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What is attachment-based therapy?

Reviewed by Stephanie Steinman, PhD, CSAC

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Attachment-based therapy (ABT) is an umbrella term for treatments that explore the ways your earliest experiences with caregivers have taught you to form relationships (or “attach”). Therapists use specific techniques called attachment-based interventions (ABIs) to identify and change unhealthy attachment patterns.

In general, attachment-based therapy can benefit anyone who wants to break unhealthy patterns and build healthier relationships. It can help address childhood trauma and other painful experiences that get in the way of healthy connections. Attachment-based family therapy (ABFT), a youth-centered form of ABT, can be especially helpful for teens (and families of teens) struggling with depression and suicidal thinking.

ABT, ABIs, and ABFT are all based in attachment theory—the theory that our bonds with our primary caregivers shape our lifelong emotional and social development. Note that none of these approaches are related to “attachment therapy,” a similarly named treatment that’s been proven harmful and ineffective.1

Who should use attachment-based therapy?

ABT focuses on a person’s ability to form secure relationships, and it can apply in many situations. It may be particularly effective for:

What to expect from attachment-based interventions

Because attachment-based interventions can be used in other approaches, such as couples, family, or group therapy, there isn’t one set process you can expect to go through. But in general, you’ll be asked to:

  • Reflect on your past and present relationships with your caregivers (biological parents, adoptive parents, stepparents, grandparents, guardians, etc.)
  • Consider how dynamics from those relationships continue in your relationships today, whether with friends, romantic partners, dependent kids, coworkers, or others
  • Identify and change patterns that keep you from feeling secure in your relationships

What happens in attachment-based family therapy?

Attachment-based family therapy is used specifically to treat teenagers with depression, especially if they’ve expressed suicidal thoughts or actions.3 The goal is to turn the teen’s family relationships into a secure base they can explore the world from. Caregivers also learn more effective ways to support their child.

ABFT participants work on completing five central “tasks” that happen in a set order and build on each other.

1. Setting the therapy goal

First the therapist speaks with the teenager and their caregivers together. The family discusses their relationships and explores what may be keeping the teen from approaching their caregivers with difficulties. Instead of framing the young person’s depression as a problem to be solved, the participants agree to make building open, supportive relationships the goal of therapy.

2. Working with the adolescent

In one-on-one sessions with their therapist, the teen discusses past family experiences and issues that may be causing conflict. They’re encouraged to see the importance of their family relationships and to work on improving them.

3. Working with the caregivers

During the third task, the therapist has sessions with just the caregivers. Caregivers discuss their own childhood experiences with attachment, identify any current stresses affecting their mental health, explore their role in supporting their child, and talk about patterns they feel should be addressed or changed. They may also learn some new, emotion-focused parenting skills.

4. Healing attachments

During this step, the young person and their caregivers are brought back together for group sessions. The teen is encouraged to discuss past events or dynamics that made them feel they couldn’t turn to their caregivers for support. The caregivers are encouraged to listen with empathy and recognize the teen’s needs. Together, the family begins to rebuild trust, strengthen bonds, and learn new patterns for moving forward.

5. Building independence

Once the young person begins to think of their caregivers as a secure support system, they’re encouraged to explore new goals outside the therapy room. This may involve finding a job, improving their grades, or joining a sports team—challenges aimed at improving problem-solving skills and boosting confidence.

How to find support

It’s important to find a therapist and a type of therapy you feel comfortable with. Attachment-based therapy may be a good fit for you if you have unresolved issues in your relationship with a primary caregiver. Browse our directory to connect with a licensed mental health professional today.

Get help now

If you or a loved one are in crisis and need immediate help, call the 988 Lifeline at 988 for free, confidential support 24/7. You can also chat or text HOME to 741741 to speak with a crisis counselor.

About the author

The editorial team at works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.

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