Attachment-based therapy applies to interventions or approaches based on attachment theory, originated by John Bowlby. Therapeutic approaches include working with individuals, couples, families, social systems, public health programs, and interventions specifically designed for adoption and foster care. Attachment theory has become a major scientific theory of biopsychosocial development with one of the broadest, deepest research lines in modern psychology and has and continues to spawn approaches to improving human health.
Attachment is a complex concept which continues to evolve. There are at least five attachment theories and several attachment assessments. These are generally in the developmental psychology or the social psychology disciplines which can differ in their understanding of relational problems and terminology describing the attachment concept. It's helpful to know which theory a therapy relies on, what part of the theory the therapy is addressing, and if the therapy is modifying the underlying theory. Failure to be clear about that has, in the past, led to coercive and harmful therapies allegedly based on attachment. Some attachment therapies utilize attachment assessments and some don't.
There may be a difference between the terms attachment based/focused/influenced/related, although it is likely hard to draw distinct lines. Because attachment describes a fundamental and universal human biopsychosocial system, most modern therapeutic models incorporate attachment to at least some degree. Not every such therapy can be identified in this article.
Brief definition of attachment The definition of attachment varies by theory and within theory branches. Theories vary in the breadth of issues which are or can be identified. This relates in part to the amount and quality of assessment methods the theory relies on.
Broadly, attachment describes a human system to support survival, reproduction, and protection of progeny. It's not unlike the fight-flight-freeze system albeit more complex, involving a collection of neurobiological systems working to optimize survival in relationship contexts. The attachment behavioral system starts to develop at around 7 months, or at least becomes observable, develops into patterns in the first several years of life, and continues to be an active and patterned system throughout the lifespan. Patterns sometimes change throughout.
Attachment is thought to involve a mix of interacting factors including neurobiology, genetics, epigenetics, emotion, affective and cognitive systems, memory systems, relationship experiences, and social and environmental factors. These all interact to influence responses by humans (and mammals and other animals) to danger across domains of emotions, behavior, thoughts, information processing, communication styles, the use of memory systems, and experience of trauma and loss. Attachment experiences can create biases in any of those domains.
Attachment theories describe the significance and effect of loss and trauma. Some theories describe attachment as a system relevant to understanding adult and romantic partner interactions. Some focus on a child or adult need for safety and the impact on defense mechanisms. Some on the need for protection from danger and need for comfort after exposure to danger and the impact on information processing and self-protective strategies.
Attachment and bonding share elements in common but they are distinguishable terms. Bonding-specific therapies are not necessarily identified in this article.
Attachment theories and assessment methods
Ainsworth model (ABC) Mary Ainsworth became Bowlby's colleague and they collaborated to develop attachment from 1940 to 1980. She was an American developmental psychologist who, in the 1960s, created the first scientific method to assess attachment, for a young child's attachment pattern. It is called the strange situation, or strange situation procedure (SSP), and is a highly respected assessment method used in many studies across the globe.
Ainsworth identified three primary patterns of attachment behaviors, which she initially labeled A, B, and C. Nine sub-patterns were identified by the time of her death A1, A2, B1, B2, B3, B4, B5, C1 and C2. These patterns endure in other models but go by different top level terms and may be described somewhat differently. Her patterns, method of assessment and theories are often called the Ainsworth model or the Bowlby-Ainsworth model or tradition, or the ABC model of attachment. Many therapies seek to address the challenges unique to each pattern. Some therapists can utilize an SSP or other age-appropriate assessment.
Berkeley model (ABC+D) Beginning in the 1970s some of Ainsworth's graduate students in the developmental discipline, including Mary Main, helped to expand her theory and science. Some of this work was done at the University of California, Berkeley, with Main's graduate students, so their model is sometimes called the Berkely model. Carol George, Judith Solomon, Jude Cassidy, and Ruth Goldwyn are some of people commonly associated with this group.
George and colleagues developed several assessment methods including the Adult Attachment Interview (AAI) and Adult Attachment Projective (AAP). The AAI is used extensively in research, and considered a comprehensive, if complex, adult assessment. Some therapies and therapists use assessments as a tool or use findings and theory developed from AAI science as a foundation for working with the client., The Berkeley model assessment methods allowed attachment science to confirm that childhood attachment experiences can directly impact how adults direct their attention, feel, behave, think, communicate, respond to threat, experience trauma and loss, and utilize memory systems.
Disorganized attachment was a fourth pattern they believed they identified. Thus, their model is also called the ABC+D model. The concept of disorganized attachment became wildly popular, particularly among clinicians and social workers, and a massive amount of research was conducted using this concept. However the concept was eventually determined to have no clinical or forensic usefulness in a 2017 paper penned by lead author Pehr Granqvist and signed by 43 authors including the five theory developers identified above. This paper likely casts serious concern about any attachment-informed therapy purporting to address disorganized attachment.
The ABC+D model differs in some respects to the Bowlby-Ainsworth model, and there are branched ABC+D theories. Not counting any disorganized patterns, this model expanded Ainsworth's original nine patterns to something over 20 total attachment sub-patterns, with different descriptions for children and adults.
Social psychology models (romantic/adult attachment) Also beginning in the 1970s, social psychologists developed an attachment theory from Bowlby's and Ainsworth's work, and from the perspective of their discipline. Several theory modifications branched off. Proponents include Phillip Shaver, Mario Mikulincer, Chris Fraley, Kelly Brennan, and Kim Bartholomew. These tend to focus on adult romantic and other significant adult relationships, and are described as romantic attachment, or vaguely "adult attachment". They developed a variety of self-report questionnaires to use in research, clinical settings, and for individual and group therapy, notably the Experiences in Close Relationships (ECR) measure. They utilize a set of terms and concepts often similar but often apparently or noticeably different than those used in the developmental tradition. It's unclear how closely the attachment phenomena they describe is to that described by development-based models. Sometimes the same words in the two disciplines are the same, congruent, or have quite different meanings. Sometimes they use the disorganized attachment concept, and sometimes a different concept called fearful attachment as a fourth attachment pattern.
The essence of this model is that attachment describes a person's search for protection and support in times of need and the psychological consequences of gaining and losing a sense of security. The model has sought to expand coverage from the self and dyads to cover dynamics in social, organizational, and religious groups.
Dynamic Maturational Model of Attachment and Adaptation (DMM, ABC+DMM) Patricia Crittenden began to develop the Dynamic-Maturational Model of Attachment and Adaptation in the 1980s. Between 1990-2010 she developed a comprehensive lifespan model centered more squarely on the Bowlby-Ainsworth tradition, and particularly expanded from Bowlby's ideas about information processing. In many ways the DMM is generally consistent with the ABC+D model and the developmental tradition, and arguably offers more clarity and insight from better definitional precision. Particularly since the collapse of the disorganized concept, some Berkeley model theorists began updating their language in ways consistent with the DMM.
The DMM maintains the Ainsworth ABC alphanumeric system and expands the patterns to 26 primary sub-patterns. It also describes how opposing patterns can be alternated or blended. It never included disorganized as an attachment concept.
Crittenden updated the AAI and SSP assessments, and developed a comprehensive suite of lifespan attachment assessments. Additional DMM-based assessments have been developed by others. Like Bowlby, the DMM incorporates scientific findings from many additional disciplines. Thus, it provides an updated model of attachment as well as a more comprehensive biopsychosocial model describing the way exposure to danger, including relationship danger, impacts how humans feel, behave, think, communicate, respond to threat, experience trauma and loss, and utilize memory systems. It also addresses specific issues such as depression, disorientation, and use of distorted, omitted, falsified, denied and delusional information.
The essence of this model is that the attachment system describes a relationship between a person who needs protection from danger and a relationship with a person who can provide protection and comfort, the effect on each from the interaction of the relationship. It also offers a comprehensive method of discourse analysis and model of how people process information in the context of exposure to danger. The Family Relations Institute supports the DMM.
Evidence-based approaches
Child–parent psychotherapy (CPP) Child–Parent Psychotherapy (CPP) is an intervention designed to treat the relationship between children ages 0–5 and their caregivers after exposure to trauma or in high risk situations. This intervention was developed in part from infant-parent psychotherapy, a psychoanalytic approach, and was expanded by Alicia Lieberman and colleagues into child–parent psychotherapy, a manualized intervention. CPP incorporates attachment theory by considering how attachment relationships are formed between child and caregiver, how challenges may influence attachment relationships, and how caregiver's sensitivity may influence the attachment behavior system for infants and toddlers.