Imagine if you felt free to be entirely yourself and no matter what you did, said or even thought, you would be completely and utterly loved for it.

Notice what you think and feel about this sentence.

Unlike many other animals, human newborns are entirely dependent upon another to be taken care of, for food, water, warmth and physical safety. It takes many years, if ever, for humans to become fully ‘independent’. This ‘dependence upon others’ has striking psychological effects.

John Bowlby (1907-1990), son of Sir Anthony Bowlby surgeon to King Edward VII’s household, studied medicine at Cambridge before working with children described as ‘maladjusted’. He developed Attachment Theory and was later a Mental Health Consultant to the World Health Organisation in the aftermath of the Second World War and it’s impact on children, through attachment, loss and separation. With Mary Ainsworth (1913-1999) Bowlby developed his ideas about different attachment styles, of which a brief summary follows:

Ideally babies/children grow up with a secure attachment style, a secure attachment with care giver(s) within which they can be themselves and have no fear of abandonment. Research suggests just over half of the population have a secure attachment style. Experiences such as repeatedly crying for long periods of time with no care giver showing up to provide soothing can lead to the development of an anxious attachment style; fearing abandonment. This fear of abandonment can lead a person to believe they need to behave a certain way in order to not lose contact with others (conditional positive regard). Around one in five of the population has an anxious attachment style.

An avoidant attachment style can be developed if the baby’s caregiver is mis-attuned to the needs of the child. Experiences such as crying when hungry and the cargiver changes the nappy and fails to feed encourages a child to not ask for it’s needs to be met. There is no point in asking for one’s needs to be met when they are repeatedly ignored or not met, so the child learns to ignore and avoid it’s needs, through the development of specific deactivating strategies. Research suggests around a quarter of the population have an avoidant attachment style.

A combination of experiences can lead to a rarer attachment style that combines both anxious and avoidant styles. About three to five people in one hundred have an anxious-avoidant attachment style and this can be a key mechanism in issues such as borderline process. One effect of this can be an internal conflict about interpersonal relationships, oscillating between anxiety about abandonment/ rejection and wanting to avoid closeness/ intimacy. This can lead to intense new friendships/ relationships, characterised initially by idealisation and then by devaluation ‘the best person I’ve ever met turns out to be the worst person I’ve ever met’.

Increasingly the impact of attachment styles on adults is being recognised. Whilst they are often more sophisticated in hiding it, adults also need a secure base and the absence of this for one or both partners can be a key underlying issue in couples counselling. When faced with adversity, adults with different attachment styles can manifest processes such as anxiety and depression in subtly different ways e.g. the avoidance of anger with a line manager can result in a person with an avoidant attachment style becoming depressed and saying ‘I’ve no idea why I’m depressed’.

Attachment styles can be assessed using psychological measures, such as the Experiences in Close Relationship (ECR) questionnaire, and more recently attachment style thinking has been adapted to consider the range of attachments an individual might have with the different people in their lives e.g. the Experiences in Close Relationships – Relationship Structures (ECR-RS). For illustrative purposes, following is an example of typical relationships a person might have overlaid onto a grid showing the four different attachment styles, defined by the extent to which a person perceives anxiety (fear of abandonment) or avoidance (need to avoid feelings, intimacy, closeness, etc.):

attachment styles.png

Attachment styles are considered to be ‘stable and plastic’, meaning they tend to remain as they were in babyhood and they can change over time, for example through personal development activity, counselling, etc. Following are some examples, for illustrative purposes of real-life changes in attachment styles with general relationships some clients have experienced through work with Dr Tony Weston:


Changes between attachment styles may be considered along both axes, to the extent that clients have reduced their level of attachment anxiety from higher to lower anxiety and to the extent that clients have reduced their level of attachment avoidance from higher to lower avoidance. Research at this service shows the following changes in both anxious and avoidance dimensions. Firstly, as at July 2022 for 40 clients starting with an anxious attachment and after an average of 14 sessions experiencing a more secure attachment to specific personal relationships in their lives:

6 anx att

Secondly, as at July 2022 for 35 clients starting with an avoidant attachment and after an average of 13 sessions experiencing a more secure (in this case transparent as opposed to avoidant) attachment to specific personal relationships in their lives:

6 av att

In the development process for the ECR-RS questionnaire researchers found the notion of ‘trust’ in a relationship was unhelpful for discriminating between relationship anxiety and avoidance (‘trust’ maps onto both concepts). However, in a naturalistic counselling setting the idea of trust is perhaps helpful for illustrating changes in relationships. As at July 2022 for 34 clients with low levels of trust in specific relationships after an average of 15 counselling sessions higher levels of trust were observed in the same specific relationships, leading clients to feel more emotionally secure and to have a greater sense of the secure base that Bowlby wrote about as being essential to human wellbeing:

6 trust att

This naturalistic research suggests changes in attachment styles are possible through therapy.

Imagine if you felt free to be entirely yourself and no matter what you did, said or even thought, you would be completely and utterly loved for it.

Now notice what you think and feel about this sentence.