Clin Soc Work J (2008) 36:21–30

DOI 10.1007/s10615-007-0110-8

ORIGINAL PAPER

What is Adult Attachment?

Published online: 24 August 2007

Abstract This paper explores the concept of adult Despite the advances in investigating adult attachment,
attachment. Although attachment theory is now getting a there is still limited understanding of what it means to be
great deal of attention, there is not yet a clear picture of attached in adulthood (Crowell et al. 1999; Hazan et al.
what it means to be attached in adulthood or what the 2004; Main 1999). For example, there is not a consensus of
clinical applications of the approach might be. Using what relationships are considered to be adult attachments,
Bowlby’s distinctive ethological-evolutionary framework or how to characterize their functions and expression.
and updating it with findings from neurobiology and According to Bowlby (1969), a child targets his attachment
attachment research, it is proposed there is an attachment behavior to someone perceived to be older, stronger and
behavioral system that operates throughout the lives of wiser, but this point can be misleading when applied to the
adults and that this changes the way we understand our reciprocal attachment behavior and the sexual nature of
clients’ distress and carry out psychotherapy. some adult attachments. Moreover, Marrone (1998) notes
that attachment theorists may have focused more on the
Keywords Adult attachment
Ethology
Evolution
mother-child bond because it was considered to have
Psychotherapy greater influence on development. And, although Bowlby
himself repeatedly stated that attachment was a lifelong
phenomenon, neither he nor Ainsworth wrote as much
Introduction about adults. Similarly, the literature on psychotherapy
with adults is less developed (Eagle and Wolitzky in press;
As John Bowlby intended it to be, attachment theory is now Harris 2004). As a result, the knowledge base of adult
recognized and accepted as a ‘‘lifespan developmental attachment is still evolving, not yet conclusive or complete.
theory’’ (Crowell et al. 1999, p.434), relevant for under- There are many dimensions and functions involved in
standing how certain early affectional experiences adult relationships, and we don’t yet know how far
influence emotional and physical well-being, not only in attachment concepts go in explaining this complexity. In
childhood but throughout adulthood as well. Though particular, Hazan et al. (2004) point out that Bowlby con-
Bowlby’s view of the nature of the infant—caregiver bond tended it was necessary to delineate the development and
was his first concept to gain interest and attention in functioning of normal attachment in order to identify
attachment, there is now an enormous amount of research dysfunctional variations. However, the extensive research
and literature on adult attachment, including how the the- on attachment patterns, stemming from Ainsworth’s
ory can be useful in clinical practice. (Ainsworth et al. 1978) Strange Situation procedure, shif-
ted the focus onto individual differences. As a result, there
has been less progress in delineating what processes are
involved in establishing and carrying out the functions of
P. Sable (&) normative attachment and how these change over time
School of Social Work, University of Southern California, 877
Teakwood Road, Los Angeles, CA 90049-1334, USA
(Berscheid 2006; Hazan et al. 2004; Kirkpatrick 2005).
e-mail: [email protected] Furthermore, there are substantial differences in what the

123
22 Clin Soc Work J (2008) 36:21–30

various studies on adults measure, which makes it ques- parents and cared for by strange persons in strange sur-
tionable to attempt generalizations from the findings roundings. In describing what it was like for these children
(Crowell et al. 1999; Hazan et al. 2004). Kirkpatrick to be alone, trying to cope without the support and reas-
(2005) alleges that adult attachment studies also fail to surance of their familiar caregivers, Bowlby discovered the
fully take account Bowlby’s distinct ethological-evolu- pain of separation as well as the anguish of loss. This led
tionary perspective. him to consider that a special bond with the parental
The purpose of this paper is to explore what is meant by caregivers was disrupted by prolonged separation. He
the concept of adult attachment. Using Bowlby’s etholog- called for research to specify what caregiving experiences
ical-evolutionary perspective as a framework, and updating children need in order to develop confidence in themselves
it with findings from attachment-based research and neu- and their ability to deal with the challenges they will meet
robiology, it is proposed that there is now sufficient in life. His allegation of the pivotal role security had in
evidence to support Bowlby’s hypothesis of a behavioral adaption shifted the focus of child development away from
system of attachment which, initiated in infancy, extends the classical psychoanalytic developmental view empha-
into and throughout adulthood. Its function, essentially sizing sexuality and conflict, and toward safety and
similar to that of attachment in infancy, is to assure the familiarity in relationships (Holmes 1995). Bowlby also
formation of reliable relationships that can be counted on added an ethological-evolutionary perspective proposing
for psychological and physical protection, affect regula- that a mother was indispensable to her child, not primarily
tion, and ultimately, reproductive success (Bretherton for oral needs and feeding, but for the biological function
1985; Crowell et al. 1999). It is further proposed that a of protection from danger. He incorporated this ethological
fuller understanding of the normative aspects of adult orientation, along with concepts from control theory, to
attachment can facilitate identifying maladaptive tenden- hypothesize a behavioral system composed of a set of
cies, improving our ability to understand and help our instinctive behaviors to explain how an infant establishes
clients. and maintains the connection so essential to its emotional
The discussion begins with a brief overview of attach- security and actual survival.
ment theory, followed by findings from the field of More recently, research on the ‘‘neurobiology of
attachment research that can be utilized to define adult attachment’’ has extended the basis of Bowlby’s concept of
attachment. Next, the function and expression of attach- an attachment behavior system by suggesting that its
ment in adults is addressed. The theoretical basis advanced functions are carried out by the right hemisphere of the
by findings from neuroscience and animal studies is then brain, specifically the right cortex (Schore 1994). Like
considered. The discussion concludes with a look at Bowlby’s premise that the attachment system evolved for
attachment-based psychotherapy, a part of the theory that protection from predators and other dangers, the brain is an
has tended to be less clear for clinicians (Brisch 2002; evolving organ, ‘‘designed by natural selection’’ (Kirkpa-
Diamond and Marrone 2003; Eagle 2006; Eagle and trick 2005, p. 162), then shaped by experiences and the
Wolitzky in press; Rutter 1997). An area of emphasis is environment. Secure attachment and adaptive functioning
how Bowlby used an evolutionary framework to connect are promoted by a caregiver who is emotionally available
brain, body, and mind in his reformulation of traditional and appropriately responsive to her child’s attachment
psychoanalytic theory and how this offers an additional behavior, as well as capable of regulating both his or her
perspective for understanding and helping our clients. positive and negative emotions.
Schore (1994, 2003a,b) contends that though the brain
retains some plasticity throughout life, the quality of early
The Ethological-Evolutionary Framework of caregiving has a particularly significant impact on its
Attachment development, structure and functioning. Bowlby (1969)
also emphasized that the potential for attachment difficul-
According to Bowlby (1969, 1973, 1980), attachment ties or disruptions to activate ‘‘attachment behavior does
theory is based on the premise that human beings, like not disappear with childhood but persists throughout life’’
many other animals, have a natural inclination to make and (p. 350). Although elicited with less urgency, the need to
maintain lasting affectional bonds—or attachments—to maintain contact with attachment figures and to especially
familiar, irreplaceable others, and, once established, the seek them out when stressful situations arise is a hallmark
quality, security and stability of these ties is related to of attachment throughout the whole life cycle. The means
emotional health and well-being throughout life. The the- of achieving proximity and communication become
ory actually began with Bowlby’s attempt to explain developmentally more organized, diverse and sophisti-
observations that he and social worker James Robertson cated, and attachment behavior becomes directed to
made of young children who were separated from their persons and groups beyond the family, but the conditions

123
Clin Soc Work J (2008) 36:21–30 23

that elicit the behavior do not change. At times of threat, without them’’ (Antonucci 1986, p. 10). In the middle
danger, separation or loss, adults are likely to seek emo- circle, they are asked to place those who are ‘‘not quite as
tional support and protection from affectional figures. In close but who are still very important,’’ and in the outer
some situations an adult may be able to reduce distress circle, those not included in the first two circle but who
simply by thinking about an attachment figure but under are ‘‘close enough and important enough in their life that
certain circumstances these mental representations would they should be placed somewhere in their network of
not bring relief, and the person requires actual proximity relationships’’ (Antonucci 1986, p.11). The procedure has
(Mikulincer and Shaver 2007). This behavior has been been administered by mail-in questionnaire or personal
dramatically captured on television when, for example, interview to individuals ranging in age from 18 to 95 with
family members reunited after a disaster vigorously touch varied health and cultural backgrounds. The researchers
and hug each other. concluded that relationships with individuals placed in
the respondents’ innermost circle could be considered
equivalent to attachment relationships, and that personal
Research Defining Adult Attachment well-being across the life cycle would be dependent on
having at least one of these close relationships. Figures
The assumption that the attachment behavioral system placed in the outer two circles comprise a network of
operates across the lifespan provides the scaffolding for social support that enhances life though it is considered
exploring and clarifying a concept of adult attachment. that the loss of these would not lead to the grief and
Through what Bowlby (1969, 1973) called internal mourning that would follow the loss of those in the inner
‘‘working models,’’ early attachment experiences are car- circle.
ried forward as mental representations of attachment These conclusions are supported by Weiss’s (1988)
figures in relation to the self ‘‘along the pathway toward studies of divorced and widowed individuals in which he
the adult personality’’ (Grossmann et al. 2005, p. 104). In hypothesized that there are two types of loneliness: an
terms of attachment in adults, the earliest research evi- emotional loneliness that results from the loss of attach-
dence of its effects came from the works of Marris (1982), ment; and a social loneliness that results from gaps in a
Parkes (1991), and Weiss (1982, 1991), who found that group or social network. This differentiation was evident in
separation or loss of key affectional figures led to a my research with women who had been widowed from one
sequence of responses—protest, despair, detachment— to three years (Sable 1989). Like Weiss, I found the women
comparable to those Robertson and Bowlby had identified reported a loneliness that was difficult for them to over-
in young children who were separated from their parents. come, and they made it clear that though social ties eased
Subsequent adult attachment research such as Kahn and the pain of their loss they did not replace having an
Antonucci’s (1980) social convoy diagram, and Hazan and exclusive attachment.
Shaver’s (1987) self-report measure of adult romantic Another adult attachment study is that of Hazan
relationships have shown that there are certain adult and Shaver’s (1987) whose self-report measure of adult
relationships which are felt to be unique and irreplaceable, attachment was used to investigate the impact of attach-
and which provide a sense of familiarity, companionship ment quality on romantic love. Their questionnaire asks
and emotional security. Generally, pair-bonds of marriage respondents to choose which of three statements most
or other committed heterosexual or gay relationships accurately describes their general feelings about them-
are perceived to be the prototypical indication of these selves in intimate relationships. The choices: secure,
attachments (Berscheid 2006). However, there is research ambivalent or avoidant are modeled on Ainsworth’s infant
evidence, for example by Kahn and Antonucci (1980), that classifications of attachment patterns. In addition, there are
other family members, selective friends, pets, or therapists questions about childhood relationships and a significant
also provide elements of attachment, even though the romantic relationship. Hazan and Shaver found that secure
provisions of these bonds may not be as extensive, flexi- attachment was associated with both happier love rela-
ble, or interchangeable as the more physical availability of tionships and reports of a caring and attentive childhood.
a romantic partner (Antonucci 1994; Mikulincer and Subsequent research has extended the instrument to include
Shaver 2007; Sable 1995; Siegel 1999; Weiss 1991). Kahn a fourth attachment style ‘‘fearful’’ as well as an Adult
and Antonucci (1980) designed a Social Convoy diagram Attachment Questionnaire (AAQ) (Simpson et al. 1996)
to address various aspects of adult relationships over time. which converted the prototypes into a series of Likert-type
The Social Convoy consists of three concentric circles items. Findings from the AAQ basically support Hazan
with the word ‘‘you’’ in the center. Respondents are asked and Shaver’s (1987) measure, with insecure attachment
to place in the inner circle those figures to whom the represented by two dimensions, avoidance or anxiety
individual feels ‘‘so close that it’s hard to imagine life (Mikulincer and Shaver 2007).

123
24 Clin Soc Work J (2008) 36:21–30

Still another study of adult attachment, based on Ains- proximity, safety, and reassurance if distressed or unhappy.
worth’s attachment patterns, is the Adult Attachment Besides being a pejorative term, dependency can imply the
interview (AAI) devised by Main and colleagues (George person should mature and become independent-that is
et al. 1996) to explore the meaning adults assign to their having less need for others. It was this point that led
childhood experiences. The semi-structured interview asks Bowlby (1969) to write that the term regression be used
individuals to describe their relationships with childhood with caution because an adaptive activation of attachment
attachment figures and to recall incidents which substan- behavior could mistakenly be seen as pathological depen-
tiate their memories. There are direct questions about dency in an adult. In fact, we know from extensive research
attachment events such as separation, loss or rejection, that adults live longer and have happier and healthier lives
followed by requests to offer explanations of how parents’ when they are in lasting, committed relationships (Dia-
behavior may have influenced their adult personality. The mond and Hicks 2004); without close relationships
AAI is scored according to the person’s current ‘‘state of individuals are more susceptible to psychological and
mind with respect to attachment’’ (Hesse 1999, p. 395), physiological distress, including injury, disease, substance
with interviews classified as secure/autonomous, dismiss- abuse, depression and suicide (Gilbert 2001; Hazan and
ing, preoccupied or unresolved/disorganized. Adult Zeifman 1999). Bowlby’s (1969) concept of a psychobio-
security was identified by the respondents’ ability to reflect logical system of attachment functioning to regulate
on their experiences and to describe them in an open and emotions and assure the continuity and security of affec-
coherent manner. Their actual early experiences need not tional bonds accounts for this ‘‘vastly complex intertwining
have necessarily been trouble-free as long as they were of our biology and our emotions’’ (Sapolsky 1998, p. 2).
integrated into a balanced view that neither idealized nor Additionally, his concept of internal working models
maligned their parents. The other patterns suggest a accounts for the continuity of earlier attachment experi-
defensive strategy which either maximizes (preoccupied) ences, as well as the potential for change.
or minimizes (dismissing) attachment behavior. The working models of adults are cognitive-affective
Although the measures were designed for different structures that regulate the attachment system by moni-
purposes, the results of each suggest there is an attachment toring and managing cognition, feelings and behavior in
behavioral system that remains active throughout life. The response to attachment-related situations (Collins et al.
system has the same evolutionary purposes of security and 2006). The complexity and flexibility of representations
safety as it does for the young but because it does not need built up over years of experience make it possible to think
to be as readily activated, and tends to be more subtle and through the details and options for dealing with events;
flexible, it may not be as easily recognized for what it is. activate attachment behavior to contend with threatening
conditions; and assess the intensions and availability of
attachment figures. In the same way that children use their
The Function of Attachment in Adult Relationships caregivers for refuge and protection, adults will seek
proximity to attachment figures at times of adversity. In
Bowlby (1969, 1973) introduced the term ‘‘attachment’’ to fact, attachment-based research has confirmed that a
describe certain emotional relationships that individuals characteristic of secure attachment is ‘‘a capacity to rely
form and try to maintain because they are fundamental to trustingly on others when occasion demands’’ (Bowlby
feelings of belonging, security and protection from fear. He 1973, p. 359), a characteristic that Bowlby points out exists
called the figures to whom attachment behavior is directed in individuals who are truly self-reliant. Although adults do
‘‘attachment figures’’ and said that the stability of these not generally need the regular physical presence of an
bonds was related to mental and physical well-being attachment figure which is required for the young, they do
throughout the entire life cycle. With a secure base in need to know they would have a reliable base available and
relationships, a person of any age feels freer to move out responsive if they were frightened or ill, wanted advice or
and about in the world, exploring new experiences and reassurance. They need to know they have someone look-
activities, assured of a comfortable and reassuring refuge to ing out for them who would track them down if they did
return to should this be needed (Ainsworth 1991). not show up when expected. Over the course of evolution,
The distinction Bowlby (1973) made between attach- attachment has proven to be a well-designed mechanism
ment and dependency is important for understanding this for motivating two individuals to stay together and to react
feature of adult attachment. Self reliance and the ability to strenuously if their relationship is in jeopardy (Hazan and
function with confidence stem from having had a founda- Zeifman 1999). Rothchild (2000) uses the concept of an
tion with available and responsive caregivers who both anchor to depict a feeling that comes from having someone
offered comfort and support and encouraged exploration. who gives a person a feeling, in both mind and body, of
It is considered adaptive, not over-dependency, to seek safety, relief, and well-being. Like Schore (2003a),

123
Clin Soc Work J (2008) 36:21–30 25

Rothchild uses findings from neuroscience as a theoretical neurobiological underpinnings that sustain attachment. The
basis for understanding the mind-body connection in physiological co-regulation that is characteristic of
her treatment of individuals dealing with traumatic attachment has been investigated and documented by infant
experiences. researchers such as Tronick (1989, 2007) and Stern (1985)
and it has also been identified in animal research such as
that of Harlow (Harlow and Zimmerman 1959) and Hofer
Neurobiology and Adult Attachment (1995). It was a major paradigm shift when Bowlby (1969)
recognized that animal studies could have relevance for
In his foreword to the reissue of Bowlby’s Volume I, understanding the instinctive roots of attachment behavior
Attachment, Schore (2000) writes that Bowlby’s charting in humans, and he framed his reformulations of traditional
of attachment anticipated the recent advances in under- theory within an ethological perspective. Bowlby had been
standing brain-mind-body processes and how they mediate searching for an alternative explanation of the observations
the attachment system. Schore’s (1994, 2000, 2003a,b) of the separation experiences in young children than the
work, which integrates findings from neurobiology with explanations that existed in traditional psychosexual
attachment research, makes a significant contribution to developmental theory. When he was introduced to the work
this understanding of brain development by identifying the of ethologists, such as Lorenz (1952) and Tinbergen
psychobiological processes based in the right brain to right (1951), he saw the potential to apply their concepts and
brain connection between caregiver and infant. Schore research strategies to certain aspects of human behavior.
(2000) perceives attachment theory as a theory of dyadic An example which supports Bowlby’s observations and
affect regulation and explains that the nature and quality of assumption of an innate attachment system that is pertinent
early caregiving influences brain development and, in turn, to adult attachment comes from studies of prairie voles,
a later capacity to regulate emotions. Schore (2003a) small rodents, which form lasting bonds and display
reinforces attachment theory by emphasizing that respon- attachment behavior to their mates. Another pair-bonding
sive caregiving implies a caregiver who is emotionally species, titi monkeys, stay physically close to each other
available and psychobiologically attuned to her child. and become agitated and distressed if separated (Hazan
Although ongoing events post-infancy (including et al. 2004). There is also research supporting Schore’s
external social and cultural factors), can alter develop- (2003b) belief in ‘‘the critical role of somatic, bodily based
mental pathways, the ‘‘repeated sequences of interactive activities’’ (p. 259) of caregiving for later adaption. For
experience’’ (Stern 1977, p. 5) that take place between example, there is evidence that touching rat pups early in
mother and child during the first 18 months to 2 years are their lives influences how they age years later. From either
seen as the foundation of emotional development. More- a person handling the pup in a laboratory for 15 minutes a
over, Schore’s (2003a) depiction of the importance of the day during its first weeks, or the licking and grooming of a
child having positive experiences with his or her caregiver mother rat to her offspring in those same early weeks,
has evolutionary significance. Attuned interactions Meaney and colleagues (Issa et al. 1991) found that there
between caregiver and child trigger endogenous opiods was less memory impairment at age two than found in
such as endorphins that elicit feelings of pleasure and well- other ‘‘old’’ rats. There is also research that shows licking
being. Positive experiences motivate proximity and com- and grooming behavior is correlated with decreased phys-
munication, resulting in greater likelihood of protection iological responses to stress in the rat’s adult lives (Liu
and healthy development (Hazan et al. 2004; Schore et al. 1997).
2003a). Conversely, negative experiences such as incon- In showing that caregiving and pair-bonding for both
sistent, abusive or neglectful caregiving can undermine humans and animals gives rise to certain similar, persisting
resilience, rendering a person more prone to emotional behavior patterns, it seems plausible to suggest that the
distress when confronted with environmental demands or phenomenon of attachment is not exclusive to humans; nor
danger (Bowlby 1977). is it confined to childhood. Furthermore, animal data in
particular indicate that the consequences of early experi-
ences do not depend on language or complex thinking but
Animal Studies and the Neurobiology of Attachment are a product of evolutionary processes that apply to non-
human and humans alike (Bowlby 1969; Suomi 1999).
Schore’s (2000) concept of attachment theory as a theory People obviously have cognitive processes which allow
of affect regulation adds an important dimension to iden- for more sophisticated and symbolic thought, as well as
tifying aspects of adult attachment, in particular how attachment behaviors that are more flexible and varied.
emotions are a defining feature of the attachment behav- However, the instinctive origins are the beginning—for
ioral system, and also how research is elucidating the people like they are for animals—built into our feelings

123
26 Clin Soc Work J (2008) 36:21–30

and behavior, providing the physiological underpinnings of whether attachment figures would be available and
attachment behavior. Subsequent experiences then influ- responsive if called upon (Kirkpatrick 2005). This suggests
ence the direction that developmental pathways take, that clients often seek therapy when their instinctive needs
veering the person toward resilience and the ability to for attachment and security are not being met (Harris
process and integrate experiences (Rothchild 2000)) or 1997), regardless of whether they are able to let themselves
conversely toward a vulnerability to succumb to psycho- know this or not. By helping clients understand the
logical distress when faced with stressful situations. evolutionary significance of attachment as well as the
evolutionary function of their problems, the door is opened
to a revised perspective on feelings and behavior that once
Attachment-based Psychotherapy with Adults seemed puzzling or maladaptive (Kirkpatrick 2005).
Within this framework for understanding emotional dys-
The concept of developmental pathways, replacing the regulation and distress, advances in understanding bodily
model of development based on psychosexual stages, fix- processes and brain development are expanding while also
ation, and regression, suggests an array of possible supporting Bowlby’s (1988) view of the role of the thera-
pathways along which a person may progress, depending pist and the therapeutic process. Bowlby stated that it is
on current and past experiences with attachment figures as through having a new kind of attachment experience with
well as environmental conditions (Bowlby 1988). When the therapist, together with revising the story of one’s life
adverse experiences divert development onto a suboptimal into a more coherent narrative, that a person may be able to
pathway, adaptive functioning is put in jeopardy, and can reappraise and restructure maladaptive working models.
eventually lead to what Schore (2003a) describes as a Park (2004) defines coherent narrative as a mental
disturbance of affect regulation. Schore posits that adult construct that clients form as they are able to rethink and
attachment disorders reflect the lasting effects of early alter assumptions about their attachment experiences. The
maternal misattunement which had a negative impact on ‘‘springboard for change’’ (Park 2004, p.137) is provided
the child’s developing brain. Bowlby (1973, 1980) also by the therapist who tries to engage the client in a ‘‘joint
connected early disruptions in caregiving to later psycho- exploration’’ (Bowlby 1991, p. 460) of the unhappy events,
logical disturbance with his thesis that certain distress is an painful feelings and memories which may be relevant to
‘‘expression of attachment-related problems’’ (Lashinger, current emotional problems. The role of the therapist is to
et al. 2004, p. 161) reflecting ‘‘unmet attachment needs’’ become a ‘‘relatively secure base’’ (Bowlby 1981, p. 251)
(Karen 1994, p.386) which continue to plague the person as where the client can begin to experience the feeling of
an adult. According to his Darwinian perspective, symp- safety and support that comes from having a caring, reli-
toms of intense anxiety, depression, and/or anger that move able relationship. Schwartz and Pollard (2004) and Eagle
these people to seek therapy are part of our innate equip- (2006) note that this is not likely to be automatic, and may
ment, elicited to preserve vital bonds of attachment. take time, since many individuals come to therapy because
However, disruptive or traumatic experiences have either they have had difficulty making and sustaining satisfactory
exacerbated these natural feelings or caused them to be bonds in the past. Also, attachment theory presumes that it
inhibited and/or redirected to other situations or persons. takes time for the therapist to be considered an attachment
Bowlby (1980) called the defensive process which shuts figure and requires that the therapist is felt to be familiar,
out the meaning and/or memories of certain painful events, emotionally available and affectively attuned to the client.
defensive exclusion. It can lead to disjointed thoughts and As attachment forms through a gradual internalization of
emotions, hampering the ability to regulate affect, relate to soothing and calming interactions with the therapist, the
others, or cope with the tasks and stresses of everyday life. person experiences psychological and physiological regu-
In looking at attachment-based therapy, Bowlby (1979) lation of dysregulated states and begins to develop the
acknowledged there was common ground with other the- ability to integrate and regulate his or her own feelings and
ories, but said it could be distinguished from them by both thoughts (Baylis 2006; Mikulincer and Shaver 2007).
its emphasis and orientation. He especially noted that ‘‘how A concept to come out of attachment theory that clini-
we conceive the place of attachment behavior in human cians are finding helpful (see, for example, Bettmann 2006;
nature’’ (p. 156) and how we think that individuals come to Shilkret 2005) is that part of a therapist’s attunement is
acquire certain distressing symptoms influence how we assessing the client’s attachment style and then regulating
carry out therapy. Bowlby’s approach, to frame these therapeutic approach accordingly. For example, some years
considerations with an ethological-evolutionary perspec- ago I (Sable 1983, 2000) wrote about Kelly, a young adult
tive, suggests that whatever one’s age, the attachment woman who I described as ‘‘emotionally detached’’ (based
system is continually alert and adjusting to a variety of both on Bowlby’s 1977 delineation, but what might currently be
internal and external conditions with a particular focus on called unresolved/disorganized), and suggested that this

123
Clin Soc Work J (2008) 36:21–30 27

was an alternative to diagnosing her as borderline or nar- base, attachment behavior over natural clues is less com-
cissistic, adapting our understanding of her symptoms, pelling and the person can use his or her base for
attachment history, and transference reactions to a new exploration, increasing opportunities for new experiences
theoretical base. Kelly came for therapy because of the and relationships. With Kelly, her faulty attachment
fear, anxiety, and dissociation she noted whenever she experiences such as separation and threat of separation
tried to make a romantic relationship with a man. Her upset the balance between attachment and exploration.
anxiety symptoms included fear of the dark, ‘‘strange Thus, as an adult she withdrew from close relationships
areas,’’ crowds, and going most places alone like shopping that made her feel vulnerable and afraid, and felt uneasy
or the theater. At times she became depressed and suicidal, when away from home too long or moving about in strange
withdrawing to her home except for going out to work. areas alone. From an evolutionary standpoint, Kelly’s
When she began treatment, Kelly reported she could attachment style was a strategy to adapt to a dysfunctional
barely remember any details about her childhood. How- family environment, resulting in what Gilbert (2001) calls
ever, she did remember that she always felt afraid, on guard an ‘‘evolutionary trade-off’’.
and cautious. She was also cautious with her therapist, This is an important attachment concept for under-
acting tense and distant, speaking haltingly with few words standing adult distress and also helping clients appreciate
and minimal affect. The therapy hours during those first that their emotions are a product of evolution, serving
months seemed interminable. Only slowly and over the the essential function of protection and survival. Apply-
four years of our work together, did Kelly come to develop ing an attachment orientation, I attempted to help Kelly
trust and a feeling of safety, and start to let herself understand that her feelings were a reasonable response
remember and sort through a tumultuous and traumatic to her real experiences, while also putting together a
childhood of alcoholic parents, family violence, and a history of how they developed. Fonagy (2001) has
mentally ill mother who was critical and frightening. Her explained that a child like Kelly can lock away
parents, for instance, threatened to abandon or send Kelly unbearable thoughts and feelings, and that without
away when she misbehaved and later, following her par- someone with whom to remember and share them with,
ents’ divorce, sent to live with her father, was warned by carry working models into adulthood that could distort a
her step mother to beware of men and sex. Learning at a current experience.
young age that she could not rely on her caregivers, or
make sense of their illogical communications, Kelly
deactivated her attachment behavior, not allowing herself Conclusion
to access or express the love and comfort she so desper-
ately wanted. Using an evolutionary perspective, Bowlby believed there
Kelly’s deactivated attachment system also demon- was a biological imperative for attachment which stays
strates that affective experiences are rooted in the body with us throughout life. The concept of adult attachment is
(Park 2004) and illustrates Nelson’s (2005) notion that a theoretical attempt to capture the essence of this inherent
adult tears like those of children, can be an expression of need and how it leads individuals to form close and
attachment behavior, signaling a need to be close to others. enduring bonds that can be counted on for both pleasure
Kelly’s mother would tell her to stop acting like a baby if and protection. Though pair- bonds are the most common
she cried and as an adult she did not cry, claiming that the characterization of adult attachment (and are likely to also
only result was sore eyes. Likewise, she visualized ‘‘dire include caregiving and reproductive behavioral systems),
consequences’’ if she expressed anger and the mere thought research such as the Social Convoy diagram indicates there
of doing this made her feel ‘‘wooden, with a whirl of are a variety of relationships that can have the emotional
thoughts and a knot in my stomach.’’ Similarly, her ago- ‘‘force’’ (Stern, 2000) of attachment. For instance, I (Sable,
raphobic symptoms are physiological indications of having 2000) have proposed that pets provide a component of
failed to internalize a secure base (Eagle 2003). Bowlby attachment which may explain situations like the refusal of
(1973) argued that these kinds of fears are part of a group people to abandon their pets following the Katrina disaster,
of ‘‘natural clues to danger’’ that are hard-wired into even to the point of endangering their own lives. Although
humans, and have the function of motivating movement it is possible that elements of the caregiving behavioral
away from potential threat and toward the safety of an system were involved, there were obviously powerful
attachment figure. These clues which quickly activate fear feelings which overcame imminent danger. This is less
and attachment behavior include external stimuli such as surprising when we see how research on companion ani-
being alone, strangeness, heights or sudden change in light mals, especially dogs, has found they promote both mental
or sound, and internal states such as pain, illness or fatigue. and physical health, reduce stress and loneliness, and have
With age, development, and the internalization of a secure a calming effect.

123
28 Clin Soc Work J (2008) 36:21–30

The joy many people feel in living with pets points out to expand, the conceptual framework of attachment will
another aspect of attachment theory: it is a positive theory, continue to offer new possibilities for therapists to better
accentuating the evolutionary significance of meaningful understand their clients and how to help them make their
affectional relationships. Moreover, as Bowlby (1980) emotional bonds happily enduring and increasingly secure.
wrote, these few specific ties are ‘‘the hub around which a
person’s life revolves’’ (p. 442). Schore’s integrative work
builds on this legacy of Bowlby’s by demonstrating that References
early attachment experiences actually impact brain devel-
opment, later affect regulation and capacity to make these Ainsworth, M. D. S. (1991). An ethological approach to personality
ties secure. development. American Psychologist, 46(4), 333–341.
Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978).
Despite the current popularity of attachment concepts Patterns of attachment: Assessed in the strange situation and at
and research, there is still much to learn about adult home. Hillsdale, NJ: Lawrence Erlbaum.
attachment. Both Kirkpatrick (2005) and Simpson (1999) Antonucci, T. C. (1986). Social support networks: A hierarchical
allege that advances rest on completing integration of mapping technique. Generations, 10, 10–12.
Antonucci, T. C. (1994). Attachment in adulthood, and aging. In M.
attachment theory into an evolutionary perspective. For B. Sperling, & W. H. Berman (Eds.), Attachment in adults:
example, Berlin and Cassidy (1999) suggest a need for Clinical and developmental perspectives (pp. 256–272). New
research to further clarify whether the association between York: Guilford Press.
early attachment experiences and adult relationships is Baylis, P. J. (2006). The neurobiology of affective interventions: A
cross-theoretical model. Clinical Social Work Journal, 34(1),
evolutionarily adaptive. Future research can address issues 61–81.
such as how adult attachments are established, how they Berlin, L. J., & Cassidy, J. (1999). Relations among relationships:
are distinguished from non-attachments, and how attach- Contributions from attachment theory and research. In J.
ment patterns change over time (Berlin and Cassidy 1999; Cassidy, & P. R. Shaver (Eds), Handbook of attachment:
Theory, research, and clinical applications (pp. 688–712). New
Rholes and Simpson 2004). Animal studies on the neuro- York: Guilford Press.
biology of bonding will have additional implications for Berscheid, E. (2006). Seasons of the heart. In M. Mikulincer, & G. S.
understanding normative attachment in adults (Hazan et al. Goodman (Eds.), Dynamics of romantic love (pp.404–422). New
2004). Furthermore, Eagle and Wolitzky (in press) state York: Guilford Press.
Bettmann, J. E. (2006). Using attachment theory to understand
there is not yet one specific approach to individual adult treatment of adult depression. Clinical Social Work Journal,
treatment, and therefore, agree with Slade (1999) that, for 39(4), 531–542.
now, attachment theory is best described as informing Bowlby, J. (1969). Attachment and loss, Vol. 1. Attachment. New
rather than defining clinical practice. York: Basic Books.
Bowlby, J. (1973). Attachment and loss, Vol. 2. Separation: Anxiety
The ethological-evolutionary perspective is a paradigm and anger. New York: Basic Books.
shift which adds ‘‘something extra’’ (Harris 2004, p.204) to Bowlby, J. (1977). The making and breaking of affectional bonds.
psychotherapy. For example, Harris (1997) suggests that the British Journal of Psychiatry, 130, 201–210, 421–431.
most important implication of attachment theory for treat- Bowlby, J. (1979). On knowing what you are not supposed to know
and feeling what you are not supposed to feel. Canadian Journal
ment may be its tenet that attachment behavior is instinctive. of Psychiatry, 24, 403–408.
Although we now know the ‘‘environment of evolutionary Bowlby, J. (1980). Attachment and loss, Vol. 3. Loss: Sadness and
adaptedness’’ in which humans evolved was not as benign as depression. New York: Basic Books.
Bowlby portrayed (Kirkpatrick 2005), our feelings remain Bowlby, J. (1981). Psychoanalysis as a natural science. International
Review of Psycho-Analysis, 8, 243–256.
tied to our evolutionary past and to our bodies. Under- Bowlby, J. (1988). A secure base. New York: Basic Books.
standing that attachment experiences, both present and past, Bowlby, J. (1991). Charles Darwin. New York: W.W. Norton and Co.
can alter brain-body processes (Diamond 2003), Ogden Bretherton, I. (1985). Attachment theory: Retrospect and Prospect.
(Ogden et al. 2006) and Orbach (2004) are two current cli- Monograph of the society for research in child development,
serial number 209. In I. Bretherton & E. Waters (Eds.), Growing
nicians who are devising techniques that use attachment points of attachment theory and research (pp. 3–35).
concepts to treat symptoms as well as deal with physiolog- Brisch, K. H. (2002). Treating attachment disorders. New York:
ical elements that are related to client difficulties. Diamond Guilford Press.
(2003) has said that this cutting edge approach actually Collins, N. L., Guichard, A. C., & Ford, M. B. (2006). Responding to
need in intimate relationships: Normative processes, and indi-
brings an ‘‘emphasis back to the body’’ (p. 410). This going vidual differences. In M. Mikulincer, & G. S. Goodman (Eds.),
back refers to the origins of psychoanalysis, to Freud and Dynamics of romantic love (pp. 149–189). New York: Guilford
Bruer’s work on hysteria and its relationship between mind Press.
and body (Orbach 2004). Bowlby’s evolutionary perspective Crowell, J. A., Fraley, R. C., & Shaver, P. R. (1999). Measurement of
individual differences in adolescent, and adult attachment. In J.
may take us back, but it also takes us forward by presenting Cassidy, & P. R. Shaver (Eds.), Handbook of attachment:
an innovative view of human nature that is more compatible Theory, research and clinical applications (pp. 434–465). New
with modern biology and neurophysiology. As it continues York: Guilford Press.

123
Clin Soc Work J (2008) 36:21–30 29

Diamond, N. (2003). Attachment, trauma, and the body. In M. Cortina Issa, A., Rowe, W., Gauthier, S., & Meaney, M. (1991). Hypotha-
& M. Marrone (Eds.), Attachment theory and the psychoanalytic lamic-pituitary-adrenal activity in aged, cognitively impaired and
process (pp. 409–429). Philadelphia: Whurr. cognitively unimpaired rats. Journal of Neuroscience, 10, 3247.
Diamond, L. M. & Hicks, A. M. (2004). Psychological perspectives Kahn, R. L., & Antonucci, T. C. (1980). Convoys over the life cycle
on attachment: Implications for health over the lifespan. In W. S. course: Attachment roles and social support. In P. B. Baltes & O.
Rholes, & J. A. Simpson (Eds.), Adult attachment: Theory, Brim (Eds.), Lifespan development and behavior, (Vol. 3, pp
research, and clinical implications (pp. 240–263). New York: 253–286). New York: Academic Press.
Guilford Press. Karen, R. (1994). Becoming attached. New York: Warner.
Diamond, N. & Marrone, M. (2003). Attachment and intersubjectiv- Kirkpatrick, L. A. (2005). Attachment, evolution, and the psychology
ity. London and Philadelphia: Whurr. of religion. New York: Guilford Press.
Eagle, M. (2003). Clinical implications of attachment theory. Lashinger, B., Purnell, C., Schwartz, J., White, K., & Wingfield, R.
Psychoanalytic Inquiry, 23, 27–53. (2004). Sexuality and attachment from a clinical point of view.
Eagle, M. (2006). Attachment, psychotherapy and assessment: A Attachment and Human Development, 6(2), 151–164.
commentary. Journal of Consulting and Clinical Psychology, 74, Liu, D., Diorio, J., Tannenbaum, B, Caldji, C., Francis, D., Freedman,
1086–1097. A., Sharma, S., Pearson, D., Plotsky, P. M., & Meaney, M. J.
Eagle, M. & Wolitzky, D.L. (In press). The perspectives of (1997). Maternal care, hippocampal glucocorticoid receptors,
attachment theory and psychoanalysis: Adult psychotherapy. In and hypothalamic-pituitary-adrenal responses to stress. Science,
E. Berant & J.H. Obegi (Eds.), Clinical applications of adult 277, 1659–1662.
attachment. New York: Guilford Press. Lorenz, K. (1952). King Solomon’s Ring. London: Methuen.
Fonagy, P. (2001). Attachment theory and psychoanalysis. New York: Main, M. (1999). Epilogue. Attachment theory: Eighteen points with
Other Press. suggestions for future studies. In J. Cassidy & P. R. Shaver
George, C., Kaplan, N., & Main, M. (1996). Adult attachment (Eds.), Handbook of attachment: Theory, research, and clinical
interview protocol (3rd ed.). Unpublished manuscript, University applications (pp. 845–887). New York: Guilford Press.
of California, Berkeley. Marris, P. (1982). Attachment and society. In C. M. Parkes & J.
Gilbert, P. (2001). Evolutionary approaches to psychopathology: The Stevenson-Hinde (Eds.), The place of attachment in human
role of natural defenses. Australian and New Zealand Journal of behavior (pp. 185–201). New York: Basic Books.
Psychiatry, 35, 17–27. Marrone, M. (1998). Attachment and interaction. Philadelphia:
Grossman, K., Grossman, K. E., & Kindler, H. (2005). Early care Jessica Kingsley.
and the roots of attachment and partnership representations: Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood:
The Bielefeld and Regensburd Longitudinal Studies. In K. E. Structure, dynamics and change. New York: Guilford Press.
Grossman, K. Grossman, & E. Waters (Eds.), Attachment from Nelson, J. K. (2005). Seeing through tears: Crying and attachment.
infancy to adulthood (pp. 98–136). New York: Guilford Press. New York: Routledge.
Harlow, H. F. & Zimmerman, R. R. (1959). Affectional responses in Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A
the infant monkey. Science, 130, 421. sensorimotor approach to psychotherapy. New York: W.W.
Harris, T. (1997). Adult attachment processes and psychotherapy: A Norton and Co.
commentary on Bartholomew and Birtchnell. British Journal of Orbach, S. (2004). What can we learn from the therapist’s body?
Medical Psychology, 70, 281–290. Attachment and Human Development, 6, 141–150.
Harris, T. (2004). Chef or chemist? Practicing psychotherapy within Park, J. (2004). Walking the tightrope: Developing an attachment-
the attachment paradigm. Attachment and Human Development, based relational curriculum for trainee psychotherapists. Attach-
6, 191–207. ment and Human Development, 6(2), 131–140.
Hazan, C. & Shaver, P. R. (1987). Romantic love conceptualized as Parkes, C. M. (1991). Attachment, bonding and psychiatric problems
an attachment process. Journal of personality and social after bereavement in adult life. In C. M. Parkes, J. Stevenson-
psychology, 52, 511–524. Hinde, & P. Marris (Eds.), Attachment across the life cycle (pp.
Hazan, C. & Zeifman, D. (1999). Pair bonds as attachments: 268–292). New York: Tavistock/Routledge.
Evaluating the evidence. In J. Cassidy, & P. R. Shaver (Eds.), Rholes, W. S., & Simpson, J. A. (2004). Attachment theory: Basic
Handbook of attachment: Theory, research and clinical appli- concepts and contemporary questions. In W. S. Roles, & J. A.
cations (pp. 336–354). New York: Guilford Press. Simpson (Eds.), Adult attachment: Theory, research, and
Hazan, C., Gur-Yaish, N., & Campa, M. (2004). What does it mean to clinical implications. (pp. 3–14). New York: Guilford Press.
be attached? In W.S. Rholes & J. A. Simpson (Eds.), Adult Rothchild, B. (2000). The body remembers. New York: W.W. Norton
attachment: Theory, research, and clinical applications (pp. 55– and Co.
85). New York: Guilford Press. Rutter, M. (1997). Clinical implications of attachment concepts:
Hesse, E. (1999). The Adult Attachment Interview: Historical and Retrospect and prospect. In L. Atkinson, & K. J. Zucker (Eds.),
current perspectives. In J. Cassidy & P. R. Shaver (Eds.), Attachment and psychopathology (pp. 17–46). New York:
Handbook of Attachment: Theory, research and clinical appli- Guilford Press.
cations (pp. 395–433). New York: Guilford Press. Sable, P. (1983). Overcoming fears of attachment in an adult with a
Hofer, M. A. (1995). Hidden regulators: Implications for a new detached personality, Psychotherapy: Research and Practice,
understanding of attachment, separation, and loss. In S. Gold- 20, 376–382.
berg, R. Muir, & J. Kerr (Eds.), Attachment theory, social, Sable, P. (1989). Attachment, anxiety and loss of husband. American
developmental, and clinical perspectives (pp. 203–230). Hills- Journal of Orthopsychiatry, 59, 550–556.
dale, N.J.: Analytic Press. Sable, P. (1995). Attachment theory and post-traumatic stress
Holmes, J. (1995). ‘‘Something there is that doesn’t love a wall:’’ disorder. Journal of Analytic Social Work, 2, 89–109.
John Bowlby, attachment theory and psychoanalysis. In S. Sable, P. (2000). Attachment and adult psychotherapy. Northvale,
Goldberg, R. Muir, & J. Kerr (Eds.), Attachment theory: social, N. J.: Jason Aronson.
developmental, and clinical perspectives (pp. 19–43). Hillsdale, Sapolsky, R. M. (1998). Why zebras don’t get ulcers. New York:
N.J.: Analytic Press. W.H. Freeman.

123
30 Clin Soc Work J (2008) 36:21–30

Schore, A. N. (1994). Affect regulation and the origin of the self: Stern, D. N. (2000). Foreword to ‘‘On the evolution of attachment-
The neurobiology of emotional development. Hillsdale, NJ: disordered behavior’’ by Helga Fischer-Mamblona. Attachment
Erlbaum. and Human Development, 2, 3–4.
Schore, A.N. (2000). Foreword. In J. Bowlby, Attachment and loss: Suomi, S. J. (1999). Attachment in rhesus monkeys. In J. Cassidy, &
Vol. I. Attachment (Reissue). New York: Basic Books. P. R. Shaver (Eds.), Handbook of attachment: Theory, research
Schore, A. N. (2003a). Affect dysregulation and disorders of the self. and clinical applications (pp. 181–197). New York: Guilford
New York: W.W. Norton and Co. Press.
Schore, A. N. (2003b). Affect regulation and the repair of the self. Tinbergen, N. (1951). The study of instinct. Oxford, England:
New York: W.W. Norton and Co. Clarendon.
Schwartz, J., & Pollard, J. (2004). Introduction to the special issue: Tronick, E. Z. (1989). Emotions and emotional communication in
Attachment-based psychoanalytic psychotherapy. Attachment infants. American Psychologist, 44, 112–119.
and Human Development, 6(2), 113–115. Tronick, E. (2007). The neurobehavioral and social - emotional
Shilkret, C. J. (2005). Some clinical applications of attachment theory development of infants and children. New York: W. W. Norton
in adult psychotherapy. Clinical Social Work Journal, 33(1), 55– and Co.
68. Weiss, R. (1982). Attachment in adult life. In C. M. Parkes, & J.
Siegel, D. J. (1999). The developing mind: Toward a neurobiology of Stevenson-Hinde (Eds.), The place of attachment in human
interpersonal experience. New York: Guilford Press. behavior (pp. 171–184). New York: Basic Books.
Simpson, J. A. (1999). Attachment theory in modern evolutionary Weiss, R. (1988). Loss and recovery. Journal of Social Issues, 44, 37–
perspective. In J. Cassidy, & P. R. Shaver (Eds.), Handbook of 52.
attachment: Theory, research and clinical applications (pp. 115– Weiss, R. (1991). The attachment bond in childhood and adulthood.
140). New York: Guilford Press. In C. M. Parkes, J. Stevenson-Hinde, & P. Marris (Eds.),
Simpson, J. A., Rholes, S. W., & Phillips, D. (1996). Conflict in close Attachment across the life cycle (pp. 66–76). New York:
relationships: An attachment perspective. Journal of Personality Tavistock/Routledge.
and Social Psychology, 71, 899–914.
Slade, A. (1999). Attachment theory and research: Implications for Author Biography
the theory and practice of individual psychotherapy with adults.
In J. Cassidy, & P. R. Shaver (Eds.), Handbook of attachment: Pat Sable is an adjunct professor at the University of Southern
Theory, research and clinical applications (pp. 575–594). New California, School of Social Work and has a private practice of
York: Guilford Press. psychotherapy in West Los Angeles. Dr. Sable has taught attachment
Stern, D. N. (1977). The first relationship: Infant and mother. theory for many years and published extensively in professional
Cambridge, MA.: Harvard University Press. journals on application of attachment theory to clinical practice with
Stern, D. N. (1985). The interpersonal world of the infant. New York: adults. She is the author of the book, ‘‘Attachment and Adult
Basic Books. Psychotherapy.’’

123