Attachment theory in psychiatric rehabilitation: informing clinical practice

Although attachment theory was initially developed on the basis of observations of infants and their caregivers, attachment relationships and attachment styles have relevance across the lifespan (Ainsworth 1978; Bowlby 1982). Proponents of the theory argue that attachment relationships continue to be important throughout adulthood by providing the individual with a secure base from which to grow and develop (Ainsworth 1978; Bowlby 1982). There is now a substantial body of research to support the concept of adult attachment styles and the influence of ‘secure’ versus ‘insecure’ attachments on interpersonal functioning and relationships in adulthood (Goodwin 2003a; Ma 2006). A high proportion of people with mental health problems have been found to have an insecure attachment style and this has been seen as a major vulnerability factor for a range of psychiatric conditions (Ma 2006). Accordingly, the role of mental health professionals in facilitating the development of secure attachments has been acknowledged. More specifically, the therapeutic relationship has been conceptualised as an attachment relationship that can provide a secure base for self-exploration and the modification of insecure attachment styles (Ma 2007). The potential influence of attachment theory on the organisation of healthcare services has also been recognised. The National Advisory Group on Mental Health, Safety and Well-Being set out key principles for the operation of mental health services (Box 1) and argued that attachment theory provides the soundest evidence-base on which to design and measure mental health services (Seager 2007). Our article builds on previous papers highlighting the role of attachment theory in mental healthcare by focusing specifically on the relevance of the theory for psychiatric rehabilitation.