherapy: Considerations of the Real Relationship. Psychotherapy, 48, 368-373. https://doi.org/10.1037/a0022421
[44]
Wang, C.C. and Mallinckrodt, B. (2006) Differences between Taiwanese and U.S. Cultural Beliefs about Ideal Adult Attachment. Journal of Counseling Psychology, 53, 192-204. https://doi.org/10.1037/0022-0167.53.2.192
[45]
Fraley, R.C., Waller, N.G. and Brennan, K.A. (2000) An Item Response Theory Analysis of Self-Report Measures of Adult Attachment. Journal of Personality and Social Psychology, 78, 350-365. https://doi.org/10.1037/0022-3514.78.2.350
[46]
Tsagarakis, M., Kafetsios, K. and Stalikas, A. (2007) Reliability and Validity of the Greek Version of the Revised Experiences in Close Relationships Measure of Adult Attachment. European Journal of Psychological Assessment, 23, 47-55. https://doi.org/10.1027/1015-5759.23.1.47
[47]
Horvath, A.O. and Greenberg, L.S. (1989) Development and Validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223-233. https://doi.org/10.1037/0022-0167.36.2.223
[48]
Papadimitriou, G. and Papakostas, I. (2002) The Relationship between the Patient and the Doctor. Medicine, 85, 44-56.
[49]
Dowd, E.T., Milne, C.R. and Wise, S.L. (1991) The Therapeutic Reactance Scale: A Measure of Psychological Reactance. Journal of Counseling and Development, 69, 541-545. https://doi.org/10.1002/j.1556-6676.1991.tb02638.x
[50]
Brehm, J.W. (1966) A Theory of Psychological Reactance. Academic Press, Oxford.
[51]
Snyder, C.R., Harris, C., Anderson, J.R., Holleran, S.A., Irving, L.M., Sigmon, S.T., Harney, P., et al. (1991) The Will and the Ways: Development and Validation of an Individual-Differences Measure of Hope. Journal of Personality and Social Psychology, 60, 570. https://doi.org/10.1037/0022-3514.60.4.570
[52]
Moustaki, M. and Stalikas, A. (2012a) The Hope Scale (HS). In: Stalikas, A., Triliva, S. and Roussi, P., Eds., Psychometric Instruments in Greece, 2nd Edition, Pedio, Athens, 517.
[53]
Pezirkianidis, C., Karakasidou, E., Dimitriadou, D. and Stalikas, A. (2017) Translation and Adaptation of Psychometric Tools. In: Galanakis, M., Pezirkianidis, C. and Stalikas, A., Eds., Basic Psychometric Issues, Topos Publications, Athens, 489-514.
[54]
Cohen, P., Cohen, J., West, S.G. and Aiken, L.S. (2002) Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. Lawrence Earlbaum Associates, Hillsdale.
[55]
Piedmont, R.L. (2014) Inter-Item Correlations. In: Michalos, A.C., Ed., Encyclopedia of Quality of Life and Well-Being Research, Springer, Dordrecht, 3303-3304. https://doi.org/10.1007/978-94-007-0753-5_1493
[56]
Williams, B., Onsman, A. and Brown, T. (2010) Exploratory Factor Analysis: A Five-Step Guide for Novices. Australasian Journal of Paramedicine, 8, 1-10.
[57]
Hair, J., Black, W., Babin, B. and Anderson, R. (2010) Multivariate Data Analysis. 7th Edition, Prentice-Hall, Inc., Upper Saddle River.
[58]
Hu, L.T. and Bentler, P.M. (1999) Cut-Off Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria versus New Alternatives. Structural Equation Modeling, 6, 1-55. https://doi.org/10.1080/10705519909540118
[59]
Browne, M.W. and Cudeck, R. (1993) Alternative Ways of Assessing Model Fit. In: Bollen, K.A. and Long, J.S., Eds., Testing Structural Equation Models, Sage, Newbury Park, 136-162.
[60]
Bentler, P.M. (1990) Comparative Fit Indexes in Structural Models. Psychological Bulletin, 107, 238-246. https://doi.org/10.1037/0033-2909.107.2.238
[61]
Tucker, L.R. and Lewis, C. (1973) A Reliability Coefficient for Maximum Likelihood Factor Analysis. Psychometrika, 38, 1-10. https://doi.org/10.1007/BF02291170
[62]
DeVellis, R.F. (2012) Scale Development: Theory and Applications. Sage, Los Angeles.
[63]
Kyriazos, T. (2017) Reliability of Psychometric Instruments. In: Galanakis, M., Pezirkianidis, C. and Stalikas, A., Eds., Basic Psychometric Issues, Topos, Athens, 85-121.
[64]
George, D. and Mallery, M. (2010) SPSS for Windows Step by Step: A Simple Guide and Reference, 17.0 Update, 10th Edition, Pearson, Boston.
[65]
Davidshofer, K.R. and Murphy, C.O. (2005) Psychological Testing: Principles and Applications. 6th Edition, Pearson, Upper Saddle River.
[66]
Cohen, J., Cohen, P., West, S.G. and Aiken, L.S. (2003) Applied Multiple Correlation/Regression Analysis for the Behavioral Sciences. Taylor and Francis, Abingdon-on-Thames.
[67]
Wei, M., Heppner, P.P. and Mallinckrodt, B. (2003) Perceived Coping as a Mediator between Attachment and Psychological Distress: A Structural Equation Modeling Approach. Journal of Counseling Psychology, 50, 438-447. https://doi.org/10.1037/0022-0167.50.4.438
[68]
Wei, M., Mallinckrodt, B., Russell, D.W. and Abraham, W.T. (2004) Maladaptive Perfectionism as a Mediator and Moderator between Adult Attachment and Depressive Mood. Journal of Counseling Psychology, 51, 201-212. https://doi.org/10.1037/0022-0167.51.2.201
[69]
Mallinckrodt, B. and Wei, M. (2005) Attachment, Social Competence, Social Support, and Psychological Distress. Journal of Counseling Psychology, 52, 358-367. https://doi.org/10.1037/0022-0167.52.3.358
[70]
Chan, Y.-C., Chan, F., Ditchman, N., Phillips, B. and Chou, C.C. (2013) Evaluating Snyder’s Hope Theory as a Motivational Model of Participation and Life Satisfaction for Individuals with Spinal Cord Injury: A Path Analysis. Rehabilitation Research Policy and Education, 27, 171-185. https://doi.org/10.1891/2168-6653.27.3.171
[71]
Davidson, O.B., Feldman, D.B. and Margalit, M. (2012) A Focused Intervention for 1st-Year College Students: Promoting Hope, Sense of Coherence, and Self-Efficacy. The Journal of Psychology, 146, 333-352. https://doi.org/10.1080/00223980.2011.634862
[72]
Schiff, M. and Levit, S. (2009) Correlates of Therapeutic Alliance and Treatment Outcomes among Israeli Female Methadone Patients. Research on Social Work Practice, 20, 380-390. https://doi.org/10.1177/1049731509347854
[73]
Giovazolias, T., Leontopoulou, S. and Triliva, S. (2010) Assessment of Greek University Students’ Counselling Needs and Attitudes: An Exploratory Study. International Journal for the Advancement of Counselling, 32, 101-116. https://doi.org/10.1007/s10447-010-9092-2
[74]
Koutra, A., Katsiadrami, A. and Diakogiannis, G. (2008) The Effect of Group Psychological Counselling in Greek University Students’ Anxiety, Depression, and Self-Esteem. European Journal of Counselling and Psychotherapy, 12, 101-111. https://doi.org/10.1080/13642537.2010.482733
[75]
Brouzos, A., Vassilopoulos, S. and Korfiati, A. (2015) Secondary School Students’ Perceptions of Their Counselling Needs in an Era of Global Financial Crisis: An Exploratory Study in Greece. International Journal for the Advancement of Counselling, 37, 168-178. https://doi.org/10.1007/s10447-015-9235-6
[76]
Yotsidi, V., Bohtsou, V., Kroupi, K., Pouloudi, M. and Fragkouli, A. (2018) What Makes the Difference? Community Mental Health Providers’ and Users’ Perceptions on Dealing with the Crisis in Greece. Journal of Psychosocial Rehabilitation and Mental Health, 1-13. https://doi.org/10.1007/s40737-018-0106-4
