Attachment-Based Therapy

For attachment-based therapy to be effective, individuals typically must explore their childhood, including their early relationships with their caregivers, their family dynamics, and any significant childhood experiences they can recall. They may also examine connections between their present relationships and how the past may affect them.

Establishing a secure therapeutic relationship

Attachment-based therapy generally has two central processes. The first usually consists of the therapist creating a responsive, open, and secure relationship with the patient, which is typically essential for a good therapeutic outcome.

To foster this secure relationship, the therapist and client usually talk about the client’s upbringing in detail, discussing their relationships with caregivers, significant early memories, and family dynamics. They may then talk about the ways in which their upbringing continues to influence their current relationships. When the client can tell the stories of their childhood while feeling safe and secure in a therapeutic setting, this usually begins to decrease the power these experiences hold over them in the present.

Over time, the client may grow to trust and feel comfortable with the therapist as they are provided with empathy and acceptance during these potentially vulnerable conversations. This can show them that they are capable of forming a healthy, secure relationship.

Facilitating adaptive growth

The second central process of attachment-based psychotherapy normally depends on the relationship established in the first. It typically focuses on facilitating and strengthening adaptive thoughts, behaviors, and emotions by addressing the maladaptive thoughts, behaviors, and emotions the patient may have learned to suppress or overemphasize in early insecure attachment relationships. This can be thought of as “re-parenting” the client’s inner child. The client, as an adult, can extend care and compassion to their inner child throughout this process, taking back power from their caregivers and gaining inner strength.

Based on previous conversations about the client’s childhood and maladaptive coping skills, the therapist can guide them to consider ways to shift these coping skills to be healthier and more constructive. This can be an enlightening process of learning and growth in which the client begins to fully understand how the protective mechanisms they developed as a child could be holding them back in their current relationships.

It can be empowering for clients to discover that it’s possible to adapt their thoughts, emotions, and behaviors in a way that enables them to have fulfilling, healthy adult relationships. The therapist may help them gain awareness of potentially harmful defense mechanisms like projection and denial and teach them skills like active listening, assertive communication, boundary setting, and conflict resolution.

Reshaping adaptive capacities

These two processes may allow the therapist to help the patient reshape their capacity for adaptive behaviors. This often requires that the therapist understand what the patient feels unsafe thinking, perceiving, feeling, doing, or communicating. If attachment-based therapy is successful, the patient’s earliest internal models of who they are may change, which may help them become more adaptive and open, leading to them having better relationships and being more effective in the world. 

In attachment-based therapy, the therapist typically learns about the patient’s early childhood and relationships with their caregivers. After the therapist has enough information, they may identify their patient’s attachment style, which may affect how therapy proceeds.

Identifying attachment styles

There are multiple attachment styles that therapists may identify in attachment-focused therapy. Anxious attachment style can form when a baby has an inconsistent caregiver. This type can occur when the primary caregivers do not meet the infant’s needs consistently. The baby learns that their caregivers may not give them the attention they need, so they may not be easily comforted by their caregivers. In adult relationships, people with this attachment style may be needy or clingy and need constant reassurance. 

Another attachment style is avoidant, which may form when a baby does not get enough emotional support from their caregiver. The baby may learn they cannot rely on others to meet their emotional needs. People with this attachment style may be overly self-sufficient or avoid emotional conversations. They can be emotionally guarded and may be seen as self-reliant and distant.

Disorganized attachment, also referred to as fearful-avoidant attachment, is considered one of the more complex attachment styles. This type can form when infancy and childhood are marked by trauma or fear, and it tends to stem from an erratic caregiver relationship. As adults, people with this attachment style may have personality disorders or other mental health disorders. They may desire close relationships but push people away when they show affection or attention.

Determining the therapeutic approach

Once the therapist identifies the attachment style, they typically work with the person to help them develop a more secure attachment style. Therapists may accomplish this by helping people learn how to express their feelings and needs, develop a stronger sense of self, and be emotionally available to others. The therapist's methods may heavily depend on the type of attachment style.

Attachment-based therapy can benefit anyone with an unhealthy attachment style and can be used in family, individual, couple, and group therapy settings. Those who may benefit from this type of therapy include: 

• People who have experienced intimate partner violence
• People who were adopted as children
• Children in foster care or adults who have been in foster care
• Children who experienced trauma or adults who experienced trauma as children
• Adolescents and young adults experiencing anxiety, depression, or thoughts of suicide
• Adolescents and young adults living with bulimia nervosa⁴ or binge eating disorder.⁵

Attachment-based therapy typically hinges on the individual’s attachment to the therapist. Recent research shows that the individual’s perception of the attachment in the patient-therapist relationship has a more significant influence on the success of therapy than the attachment style of the therapist. This study found that a patient’s representation of attachment to the therapist reasonably influenced their attachment to their therapist but that the therapist’s attachment style did not significantly affect the patient’s attachment to them.

Recent research looked at the neuroscience of attachment and how it affects psychological therapies and the therapist-patient relationship. Researchers believe that attachment therapy relies on patients being able to revise their old assumptions and that the therapist must give the patient the freedom to think and speak their mind while also accepting that, in the beginning, the patient may mistrust or reject the therapist. This research indicates that mentalizing, or the ability to understand the mental state of oneself or others and how it affects one’s behavior, may be a key to the success of psychotherapy. According to the authors, compromised mentalizing is typical of insecure attachments. Once the patient can mentalize effectively, they may develop more realistic views of themselves and others, including their therapist, which may lead to better results.

As mentioned in the research noted above, the relationship between the patient and the therapist is typically essential to attachment-based therapy, which means that it can be vital to find a therapist with whom you connect well.

If you want to learn more about attachment-based therapy, you might consider online therapy. When you sign up for online treatment, you can typically be matched with a licensed therapist within 48 hours. With BetterHelp, you can change therapists at any time. With a platform like BetterHelp, you can choose from more than 25,000 therapists based on your needs, preferences, and location from the comfort of your own home, so you can make sure you find one with whom you can build a secure relationship. To learn more, reach out to BetterHelp today.