Attachment-Based Therapy

Robertson named the sequence he had filmed: protest, then despair, then detachment. Detachment is the phase that looks like a child settling down, and traditionally it is the one adults have been most relieved to see.

Robertson showed the film to doctors at the Royal Society of Medicine. Many were offended, and some argued the ward he filmed was unrepresentative. But over the next twenty years, the film changed hospital visiting rules across Britain.

The psychiatrist who had handed him the camera was John Bowlby, and he had his own history with being left. Bowlby was raised largely by a nanny named Minnie, who left the household when he was about four, and he was sent to boarding school at seven. He wrote later that he wouldn’t send a dog away at that age.

In 1944 he published a study of 44 juvenile thieves he had seen at a London clinic and found that the ones who could not feel for other people had almost all been separated from their mothers early and for a long time.

In 1950 the World Health Organization asked him to report on the children left homeless across postwar Europe. His 1951 report, Maternal Care and Mental Health, argued that a child needs a warm and continuous relationship the way a body needs vitamins. It sold widely, and it made him famous and disliked in equal measure.

Bowlby then went looking outside psychoanalysis for proof. He found Konrad Lorenz’s goslings, which followed the first moving thing they saw, and Harry Harlow’s infant monkeys in Wisconsin, who were taken from their mothers and given a wire feeder and a cloth dummy. The monkeys clung to the cloth and went to the wire only to eat. The studies were cruel, but they showed that comfort was not a by-product of feeding.

Between 1969 and 1980 Bowlby published three volumes, Attachment, Separation and Loss. He argued that a child builds an internal working model, a set of expectations about whether reaching out gets answered, and carries it into every relationship after.

The person who turned that into something measurable was Mary Ainsworth. She had grown up in Toronto and taken her doctorate there, then joined Bowlby at the Tavistock in London in 1950. In the mid-1950s she followed her husband’s work to Uganda and spent nine months visiting mothers and babies in villages near Kampala, sitting in their homes with an interpreter and writing down what she saw.

What she noticed was that babies didn't simply need their mothers nearby. A baby would crawl away to explore, check back with their mother and go further when the checking went well.

In 1963 she started again in Baltimore with 26 families, visiting each home for a year. At the end she brought each mother and baby into a room with toys, then had the mother step out and come back twice over twenty minutes, with a stranger coming and going too. Ainsworth called it the Strange Situation.

What the babies did when their mothers came back told her the most. Some protested at the leaving, then settled quickly in their mothers' arms and went back to playing. Some could not be soothed and stayed fixed on their mothers. Some carried on as though they had not noticed their mothers go, though later researchers measured their heart rates and found them racing.

In 1978 Ainsworth and her colleagues published Patterns of Attachment and named the three patterns: secure, avoidant, and ambivalent - the one now usually called anxious. In 1986 Mary Main and Judith Solomon went back through tapes that had never fit a category and named a fourth, disorganized, for babies who ran toward the parent and froze, or approached backwards.

Mary Main also built the Adult Attachment Interview. It asks about childhood and scores how it's told, not what happened. What predicted a child's security was not whether the parent had a happy childhood, but whether the parent could tell their own story coherently, hard parts included. Researchers later gave the interview to pregnant women, and it predicted how their babies behaved a year after they were born. Why it works is still argued about.

In 1987 Cindy Hazan and Phillip Shaver printed a love quiz in a Denver newspaper. One question asked readers to pick which of three descriptions sounded most like them. They described secure, anxious and avoidant attachment styles. The three groups answered the rest of the quiz differently. Secure respondents reported longer relationships and warmer memories of both parents. Anxious respondents reported obsession and jealousy, and remembered fathers as unfair. Avoidant respondents reported fear of intimacy and remembered mothers as cold. That question is what every online attachment style quiz has copied since.

For decades this was a research field and not a therapy. It became one slowly, in specific models. Three therapists in Spokane built Circle of Security with parents in a Head Start program. Guy Diamond built Attachment-Based Family Therapy at Drexel for depressed and suicidal teenagers. Daniel Hughes built Dyadic Developmental Psychotherapy for adopted and fostered children. For adults in individual therapy, attachment arrived mostly as a lens, brought in by writers like David Wallin in 2007.

But the theory carries harm with it.

The argument that a child needs a continuous maternal attachment was used against mothers almost immediately. A generation of women were told that working was damaging to their babies. That blame still lands on mothers first when a child struggles.

Fathers, grandmothers, aunties and everyone else who raises children went largely unstudied in attachment theory. Michael Rutter corrected the record in 1972, showing that children need reliable relationships rather than one exclusive mother, but the blame had already set. Most attachment research still focuses on mothers.

The Strange Situation was built on white middle-class American families and it is still used as a universal ruler. Japanese babies, rarely left alone, looked ambivalent. North German babies, raised toward early independence, looked avoidant. Cultures that raise children in webs of kin failed a test written somewhere else.

The ugliest branch grew in the 1990s, when clinics sold something called attachment therapy to adoptive and foster parents, promising to force a bond through restraint, rage and hours of forced holding. In 2000, at a clinic in Evergreen, Colorado, a ten-year-old girl named Candace Newmaker was wrapped in a sheet and pressed under the weight of adults for over an hour in a rebirthing session. She said she couldn’t breathe, and she died. Two unlicensed therapists went to prison, Colorado and North Carolina outlawed rebirthing, and the practice was condemned by child maltreatment professionals. It wasn't attachment theory, but it used the name.

Trauma-sensitive attachment-based therapy works inside those gaps. It holds your patterns as adaptations to the people who cared for you, not evidence of a defect. It reads your patterns inside your own family and culture, not against a stranger's idea of normal. It asks who raised you and what environment you were raised inside, including poverty, racism and family separation. It never forces closeness, because forced closeness is a harm itself. And it treats an attachment style as a description, not a diagnosis, and one that changes based on who you're relating to.

Trauma-sensitive therapy starts by honoring how you learned to stay safe.