Individual differences in attachment organization among adults with serious psychopathological disorders were related to strategies of treatment use. Forty young adults with serious psychopathological disorders were administered the Adult Attachment Interview (George, Kaplan, & Main, 1984), and their clinicians completed ratings of treatment use. Attachment organization was assessed using the Attachment Q-set (Kobak, 1989), yielding ratings of security/anxiety and avoidance/preoccupation. In preliminary analyses, diagnosis was found to be related to security, with greater security associated with affective rather than thought disorders. Gender was related to avoidance/preoccupation, with males having stronger avoidant tendencies than females. The effects of diagnosis and gender were partialled out of subsequent analyses. As predicted, greater security was associated with more compliance with treatment, as rated by clinicians. Stronger avoidant tendencies were associated with greater rejection of treatment providers, less self-disclosure, and poorer use of treatment. These findings suggest that attachment organization may be an important determinant of how individuals with serious psychopathological disorders approach attachment figures.