Traditional Therapeutic Approaches for Adult Attachment Insecurity

By Dr. David Elliott and Dr. Traill Dowie

Those of us who want to promote mental health, who want to provide effective psychotherapeutic interventions to help people with insecurity to become secure (or 'earned secure' in the lingo of the attachment field), have a variety of treatment approaches available to learn and practice.  Integrative Attachment Therapy (IAT) is but one treatment approach which recognises the central relevance of attachment repair as part of clinical treatment.  But IAT integrates the best elements of other treatments, and as such is particularly effective and efficient as a treatment for adult attachment insecurity.

Traditionally, treatments for attachment insecurity have tended to focus on the relational origins of the condition and employ relational forms of resolution. These methods emphasize the therapeutic relationship as a corrective emotional experience, allowing individuals to form new, secure attachments within the therapy context. In approaches such as these the central guiding principle is what we call the therapist as good attachment figure (TAGAF) model, through which the therapist provides the conditions for the patient or client to experience the therapist as a secure base for exploration and healing.  

The specific ways that the TAGAF approach are brought into the therapy process can vary. 

Schema therapy, developed by Jeffrey Young, incorporates a concept known as 'limited re-parenting', where the therapist provides a corrective emotional experience that helps to address and heal attachment wounds. Diana Fosha’s work on transforming core affects emphasizes the importance of exploring and transforming core emotional experiences within the therapeutic relationship. Fosha’s approach includes "undoing aloneness", to enhance relational security. In couples-based therapy, specifically Sue Johnson’s Emotionally Focused Therapy (EFT), there  is a focus on facilitating emotional bonding between partners. This is achieved by helping partners recognize and express their primary emotions, such as the fear of abandonment or the longing for connection. EFT also targets past attachment injuries and current relational distress, aiming to repair emotional wounds and rebuild trust and intimacy between partners. 

Metacognitive-focused treatments have focused on treatment of personality disorders, but because of the high correspondence between personality disorders and attachment insecurity, they have been fruitfully applied to treatment of insecurity.  They have less of a focus on TAGAF, but prioritize a dimension of functioning that Integrative Attachment Therapy includes as the second of the Three Pillars of treatment.  Metacognitive treatments have been shown to be of tremendous value in psychological practice. These approaches include Mentalization-Based Treatment (e.g., Allen, Fonagy, & Bateman, 2008) and Metacognitive Interpersonal Therapy (developed by Dimaggio et al., 2020). These approaches focus on enhancing the person’s ability to, for example, reflect on their own and others’ mental states, which is a central correlate of secure attachment. 

Integrative Attachment Therapy (IAT) has identified and incorporated the best of traditional and newer models for treating adult attachment disruption. IAT offers a comprehensive approach to the treatment of adult attachment insecurity through the use of what we term the Three Pillars model (see Brown & Elliott, 2016). These pillars address the core issues of attachment insecurity by enhancing collaborative and metacognitive skills, and creating new, positive attachment representations through the Ideal Parent Figure (IPF) imagery protocol.

References:

Allen, J.G., Fonagy, P., & Bateman, A.W. (2008).  Mentalizing in Clinical Practice. Washington, D.C.: American Psychiatric Publishing.

Brown & Elliott, 2016

Dimaggio, G., Ottavi, P., Popolo, R., & Salvatore, G. (2020).  Metacognitive Interpersonal Therapy: Body, Imagery, and Change.  New York: Routledge.