Attachment-Based Psychotherapy in Practice
For individuals in the U.S. & U.S. territories
Early attachment experiences with our primary caregivers shape the adults that we become. The goals of attachment-based psychotherapy are to address the limiting effects of negative early attachment experiences and to strengthen the capacity for secure relationships and adaptive actions in the world.
To do this, the therapist first establishes a security-engendering therapeutic relationship with the patient and then within that relationship helps the client to elaborate and express the types of communications, emotions, perceptions, and behaviors that were defensively excluded in earlier, formative relationships with attachment figures. As a result, the client becomes better able to communicate openly and accurately and to access more adaptive feelings, thoughts, and behaviors in his or her own life.
In this video, Dr. Peter C. Costello discusses the theoretical basis of attachment-based psychotherapy, and explores with a client the origins of her inability to communicate her needs and fears to those on whom she most depends.
Attachment-based therapy is an approach to therapy that specifically targets those thoughts, feelings, communications, behaviors, and interpersonal exchanges that patients have learned either to suppress and avoid or to amplify and overemphasize because of early attachment experiences.
There are two central processes that run throughout an attachment approach to therapy.
The first is the creation of a progressively more open and more secure relationship between the therapist and patient. The quality of the therapeutic relationship is the single most powerful element that has been identified by psychotherapy research for producing a good therapeutic outcome. Attachment theory has a particular understanding of the characteristics of a security-engendering relationship that is based on research with security-engendering mothers. The construction of a secure, responsive, and open relationship around precisely the issues that are difficult and troublesome for the patient is a major component of the therapy. It is an effective technique because of the progressive developmental processes that it unleashes in the patient.
The second central process in attachment-based psychotherapy depends on the first: it is the facilitation and strengthening of adaptive capacities by addressing the emotions and the communications that the patient has learned to suppress or to overemphasize in early attachment relationships.
These two processes — the creation of a secure-base relationship and the reclaiming of lost capacities — are central to attachment-based therapy. The ability as therapists to re-shape these capacities depends on understanding exactly what the patient cannot safely think, feel, perceive, communicate, or do.
As a result of attachment-based psychotherapy, the patient finds new ways of behaving in relationships and new ways of approaching the world of work and exploration. Their early and constrained internal working model of self and other begins to change, becoming more open and adaptive, supporting better intimate relationships and more effective action in the world.
Dr. Peter C. Costello is a clinical psychologist practicing in New York City, working with individuals and couples, and an associate professor of communication at Adelphi University, where he teaches seminars in attachment theory, interpersonal communication, and adult romantic relationships.
He is the author of Attachment-Based Psychotherapy: Helping Patients Develop Adaptive Capacities, published by APA Books in 2013.
He is a graduate of Swarthmore College and holds two doctoral degrees: one in clinical psychology from The Graduate School and University Center of the City University of New York (City College) and another in communication from New York University. His work combines both fields.
Dr. Costello completed his clinical training at The New York State Psychiatric Institute and at the New York-Presbyterian/Columbia University Medical Center.
In addition to attachment theory, his current interests include an integrative approach to psychotherapy, and in recent years he has co-chaired two international conferences sponsored by the Society for the Exploration of Psychotherapy Integration. He also serves on the editorial board of the Journal of Unified Psychotherapy and Clinical Science.
- Bowlby, J. (1982). Attachment and Loss: Vol. 1. Attachment (2nd ed.). New York, NY: Basic Books. (Original work published 1969)
- Bowlby, J. (1973). Attachment and Loss: Vol. 2. Separation: Anxiety and Anger. New York, NY: Basic Books.
- Bowlby, J. (1980). Attachment and Loss: Vol. 3. Loss. New York, NY: Basic Books.
- Bowlby, J. (1988). A Secure Base: Parent–Child Attachment and Healthy Human Development. New York, NY: Basic Books.
- Cassidy, J., & P.R. Shaver (Eds.). (2008) Handbook of Attachment: Theory, Research, and Clinical Applications (2nd Ed.). New York, NY Guilford Press.
- Costello, P.C. (2013). Attachment-Based Psychotherapy: Helping Patients Develop Adaptive Capacities. Washington, DC: American Psychological Association.
- Hazan, C., & M.I Campa (Eds.). (2013). Human Bonding: The Science of Affectional Ties. New York, NY: Guilford Press.
- Mikulincer, M., & Shaver, P.R. (2007). Attachment in Adulthood: Structure, Dynamics, and Change. New York, NY: Guilford Press.
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