Attachment Therapy for Adults with Insecure Attachment Style

Attachment Therapy for Adults with Insecure Attachment Style

Tara Emery

Social Work Department, University of Calgary

SOWK 604 S01 Advanced Practice Theories in Context

Instructor Charlene Richard 

February 5, 2022

Introduction 

Relationship problems are common and can be normalized in western culture, but the extent to which individuals struggle can vary widely. Social workers should work with their clients to investigate relationship struggles and patterns for an insecure attachment style. Sometimes we might hear parents blaming problems in the relationship on their children, seeing them as difficult or bad, unaware of how their insecure attachment style might be impacting their view. Attachment wounds, especially those from our childhood, can have lasting impacts on our mental wellness and the health of our relationships. Fortunately, attachment healing is possible and common in adulthood. Having a relationship with a securely attached individual, including a therapist, helps create this foundation for healing (Heller, 2013 ). This mid-level theory is available to support individuals to build lasting relationships and bonds (Coady, N., & Lehmann, P., 2016). 

Adults with Insecure Attachment Style

Adults with insecure attachment styles struggle with various mental health diagnoses and many symptoms of depression, anxiety, and personality disorders (Taylor et al., 2015). Connection, love and attachment is vital to our overall well-being and development as human beings. Siegel explains how the “brain is shaped by our communication within interpersonal relationships” (2020, p. 1). Our “mammalian brains are profoundly social; our relationships have profound impacts on [developing] neuronal function” (Siegel, 2020, p. 4). The love, support, and safety developed within the attachment system facilitate the expansion of the child and infant’s coping strategies (Schore, 2001). This expansion carries into adulthood unless interrupted by new healthy relational experiences. 

Our [Attachment style] creates a blueprint of expectations of sorts, built out of our early encounters with others. When we are raised with secure attachment, we tend to find relationships are easier. We expect to be treated well and know that is what we deserve. We treat our partners with respect as well. We trust our partners and others realistically, and we trust in humanity and the world more or less unconditionally (Heller, 2013). 

Whereas individuals with an insecure attachment style struggle with ongoing relational conflicts and feelings that they cannot trust in the people around them. These individuals cannot access an internal sense of self, which helps in determining needs, providing an internal reference point at times of stress, and a positive sense of self (Brier et al., 2014). 

We can also think of insecure attachment like eating at a lousy restaurant every day; you don’t feel good, often have an upset stomach, and perhaps suffer from multiple health complaints. But if this is the only food you know, you might not understand there is a better option? To heal, one would have the experience of eating a better meal. One would have to experience what it is like to feel comfortable in their body (Heller, 2013 p. 7-8). This lack of secure experiences is why it can be common for these adults to be caught in abusive relationship cycles in which they might be the victim or the perpetrator. 

Alternatively, other insecure adults instead live in social isolation, finding it easier than coping with the anxiety or abuse that has been related to their relationships. Unfortunately, living in isolation create’s increased symptoms of depression and can worsen social anxiety. To cope with these symptoms, many individuals will develop addictions and use substances to combat their daily discomfort (Kolk, 2015). On a very basic level going to the grocery store or running into a neighbour can be fraught with real or potential relational conflicts causing severe anxiety and panic attacks. 

Van der Kolk also described how the different insecure attachment styles can impact the behaviour of a caring parent. He found that “hostile/ intrusive mothers were more likely to have childhood histories of physical abuse and/ or witnessing domestic violence, while withdrawn/ dependent mothers were more likely to have histories of sexual abuse or parental loss” (2015, p. 122). His research documented how these insecure attachment styles caused unconscious negative behaviours creating further conflicts with the individuals they loved most. Living with an insecure attachment style is incredibly painful causing isolated, confusion, mental health struggles and ongoing cycles of conflict. 

Attachment Theory Summary

The effects of early adverse childhood experiences were first noted in the 1950s by Mary Ainsworth and John Bowlby. These researchers noted how they were constantly confronted with extreme early experiences of trauma in the “disturbed children” they worked with (Gauthier, 2011, p. 590). Ainsworth and Bowlby, along with James Robertson, worked together with a research team to develop the foundation for Attachment Theory. Attachment theory underscored the importance of early childhood experiences on human development. Mary Ainsworth famously developed the strange situation in which the relationship between caregiver and child was closely observed. Ainsworth first identified three attachment styles secure, avoidant, and ambivalent. Her colleagues Main and Solomon contributed the fourth style of disorganized attachment. Bowlby characterized attachment by building secure bonds characterized by qualities of love, protection, support, and comfort.

In contrast, attachment disorders develop when early trauma impacts the caregiver-child relationship and bonding (Lahousen et al., 2019). There can be a range of internal or external reasons for this disruption of attachment, such as poverty, illness, and commonly parental attachment styles or disorders (Gervai, 2009). Most individuals “in low social risk community samples are typically ~55% secure, ~15% avoidant, ~10% resistant, and ~15% disorganized” (Gervai, 2009, p. 8-10). However, it is essential to think of attachment existing on a spectrum or a continuum. Meaning many individuals can enjoy secure attachment, but they will also have experience with other attachment styles. There is some cross-cultural variation in these frequencies, but differences within any culture can be as large as between cultures. “In high social risk groups exposed to severe deprivation and maltreatment or among infants of adolescent mothers, frequencies can be dramatically different with 0-30% secure, 20-50% avoidant and resistant, and as many as 50-80% disorganized infants.” (Gervai, 2009, p. 8-10)

DSM-V Attachment Disorder’s

The DSM-V recognizes two types of attachment disorders reactive attachment disorder (RAD) and disinhibited social engagement disorder (DED). RAD describes the inability to attach to a preferred caregiver (similar to the avoidant style but could include disorganized traits). DED describes the opposite indiscriminate attachment (similar to the ambivalent style but could consist of disorganized traits). Prevalence rates of Attachment disorders reported in the available studies vary widely because the symptoms are subtle and measures used to determine them are variable. “Based on current epidemiologic studies, prevalences in the general population range from 0.9% to 1.4%.” (Reichenberg, 2013, p. 146)

The DSM-5 Criteria for Disinhibited Social Engagement Disorder

A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following: Reduced or absent reticence in approaching and interacting with unfamiliar adults.

DSM-5 Criteria for Reactive Attachment Disorder (RAD)

Minimal social and emotional responsiveness to others.

Limited positive affect. Episodes of unexplained irritability, sadness, or fearfulness are evident even during nonthreatening interactions with adult caregivers (Reichenberg, 2013, p. 146).

Application of Attachment Theory for Adults with Insecure Attachment

The following research studies examine attachment theory and interventions on insecure attachment styles adults. There continues to be an ongoing debate to challenge attachment theory citing the influence of genetics in children’s temperament and attachment bonding. The evidence has been firm that environmental factors have the primary effect on the development of attachment; however, genetics have some influence. Several researchers reviewed previous studies using Mary Ainsworth’s strange situation technique to research twins’ attachment styles in the first year of their lives. This study has been repeated various times to examine genetics’s role in attachment styles and development. The researchers also repeat the study with 157 twins in mid to upper-class homes in Europe. The previous studies accounted for approximately 14% of genetics, attributing parent sensitivity (care, support, safety) as primary importance to developing a secure attachment. Additionally, when these researchers repeated the study, they found an even higher environmental percentage decreasing the expected genetic component to be closer to 10% (Bokhorst et al., 2003). I feel these studies highlight the importance of attachment theory. Gaps in the research were that the study samples were predominantly middle class, the dominant race, and upper to middle-class families. 

A serious limitation of attachment theory is its failure to recognize the profound influences of social class, gender, ethnicity, and culture on personality development. Independent of a mother’s sensitivity, these factors can be as significant as the quality of the early attachment (The One Thing That’s Missing from Attachment Theory, 2011).

In Canada, Choate’s et al. examined the use of attachment theory with Aboriginal Peoples. The research combines knowledge from an academic social worker, Aboriginal elders, and lived experience by Aboriginals who were adopted into non-aboriginal homes. The authors examine the application of attachment theory (AT) onto Aboriginal peoples. The research agrees with the basic principles of AT; children require a sense of security, a secure development of identity, and a place of belonging. However, they show how the application of the theory from the existing colonial framework has created harm, particularly in the child protection system. Aboriginal elders explain there is no word for attachment in their culture. Instead, elders describe the widely used term “all my relations” for the communal nature of attachment. The researchers ask that we no longer try to fit Aboriginal culture into AT, calling for new understandings and assessments defined by Aboriginal People (2020). Social workers should be cautious when applying attachment theory and interventions when working with Aboriginal People. It would be essential to refer to Aboriginal helping professionals whenever possible and seek out elders’ guidance.  

In looking at applying attachment therapy interventions, Balwin et al. provide evidence to support the use of a common attachment therapy intervention in decreasing the threat response of insecure adults. The researchers explain how evidence has linked compassion and self-compassion to improved well-being. However, for individuals with insecure attachment, this is not necessarily true, as research has shown how the threat response is activated when they are exposed to compassion-based images. Additionally, this population is also reporting greater anxiety in therapy, telling us why it is important to look at how we can better support these adults (2020). 

Balwin et al. look at the possibility of reducing the compassion threat by enhancing attachment security in these insecure students. The study of 68 students identified those struggling with insecure attachment by way of self-assessment. The researchers confirmed the self-assessments by exposing the students to compassion-focused imagery, which produced a threat response in those students with insecure attachment styles. The sample group of students was then offered a 10-minute attachment prime (a mindfulness recording promoting the individual to think of someone who makes them feel safe and secure, reflecting on an experience of their support) before being exposed to compassion-focused imagery. In the sample group, heart rate variability showed an increased ability to self-soothe after the attachment prime. The control group was offered an Interpersonal Skill Module (a 10-minute practice using the “I” statement and reflecting on how this skill might improve their communication). The control group showed no changes in their heart rate responses, whereas improvements were noted in all the individuals of the sample group. This research suggests individuals’ negative working models of attachment seem to underpin the immediate threat response. The research also shows how reductions in threat response to compassion require individuals to feel more secure in their working attachment models (2020). This study highlights why it is important for helping professionals to identify individuals who are struggling with insecure attachment. Additionally, it show’s us why attachment therapy interventions are of primary importance for this population.

Taylor et al. take a more general approach by examining whether attachment styles tend to become more secure with psychotherapy. The North American research describes how working attachment models such as insecure styles can be revised through interpersonal circumstances that deviate from early attachment experiences. The research collected data from peer-reviewed journals using a quantitative methodology; 63 studies were included. The results assessed whether there was a change in attachment before and after treatment or during treatment. Attachment-focused therapies were included with data as well as other treatment modalities. The variety of therapy approaches and a wide range of experience in helping professionals did create some difficulty in the integrity of the study. Overall there is available evidence (11 of 14 studies) showing client-centered attachment increases during therapy. The limitation of this study is the lack of focus on attachment-specific therapies and interventions. However, this study helps to guide therapists to assess for attachment security, emphasizing increasing attachment security using assessment of increased security as a measurement of therapy success. 

Attachment Therapy Interventions

Assessment 

There are various tools, questionnaires, and assessment tools for professionals looking to do attachment therapy with their clients. The Adult Attachment Questionaire is commonly used, but the research does not favour it over other assessment tools (Taylor et al., 2015). Dianna Poole Heller also offers a user-friendly attachment quiz that can be easy for individuals to fill in and provides a pie chart, breaking down the percentage of attachment style’s one is experiencing in their closet relationship (D. P. Heller, 2020). A risk of completing these assessments is that the adult could become overly fixated on being a particular attachment style (similar to a DSM diagnosis). Providing psychoeducation that attachment healing is possible and common in adulthood can be helpful.

Attachment Interventions

The counselling relationship can provide an excellent opportunity for individuals to experience relational safety while examining their core schemas and their capacity to form and maintain meaningful connections (Brier et al., 2014). Therapy should begin with the safety and stabilization of the attachment system to decrease the threat response, which will get in the way of interventions. Attachment therapy believes on an intrinsic level that we all have an original healthy impulse for secure attachment and bonding (Heller, 2013). As therapists, we must help our clients locate a secure relationship of any kind. We can explore times when the individual has felt seen and heard, which should not be limited to human relationships. Therapy should discover and highlight where the adult can feel these qualities of security and safety in their life. Sometimes this might mean studying the relationship one has with a pet, with nature, or a spiritual power; it is also about studying the therapy relationship. By highlighting and bringing awareness to these secure moments, we can promote secure attachment giving our clients a self-soothing tool to return to during times of insecurity. During the initial stage, problem-solving relational conflicts should be avoided until the clinician feels confident in the client’s ability to self-soothe (Brier et al., 2014).

These initial sessions should also focus on exploring relational safety within the therapeutic environment. Taking time to explore what creates a comfortable environment, such as more physical space, less eye contact, providing a blanket, can be a rich experience for individuals to feel cared for and help build their internal self-awareness. 

Early inferences about self and others, referred to as “relational schemas,” are encoded preverbally. These childhood memories are non-verbal, and they do not have a sense of time; they are triggered by environmental stimuli and are referred to as implicit memories (Brier et al., 2014, p. 202). Talk therapy styles may not be effective for working with these early childhood memories. The solution requires finding ways to help people alter the inner sensory landscape of their bodies (Bell, 2015). By utilizing attachment-focused mindfulness practices, we are increasing body-based awareness which allows us to build increasing awareness of the secure attachment system. Posing questions like, “How do you feel when your pet greets you at the door? What sensations do you notice in your body?” strengthens this internal system of support. 

It is common in attachment therapy, for the client to want to drop out, just when something important is occurring, often due to perseved relational conflict. Both the client and the therapist need to be aware of this common experience so it can be normalized and prepared for. Creating transparent agreements such as having a closing session and engaging in ongoing treatment planning can help the individual endure these difficult moments or at least safely end the sessions. One of the signs that the counsellor has created a safe relational environment is when the individual can both identify and share their needs letting the counsellor know what is working and what is not. 

It is important to also note that longer-term therapy should be expected in attachment work as building a relationship of trust, and deep connectedness provides the most effective state for processing relational trauma, especially if it is preverbal in nature as building the therapeutic relationship in itself becomes the natural platform to challenge old relationship schemas (Brier et al., 2014, p. 210). 

Summary 

Attachment therapy has been shown to be helpful for individuals who are struggling with insecure attachment styles. Though caution is advised when thinking of applying attachment theory to individuals from diverse cultural backgrounds. More research is required to look at diverse ways that secure attachment is being built amongst Aboriginal Peoples as well in other cultural groups. However helping professionals are encouraged to assess for insecure attachment styles and utilize attachment therapy specific interventions.  These attachment building interventions can work bring secure attachment moments into awareness, and this increased awareness will allow individuals to become more secure and learn about vital gifts of having secure, safe, and supportive love. 

Resources

Baldwin, Bandarian‐Balooch, S., & Adams, R. (2020). Attachment and compassion‐threat: Influence of a secure attachment‐prime. Psychology and Psychotherapy, 93(3), 520–536. https://doi.org/10.1111/papt.12244

Briere, J. N., & Scott, C. (2014). Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment ( DSM-5 Update) (Second ed.). SAGE Publications, Inc.

Bokhorst, C. L., Bakermans-kranenburg, M. J., Pasco Fearon, R. M., van Ijzendoorn, M. H., Fonagy, P., & Schuengel, C. (2003). The Importance of Shared Environment in Mother-Infant Attachment Security: A Behavioral Genetic Study. Child Development, 74(6), 1769–1782. https://doi.org/10.1046/j.1467-8624.2003.00637.x

Coady, N., & Lehmann, P. (2016). Theoretical perspectives for direct social work 

practice: a generalist-eclectic approach. Springer Publishing Company. 

Choate, CrazyBull, B., Lindstrom, D., & Lindstrom, G. (2020). Where do we go from here?: Ongoing colonialism from Attachment Theory. Aotearoa New Zealand Social Work, 32(1), 32–44. https://doi.org/10.11157/anzswj-vol32iss1id702

Gauthier, Y. (2011). Child analysis in a changing world. In the face of a paradigm shift from the mind to the brain: Can we meet the challenge? Infant Mental Health Journal, 32(6), 583–595. https://doi.org/10.1002/imhj.20317

Gervai J. (2009). Environmental and genetic influences on early attachment. Child and adolescent psychiatry and mental health, 3(1), 25. https://doi.org/10.1186/1753-2000-3-25

Heller, D. P. (2020, July 9). Attachment Styles Test: Attachment Style Quiz from Dr. Diane Poole Heller. Trauma Solutions. Retrieved February 15, 2022, from https://dianepooleheller.com/attachment-test/

Heller, D. P. H. (2013). Navigating the Labyrinth of Love – How Attachment Styles Sneak into Adult Relationships. Https://Dianepooleheller.Com/Wp-Content/Uploads/2018/12/Navigating-the-Labyrinth-of-Love.Pdf. 

Kolk, V. B. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (Illustrated ed.). Penguin Books.

Lahousen, T., Unterrainer, H. F., & Kapfhammer, H. P. (2019). Psychobiology of Attachment and Trauma-Some General Remarks From a Clinical Perspective. Frontiers in psychiatry, 10, 914. https://doi.org/10.3389/fpsyt.2019.00914

Reichenberg, L. W. (2013). Dsm-5 essentials : The savvy clinician’s guide to the changes in criteria. John Wiley & Sons, Incorporated.

Schore, A. S. (2001). Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health. Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health, 22(1–2), 7–66. http://www.allanschore.com/pdf/SchoreIMHJAttachment.pdf

Siegel, D. J. (2020). The Developing Mind, Third Edition: How Relationships and the Brain Interact to Shape Who We Are (Third ed.). The Guilford Press.

Spinazzola, J., van der Kolk, B., & Ford, J. D. (2018). When Nowhere Is Safe: Interpersonal Trauma and Attachment Adversity as Antecedents of Posttraumatic Stress Disorder and Developmental Trauma Disorder. Journal of traumatic stress, 31(5), 631–642. https://doi.org/10.1002/jts.22320

Taylor, Rietzschel, J., Danquah, A., & Berry, K. (2015). Changes in attachment representations during psychological therapy. Psychotherapy Research, 25(2), 222–238. https://doi.org/10.1080/10503307.2014.886791

The One Thing That’s Missing from Attachment Theory. (2011, March 1). Psychotherapy Networker. Retrieved February 5, 2022, from https://www.psychotherapynetworker.org/blog/details/617/the-one-thing-thats-missing-from-attachment-theory