Attachment-Focused Therapy

What is attachment-focused therapy?

Attachment-focused therapy describes a way of working informed by attachment theory. It pays attention to closeness, trust, conflict and repair in current relationships, including the relationship with the therapist. It is not one manualized treatment: several distinct therapies have grown from attachment theory, and each has been studied separately.

Attachment patterns are descriptions used in research and clinical thinking. They are not diagnoses, and a quiz or checklist cannot diagnose anyone.

What an attachment-focused approach pays attention to

Closeness and depending on others. Adult attachment research describes differences on two continuous dimensions: anxiety in relationships, meaning worry about rejection or abandonment, and avoidance of closeness, meaning discomfort with closeness and with depending on others.¹ The evidence fits this dimensional picture better than fixed types, and a person's position can differ from one relationship to another.²

Conflict. A person's higher anxiety in relationships or avoidance of closeness is linked with lower relationship satisfaction for them, and to a lesser degree for their partner.⁴ In one study of 175 heterosexual couples in Spain, higher avoidance went together with withdrawing during conflict, and the pattern in which one partner withdraws while the other presses or turns aggressive was linked with lower satisfaction for both. The study measured these at one point in time, so it cannot show cause.⁵

Support. In adult relationships, a partner's responsive support has been linked with the other partner's readiness to explore and pursue their goals.⁶ This describes what a supportive relationship can offer. It is not a standard any partner meets perfectly, and one partner is not expected to be the only source of safety.

The therapy relationship. Moments of misunderstanding or strain between client and therapist are expected, and repairing them together is associated with better outcomes.⁷ Across many therapy approaches, a stronger working relationship between client and therapist is consistently linked with better outcomes, although this is an association rather than proof of cause.⁸

Can attachment patterns change?

Studies that followed attachment security from infancy into early adulthood found moderate continuity that weakens over time. These studies measured security in children and young people, not the adult anxiety and avoidance dimensions described above. In a large review, no statistically clear link remained once more than about fifteen years separated the two measurements, although this may partly reflect how few studies cover such long spans.⁹ An earlier meta-analysis found the same moderate overall stability and a weaker link across intervals of roughly 5 to 21 years, so the two reviews do not fully agree about the longest spans.¹⁰

A review of studies across different kinds of psychological therapy, mostly without comparison groups, found that attachment security can increase and anxiety in relationships can decrease over a course of therapy. Findings on avoidance are unclear, and controlled trials are still needed.¹¹ These studies do not show that an attachment-focused approach is what brings the change. No timeframe can be promised, and change looks different for each person.

Attachment-informed work with couples and families

At True Self Practice, couples work is informed by Emotionally Focused Therapy (EFT) and by the Gottman approach. This describes how we draw on these approaches; it does not mean certification in either model.

In a meta-analysis of randomized trials, Emotionally Focused Couple Therapy, a couple therapy built on attachment theory, and behavioral couple therapy both improved relationship satisfaction, with no significant difference between them. This does not show the two are equal, and the authors cautioned about possible publication bias.¹² A 2026 review that applied the Chambless criteria to couple relationship distress found that several couple therapy models, including emotionally focused and Gottman approaches, have modest research support, that none met its threshold for strong support, and that larger and more diverse trials are still needed. Reviews that use other criteria may classify the same evidence differently.¹³

Attachment-focused therapy at True Self Practice

Hanouf Alahmari and Ahad Alotaibi both draw on attachment-informed approaches in their work with adults, and Hanouf also works with couples and families. Sessions are online, in Arabic or English.

References

1. Brennan, K. A., Clark, C. L., & Shaver, P. R. (1998). Self-report measurement of adult attachment: An integrative overview. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 46–76). Guilford Press. [Book chapter]
2. Fraley, R. C., Hudson, N. W., Heffernan, M. E., & Segal, N. (2015). Are adult attachment styles categorical or dimensional? A taxometric analysis of general and relationship-specific attachment orientations. Journal of Personality and Social Psychology, 109(2), 354–368. https://doi.org/10.1037/pspp0000027
3. Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61(2), 226–244. https://doi.org/10.1037/0022-3514.61.2.226
4. Candel, O.-S., & Turliuc, M. N. (2019). Insecure attachment and relationship satisfaction: A meta-analysis of actor and partner associations. Personality and Individual Differences, 147, 190–199. https://doi.org/10.1016/j.paid.2019.04.037
5. Bretaña, I., Alonso-Arbiol, I., Recio, P., & Molero, F. (2022). Avoidant Attachment, Withdrawal-Aggression Conflict Pattern, and Relationship Satisfaction: A Mediational Dyadic Model. Frontiers in Psychology, 12, 794942. https://doi.org/10.3389/fpsyg.2021.794942
6. Feeney, B. C. (2004). A Secure Base: Responsive Support of Goal Strivings and Exploration in Adult Intimate Relationships. Journal of Personality and Social Psychology, 87(5), 631–648. https://doi.org/10.1037/0022-3514.87.5.631
7. Eubanks, C. F., Muran, J. C., & Safran, J. D. (2018). Alliance rupture repair: A meta-analysis. Psychotherapy, 55(4), 508–519. https://doi.org/10.1037/pst0000185
8. Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172
9. Pinquart, M., Feußner, C., & Ahnert, L. (2013). Meta-analytic evidence for stability in attachments from infancy to early adulthood. Attachment & Human Development, 15(2), 189–218. https://doi.org/10.1080/14616734.2013.746257
10. Fraley, R. C. (2002). Attachment Stability From Infancy to Adulthood: Meta-Analysis and Dynamic Modeling of Developmental Mechanisms. Personality and Social Psychology Review, 6(2), 123–151. https://doi.org/10.1207/S15327957PSPR0602_03
11. Taylor, P., 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
12. Rathgeber, M., Bürkner, P., Schiller, E., & Holling, H. (2019). The Efficacy of Emotionally Focused Couples Therapy and Behavioral Couples Therapy: A Meta‐Analysis. Journal of Marital and Family Therapy, 45(3), 447–463. https://doi.org/10.1111/jmft.12336
13. Jackson, J. B., Codecá, L., Miller, R. B., Simpson, J. E., O'Leary, A. M., & Renner, S. M. (2026). Empirically Supported Couple Therapy Models for Couple Relationship Distress: A Replication and Update. Journal of Marital and Family Therapy, 52(4), e70162. https://doi.org/10.1111/jmft.70162