The Three Pillars of Integrative Attachment Therapy

By Dr. David Elliott and Dr. Traill Dowie

Attachment matters significantly in adult psychotherapy because it influences emotional and psychological development. Having a therapist who both understands and more importantly possesses the skills for addressing attachment issues can lead to profound improvements in mental health, relationship satisfaction, and overall personal growth. 

Integrative Attachment Therapy represents a significant advance in the field of psychotherapy for attachment insecurity.  It offers a holistic framework that addresses the multifaceted nature of attachment-related problems. Through the Three Pillars of attachment repair (Brown & Elliott, 2016) -- collaboration, metacognition, and a method using mental imagery, IAT provides a path to healing and resilience, transforming the lives of those adversely affected by attachment insecurity. 

The First Pillar: Collaborative Enhancement and Development

Our first pillar targets the deficits in collaborative and cooperative behaviours that often result from insecure attachment. The conditions that create attachment insecurity also impede the development of collaborative relational abilities. This pillar of treatment focuses on enhancing these behaviours to remedy relational development deficits. Good therapy, as noted by Giovanni Liotti, is inherently collaborative. Key practices include establishing a clear therapeutic treatment frame, using inclusive language such as ‘we,’ ‘us,’ and ‘let's’ to foster a sense of partnership, and addressing non-collaborative behaviors, both verbal and non-verbal, to promote coherence and synchrony in communication. By focusing on collaboration, therapists can help patients or clients build healthier relational dynamics, both within and outside of the therapy, supporting their journey toward earned secure attachment.

The Second Pillar: Metacognitive Enhancement and Development

Our second pillar addresses the underdeveloped metacognitive skills in individuals with insecure attachment. The conditions that create attachment insecurity also impede the development of metacognitive abilities. Metacognition is crucial for understanding and reflecting on one's own and others' mental states. Enhancing these skills supports overall well-being and reduces cognitive distortions about the self, others, and the world. By developing metacognitive abilities, people can function with a more coherent and flexible mindset.

The Third Pillar: The Ideal Parent Figure (IPF) Protocol

Our third pillar uses therapist-and-patient-co-created mental imagery to establish new, positive IWMs of attachment. This method is more efficient than relying solely on the therapist-patient dyad to develop secure attachment. The IPF protocol involves several steps: 1) Bringing the patient's awareness to bodily, felt-sense experience in the moment; 2) Imagining being a very young child, in an embodied, felt-sense way; 3) Imagining being with and interactive with new and different parents, who provide all the conditions that contribute to the development of security in the attachment relationship; 4) Enhancing the bodily felt-sense of the positive experiences with the Ideal Parent Figures (IPFs); 5) Establishing awareness of the continued availability of the imagined IPFs even outside of the imagery and therapy sessions. 

The Three Pillars are interdependent and mutually enhancing. Collaborative enhancement supports metacognitive development, which in turn makes the IPF protocol more effective. Together, they form a comprehensive approach that addresses all relevant domains of attachment insecurity.

Integrative Attachment Therapy, applying the Three Pillars model, offers a robust and effective approach to treating attachment insecurity. By focusing on collaboration, metacognition, and the transformative application of mental imagery, IAT seeks to support patients to build new, positive attachment representations and develop the skills necessary for secure attachment in adult life. IAT provides a comprehensive and integrated method to address the complexities of attachment-related issues, providing a path to healing and resilience for those affected by attachment insecurity.

The journey to secure attachment is a path to healing, resilience, and personal growth, making it an essential focus in the realm of adult psychotherapy.  We hope you can join us on our journey at the IAT Institute toward a more securely attached world.

References:

Brown & Elliott, 2016