Attachment-Based Therapy

Medically reviewed by Julie Dodson, MA
Updated May 23, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that include abuse which could be triggering to the reader. If you or someone you love is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Attachment based therapy stems from attachment theory, which posits that how you were treated as a child may influence your relationships as an adult. Those who experienced challenging or dysfunctional relationships as children with unmet emotional or physical needs may experience relationship problems or mental health problems later in life. Learning about attachment styles and attachment based therapy may help you explore potential solutions and types of treatment with a mental health professional.  

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What is attachment theory?

Attachment theory is a psychological, evolutionary theory developed by psychologist John Bowlby in the 1940s to describe how individuals form healthy relationships. Bowlby’s clinical psychology theory states that humans developed emotional attachments as an evolutionary response to ensure the species’ survival. 

Attachment theory suggests that how primary caregivers treat children and how they form a strong early attachment establishes how that person will relate to others throughout their lives. This theory of early attachment wounds influencing adult attachment patterns aligns best with the attachment parenting style. Psychologist Mary Salter Ainsworth later worked with Bowlby to refine the theory and develop the four primary attachment styles.

Attachment styles

There are four primary attachment styles, including the following: 

Secure attachment 

Secure attachment is the ideal form of attachment that allows adults to form and maintain healthy, secure relationships. They may feel comfortable setting and accepting boundaries, taking space or being close, and starting or stopping a relationship when necessary. 

Anxious attachment 

Those with an anxious-preoccupied attachment style may experience fear of abandonment in adult relationships. They might seek reassurance, attempt to keep close to others, or try to control how others act. People with an anxious attachment style may find relationships to be anxiety inducing.

Avoidant attachment 

Those with this attachment style might avoid intimate or physical relationships. They may feel uncomfortable connecting with others, opening up, or discussing emotions. People with dismissive-avoidant insecure attachments may find relationships to be uncomfortable, especially if the other partner desires more closeness than they want or are used to.
Disorganized attachment style (fearful-avoidant) 
Those with a fearful-avoidant or disorganized style may demonstrate emotional and social insecurity. They might crave close connection and physical affection but become afraid and avoidant once they are attained. This attachment style may be caused by early attachment wounds that occurred during child development, like neglect or abuse.

What is attachment-based family therapy?

Attachment based therapy, also called attachment therapy or attachment-based family therapy (ABFT), is a style of counseling based on Bowlby’s theory centering on the role of interactions between children and their parents or guardians. Attachment based therapy developed from attachment theory, which suggests that our earliest relationships with caregivers shape how we perceive and respond to the world. ABFT is often used to treat children and adolescents with emotional and behavioral issues rooted in childhood trauma and insecure attachment styles. Attachment based therapy often addresses attachment concerns in adults with complex trauma or adverse childhood experiences. 

Peter C. Costello, Ph.D., author of Attachment-Based Psychotherapy in Practice, states, “Attachment based therapy is an approach to therapy that specifically targets those thoughts, feelings, communications, behaviors, and interpersonal exchanges that patients have learned either to suppress and avoid or to amplify and overemphasize because of early attachment experiences.”  

Reactive attachment disorder (RAD) is a condition in which a child has difficulty forming a healthy attachment to their primary caregivers. This is often due to severe neglect, abuse, or frequent changes in caregivers during early childhood. Attachment-based therapists are trained to work with children and families dealing with RAD, aiming to help them form strong early attachments and develop healthy attachment patterns in the future.

What to expect from adult attachment-based therapy

Attachment patterns developed in early childhood can persist into adulthood, influencing adult relationships and human development. Attachment-based treatment can help adults recognize and address their attachment patterns, allowing them to build healthy attachment habits in their relationships and improve their mental health.

Individual attachment based therapy may focus on helping clients overcome the effects of insecure attachments formed during childhood. In this type of treatment, expect to discuss your past experiences and family relationships as you build trust with your therapist. Attachment-based family therapy may shift toward helping you express and explore your feelings and how they relate to your behaviors to create functional, healthy relationships. 

While attachment disorders are only diagnosable in children, adults can experience insecure attachment styles, trauma, post-traumatic stress disorder, and relationship difficulties. Adult attachment patterns include secure, anxious, dismissive-avoidant, and fearful-avoidant. Working with a therapist can help a person develop communication skills to form meaningful connections with others and maintain them throughout time. You might consider attachment-based counseling if you find it challenging to make yourself emotionally vulnerable or trust others. 


How attachment based therapy works

Various attachment-based therapies are available, and your counselor may examine your situation to decide which type will benefit you most. A few ABFT techniques include the following: 

For children, teens, and families

In childhood or family-based attachment therapy, a family therapist can help children and families with the following: 

  • Daily life or conflict roleplaying 
  • Learning effective ways to communicate
  • Healing damaged relationships and repairing attachments
  • Working to change expectations and family narratives

Attachment-based family therapy should not involve harmful practices like rebirthing therapy, forceful touch, physical restraint, or hypnosis to manipulate a child, teen, or adult These practices are banned and unethical. However, if you see them occurring or are suggested a similar type of therapy, report it to your state board. 

For adults
Adult attachment based therapy may involve the following types of therapy methods: 
  • Practicing self-compassion
  • Gaining communication and conflict-resolution skills
  • Building trust with a therapist to facilitate open communication
  • Conducting an Adult Attachment Interview or attachment-style quizzes
  • Providing psychoeducation about attachment styles and healthy human development
  • Building insight and resilience
Benefits of attachment therapy

Lingering issues may affect a child’s ability to have positive interactions and meaningful relationships with others as an adult. Through working with a therapist in attachment based family therapy, many people with insecure attachment styles may gain a sense of security for themselves and those they love.  

Therapy may also help you understand a traumatic past and find emotional balance, increasing self-confidence and self-esteem. Other benefits of attachment therapies may include a shift toward more positive, optimistic thinking, growing communication and social skills, fewer conflicts, healthier relationships, stronger family bonds, and improved symptoms of mental health conditions. Some therapists who are more familiar with mindfulness-based approaches may incorporate therapy using non-attachment techniques that help the clients let go of harmful beliefs from their childhood.

While how you relate to others may have been developed during infancy and childhood, you can overcome unhealthy attachment styles and habits. Many studies have found that insecure attachment styles can change with therapy and an extensive understanding of how attachment works.

Is attachment-based therapy effective?

Researchers at the Drexel University Center for Family Intervention Science state that attachment based therapy is an empirically supported treatment with a process-oriented, trauma-informed approach to treating suicidal behaviors and mental health conditions associated with depression and trauma. An attachment-based approach offers therapists “a clear structure and road map” to help them address attachment at the core of a family.  

However, the effectiveness of attachment based therapy can also depend on personal factors. You may have to be willing and comfortable for the therapy to work. Building a trusting, supportive relationship with your therapist can be crucial to the attachment therapy process. If you feel your therapist has harmed you or is not compassionate, you might not benefit from discussing sensitive topics with them.

Who can benefit from counseling?

Attachment based therapy can be conducted in multiple therapeutic settings. You might choose between individual, family, couples, or group therapy for you, your child, or your family members. If you or one of your loved ones have experienced trauma or are living with an insecure attachment style, this type of therapy with an attachment based therapist may be beneficial.

Attachment therapy may also benefit the following individuals: 

  • Adopted children or individuals in prior foster care removed from their birth homes or those experiencing adoption or foster-related trauma 
  • Children of parents living with a mental health condition 
  • Those who have experienced trauma, abuse, or neglect from a primary caregiver 
  • Adolescents experiencing depression or suicidal thoughts
  • Adults experiencing fear of abandonment, trust issues, or anxiety
  • Adults with difficulty controlling or expressing emotions 
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Is attachment-based therapy right for you?

While attachment based therapy may not work for everyone, past researchers like Bowlby believed that all adults have an attachment style. If you are experiencing an insecure attachment style, you might find attachment based therapy beneficial, even if you felt your childhood was not traumatic or challenging. Attachment therapy can help you learn more about your current behavioral patterns and relationship goals.  

Counseling options 

While you may be aware of your past, seeing how those experiences influence you as an adult can be challenging. Consider speaking with a therapist if you struggle to relate to others or build and maintain healthy, functional relationships. Attachment based therapy may help you reshape your perspective about yourself and others in relationships while building communication skills. You may learn more about the family process and its influence on your ability to form a secure relationship when you meet someone new. 

If you face barriers to mental healthcare like cost or scheduling, you can also consider online therapy. Many people are turning to online individual psychotherapy platforms to seek mental health support due to the lower cost, increased convenience, and flexible appointment methods. You can set your own schedule through the platform and choose between phone, video, or live chat sessions. 
In addition to the benefits of online counseling, there is plenty of empirical support for its effectiveness for anxiety disorders, depression, and other mental illnesses. One study found that 71% of participants preferred internet-based treatment methods to traditional methods, and some experienced a higher quality of life and symptom reduction. With individual therapy online, you may find that you feel more comfortable connecting with a therapist than you do with in-person therapy. 
Attachment-based therapy may help adults address attachment styles, understand their childhood experiences, and form healthy connections with those they love. Attachment-based therapy may also be available for families with children. If you’re interested in this form of treatment, consider reaching out to a therapist specializing in attachment theory to learn more about your options and receive compassionate guidance.
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