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Attachment-based therapy: Basics, styles, and disorders

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What Is Attachment-Based Therapy?

Attachment-based therapy is a therapeutic approach based on attachment theory. Attachment theory states that people learn how to develop relationships with others based on their experience as an infant attaching to their primary caregiver.

Attachment Theory Basics

What Is Attachment?

Attachment refers to a relational bond between individuals. The first attachment humans make occurs when we are still infants. Your first attachment centers on a single caregiver, often (but not always) your mother.

Attachment theory states that this experience of infant attachment affects how we relate to and attach to others later in life. The security we experience as infants—or lack thereof—characterizes how secure we feel in our relationships as adults.

4 Stages of Infant Attachment

Many parents feel pressure to “get it right” when it comes to attachment. However, attachment styles don’t permanently form the first time a baby is held or fed. Like many aspects of child development, infant attachment occurs over time. There are four stages of infant attachment:

  1. Pre-attachment: In the pre-attachment stage, infants do not attach to or have a preference for anyone in particular. This stage can last anywhere from six weeks to three months.
  2. Indiscriminate attachment: At this stage, infants begin to make distinctions between their primary and secondary caregivers. They will likely show a preference for a specific caregiver, although they will still accept care from others without experiencing anxiety. Indiscriminate attachment can occur as early as six weeks and typically lasts until the infant is seven months old.
  3. Discriminate attachment: This is the stage in which infants show a strong preference for their primary caregiver. They may object or experience anxiety when cared for by secondary caregivers. The discriminate attachment stage typically occurs when the infant is between seven and 11 months old. During this stage, the infant may experience separation anxiety when their primary caregiver leaves a room.
  4. Multiple attachments: The final stage of infant attachment can begin anywhere between nine and 11 months of age. At this stage, the infant begins forming strong attachments with people besides their primary caregiver, such as other family members. The intensity of their preference for their primary caregiver subsides.

4 Attachment Styles

The four stages of infant attachment culminate in the development of an attachment style. An attachment style, also known as an attachment pattern, is a blueprint for how an individual builds relationships. The four types of attachment styles are:

  1. Anxious attachment: Children with anxious attachment, also known as ambivalent attachment, struggle and experience distress when their parent or caregiver leaves. Adults with anxious attachment styles may be perceived as clingy and spend an inordinate amount of time worrying about their relationships.
  2. Avoidant attachment: Children with avoidant attachment do not seek comfort from their parents or caregivers. They have learned that their caregivers are unable to reliably meet their needs, so they overly rely on themselves instead. Adults with avoidant attachment may struggle to be vulnerable or intimate in their relationships.
  3. Disorganized attachment: Children with disorganized attachment experience a mix of anxious and avoidant behaviors. This attachment style develops when a child’s parent or caregiver—on whom they depend for comfort and safety—is also a source of fear or terror. Adults with disorganized attachment tend to have chaotic and volatile relationships.
  4. Secure attachment: Children with secure attachment trust their parent or caregiver to meet their needs and provide comfort and safety. They are also able to separate from their caregiver without too much anxiety. Adults with secure attachment experience positive relationships based on trust and vulnerability.

Each attachment style is associated with a set of assumptions that formed based on our experiences during infancy. How we express these styles changes from childhood to adulthood. For example, a child with anxious attachment may scream when their parent leaves the room, whereas an adult with this attachment style may express worry or anxiety about their partner leaving the relationship.

What Are Attachment Disorders?

Attachment disorders occur when young children struggle or are unable to form attachments with caregivers. It’s important to note that attachment disorders can occur in children who have formed any of the four attachment styles, including secure attachment.1 There are two main types of attachment disorders:

  • Reactive attachment disorder (RAD): Children with RAD avoid adults because of past negative experiences, such as abuse, neglect, or trauma. They rely on themselves for comfort when they are feeling stressed, although they typically struggle to regulate their emotions, often resulting in intense expressions of anger, fear, or sadness.
  • Disinhibited social engagement disorder (DSED): Children with DSED seek care and affection from any and all adults, showing little to no preference for their parents or primary caregivers. They are overly friendly with strangers, often inadvertently putting themselves in vulnerable or risky situations.

Types of Attachment-Based Therapy

Therapists specializing in attachment-based therapy use attachment theory to help people strengthen their ability to trust and build relationships with others. Attachment-based therapy can be used in a variety of settings, including:

  • Individual therapy for adults
  • Individual therapy for children
  • Couples therapy
  • Family therapy (known as ABFT)
  • Group therapy

Visit our directory to find a provider of attachment-based therapy near you.

Other Treatments for Attachment Disorders

In addition to attachment-based therapy, there are other therapeutic approaches that can address the effects of certain attachment styles and treat attachment disorders, including:

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