Attachment-Based Therapy: How It Works, Techniques, & Effectiveness

What Is Attachment-Based Therapy?

Attachment-based therapy is a style of trauma-informed therapy that is based on attachment theory, which focuses primarily on the role of early interactions between a child and their adult caregivers. Attachment-based family therapy (ABFT) falls within this category, and is a type of family therapy that is used to treat kids and teens with behavioral and emotional problems that stem from childhood trauma associated with poor attachment styles.

Poor attachment styles are strongly connected to trauma and oftentimes children and adolescents will turn to drugs and alcohol to cope with these problems. As a result, many children and adolescents will present with substance use disorders and mental health disorders when in reality these stem from unhealthy childhood attachments.

This model of therapy draws from attachment theory, family systems, emotion focused therapy for couples, and behavioral therapies like CBT and DBT.^5,6 Attachment-based therapy can also be combined with couples or individual counseling for those who did not have their emotional needs met in childhood. It is a trauma-informed, process-oriented model designed to help people strengthen their relationships with themselves and others.⁵

Attachment Based Therapy for Adults

With adults, attachment-based therapy often involves reviewing early memories from childhood through the lens of attachment theory, identifying unmet needs, and helping clients draw on inner and outer resources to meet these needs now.⁴

Attachment Based Therapy Vs. Attachment Therapy

Attachment-based therapy is not the same as attachment therapy, which is a controversial therapy that promotes questionable methods like the physical restraint of children.

What Is Attachment Theory?

Attachment theory was developed in the 1960’s by two psychologists named John Bowlby and Mary Ainsworth. They believed that strong, close relationships between children and their caregivers is an essential ingredient for normal child development.^2,3 When this is present, they theorized that children develop a “secure attachment style” that allows them to develop normally and form healthy relationships with others.^4,7 When it is not present, children develop an ‘insecure attachment style’ which predisposes them to a range of emotional, behavioral, and interpersonal problems.^{1, 8}

Some of the problems related to insecure attachment styles are present in childhood and can include issues like separation anxiety, tantrums, and low self-esteem. Bowlby and Ainsworth also believed that attachment issues follow people into adulthood, leading to increased risk for anxiety, depression, substance use disorders, and relationship problems.⁸ Some examples of problems linked to insecure attachment include codependent relationships, avoidant behaviors, obsessive compulsive disorder (OCD), and personality disorders.⁷ This theory has gained popularity again in recent years, and attachment-based therapy has also become more widely used.¹

There are three different insecure attachment styles in attachment theory, which include:^{2, 3}

• Avoidant attachment style: This attachment style is characterized by avoidance of relationships or intimacy, which is usually caused by deep-seated trust issues that develop in response to childhood trauma or family dysfunction
• Anxious attachment style: This most commonly occurs because of a deep fear of abandonment, usually the result of abuse, neglect, or inconsistent caregiving in childhood
• Disorganized attachment style: Often considered the most severe form of insecure attachments, a disorganized style leads to extreme emotional and social instability, and is often the result of emotional neglect in childhood.

When Is Attachment-Based Therapy Used?

Attachment-based therapy can be used with children, families, couples, or adults. This kind of therapy can help people struggling with a wide range of mental health problems and relationship issues, but is most often used with adults who report a history of childhood trauma or family dysfunction.

Attachment-based therapy is more commonly used with children and teens who present with social, emotional, or behavioral problems.^4,5,6

Attachment-based family therapy might be especially helpful for children and teens who:^1,7

• Have been placed in foster care or up for adoption
• Experienced separation from a caregiver
• Were victims of abuse or neglect
• Had a parent or caregiver die
• Had their parents divorce or separate
• Had a parent or caregiver with a mental illness or addiction
• Are acting out or displaying symptoms of ODD or conduct disorder
• Internalize their emotions or have symptoms of anxiety or depression

Attachment-based therapy might be recommended for adults who:^4,5,6,7

• Experienced trauma, abuse, or neglect in childhood
• Struggle with complex trauma or have symptoms of a personality disorder
• Have strained or unhealthy relationships with their family of origin
• Have a previous or current diagnosis of posttraumatic stress disorder (PTSD)
• Are unable to regulate their emotions or express them in healthy ways
• Have a tendency to get involved in unhealthy, abusive, or codependent relationships
• Have deep-seated trust issues that stem from childhood, are socially avoidant, or unable to form close relationships with people
• Struggle with intense fears of abandonment that cause problems in their relationships
• Struggle with OCD or high levels of anxiety
• Struggle with a substance use disorder

Benefits of Attachment-Based Therapy

While attachment-based therapy isn’t right for everyone, many people benefit greatly from this kind of treatment. Those who have a history of abuse, neglect, or childhood trauma may be especially likely to benefit from attachment-based therapy, as it is a trauma-informed approach.

Potential benefits of attachment therapy include:^4,9

• Feeling more secure and stable
• More positive and optimistic thinking
• Improved emotional regulation
• Improved social and communication skills
• Healthier relationships and fewer conflicts
• Improved parent-caregiver bonds (in kids and teens)
• Reduced symptoms of depression, anxiety, and other mental illnesses
• Improved parenting (for kids and teens in family therapy)

Is Attachment-Based Therapy Effective?

There has not been a lot of research on the effectiveness of attachment-based therapy approaches. What little research has been done focuses more so on its efficacy with children and adolescents, rather than adults. Most of these studies combine elements of attachment-based therapy with family therapy, found to be beneficial in treating younger populations struggling with depression, suicidality, and trauma.⁵

One meta-analysis found that attachment-based therapy was helpful to children and teens who display signs of insecure attachments or attachment disorders.¹⁰ Other studies found that attachment-based approaches were no more effective than other forms of family therapy in addressing anxiety, depression, and suicidality.⁶

Attachment-Based Therapy Techniques

The methods of interventions used in attachment-based therapy will vary depending on the client’s age and presenting issue. The focus of attachment-based treatment with kids and teens is usually on strengthening the parent-child relationship, while the focus with adults is centered around individual goals.^1,4,5,6

When working with kids and teens, therapists often recommend that parents or caregivers be actively involved in treatment, and treatment often includes a mix of family therapy, individual therapy, and parenting skills. When used with adults in individual counseling, attachment-based therapy is more similar to a trauma-informed counseling style than a type of family therapy.

Common attachment-based therapy techniques used with children, teens, and families include:^4,9,11

• ABC approach: The Attachment and Biobehavioral Catch-up (ABC) approach, developed by Mary Dozier, is used to help parents respond in more positive and nurturing ways.
• Communication skills training: Many attachment-based family therapists spend time helping parents/caregivers communicate more empathetically with their child or teen.
• Role-playing: Role-plays are sometimes used in therapy to help parents and children ‘practice’ different ways of communicating and responding to one another in normal daily interactions, as well as conflict situations.
• Rewriting narratives: Attachment-based family therapists often work with families to identify and change ‘narratives’, or expectations, they’ve developed about how their family members will respond to them.
• Repairing attachment: Repairing attachment is the process of trying to heal old relationships and attachment ruptures that may have occurred between family members. This process usually involves encouraging clients to express their desire for closeness with one another, and then helping them identify ways to attain it (i.e., through quality time, positive interactions, etc.).

Common attachment-based therapy techniques used with adults include:^{4, 11}

• Rapport building: Attachment-based therapists will work to establish a ‘secure base’ or strong relationship with each of their clients by using rapport-building techniques and person-centered approaches aimed at fostering trust and openness.
• Psychoeducation: Psychoeducation will be provided to help clients understand the importance of early attachment, experiences that can disrupt attachment, and some of the lasting effects of insecure attachments
• Assessment: The Adult Attachment Interview may be used to gather more information about a person’s early childhood, relationship with adult caregivers, and to identify early attachment wounds that might be impacting the person today.
• Attachment style quiz: Attachment style quizzes or assessments may also be used to identify a person’s attachment style, which is used to tailor a treatment plan to the specific needs of each client.
• Insight building: Attachment-based therapists may help clients develop more insight and self-awareness into “inner working models”, allowing them to examine how their attachment style affects their mental health, communication patterns, and relationships.
• Resilience building: During a session, clients tap into their inner resources to manage stress and anxiety, regulate their emotions, and respond more effectively to stressful situations.
• Communication skills: Because attachment-based therapy focuses on the importance of strong, close relationships with others, communication skills and conflict resolution are typically a component of therapy.
• Self-compassion: Attachment-based therapy for adults may focus highly on repairing a person’s relationship with themselves by promoting improved self-talk, self-compassion, and self-care.

Is Attachment-Based Therapy a Good Fit for Me?

There are many different variations of counseling and therapy available, and it’s really important to find one that is a good fit for you. Certain people might respond better to attachment therapy than others.

You might be more likely to benefit from attachment-based therapy if you:^1,7

• Have a history of unresolved childhood trauma or come from a dysfunctional home
• Suspect your childhood experiences are a root cause of your current issues
• Want to better understand how your past is affecting you now
• Want to know how to heal and move on from your childhood
• Have significant trust or abandonment issues that interfere with your relationships
• Find yourself repeating unhealthy patterns in your relationships
• Struggle with negative self-talk, low self-esteem, insecurities or shame
• Want to develop better, healthier coping skills for difficult emotions

When Is Attachment-Based Therapy Not the Right Fit?

You might be less likely to benefit from attachment therapy if you:

• Don’t have any childhood trauma and have a strong, close relationship with your family
• Do not suspect that childhood issues are causing the problems you’re having now
• Have had mostly healthy relationships that were close, stable, and long-term
• Want to focus on more recent or current issues in therapy (vs. from your childhood)
• Are looking for practical and concrete solutions for current problems you’re facing
• Aren’t having relationship issues, and need help for something else

How to Find an Attachment-Based Therapist

If you’re looking for a therapist who uses an attachment-based approach, you might want to consider using an online therapist directory that allows you to narrow down your search by location, insurance type, and certain issues that each therapist specializes in. Look for therapists who list ‘attachment-based therapy’ or ‘attachment theory’ in their profile, as well as those who mention ‘trauma’ or ‘trauma-informed therapy’.

Once you’ve identified a few different therapists you like, consider scheduling a consultation call with each one. This gives you the chance to ask questions, get information, and learn more about their approach. This helps to ensure that you find the right therapist with a fitting background, experience, and approach.

Some questions to consider asking a prospective therapist include:

1. How long have you been using attachment-based therapy with your clients?
2. How do you incorporate attachment-based therapy into your approach?
3. Do you think an attachment-based approach would be helpful for me (after giving some preliminary information about your issue)?
4. Based on your experience, how long do you expect treatment to last?
5. What are some of the potential benefits of this kind of treatment for someone with my issues?

Final Thoughts on Attachment Based Therapy

Attachment-based therapy draws from attachment theory, which posits that early bonding between children and their adult caregivers is an essential building block for development. Without this, insecure attachment styles can form, which are believed to place a person at higher risk for a range of different psychological and social problems.^1,2,3 Attachment-based therapy approaches aim to correct and heal old attachment wounds in order to improve a person’s mental health, self-esteem, and personal relationships.^1,4