After obsessively reviewing the extensive research paper by Bakermans-Kranenburg, Dagan, Cárcamo, and Van IJzendoorn (2024) on more than 26,000 Adult Attachment Interviews (AAIs), I was excited to share some fascinating insights about attachment patterns and their clinical significance. I tried to keep it short and accessible, but if you are interested in this topic as a clinician or just as a human with relationships, there is a link to the full article at the bottom of the page.

What the Research Found

This comprehensive analysis revealed several key findings about adult attachment classifications:

• 1. Distribution in the general population: Most non-clinical adults (54%) are classified as secure-autonomous, with 30% classified as insecure-dismissing, 14% insecure-preoccupied, and 17% unresolved, disorganised/can’t classify.
• 2. Gender differences: While three-way classifications (secure, dismissing, preoccupied) didn’t differ significantly between genders, men were more likely to be classified as dismissing and less likely as secure compared to women in four-way classifications (including the unresolved category).
• 3. Clinical relevance: The unresolved/disorganised classification emerged as critically important for understanding clinical populations. Almost all clinical groups showed an overrepresentation of unresolved/disorganised classifications.
• 4. Specific clinical patterns: Different mental health conditions showed distinctive attachment patterns:
  Borderline personality disorder, autism spectrum disorders, and gender dysphoria shared high scores on both unresolved and insecure-preoccupied dimensions. High scores on unresolved and insecure-dismissing dimensions characterised by anxiety problems, OCD, and thought disorders
• 5. Physical disabilities: Interestingly, adults with physical disabilities (without psychiatric symptoms) showed attachment distributions similar to non-clinical groups. This has been especially interesting for me as a researcher in the body-mind-soul space.

Why This Matters for Clinical Practice

As a clinician, these findings have profound implications for how we understand and work with our clients:

Recognising Attachment Patterns

• The AAI helps us see beyond symptoms to understand how early relationships have shaped a client’s ways of relating. This research confirms that most people with clinical presentations have insecure attachment patterns, with the unresolved/disorganised classification being particularly important.
• When we recognise that a client with borderline personality features might have both unresolved trauma and preoccupied attachment, we can tailor our therapeutic approach accordingly. Similarly, understanding that anxiety disorders often co-occur with dismissing attachment patterns helps us anticipate potential challenges in the therapeutic relationship.

The Crucial Role of Unresolved Trauma

• Perhaps the most striking finding is how central unresolved loss or trauma is across clinical presentations. This suggests that addressing unresolved experiences should be a key focus in therapy, regardless of the presenting diagnosis.
• The research reminds us that dissolving the unresolved category into other classifications would make the AAI less useful for clinical applications. The ability to identify and work with unresolved trauma is essential for effective therapy.

Attachment-Informed Treatment

Different attachment patterns may require different therapeutic approaches:

• For clients with dismissing patterns (common in anxiety disorders, OCD, and thought disorders), we might need to work on emotional awareness and the therapeutic relationship before addressing core issues
• For clients with preoccupied patterns (seen in borderline personality disorder), we might focus on emotion regulation and boundaries
• For clients with unresolved trauma (prevalent across most clinical presentations), trauma-informed approaches that help integrate these experiences are essential

Development Through the Lifespan

• The research shows interesting developmental patterns, including adolescents’ tendency toward dismissing attachment. This helps us understand that attachment patterns can shift across development and reminds us to consider age-appropriate interventions.

Conclusion

• This landmark research reinforces the value of attachment theory in clinical practice. By understanding the specific attachment patterns associated with different clinical presentations, we can develop more tailored and effective interventions.
• The AAI, despite being labour-intensive, provides insights that help us move beyond symptom-focused approaches to addressing the relational patterns that underlie many psychological difficulties. Most importantly, it highlights the critical importance of addressing unresolved trauma and loss across a wide range of clinical presentations.

As we continue integrating attachment theory into clinical practice, this research provides a solid empirical foundation for understanding the complex interplay between early experiences and current psychological functioning.

With Love

Andi

You can read further and download the full open-access article here:

• bravetherapy.com/the-revealing-power-of-the-adult-attachment-interview
• bravetherapy.com/how-secure-are-you-notes-on-attachment-theory
• www.tandfonline.com/doi/full/10.1080/14616734.2024.2422045?af=R

Claude.ai helped with the summary of the paper.