Attachment-Informed Psychotherapy

In the past decade or so I’ve been fascinated over the immense growth in popularity of all things “attachment.” Don’t get me wrong, I believe attachment concepts are robust, interesting, and sometimes useful. I guess I’m not on the attachment bandwagon . . . but I’m not altogether off the bandwagon either.

Here’s an excerpt from our Counseling and Psychotherapy Theories text on Attachment-Informed Psychotherapy. I wonder, before you read this do you know the MAIN difference between attachment-informed psychotherapy and psychoanalytic psychotherapy? I ask this because mostly psychoanalytic psychotherapy is in disfavor, but attachment approaches are all the rage. Do you know the difference?

Attachment-Informed Psychotherapy

Attachment, both as a model for healthy child development and as a template for understanding human behavior is immensely popular within the United States (Cassidy & Shaver, 2008; Wallin, 2007). This is especially ironic because attachment theory’s rise to glory parallels decreasing interest in psychoanalytic models. If you were to ask a sample of mental health professionals their thoughts on attachment theory, you’d elicit primarily positive responses—despite the fact that attachment theory is a psychoanalytically oriented approach.

John Bowlby, who was raised primarily by a nanny and sent to boarding school at age seven, began writing about the importance of parent-child interactions in the 1950s. He was a psychoanalyst. Similar to other neo-Freudians, Bowlby’s thinking deviated from Freud’s. Instead of focusing on infant or child parental fantasies, Bowlby emphasized real and observable interactions between parent and child. He believed actual caretaker-infant interactions were foundational to personality formation (aka the internal working model).

In 1970, Mary Ainsworth, a student of Bowlby’s and scholar in her own right, published a study focusing on children’s attachment styles using a research paradigm called the strange situation (Ainsworth & Bell, 1970). Ainsworth brought individual mother-child (6 to 18 months) pairs into her lab and observed them in a series of seven 3-minute episodes or interactions.

1. Parent and infant spending time alone.
2. A stranger joins parent and infant.
3. The parent leaves infant and stranger alone.
4. Parent returns and stranger leaves.
5. Parent leaves; infant left completely alone.
6. Stranger returns.
7. Parent returns and stranger leaves.

During this event sequence, Ainsworth observed the infant’s:

  • Exploration behavior.
  • Behavioral reaction to being separated from parent.
  • Behavioral reaction to the stranger.
  • Behavior when reunited with parent.

Based on this experimental paradigm, Ainsworth identified three primary attachment styles. These styles included:

1. Secure attachment.
2. Anxious-resistant insecure attachment.
3. Anxious-avoidant insecure attachment.

In 1986, Ainsworth’s student and colleague Mary Main (1986, 1990), identified a fourth attachment style labeled, disorganized/disoriented attachment.

Many contemporary therapists view attachment theory in general, and Ainsworth and Main’s attachment style formulations in particular, as having powerful implications for human relationships and the therapy process (Eagle, 2003; Wallin, 2007). For example, one of the most popular approaches to couple counseling relies heavily on attachment theory principles (Johnson, 2010). In addition, attachment theory has profoundly influenced child development and parent training programs (J. Sommers-Flanagan & R. Sommers-Flanagan, 2011).

At its core, attachment theory involves an effort to understand how early child-caretaker interactions have been internalized and subsequently serve as a model for interpersonal relationships. This is, of course, the internal working model—with an emphasis on how real (and not fantasized) early relationships have become a guide or template for all later relationships. Byrd, Patterson, and Turchik (2010) describe how attachment theory can help with selecting appropriate and effective interventions:

Therapists may be better able to select effective interventions by taking the client’s attachment pattern into consideration. For instance, a client who is comfortable with closeness may be able to make good use of the therapeutic relationship to correct dysfunctions in his or her working models of self and others. On the other hand, a client who is not comfortable with closeness may find it difficult to change internal working models through the therapeutic relationship. Finally, knowing that a client is not comfortable with closeness would allow the therapist to anticipate a relatively impoverished alliance, and therefore avoid interventions such as insight oriented or object relations therapies that rely heavily on the alliance. (p. 635)

As an internal working model, attachment theory also has implications for how therapists handle within-session interpersonal process. Later in this chapter we provide an attachment-informed psychoanalytic case example (see the Treatment Planning section).

It should be emphasized that many criticisms of attachment theory exist. Some critiques have similarities to criticisms of psychoanalytic theory. Perhaps the greatest criticism is the tendency for individuals to take the Mary Ainsworth’s 21 minutes of behavioral observations with one primary caregiver and generalize it to the entire global population. In this sense, the theory is not especially multiculturally sensitive. It seems obvious that there are many divergent ways to raise children and not all cultures subscribe to the “American” overemphasis and perhaps preoccupation with the infant’s relationship with a single caregiver (usually the mother).

Although scientific critiques have sought to reign in attachment theory as it has galloped its way into pop psychology and the media (Rutter, 1995), its popularity continues to escalate and the consequences seem to magnify the importance of an overly dramatized dance of love between a child and his or her mother. In the following excerpt from A general theory of love, you can see the language is absolute and, interestingly, rather sexist—in that children are typically portrayed as male and parents as female.

One of a parent’s most important jobs is to remain in tune with her child, because she will focus the eyes he turns toward inner and outer worlds. He faithfully receives whatever deficiencies her own vision contains. A parent who is a poor resonator cannot impart clarity. Her inexactness smears his developing precision in reading the emotional world. If she does not or cannot teach him, in adult-hood he will be unable to sense the inner states of others or himself. Deprived of the limbic compass that orients a person to his internal landscape, he will slip through his life without understanding it. (Lewis, Amini, & Lannon, 2001, p. 156)

Take a moment to imagine how Karen Horney or Mary Ainsworth might respond to this overgeneralization of attachment concepts and blaming of mothers for their children’s emotional deficiencies.

John and Nora

8 thoughts on “Attachment-Informed Psychotherapy”

  1. Hi John,

    I found this clarifying and well-written. I have one tiny, picky little bit of feedback. Usually when someone writes “a scholar in her own right,” or artist, or poet, etc. they are indicating the woman’s relationship to the more famous man. I like, in this instance, “also an attachment scholar,” or “who became a published scholar after her apprenticeship,” or something that doesn’t make the power-dependent relationship such an issue. Just a thought.


    1. John & Joyce: I, too, had a reaction to that same phrase when reading the blog post. I did not respond from a gendered perspective, but instead, considered how it would be more empowering for the apprentice described for the description of that person to be Joyce’s suggestion of “who became a published scholar after her apprenticeship” or perhaps even “X’s influence on the thinking and understanding on YYY theory lead to her further development as a scholar as well”, which is, what I think you were inferring, John.

      Am I understanding?

      1. Hi Merril.

        Yes. Absolutely you’re understanding. I appreciate the better language for expressing what I intended. In about 6 months I start revising the Theories text and your comment (and Joyce’s) will make it better.



  2. Hi Joyce.

    Thanks for your comment. I especially liked the part about it being clarifying and well-written:).

    Seriously, you make a fantastic point. It’s always great to get other perspectives. And now, as you can see, you’ve garnered a following with people beginning to comment in affirming ways about your comment. Cool.

    In no way did I mean to say anything diminishing of Mary Ainsworth, whom I consider to be awesome.

    Thanks again and have an awesome Thursday.


  3. John, as always, an insightful and interesting post. I don’t know what Horney and Ainsworth would say, but I have little time for those who would engage in an “overgeneralization of attachment concepts and blaming of mothers” (your post, above).

    What I think is critical to remember is that later explorers (e.g. Main) clearly believed–as I do–that one can remediate early deficits and attain what’s referred to as “earned secure” status. Following Main, it’s how we make sense of our past as adults, not how we were treated as kids that’s important.

    For your text, and the finer understanding of your readers, it’s also important to draw a distinction between the thrust of Bowlby, Ainsworth, and later, Main (one of Ailnsworth’s students) and Hesse, and those who pursue what might be described as “romantic attachment” (for lack of a better term) by Bartholomew and Horowitz, and Shaver and Mikulincer. There appears to be very little correlation between Ainsworth’s typology and Maine’s Adult Attachment Interview (AAI), and the later approaches to adult close relationships of Bartholomew and Horowitz, and Shaver and Mikulincer.

    1. Hi John.

      I always appreciate your thoughtful comments on my posts. In this case, your comments will inspire me to read some more about Main’s perspective and to try, for myself and for readers, gain that “finer understanding” that you articulate. Thanks for helping me to begin to make better distinctions.


      John SF

  4. Do you have a chapter in this book that talks about the main differences between psychoanalytic psychotherapy versus attachment I formed psychotherapy . I am writing about this topic and need resources.

    1. Hi Elizabeth,

      I just have the content from the chapter that I posted here. We also review a case that Paul Wachtel wrote about. . . which is very interesting. Here’s the citation for Wachtel’s case: Wachtel, P. L. (2010). One-person and two-person conceptions of attachment and their implications for psychoanalytic thought. The International Journal of Psychoanalysis, 91(3), 561–581.

      Hope this is helpful.


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