Conditions /

Attachment & Relational Patterns

Attachment style is not a DSM diagnosis, though DSM-5-TR does include reactive attachment disorder and disinhibited social engagement disorder for early childhood. Relational patterns underlie many conditions

By Expert review not yet recorded Updated

Insecure attachment styles (anxious, avoidant, disorganized) that create recurring difficulties in relationships, emotion regulation, and sense of self. Often rooted in early caregiving experiences. Central concern in psychodynamic, EFT, and somatic approaches.

Prevalence: ~40% of adults in non-clinical samples are classified insecure, against about 58% secure, in Adult Attachment Interview meta-analyses; markedly higher in clinical populations

Clinical Picture

Attachment patterns, the internal working models of self and other formed in early caregiving relationships, aren't a diagnosis but a lens through which many conditions can be understood. Anxious attachment amplifies emotional distress and help-seeking. Avoidant attachment suppresses emotional awareness and distances from dependency. Disorganized attachment, often associated with frightening or frightened caregivers, creates the impossible bind of needing the very person who is a source of fear. Many modalities implicitly work with attachment even when they don't explicitly name it.

Treatment Considerations

This topic includes different questions across ages: early-childhood attachment classifications, caregiver–child relationships and adult relational patterns. They are not interchangeable outcomes. The CPP study reviewed here measured attachment classifications in children from maltreating families; the CPRT pilot measured parent–child interaction and reported stress in adoptive families, without measuring attachment security. NICE NG26 concerns children adopted from care, in care or at high risk of entering care, and its parent–child psychotherapy advice specifies a preschool maltreatment subgroup and safeguarding. These findings do not establish treatment of adult attachment styles or diagnosed childhood attachment disorders.

Sources for the corrected statements:

Approaches and Evidence

Of 44 associated approaches, 2 have completed assessments for this topic, 0 have source checks awaiting assessment, and 42 have neither recorded yet. Each completed assessment states its population and rationale; source checks alone do not establish effectiveness. These categories describe different findings and review stages; they are not a ranking of treatments. 2 frameworks are shown separately.

Randomized studies (2)

These assessments describe randomized studies in the stated population. Randomized studies may include pilot or null findings; this label alone does not establish benefit.

Attachment

Child-Parent Psychotherapy

Alicia Lieberman · 1995

Reviewed population: Infants from maltreating families (about 13 months old at entry and 38 months at follow-up) and their biological mothers; the tested home-based CPP model, with child attachment security directly measured.

A randomized study followed infants from maltreating families who were assigned to home-based CPP, psychoeducational parenting work or community services. Stronach et al. (2013), following the Cicchetti et al. (2006) cohort, identify CPP with the Lieberman and Van Horn model. At one year after treatment, analyses retaining original assignments among available follow-up participants favored CPP for secure attachment. Differences in attachment disorganization and parent-reported child behavior were not significant in those analyses. Treatment refusal, missing follow-up data and specialist delivery limit confidence and generalization. NICE NG26 separately says to consider the specified Cicchetti/Toth parent–child model for the preschool maltreatment subgroup, with safeguarding addressed. This assessment does not cover adult attachment styles, diagnosed attachment disorders or every CPP format.

Reviewed

Guidelines and official sources (2)

1 clinical guideline check · 1 evidence registry check

Read the recommendation and its scope. A source may discuss an approach without recommending it.

  • Child-Parent Psychotherapy: program ratings

    California Evidence-Based Clearinghouse for Child Welfare · Current record checked September 2026 · Evidence registry · Topic Areas; Target Population

    Not a treatment recommendation

    CEBC rates CPP 1 for infant and early-childhood mental health, and 2 for child/adolescent trauma and domestic-violence services. These are topic-specific registry ratings, not clinical guideline recommendations.

    Scope: Children aged 0–5 who have experienced trauma and their caregivers.

    Source checked

  • Children’s attachment (NG26)

    NICE · 2015 · Clinical guideline · Recommendations 1.4.9–1.4.10

    Discussed in the source

    NICE says to consider parent–child psychotherapy based on the Cicchetti and Toth model. This specified model should not be assumed equivalent to every intervention called CPP.

    Scope: Preschool attachment difficulties where parents have maltreated or are at risk of maltreating their child; safeguarding concerns must be addressed.

    Source checked

Humanistic

Filial Therapy

Bernard Guerney · 1964

Reviewed population: Volunteer adoptive parents reporting concerns about children aged 2–10, receiving the 10-session CPRT variant; measured parent–child interaction/empathy and parenting stress, not attachment security or attachment-disorder recovery.

This assessment concerns the 10-session Child-Parent Relationship Therapy (CPRT) variant of filial therapy and parent–child relational outcomes. Carnes-Holt’s 2010 randomized pilot assigned 72 volunteer adoptive parents to CPRT or a waiting list, keeping partners together. Analyses of 61 parents reported improved child behavior; smaller outcome samples favored CPRT for observed parental empathy and reported total parenting stress, although the parent-domain stress result was not significant. Attrition and post-randomization exclusions, baseline stress differences, no reported adjustment for parents from the same family and no follow-up limit confidence. The study did not measure attachment security, disorganization or attachment-disorder recovery. Its findings do not establish effectiveness for all filial variants, all adoptive families or adult relational patterns. CEBC’s CPRT rating is a separate registry judgment, not the basis for this study-design classification.

Reviewed

Guidelines and official sources (1)

1 evidence registry check

Read the recommendation and its scope. A source may discuss an approach without recommending it.

  • Child-Parent Relationship Therapy: program ratings

    California Evidence-Based Clearinghouse for Child Welfare · Research reviewed September 2024 · Evidence registry · Topic Areas; Target Population

    Not a treatment recommendation

    CEBC rates the named CPRT model 3 in its listed attachment, disruptive-behavior and parent-training topics. The rating does not apply automatically to every filial-therapy variant.

    Scope: CPRT for parents of children aged 3–8 with behavioral, emotional, social or attachment concerns.

    Source checked

Assessment not yet completed (42)

No completed assessment or source check for this topic is recorded yet.

Family Systems

Circle of Security

Glen Cooper / Kent Hoffman / Bert Powell / Robert Marvin · 1998

Somatic

Hakomi

Ron Kurtz · 1980

Associated Frameworks (2)

These are conceptual or research frameworks. They are not ranked as treatment evidence.

Cases Featuring Associated Approaches

These teaching cases share approach links with this topic. They may illustrate a different presenting concern.

Panic & Avoidance
Maya, 29, marketing manager
10 formulations
Treatment-Resistant Depression
Sofia, 38, software engineer
7 formulations
Men's Masked Depression
Marcus, 36, firefighter
8 formulations
Late-Life Depression & Meaning
Harold, 74, retired engineer
6 formulations
OCD & the Meaning of Obsessions
Nathan, 26, seminary student
6 formulations
Complex Relational Trauma
Darius, 34, Black veteran, currently unemployed
11 formulations

Reading This Page

Why are these approaches listed with Attachment & Relational Patterns?

The catalogue associates 44 approaches and 2 frameworks with this topic. These links support learning and comparison; association alone is not a treatment recommendation or evidence of effectiveness.

How should I read the evidence assessments?

Assessments are specific to the population and scope stated on each card. They include a rationale, source links, and a review date. An overall review of an approach does not automatically apply to this condition, and a randomized-study label does not by itself mean that a study found benefit.

What does "Assessment not yet completed" mean?

A condition-specific assessment has not been recorded. Approaches with checked sources appear in a separate assessment-pending group; a checked source can support, oppose, or discuss an intervention without recommending it. Neither pending group means that no research exists or that the approach is ineffective. Frameworks are shown separately.

Sources and Review Scope

Source links and dates on assessment cards apply to the stated population and rationale. The clinical overview and prevalence text above are separate authored content; an approach's evidence label does not verify those statements. Recorded narrative notes and citations remain available on individual modality pages, with their review status identified. The bibliography provides further reading.