Great concern needs to be expressed about the unevaluated 'attachment therapies', in particular holding therapy. These interventions are not within the attachment paradigm and are potentially abusive.
Consonant with attachment theory, the aim of intervention is to preserve or work towards secure attachment organisation and autonomous internal working models. This enables the child to move flexibly between seeking and receiving comfort and protection and free exploration, as circumstances require. There is now firm evidence indicating that a move towards security can be, and is most effectively, achieved by enhancing maternal/caregiver sensitivity, expressed by the mother's behaviour with the child. Much of this work has been directed at high-risk samples including maltreating parents. This secondary or tertiary preventive work is important in reducing later social, emotional and behavioural difficulties for the child. However, it may not be possible to reverse disorganised attachment.
The evidence indicates that greater attachment security is most effectively achieved by work which focuses on secure base and safe haven behaviours of the mother/primary caregiver, which are devoid of hostility to the child and which are not frightening.
There are now a number of attachment-based interventions with caregivers, not all of which have been evaluated as yet. The 'gold standard' method of evaluation which includes randomised, controlled trials; manualised interventions; baseline measures and assessments which are independent of and blind to the interventions; and sufficiently large sample sizes, are not easy to achieve. These