Attachment Styles in Therapy: 6 Worksheets & Handouts

Childhood experiences can influence the traits we express in adulthood.

Early exposure to absent, neglectful, or emotionally distant parents can shape what we expect from future bonds.

According to attachment theory, the patterns of attachment we form when we are young impact our later relationships with our partners, friends, and families (Gibson, 2020).

Without at least one loving, secure, and nurturing relationship, a child’s development can be disrupted, with the potential for long-lasting consequences (Cassidy et al., 2013).

This article introduces attachment theory before exploring attachment styles and the potential to change them.

Before you continue, we thought you might like to download our three Positive Relationships Exercises for free. These detailed, science-based exercises will help you or your clients build healthy, life-enriching relationships.

Attachment Theory in Psychology: 4 Types & Characteristics

Early in the lives of the mentally well, young children develop ‘secure base scripts’ – the beginnings of early attachment patterns. For example, “When I am hurting, I go to my mother for comfort” (Cassidy et al., 2013, p. 1417).

Over time, such scripts become ‘stories,’ providing a dependable base from which to explore and a safe place to return (Cassidy et al., 2013).

When children have negligent parents or caregivers – perhaps they are not present or emotionally unavailable – they can form unhelpful attachment patterns. For example, early self-sufficiency may leave individuals unable to develop close relationships and lonely in later life.

Developed by John Bowlby and Mary Ainsworth in the 1960s, attachment theory recognizes the importance of the child’s dependence on their caregiver (Bowlby, 1988). Such an early relationship can lead to four different attachment styles with corresponding underlying characteristics (Cassidy et al., 2013; Gibson, 2020; The Attachment Project, 2020).

Dismissive-avoidant (sometimes referred to as ‘avoidant’)

Someone who has adopted a dismissive-avoidant style perpetuates a sense of defectiveness and uncertainty in their relationships.

They typically show the following characteristics:

• Appear withdrawn
• Emotionally distant in relationships
• Unlikely to connect at an intimate level
• Highly independent
• Find close involvement with their partners difficult
• Feel overwhelmed when heavily relied upon

As a result, the individual may retreat from the relationship physically and emotionally (Gibson, 2020).

Fearful-avoidant (sometimes referred to as ‘disorganized’)

An individual who experienced an untrusting relationship with caregivers (they may have been addicts or emotionally unwell) during childhood may be fearful-avoidant across all adult relationships (romantic and otherwise).

They typically:

• Feel unworthy
• Are ambivalent in relationships
• Regularly shift between being distant and vulnerable
• Over-analyze micro expressions, such as body language, to look for betrayal
• Fail to trust naturally
• Feel betrayal is always just around the corner

Having, most likely, experienced some form of abuse early in their lives, the individual craves love but expects betrayal, resulting in unpredictable behavior.

Anxious attachment

Anxious attachment also results from inconsistency during childhood, often the result of absenteeism from caregivers.

They typically:

• Are high sacrificing people-pleasers
• Fear rejection
• Have a heightened fear of being abandoned
• Overcompensate in adult relationships
• Sacrifice their own needs to maintain relationships

The individual most likely lacked consistent and predictable caregiving as a child, leaving them expecting to be rejected.

Secure attachment

Individuals with a secure attachment style often have experienced available and supportive parents.

They typically:

• Feel secure in relationships
• Are supportive, open, and available in their relationships
• Have the potential to shift individuals in other attachment styles to a more secure one

Those with a secure attachment style “were taught you can be safe while being vulnerable and that their needs were worthy of being met” (Gibson, 2020, p. 15).

How to Approach Attachment Styles in Therapy

Learning about attachment styles in childhood and their possible causes and effects makes it possible to learn to heal and potentially recover troubled relationships with partners, families, and friends (Gibson, 2020).

Attachment-based psychotherapy (not to be confused with Attachment Therapy, which has questionable efficacy and morality) is based on attachment theory as described by its originator John Bowlby (1988) and typically includes the therapist (Brisch, 2012):

• Allowing the client to speak via their attachment system
• Making themselves emotionally available and a reliable and secure base
• Taking into account the client’s attachment styles when handling closeness and interactions
• Acting as a model for dealing with separation
• Avoiding being too close and being perceived as a threat

The client is encouraged to:

• Become more aware of the attachment strategies they use in their relationships
• Consider the attachment style they adopt in therapy
• Compare current perceptions and feelings with those experienced in childhood
• Understand that their distorted perception of themselves (and others) may be outdated and unhelpful
• Verbalize their separation anxieties concerned with being without the therapist

It is crucial to recognize that “early childhood interactions between attachment figures and child carry over to therapy” (Brisch, 2012, p. 103).

Treatment should enable the client to access early painful attachment and relationship experiences and recognize how they may have led to perceptual distortions, rigid representations of the self, and destructive relationships in the present (Brisch, 2012).

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Discovering Attachment Styles: 10 Interview Questions & Questionnaires

Plotka (2011, p. 4) describes the “Adult Attachment Interview (AAI) as a method of classifying a current state of mind with respect to attachment in adults.”

Adult Attachment Interview

The Adult Attachment Interview (AAI) was initially created for research purposes but now forms a regular part of interpreting attachment styles in therapy (Brisch, 2012).

The series of questions is used to probe an adult’s early attachment memories and their current strategies for processing information and feelings.

The following 10 questions are an excerpt from an AAI protocol (modified from George et al., 1985: Brisch, 2012):

1. To help me get oriented, could you give me an idea of who was in your immediate family and where you lived?
2. Starting with your earliest memories, can you describe your relationship with your parents or caregivers?
3. What phrases or adjectives come to mind?
4. Which parent did you feel closest to? And why do you think that was?
5. When you were upset as a child, what would you do? Who would you go to?
6. Can you describe your first memory of separation from your parents?
7. Did you ever feel rejected as a child?
8. Did your parents ever threaten you?
9. How do you think your early experiences may have affected you in adulthood?
10. Why do you think your parents behaved as they did?

The above questions are not complete but provide a sample of the AAI.

Attachment Style Interview

Another approach, known as the Attachment Style Interview (ASI), takes a social psychological approach to assess attachment and the individual’s current attachment style.

The ASI is a semi-structured interview, typically taking 90 minutes to administer and explore, without predefined questions, but instead openly exploring (Bifulco et al., 2008; Centre for Abuse and Trauma Studies, n.d.):

• Current ongoing support from present partner
• Current ongoing support from close confidants
• Current ability to form and maintain relationships
• Current generalized attachment attitudes
• Overall attachment style

The ASI is particularly helpful in the adoption and fostering assessment processes.

Can You Change Them? 6 Helpful Worksheets & Handouts

“Attachment theory is concerned with safety and trust in intimate relationships.”

Chen, 2019, p. 19

Forming a better understanding of their attachment styles and behaviors can help individuals change them to ones that are more supportive and appropriate to well-balanced relationships.

The following worksheets are tools for improving attachment styles through awareness of childhood and adult relationship patterns.

Recognizing Relationship Burnout

Relationships can be exhausting, especially when one partner is dismissive, avoidant, fearful, or anxious (Chen, 2019).

Use the Recognizing Relationship Burnout worksheet to assess whether the relationship is heading for burnout.

Ask the client to rate behaviors that may apply to their relationship and provide an example for each one.

The client should review the answers and look for patterns that may result from either their own or their partner’s attachment styles. For example, are they overly needy, distant, or fearful their partner will leave?

Mapping Emotions

“Emotions have both a mental and a physical component” (Chen, 2019, p. 34). Recognizing them can be the path toward self-acceptance and self-compassion.

Use the Mapping Emotions worksheet to direct the client’s attention to their bodily experiences of emotion to reach a greater acceptance of feelings.

Ask the client to think of the last time they were angry with someone they cared about and how it felt physically.

• Where did you feel the emotion in your body (for example, shoulders, chest, stomach, etc.)?
• Think of a shape or color that best reflects that feeling (for example, a heavy red ball in the stomach).

Encourage the client, with their eyes closed, to think back to that time and the feelings they had with curiosity, acceptance, and self-compassion, then try to imagine the shape or object slowly dissolving, all color and weight leaving.

Recognizing Our Need for Safety and Security

Feeling safe and secure is important in life, particularly in relationships. “Security is about reassurance that connection and resources are and will remain available” and is crucial for relationship collaboration and intimacy (Chen, 2019, p. 43).

Use the Recognizing Our Need for Safety and Security worksheet to help the client better understand what they must have to feel safe in daily life or at a stressful time.

Ask the client to consider the following:

• What could you do to prevent yourself from getting stressed?
• What could your partner do to prevent you from getting stressed?
• What could you do to calm yourself down once you are stressed?
• What could your partner do to calm you down once you are stressed?
• What can you do to reassure yourself of the relationship connection you have?
• What things could your partner do to reassure you of the relationship connection you have?

Performing an Avoidance Stock Take

Avoidant strategies are most problematic when they stop you from being who you want or behaving in the way you would like (Chen, 2019).

Use the Performing an Avoidance Stock Take worksheet to help your client become more aware of the situations that cause them stress and lead to avoidant behavior.

Ask the client to answer the following questions concerning what they find stressful and the situations they avoid.

• What emotions are you experiencing when you are most stressed or likely to avoid a situation (for example, anger, fear, shame, guilt, hurt, or sadness, etc.)?
• What are you looking for or need when you are most stressed or likely to avoid a situation (for example, affection, warmth, love, intimacy, etc.)?
• What is happening when you are most stressed or likely to avoid a situation (for example, decision-making, losing autonomy, trying to be understood, etc.)?

Reviewing their answers should help the client recognize the feelings and behaviors they find difficult. Rather than avoid them, they can try to explore them with their partner while showing themselves more self-compassion.

Identifying Needs and Wants

While we may feel frustrated in a relationship about not getting our needs met, we must first begin by being transparent with ourselves about what these needs are.

Use the Identifying Needs and Wants worksheet to explore a situation or issue when you feel your needs have not been met.

Ask the client to consider the following:

• Describe a situation when you feel your needs were not met.
• Describe each of the needs.
• What should have happened to meet those needs?
• How would you have felt if this had happened?
• How could you share your needs more clearly with your partner?

Accepting Yourself as Being Perfectly Imperfect

Sometimes we need to be reminded to give ourselves a break. We are imperfect; we make mistakes and do or say the wrong things. We can work on getting better, but we will never be perfect.

Use the Accepting Yourself as Being Perfectly Imperfect worksheet with your client to think about when they expect perfection and how to be more kind to themselves.

Ask the client to answer the following questions:

• When in your relationship do you expect perfection from yourself?
• When in your relationship do you expect perfection from your partner?
• How do you feel when you fail to be perfect?
• How do you feel when your partner fails to be perfect?
• What do you do when you feel this way (for example, overeat, avoid your partner, shout, etc.)?
• What message might you give yourself to show more kindness and compassion to yourself and your partner?

PositivePsychology.com’s Relevant Resources

We have many resources available for therapists to support couples hoping to address relationship issues and strengthen emotional bonds.

Why not download our free positive relationships pack and try out the powerful tools contained within? Some examples include:

• Identifying Our Expert Companions
  This exercise helps clients identify expert companions (people who take care of their emotional needs and offer support) among the variety of people they know and discover what they need from them.
• The Sound Relationship House Inspection
  Examine how well a relationship is performing through the lens of the relationship house metaphor to identify opportunities for nurturing.

Other free resources include:

• Anxious Attachment Patterns
  Use this exercise to identify and understand anxious attachment patterns in a relationship by digging deeper into an uncomfortable experience.
• Understanding the Values You Want in a Relationship
  This worksheet helps you better understand your values and what gives life meaning.

More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit©, but they are described briefly below:

• The Mountain Climber Metaphor
  Successful client relationships require a strong therapeutic relationship between client and therapist. Self-determination theory suggests three key ingredients for any healthy relationship.

The Mountain Climber Metaphor is a tool for helping address client concerns and paving the way for a healthy alliance by fostering a sense of relatedness.

• Investing in Valued Relationships
  We crave meaningful and authentic relationships. In turn, we must invest less in superficial relationships while building more high-quality, valued relationships.
  • Step one – Identify the people who matter most in your life.
  • Step two – Select up to four relationships you value and explore the reasons why.
  • Step three – Reflect on how much time you invest in these relationships.
  • Step four – Find ways to invest more time in these relationships by initiating connection, showing appreciation, being present, and listening.

17 Positive Communication Exercises
If you’re looking for more science-based ways to help others communicate better, check out this collection of 17 validated positive communication tools for practitioners. Use them to help others improve their communication skills and form deeper and more positive relationships.

A Take-Home Message

Undoubtedly, our childhood experiences can influence our thinking, beliefs, and behavior much later in life.

Solid and secure relationships from caregivers can provide confidence in the bonds we form with our partners, family, and friends as adults. When caregivers are neglectful, absent, or even abusive, attachment styles can develop that predict subsequent relationship patterns.

Our past need not define our future. While attachment theory recognizes the importance of early relationships, it also promotes our capacity for change. None of us are fixed in how we relate to others, and our anxious, fearful, and avoidant behavior can be overcome.

For most of us, our aim is to develop and maintain relationships that are secure, open, supportive, and beneficial to both. Therapy can help clients identify existing unhealthy attachment styles and replace them with new and more helpful ones.

This article serves as a helpful starting point for therapists wishing to use knowledge of attachment styles to benefit their clients’ existing and future relationships and offers worksheets to begin that journey.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Relationships Exercises for free.