Cette revue de littérature synthétise les résultats des études ayant utilisé une mesure empirique de l’attachement du client au thérapeute en psychothérapie. Une recherche systématique dans les bases de données Medline, Embase, Pubmed, PsycInfo, et Web Of Science a débouché sur 25 études publiées. Une approche méta-analytique a également été utilisée pour examiner la corrélation avec l’alliance thérapeutique (11 études) et l’attachement adulte du client avant la thérapie (11 études). Les résultats montrent que l’attachement du client au thérapeute Sécure est très fortement corrélé à l’alliance thérapeutique, moyennement corrélé aux résultats, et faiblement corrélé négativement aux dimensions d’évitement et d’anxiété de l’attachement adulte. Le style Evitant–Craintif montre des résultats inverse au style Sécure, alors que le style Préoccupé–Fusionnel montre plutôt des corrélations faibles ou nulles, et qui varient suivant les études. Ces résultats sont consistants avec la conception de Bowlby concernant le thérapeute comme base sécure et confirment la pertinence de l’attachement au thérapeute comme prédicteur des résultats et du processus de changement en psychothérapie, pour différentes formes de thérapies et différents types de patients.

Attachment theory describes characteristic patterns of relating to close others and has important implications for psychotherapy. Consistent with Bowlby's (1988) secure base conception of attachment in psychotherapy, several instruments have been developed to measure client attachment to therapist. Despite a large number of studies, no review takes into account all published work. The purpose of this systematic review was to compare different measures of client's attachment to therapist, with different groups of client and in different therapeutic contexts. Medline, Embase, Pubmed, PsycInfo, and Web Of Science were searched to identify studies published between 1995 and 2019 reporting on help-seeking client's attachment to therapist. Twenty-five empirical papers met the inclusion criteria. Meta-analyses were conducted for studies that examined client attachment to therapist subscales (Secure, Avoidant–Fearful, Preoccupied–Merger) as correlates of client-rated working alliance (K=11, 892 clients), and general adult attachment (K=11, 752 clients). The results show that the client's secure attachment to therapist is strongly correlated with the therapeutic alliance (mean weighted R=0,71 [95% CI=0.62–0.79]), moderately correlated with the results, and negatively correlated with the avoidance (mean weighted r=−0,12 [IC 95%=−0.06–−0.21]) and anxiety dimensions (mean weighted R=−0,11 [IC 95%=−0.03–−0.17]) of adult attachment. With the Avoidant–Fearful style, results go in the opposite direction, negatively correlated with the therapeutic alliance (mean weighted R=−0.55 [IC 95%=−0.59–−0.50]), negatively correlated with the results, and correlated with the avoidance dimension of adult attachment (mean weighted R=0,16 [IC 95%=0.09–0.23]). The Preoccupied–Merger style shows weak (positive or negative) to zero correlations. In addition, nine studies looked at some dimensions of the psychotherapy process (e.g., resistance, transference, emotions, self-disclosure, and attitude toward psychotherapy), showing that insecurity of attachment to the therapist (both Avoidant–Fearful style and Preoccupied–Merger style) seem to interfere in one way or another with the development of a productive psychotherapy process. Overall, these results are in line with what was expected. They are consistent with Bowlby's conception of a secure base of attachment in psychotherapy. They showed that dysfunction and maladaptive developmental experience interfere with adult's ability needed to establish secure attachments and that psychotherapy may play the role of what has been previously defined as corrective emotional–or intersubjective–experience. In addition, these results do not seem to vary according to the instruments used. Together, the high correlation with therapeutic alliance and the weak correlation with pretherapy adult attachment confirm the relevance of the client's attachment to therapist as a specific variable related to the process of change in psychotherapy.