Attachment theory is today considered an integral part of contemporary psychoanalytic theory and practice, and yet the theoretical and clinical implications of Bowlby’s emphasis on fear and the search for safety have been largely overlooked. From Bowlby’s perspective, the dynamic relationship between the experience of threat and attachment shapes the development and maintenance of essential relationships, the organization of psychic structure, and the nature of defenses and adaptation. This element of attachment theory—which alerts us to the ways in which the infant or child is compelled to seek safety when in a state of fearful arousal—is particularly relevant to the clinical situation. It helps us imagine moments of fearful arousal in our patients’ pasts, attend to their manifestations in the present, and understand current suffering in light of the long-term sequelae of adaptations that were crucial to survival. Finally, it helps us find language that brings alive or mentalizes these aspects of the patient’s early experience such that transformation is possible.