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Attachment Disturbances in Adults: Treatment for Comprehensive Repair

4.7 4.7 out of 5 stars 161 ratings

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Winner of the 2018 International Society for the Study of Trauma and Dissociation (ISSTD) Pierre Janet Writing Award.

A comprehensive treatment approach for the repair and resolution of attachment disturbances in adults, for use in clinical settings.

With contributions by Paula Morgan-Johnson, Paula Sacks, Caroline R. Baltzer, James Hickey, Andrea Cole, Jan Bloom, and Deirdre Fay. 

Attachment Disturbances in Adults is a landmark resource for (1) understanding attachment, its development, and the most clinically relevant findings from attachment research, and (2) using this understanding to inform systematic, comprehensive, and clinically effective and efficient treatment of attachment disturbances in adults. 

It offers an innovative therapeutic model and set of methods for treating adult patients with dismissing, anxious-preoccupied, or disorganized attachment. In rich detail, it integrates historical and leading-edge attachment research into practical, effective treatment protocols for each type of insecure attachment. Case transcripts and many sample therapist phrasings illustrate how to apply the methods in practice.

Part I, "Foundational Concepts," features a comprehensive overview of the field of attachment, including its history, seminal ideas, and existing knowledge about the development of attachment bonds and behaviors.

Part II, "Assessment," addresses the assessment of attachment disturbances. It includes an overview of attachment assessment for the clinician and a trove of practical recommendations for assessing patients' attachment behavior and status both outside of and within the therapeutic relationship.

In Part III, "Treatment," the authors not only review existing treatment approaches for attachment disorders in adults, but also introduce an unprecedented, powerful new treatment method. This method, the "Three Pillars" model, is built on three essential clinical ingredients:

  1. Systematically utilizing ideal parent figure imagery to develop a new positive, stable internal working model of secure attachment
  2. Fostering a range of metacognitive skills
  3. Fostering nonverbal and verbal collaborative behavior in treatment

Used together, these interdependent pillars form a unified and profoundly effective method of treatment for attachment disturbances in adults―a must for any clinician.

In Part IV, "Type-Specific Treatment," readers will learn specific variations of the three treatment pillars to maximize efficacy with each type of insecure attachment.

Finally, Part V, "A Treatment Guide and Expected Outcomes," describes treatment in a step-by-step format and provides a success-assessment guide for the Three Pillars approach.

This book is a comprehensive educational resource and a deeply practical clinical guide. It offers clinicians a complete set of tools for effective and efficient treatment of adult patients with attachment disturbances.

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Editorial Reviews

Review

"The book provides a very thorough guide of how attachment disturbances can be related to psychopathology such as emotional distress, somatic disorders, trauma, addictions, and personality disorders. . . . [A]n incredibly thorough resource for someone who needs an advanced understanding of attachment issues for a course or for the mental health professional who wishes to integrate this information into their work."
PsychCentral

"I thoroughly recommend reading this book. . . . [F]ull of practical detail about the three-pillars method, and sample ‘scripts’ and sessions, which I found extremely valuable. I intend, when appropriate, to put the elements that I have described into practice."
Human Givens Journal

"A masterpiece of integration, creativity, and clinical wisdom,
Attachment Disturbances in Adults stands out as a vibrantly innovative treasure that will endure, one of those rare trail-blazers. Mental health professionals across disciplines will delight in the rich depth and breadth of this essential book, which seamlessly interweaves research, theory and treatment. Brown, Elliott and colleagues have written a tour de force that is surely destined to become an instant classic."
Kathy Steele, MN, CS, Clinical Director, Metropolitan Counseling Services, and author of Coping with Trauma-Related Dissociation

"This is an incredibly important volume that makes a stunning contribution to the field. It spectacularly achieves an integration of the lifespan literature on attachment and its sequelae with intervention. Rarely does a scholarly work contribute to the understanding of the processes underlying attachment and its dysfunction while simultaneously providing a clearly delineated prescription for treatment. Practitioners will profit from the detailed clinical vignettes and researchers will gain many ideas warranting empirical investigation."
Dante Cicchetti, PhD, McKnight Presidential Chair, Professor of Child Psychology and Psychiatry, Institute of Child Development, University of Minnesota

"This is an extraordinary achievement. The must-have book on attachment, it includes everything you need to know about attachment, and then some―history, research, typology AND treatment! Richly comprehensive, precise, and wise, it is honed by real clinical experience, with step-by-step treatment protocols tailored to each attachment classification. This book should be required reading for all graduate students in clinical programs, be they clinical psychology, psychiatry, counseling, or social work. It should be a
sine qua non for all attachment researchers. It is a book that any clinician who works with trauma and attachment disturbances―which means all clinicians, for attachment disturbances underlie most major syndromes―should have and master."
Diana Fosha, PhD, developer of AEDP, author of The Transforming Power of Affect, Director of the AEDP Institute

"
Attachment Disturbances in Adults is a book of genius, an unequalled account of how far the attachment field has evolved since Bowlby's groundbreaking studies of attachment bonds. It presents an outstanding, encyclopedic, and integrative overview of theoretical understanding, assessment, and treatment. All this leads to a highly inspirational and effective treatment model, consisting of three "pillars": The Ideal Parent-Figure Protocol, Metacognitive Interventions for Attachment Disturbances, and Fostering Collaborative Capacity and Behavior. These pillars not only include the best of what has been written before in the attachment field, but also integrate the authors' wonderful work from other domains. This extraordinary book will set the bar for many years to come."
Onno van der Hart, PhD, Emeritus Professor of Psychopathology of Chronic Traumatization, Utrecht University, and author of The Haunted Self

"
Attachment Disturbances in Adults is a comprehensive resource for understanding attachment, its development, its dysfunctions, its assessments, and its treatments. It covers relevant research in all these areas, grounding it in evidence-based actualities. But it is the book's comprehensiveness, its thorough inclusiveness―not only with regard to all the important aspects of attachment but to the full field of treatment approaches available for each aspect, drawn together into a coherent and compelling synthesizing framework―that make it clearly the exemplary and definitive book to date on this extraordinary topic. A brilliant must-have for clinicians, therapists, and interested laypeople alike."
Ken Wilber, Integral Psychology

About the Author

Daniel Brown, PhD, is Associate Clinical Professor of Psychology at Harvard Medical School, where he teaches courses on performance excellence for health professionals and judges. He is the author of sixteen books, including Memory, Trauma-Treatment, and the Law (with Alan Scheflin and Cory Hammond), winner of the 1999 Guttmacher award from the American Psychiatric Association for outstanding contribution to forensic psychiatry.
David S. Elliott, PhD, is a clinical psychologist and former president of the Rhode Island Psychological Association. He is on the faculty of the International School for Psychotherapy, Counseling, and Group Leadership, in St Petersburg, Russia, and teaches internationally on attachment, personality, and psychotherapy process.

Product details

  • Publisher ‏ : ‎ W. W. Norton & Company (September 13, 2016)
  • Language ‏ : ‎ English
  • Hardcover ‏ : ‎ 752 pages
  • ISBN-10 ‏ : ‎ 0393711528
  • ISBN-13 ‏ : ‎ 978-0393711523
  • Item Weight ‏ : ‎ 3.74 pounds
  • Dimensions ‏ : ‎ 8.3 x 1.8 x 10.4 inches
  • Customer Reviews:
    4.7 4.7 out of 5 stars 161 ratings

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Top reviews from the United States

  • Reviewed in the United States on January 10, 2024
    This textbook is not for the casual reader. It's an extensive training text for therapists on how to use a Harvard model for healing attachment trauma.

    The model is groundbreaking and should be required reading for all professionals, not only because there aren’t many research-based treatments that reliably heal attachment wounds and create secure attachment (according to the AAI), but also because it discusses the respected ones—including Fosha’s AEDP model, before describing their own.

    The “Three Pillars Model” they propose and validate has been life-changing personally and in my practice.

    Pillar 1 heals attachment by using the Ideal Parent Figure guided meditation (IPF Protocol) along with mentalizing (Pillar 2) and collaboration (Pillar 3). After security is established (again, according to the AAI), trauma processing can take place if it hasn’t already resolved by healing the attachment wounds, which it often does. (!!) Again, trauma often heals in this model without talking about it!

    This is critical because trauma processing is contraindicated for people with disorganized attachment (who often carry unresolved trauma). Processing can severely re-traumatize them, despite every intention to the contrary.

    The text also has interesting discussions about the relationship between attachment strategies and narcissism (avoidant), borderline (anxious), and dissociative identity disorder (disorganized). And it offers strategies for working with the avoidant/dismissive population, who tend to refuse treatment.

    If you’re not up for the 750 page book, you might be interested in exploring the therapy with someone who offers The Three Pillars Model or IPF Protocol (Ideal Parent Figures), which is the attachment-healing guided meditation developed by the authors, Dan Brown (now deceased) and David Elliott, keeping in mind that it's essential to choose professionals to turn to who offer a real sense of emotional safety.

    Additional support books for trauma that made a big difference in my practice include James S. Gordon's "Transforming Trauma" (which has a research-based chapter on dietary support for trauma - enormously helpful) and Bonnie Badenoch's "The Heart of Trauma: Healing the Embodied Brain in the Context of Relationships,” which explores the application of Ian McGilchrist’s brain hemispheric research for healing trauma. Her right brain imagery practices are stunning to experience.

    But back to the book at hand, if you’re wondering whether it’s worth the investment, the answer is yes. Absolutely.
    29 people found this helpful
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  • Reviewed in the United States on July 23, 2020
    The length for some may be intimidating--like The Iliad level intimidation factor.

    After finding Dr. Brown while listening to an amazing interview and podcast, I dove right in. So much makes sense. Why are therapists using EMDR ( some improperly) as the new thing to attempt to heal trauma? Dan addresses reasons why interventions do not work without digging in first to the bone. Attachment trauma, relational trauma, attunement, formation of the various systems in the body-- how can you do therapy without addressing the foundational hurts?
    Time to rethink things.
    Telling your patients to read the Enneagram or Women Who Runs With Wolves-- not cutting the mustard
    52 people found this helpful
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  • Reviewed in the United States on April 16, 2022
    This is a true find for anyone who is interested/finds meaning in the concept of attachment. It’s a valuable resource and so rich that I see it as a necessary reference tool. Wish there were yearly updates.
    7 people found this helpful
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  • Reviewed in the United States on March 13, 2020
    I like the content Dr. Brown, but it ferl like there should have been a summary, before each chapter
    5 people found this helpful
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  • Reviewed in the United States on February 7, 2021
    Another therapist suggested this book to me, after I had questions on attachment theory. It’s very well detailed and breaks down how attachment theory was developed. It also goes into treatment recommendations for the therapist and client based upon attachment issues. It also explains how to assess for insecure & secure attachment. Really recommend.
    15 people found this helpful
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  • Reviewed in the United States on February 17, 2021
    I’ve read a few attachment books, done workshops both couples workshops and trainings as a therapist, and this is by far the best resource for attachment I have come across. In a book study and course right now learning to both practice it myself and facilitate it with clients.
    30 people found this helpful
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  • Reviewed in the United States on November 25, 2018
    Excellent scientific book. My background is related and not as in depth as this book. It’s a bit of a a textbook and Iwould personally benefit from a class using it to better understand the detail. However it is a solid resource and I’ve learned much in reading it. The best part is that it helps focus my interest and curiosity about attachment theory.
    25 people found this helpful
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  • Reviewed in the United States on June 5, 2021
    This is not light reading, but it is an excellent resource.
    7 people found this helpful
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Top reviews from other countries

  • Amazon Customer
    5.0 out of 5 stars I needed this book
    Reviewed in Canada on February 24, 2020
    Chapter 7. You must read chapter 7.

    This book is huge, but every sentence is gold.

    I needed this book.
    I have many books on attachment theory. And books on how it relates to addiction, and even personality disorders.
    But this book actually gives instruction on how to repair a disturbed attachment.
  • Carla J. Freundlich
    5.0 out of 5 stars If you are a therapist, BUY it!
    Reviewed in Canada on December 5, 2019
    Fabulous book. The IPF protocol is working unbelievably well with my complex PTSD, attachment-wounded client
    2 people found this helpful
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  • Robert G McPherson
    4.0 out of 5 stars but a great help to me with my relationship issues
    Reviewed in Canada on June 29, 2018
    A bit clinical, but a great help to me with my relationship issues.