Over the past decade, there has been an explosion of interest in clinical applications of attachment theory. In the present article, we briefly describe John Bowlby's model of therapeutic change, the therapeutic relationship, and the therapist's role in emotional healing. We then review empirical evidence for three key propositions in Bowlby's model. First, a client's sense of security during therapy is crucial for facilitating therapeutic work. Second, a therapist's own sense of security contributes to positive therapeutic outcomes. Third, attachment insecurities can be effectively reduced in therapy, and movement toward greater attachment security is central to achieving favorable therapeutic outcomes. In sum, research evidence confirms the importance of establishing what Bowlby called a safe haven and a secure base within a therapeutic relationship.

The long-term contribution of mothers' attachment insecurities to their own and their children's psychological functioning was examined in a 7-year prospective longitudinal study of children with Congenital Heart Disease (CHD). Sixty-three mothers of newborns with CHD participated in a three-wave study, beginning with the CHD diagnosis (T1), then 1 year later (T2), and again 7 years later (T3). At T1, the mothers reported on their attachment style and mental health. At T2, the mental health measure was administered again, along with a marital satisfaction scale. At T3, participants completed these two measures again, and their children reported on their self-concept and completed the Children's Apperception Test. Maternal avoidant attachment at T1 was the best predictor of deterioration in the mothers' mental health and marital satisfaction over the 7-year period, especially in a subgroup whose children had severe CHD. In addition, mothers' attachment insecurities (both anxiety and avoidance) at the beginning of the study were associated with their children's emotional problems and poor self-image 7 years later.

The present study examines the relationship between mothers' attachment style and their immediate psychological reactions to the diagnosis of congenital heart disease (CHD) in their infants. The sample consisted of 151 mothers of newborns, who were divided into three groups according to their infant's health conditions: (a) healthy infants, (b) mild CHD infants, and (c) severe CHD infants. All the mothers answered self-report scales on attachment style, cognitive appraisal of motherhood, perceived support, ways of coping with motherhood tasks, and a measure of psychological distress. Results showed that securely attached mothers appraised motherhood in more positive terms, perceived more available support, were more likely to seek support, and reported less psychological distress than insecurely attached mothers. These associations were more prominent in the severe CHD group, compared with the other two groups. Moreover, appraisal and coping measures were associated with psychological distress and mediated the attachment-distress link. The discussion emphasized the stress-resistance value of secure attachment style immediately after the CHD diagnosis.In the last decade, theoretical and empirical efforts have been spent in attempting to understand the role adult attachment style plays in the process of coping with stress. Two perspectives (Hazan & Shaver, 1987;Main, Kaplan, & Cassidy, 1985) have guided this line of research. Within a developmental psychology context, Main et al. (1985) assessed a person's state of mind and his or her freedom to explore attachment themes

The longitudinal contribution of attachment style to mental health was examined among mothers of infants with Congenital Heart Disease (CHD). Eighty-five mothers of newborns with CHD completed self-report scales tapping attachment style, appraisal of motherhood, ways of coping with motherhood tasks, and mental health 2 weeks after the infant’s CHD diagnosis and 1 year later. Mothers’ attachment anxiety and avoidance at Time 1 were related to poor mental health at the same point of time. In addition, attachment avoidance at Time 1 predicted further deterioration of mental health from Time 1 to Time 2. Attachment style at Time 1 also predicted the ways mothers appraised and coped with motherhood tasks, which, in turn, were related to mental health changes. The theoretical implications of the data were discussed.

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Breast cancer had detrimental effects on survivors' well-being and daughters' distress mainly when survivors scored high on attachment anxiety. Breast cancer had also detrimental effects of daughters' distress mainly when daughters scored high on avoidant attachment. These findings highlight the importance of attachment security as an inner resource for buffering detrimental mental health effects of breast cancer among survivors and their daughters.

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