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Attachment-Based Psychotherapy

OVERVIEW

Read full text: Attachment-Focused Parenting by Dan Hughes

Article from Psychology Today, July 2022.

Attachment-based therapy is a brief, process-oriented form of counseling. The client-therapist relationship is based on developing or rebuilding trust and centers on expressing emotions. An attachment-based approach to therapy looks at the connection between an infant’s early attachment experiences with primary caregivers, usually with parents, and the infant’s ability to develop normally and ultimately form healthy emotional and physical relationships as an adult. Attachment-based therapy aims to build or rebuild a trusting, supportive relationship that will help prevent or treat mental health conditions such as anxiety and depression.

Attachment-based therapy developed from the 1960s work of British psychologist John Bowlby, who first proposed that strong early attachment to at least one primary caregiver is necessary for children to have a sense of security and the supportive foundation they need to freely interact with their environment, to explore, to learn from new experiences, and to connect with others.” Based on his work, Bowlby described four different attachment styles: secure attachment, anxious attachment, avoidant attachment, and disorganized attachment. His work has sparked tremendous interest and exploration into attachment styles and how they may inform individuals’ relationships in adulthood.

Attachment-based therapy as described here should not be confused with unconventional, unproven, and potentially harmful treatments referred to as "attachment therapy" that involve physical manipulation, restraint, deprivation, boot camp–like activities, or physical discomfort of any kind. These so-called “attachment therapies” were developed in the 1970s as interventions for children with behavioral challenges, particularly those with autism; they have since been investigated and rejected by mainstream psychology and medicine. 

When It's Used

An attachment-based approach can be used in individual, family, couple, and group therapy, with both children and adults, to help clients mend or recover from fractured family relationships. Those who may benefit from attachment-based therapy include:

Some studies have demonstrated the efficacy and benefits of attachment-based therapy, but the evidence base for it is not as robust as it is for other forms of therapy.

What to Expect

Since the goal of ABFT extends to repairing the family relationship, the therapist will work with the individual adolescent client alone, and also with the family as a group. The therapist works with the family to build and strengthen the parent-child bond and help the child to develop into an independent, self-sufficient adult.

With individual adults, the therapist aims to help the client overcome the effects of negative early attachment difficulties by establishing a secure bond between the client and the therapist. Once this relationship is solidified, the therapist can help the client communicate more openly and better explore and understand how their current feelings and behaviors are associated with earlier experiences.

How It Works

According to John Bowlby’s work, strong early attachment led to safety, security, and support, which then led children to develop healthy connections with others.

Without a healthy foundation, babies may grow to be fearful, confused, and insecure, ultimately becoming depressed or even suicidal as adolescents. Theoretically, by forming a trusting relationship with parental figures or with the therapist, the client is better prepared to form strong bonds in other relationships.

To do so, patients may explore their childhood in therapy. They may discuss their early relationship with their parent or caregiver, family dynamics as they grew up, and significant childhood experiences. They may explore connections between their childhood relationships and their adult relationships—how the past may have influenced the present. They may discuss skills to improve their current relationships, emotions, and behaviors. And they may work with their family members to improve together.

Attachment-based therapy may be used in conjunction with other forms of therapy.

References

Ewing ES, Diamond G, Levy S. Attachment-based family therapy for depressed and suicidal adolescents; theory, clinical model and empirical support. Attachment & Human Development. 2015; 17(2): 136-156.    

 

Dozier M. Attachment-based treatment for vulnerable children. Attachment & Human Development. 2003; 5(3): 253-257.

Cicchetti D, Toth SL and Rogosch FA. The efficacy of toddler-parent psychotherapy to increase attachment security in offspring of depressed mothers. Attachment & Human Development. 1999; 1(1): 34-66. Published online 2 June 2006.

Daniel S. Adult attachment patterns and individual psychotherapy: a review. Clinical Psychology Review. December 2006; 26(8): 968-984.

American Association for Marriage and Family Therapy. Adult Attachment Relationships.

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