Abstract

Attachment insecurity is a transdiagnostic vulnerability factor linked to a wide range of emotional and relational difficulties. Although early attachment patterns tend to be relatively stable, research indicates that attachment orientations can change over time, particularly in response to significant relational or therapeutic experiences. This systematic review examined 39 empirical studies published between 2000 and 2024 to determine whether engagement in psychotherapy is associated with changes in adult attachment security. Eligible studies assessed attachment both pre- and post-treatment using validated self-report measures (e.g., Experiences in Close Relationships Scale; ECR) or interview-based measures (e.g., Adult Attachment Interview; AAI), and reported statistically significant findings. Across a range of modalities, populations, and assessment tools, most studies reported meaningful shifts toward greater attachment security, with the most robust effects emerging in longer treatments—results varied by attachment measure and study quality. Discrepant use of attachment instruments limited cross-study comparability, underscoring the need for consistency in assessing adult attachment. Overall, results indicated psychotherapeutic intervention may result in increases in attachment security, even when attachment change is not explicitly targeted in treatment. The findings have implications for clinical practice, underscoring the role of attachment change, not symptom improvement, but also potentially more profound relational change.

Library of Congress Subject Headings

Attachment behavior; Psychotherapy—Evaluation

Date of Award

2025

School Affiliation

Graduate School of Education and Psychology

Department/Program

Psychology

Degree Type

Dissertation

Degree Name

Doctorate

Faculty Advisor

Edward Shafranske

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