How attachment-based therapy gets to the heart of mental health issues

As an attachment-based therapist, I’ve met with clients of many different ages, backgrounds, and reasons for seeking out counseling. While every client is unique, all of them share one thing: their humanity. Attachment-based therapy is set apart from other forms of therapy in that it recognizes the biblical truth that relationship is at the heart of human identity and healthy functioning. As science is revealing and Scripture has always said, restoration of relationship and learning how to be constructively dependent on one another — both unified and separate — is key to our being healthy and whole. My goal here is to illuminate how attachment relates to many mental health issues — and why attachment-based therapy offers such promising potential for setting a person free from them.

“Attachment-based therapy is set apart from other forms of therapy in that it recognizes the biblical truth that relationship is at the heart of human identity and healthy functioning.”

Only good (tov) together

Countless studies show that therapy works. It works to improve emotional and mental well-being. It’s linked to positive changes in the brain and body. People in therapy take fewer sick days at work and have fewer medical problems in general. Therapy has even been shown to be as effective as some medications at treating chronic issues like rheumatoid arthritis and high blood pressure (!!)

And the greatest predictor of positive outcomes is not any technique or intervention used by the therapist, but is actually just the quality of the relationship between the client and the therapist. A safe + secure relationship with your therapist can predict how successful therapy will be. But, how can it be so simple?

This makes perfect sense when you look at the most foundational aspect of our identity as created human beings. We were created to be in intimate, loving relationship with one another. When God created human beings, we were only good (tov) — that is, we only worked as we were designed to — once we were in relationship with another human being. On our own, we were not good — we couldn’t function as God intended.

Therapy, at the most basic level, is just a relationship with another human being. It’s designed to be an intimate, emotionally safe, and secure relationship. Like Eve to Adam, a therapist serves as an ezer to his or her clients— a helper, an ally, and a rescuer in times of distress. One who can bear a client’s burdens because the therapist’s own burdens are borne, ideally by God and by other human beings in their life. This is really the role every one of us is made for, and the way we’re all commanded to love. Counselors just invest a lot of time, energy, and effort into getting really good at it for the sake of those whose emotional burdens are especially big.

Needless to say, the therapeutic relationship is the greatest predictor of positive outcomes in therapy because deep + meaningful healing happens in relationship for human beings. It is in intimate, loving relationship that we work as we’re designed to. It is in intimate, loving relationship that our souls are restored.

Relational trauma is often the root

While all therapy is relational, attachment-based therapy recognizes and treats attachment as being at the core of human identity and healthy functioning. Because of this, it also recognizes attachment — and thus, attachment wounds or attachment-related trauma — as being at the heart of human identity issues and dysfunction. We recognize and know this to be true not only because Scripture says it, but because science confirms it. In fact, insecure attachment, especially early in life, is a risk factor for every mental health diagnosis and DSM disorder.

A lack of secure attachment is essentially isolation, which gives way to helplessness and disrupts healthy human development. We are overwhelmed on our own, but safe connections make distress manageable. Other people are our ultimate earthly resource - and our bodies, minds, and nervous systems know this. God designed them this way — to need each other. When we don’t have secure, human connection, we experience internal, emotional chaos and imbalance, and fail to develop a competent or coherent sense of self. We can’t be unified, and we can’t be separate either. This paves the way for all sorts of mental health issues.

“Insecure attachment, especially early in life, is a risk factor for every mental health diagnosis and DSM disorder.”

When a client comes to me with symptoms of anxiety, depression, bipolar, sexuality or gender-related issues, addictions, OCD, self-harm, or suicidal ideation, I want to know their attachment history. I want to know how they learned to relate to themselves and others. I want to know how they relate to their own emotions, body, thoughts, behaviors — and how they relate to others’ emotions, bodies, thoughts, and behaviors.

What I find, almost every time, is that these symptoms are the natural and logical outcome of early attachment trauma. The symptoms that cause them great distress, confusion, and isolation, are how they once survived in a world where they were, in some way, alone — where they were designed by their Creator to be in secure, intimate, loving relationship with other human beings, and had to be in order to feel and be human themselves — and yet, couldn’t be because it wasn’t available.

“What I find, almost every time, is that mental health symptoms are the natural and logical outcome of early attachment trauma.”

Some of the most common attachment trauma clients come in with is emotional neglect. Emotional neglect is difficult to identity because it’s about what didn’t happen, rather than what did. There is an absence of explicitly traumatic memories and, in fact, many people who are emotionally neglected are well-provided for in other ways. Yet these individuals come to therapy with huge amounts of internal chaos, loneliness, and despair.

“Look! I am doing a new thing…”

From an attachment-based perspective, mental health issues are, more often than not, determined to be symptoms caused by attachment wounds. So the focus of therapy is not on masking symptoms, but on healing the attachment issues at the heart of the disorder. And this can only be done experientially, that is, in relationship, through corrective emotional experiences that rewire the brain. The wounds that were created by past relational experiences are healed by new relational experiences. Old neural pathways are disrupted + overwritten by new, healthy ones. God quite literally makes a way in the wilderness, and forms streams of life in our mental wastelands.

“Old neural pathways are disrupted and overwritten by new, healthy ones. God quite literally makes a way in the wilderness, and forms streams of life in our mental wastelands.”

For many, therapy is where this happens because it’s the first time they experience a secure attachment. Therapy is the first time they have been in relationship with someone who is accessible, responsive, and emotionally present and available to them. That’s not how it’s supposed to be, but that’s how it is sometimes.

In fact, therapy is (or can be) a uniquely healing relational setting because we are trained in how to take responsibility for our needs out of session, so that we can set our needs aside and be engaged + attuned to their needs in session. Very simply, it’s my job to love my clients by bearing their burdens - something I’m only capable of doing if I consistently allow God + other human beings to bear my burdens. Therapists are imperfect at this, but it’s part of our job that we get better at it.

God wills and works to renew our minds and restore our souls through various means — and counseling is just one way He can do this, especially when this sort of relationship isn’t available to us otherwise (ie. within our families or communities.) As attachment-based therapy rewires the brain through corrective emotional experiences, clients develop new beliefs and ways of relating, and can go out into their relationships as healthier, more loving individuals. Seeing a client come in stuck and watching them come alive in new ways thru the process of counseling is like watching a flower bloom - it’s really beautiful.

And really, it’s very simple.

We were designed to be in secure relationship with one another. We are made to be one another’s ezers. To bear one another’s burdens. That’s how Jesus calls us to love one another. In the safety of accessible, responsive, emotionally engaged relationship, our brains rewire, our bodies relax, our emotions balance, and our whole selves come alive in beautiful ways that God designed us for…and that we really just can’t imagine, until it happens.