Attachment-based Family Therapy Research Articles

Attachment‐Based Family Therapy Between Magritte and Poirot: Dissemination Dreams, Challenges, and Solutions in Belgium

Attachment‐Based Family Therapy (ABFT) was introduced into Belgium in 2009. Since then, three home‐based services (Child Welfare System) and one inpatient young adult psychiatric unit (Mental Health Care System) have implemented ABFT as a treatment model. Although financial and organisational barriers exist, preliminary data suggest that ABFT can be successfully implemented in Belgium and yields promising results. ABFT appeals to counsellors and therapists who receive training. Future dissemination will be facilitated by the establishment of a new ABFT training centre in Belgium.

Attachment‐Based Family Therapy as an Adjunct to Family‐Based Treatment for Adolescent Anorexia Nervosa

Adolescent anorexia nervosa (AN) has a significant and long‐standing impact for the health and well being of young people and their families. The determinants of illness are multi‐factorial, however, adolescent AN has been consistently associated with parental distress (e.g., depression, anxiety, alcoholism), family conflict, and low parental warmth toward the adolescent. Whilst Family Based Therapy (FBT) for adolescent AN is the recommended first line of treatment, a substantial proportion of patients do not experience remission by the end of therapy or may relapse following remission. Although a range of adjuncts to FBT have been proposed, no preferred model has emerged. In this paper, we compare and contrast Attachment‐Based Family Therapy (ABFT) with FBT, and argue that ABFT's focus on relationships, rather than behaviours, could make a substantive contribution to the practice of FBT. We present a case study to demonstrate how ABFT may help to alleviate some of the maintaining factors of adolescent AN through the repair of parent–child relational ruptures.

Attachment‐Based Family Therapy for Suicidal Lesbian, Gay, and Bisexual Adolescents: A Case Study

The majority of sexual minority adolescents are well‐adjusted and healthy, however, on average, 28% report suicidal ideation and between 15% and 40% make a suicide attempt each year. These rates are two to seven times higher than those found among heterosexual youths. Research has shown the protective function of parental support and acceptance, as well as the deleterious effects of parental criticism, invalidation, and rejection on the mental health of sexual minority adolescents. Given these risk and protective factors, these adolescents might benefit from an intervention that targets family relationships. Toward this goal, Attachment‐Based Family Therapy (ABFT) specifically aims to improve the quality of adolescent–parent relationships. In prior treatment developmental work, ABFT was adapted and pilot tested for depressed and suicidal lesbian, gay, and bisexual (LGB) adolescents. By adopting an evidence‐based case study format, this paper provides a case summary to illustrate how the therapy was conducted. The case study consists of a vignette, followed by therapy task descriptions and illustrative transcripts. Examples of key therapeutic moments in ABFT, for depressed and suicidal LGB adolescents, are discussed in the context of the case.

Attachment‐Based Family Therapy for Suicidal Adolescents: A Case Study

Suicide is the primary cause of death in Australia for youth between the ages of 15 and 24. This is common worldwide as well. Unfortunately, very few treatments have been developed, tested, and successful for treating this difficult clinical problem. Attachment‐Based Family Therapy (ABFT) is one of the therapies demonstrating a significant decrease in suicide ideation and attempts. The effectiveness of this model may rest on the fact that ABFT targets the clinical context (e.g., family, trauma, etc.) of this problem as well as intrapsychic processes. Based on attachment theory, the model aims to help adolescents recover a more secure attachment relationship with parents so that secure‐based parenting can help protect the adolescent from future stress and self‐harm. A case study is used to demonstrate how the model unfolds, systemically seeking to repair the attachment relationships while also keeping the adolescent safe from suicidal thoughts and behaviours.

Dissemination of Attachment‐Based Family Therapy in Sweden

Attachment‐Based Family Therapy (ABFT) was introduced in Sweden in 2009, and has since spread widely, mainly within child and adolescent psychiatry, but also to some social family services. ABFT is now mentioned in clinical guidelines for the treatment of depression and suicidality in Sweden. Many therapists report successes with the model after relatively short training. Training and research efforts are presented. Difficulties in implementation of the method are examined as therapist, process, and context issues. A number of small clinical research studies have been published and are presented.

Table of Contents

Australian and New Zealand Journal of Family TherapyVolume 37, Issue 2 p. 141-141 Issue InformationFree Access Table of Contents First published: 10 June 2016 https://doi.org/10.1002/anzf.1117AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume37, Issue2Special Issue: Attachment Based Family Therapy: Adaptation and DisseminationJune 2016Pages 141-141 RelatedInformation

Attachment‐Based Family Therapy in Australia: Introduction to a Special Issue

In Australia the movement toward evidence based practice was supported by the first National Mental Health Strategy. For mental health clinicians the shift from evaluating process to outcome measurement also brought greater focus on specific disorders and targeted interventions, raising questions about the efficacy and effectiveness of treatment. The gap between research and practice is well documented, and has engendered much debate particularly in regard to empirically supported treatments (ESTs) and the technologies to widely disseminate practice whilst supporting treatment adherence. In this paper we first, describe the Attachment Based Family Therapy (ABFT) model before giving consideration to the criticisms of ESTs, and reviewing the dissemination of ABFT in Australia, and the perspectives of Australian clinicians in respect to the model and its relevance to their practice. Finally, we turn to the mission of this Special Issue which is to increase the awareness of ABFT primarily amongst practicing clinicians as we introduce the selected papers that demonstrate the application of the model to a variety of clinical presentations, and clinical settings.

Attachment‐Based Family Therapy for Teen Suicidality Complicated by a History of Sexual Trauma

This article describes the application of Attachment‐Based Family Therapy to the treatment of a 14‐year‐old female adolescent presenting with clinically significant suicide ideation complicated by a history of sexual trauma. The article begins by providing an overview of the use of attachment theory to inform treatment with this population. Then, the case study is presented to illustrate clinical application.

Attachment-based family therapy and emotion-focused therapy for unresolved anger: The role of productive emotional processing.

A growing body of research suggests that emotional processing is a central and common change mechanism across various types of therapies (Diener & Hilsenroth, 2009; Foa, Huppert, & Cahill, 2006; Greenberg, 2011). This study examined whether 10 weeks of attachment-based family therapy (ABFT), characterized by the use of in-session young adult-parent dialogues, were more effective than 10 weeks of individual emotion-focused therapy (EFT), characterized by the use of imaginal dialogues, in terms of facilitating productive emotional processing among a sample of 32 young adults presenting with unresolved anger toward a parent. This study also examined whether greater amounts of productive emotional processing predicted more favorable treatment outcomes. In contrast to our expectations, we found significantly more productive emotional processing in individual EFT than in conjoint ABFT. Results also showed that while both treatments led to significant and equivalent decreases in unresolved anger, state anger, attachment anxiety, and psychological symptoms, only ABFT was associated with decreases in attachment avoidance. Although amount of emotional processing did not explain the unique decrease in attachment avoidance in ABFT, greater amounts of productive emotional processing predicted greater decreases in psychological symptoms (but not other outcome measures) across both treatments.

La thérapie dyadique parent-adolescent centrée sur les émotions

A variety of psychotherapeutic settings have been explored in the treatment of the adolescent and his family. To our knowledge, no single psychotherapeutic setting encompasses within its own theoretical framework the dyadic parent-adolescent psychotherapy. In this article, we first review as sources of references and inspiration the Attachment-Based Family Therapy and the Emotion-Focused Family Therapy. Then, we present the Dyadic Emotion-Focused Parent-Adolescent Therapy. In the third part, we seek to illustrate through clinical extracts the dyadic intervention.

Parent‐therapist alliance and parent attachment‐promoting behaviour in attachment‐based family therapy for suicidal and depressed adolescents

This study examines whether the strength of the parent‐therapist alliance, measured during the task of alliance building with parents alone, predicted the extent of parents’ attachment‐promoting behaviour in the subsequent conjoint parent‐adolescent attachment task in the context of attachment‐based family therapy (ABFT). Nineteen suicidal and depressed adolescents and their parents received 12 weeks of ABFT. The parent‐therapist alliance and parents’ attachment‐promoting behaviour were each measured observationally by two separate and independent groups of raters. The findings show that the strength of the parent‐therapist alliance predicted parents’ subsequent attachment‐promoting behaviour. However, parents’ attachment‐promoting behaviour did not predict the post‐treatment outcomes. Clinical and methodological implications are discussed.Practitioner Points Good parent-therapist alliances are linked to parents being empathic, curious and non‐defensive during emotional conversations with their suicidal and depressed adolescents. Parental attachment‐promoting behaviour, including attunement, empathy, and active listening, may not always be sufficient curative factors. Once the parent‐adolescent attachment relationship improves, parents may support their adolescent as they cope with school and peer conflict.

What can attachment based family therapy offer suicidal youth?

What can attachment based family therapy offer suicidal youth?

Attachment-based family therapy for depressed and suicidal adolescents: theory, clinical model and empirical support

Attachment-Based Family Therapy (ABFT) is a manualized family-based intervention designed for working with depressed adolescents, including those at risk for suicide, and their families. It is an empirically informed and supported treatment. ABFT has its theoretical underpinnings in attachment theory and clinical roots in structural family therapy and emotion focused therapies. ABFT relies on a transactional model that aims to transform the quality of adolescent–parent attachment, as a means of providing the adolescent with a more secure relationship that can support them during challenging times generally, and the crises related to suicidal thinking and behavior, specifically. This article reviews: (1) the theoretical foundations of ABFT (attachment theory, models of emotional development); (2) the ABFT clinical model, including training and supervision factors; and (3) empirical support.

Attachment-based family therapy for lesbian and gay young adults and their persistently nonaccepting parents.

Describes a modification of attachment-based family therapy for working with sexual minority young adults and their persistently nonaccepting parents. The goal of the treatment is to improve the quality of young-adult-parent relationships and promote connection and mutual acceptance. We provide a brief overview of the treatment tasks that comprise the model, describe the rationale behind each task and how it is implemented, offer clinical excerpts, and conclude with thoughts about the limits of the model and future challenges. Finding out that one's child is lesbian or gay is often a life altering event. Even among parents who are generally accepting of sexual minority individuals, the realization that their own children are same-sex oriented can elicit a plethora of challenging emo- tions, including shock, shame, anger, sadness, and fear. Parents may be concerned that their children are going to be marginalized, stigmatized, and victimized. They may also grieve the loss of the hetero-normative family dream and be anxious about how they will deal with the strangeness of seeing their children with same- sex partners and involved in the gay community. They worry about their children's future and whether they will find loving, commit- ted partners and experience the joys of having their own families, however defined. Most parents also feel at least a twinge of discomfort at the thought of sharing their new status with family, friends, and colleagues. It is not surprising that research suggests over half of parents initially react to their children's disclosure with some degree of negativity (D'Augelli, Grossman, Starks, &

Future Directions in Research on Psychotherapy for Adolescent Depression

Research over the past 3 decades has shown that psychotherapy can successfully address adolescent depression. Cognitive behavioral models have been most extensively and rigorously tested, with evidence also supporting interpersonal psychotherapy and attachment-based family therapy. However, the vast majority of studies have focused on short-term treatment of depressive episodes, even as evidence accumulates that depression is frequently a recurring condition extending into adulthood. Moreover, treatment studies indicate that better longer term outcomes are attained by adolescents who respond earlier and more completely to intervention. Given what has been learned to date about adolescent depression treatment, future psychotherapy research should adopt a longer term perspective and focus on the following key challenges: (a) preventing relapse and recurrent episodes, while improving speed and thoroughness of initial treatment response; (b) identifying the necessary treatment components and learning processes that lead to successful and enduring recovery from depression; (c) determining whether—and, if so, how—to address comorbid disorders within depression treatment; (d) addressing the dilemma of simplicity versus complexity in treatment models. Given the relatively small number of evidence-based treatment models, newer approaches warrant investigation. These should be tested against existing models and also compared to medication and combined (psychotherapy plus medication) treatment. Advances in technology now enable investigators to improve dissemination, to conduct experimental psychotherapeutics and to expand application of Internet-based interventions to the goals of relapse and recurrence prevention.

Attachment-based family therapy interventions.

Attachment-Based Family Therapy is a treatment model designed specifically for depressed and suicidal adolescents. The primary goal of the treatment is to promote developmentally appropriate adolescent-parent attachment. Three core interventions are discussed: relational reframes; focusing on primary emotions and unmet attachment needs; and facilitating corrective attachment episodes. For each intervention, the theoretical/clinical rationale is presented followed by a brief illustration and relevant research findings.

Emotionally Focused Family Therapy: Facilitating Change Within a Family System

Adolescent transition to adulthood is often challenged in families with high levels of anxiety, distress, and emotional conflict. Attachment theory offers a robust developmental model for conceptualizing emotional distress and symptomatic behavior as an adaptive response to emotional insecurity in parent–child relationships. Recent developments in emotionally focused family therapy (EFFT) and attachment-based family therapy demonstrate promising empirical support for the application of attachment theory to the treatment of childhood disorders and family distress. However, few resources exist that demonstrate the practice of EFFT and its conceptual approach to facilitate family change. The authors demonstrate the successful application of EFFT to a parent–adolescent problem and examine key moments in the process of change from an attachment perspective.

Evidence-Based Psychosocial Treatments for Pediatric Mood and Anxiety Disorders

Treatment of internalizing disorders in youth often entails a multimodal approach, including pharmacotherapy, psychotherapy, and systems-based intervention in familial, school, and social settings. Prior to selecting appropriate treatments, a comprehensive, lifetime assessment employing multiple informants (youth, parents, teachers) and methods (questionnaires, semi-structured evaluation, clinical interview) should be conducted. Given the high rate of co-occurrence of multiple internalizing disorders, comorbidity of mood and anxiety with other psychiatric problems, and symptom overlap across diagnostic categories, thorough assessment taking into account differential diagnoses is essential. Following evaluation, treatment selection should be based on the primary presenting problem, degree of impairment, and current evidence. For moderate-to-severe adolescent depression, a combination of cognitive-behavioral therapy (CBT) with pharmacotherapy (e.g., selective serotonin reuptake inhibitors [SSRIs]) has the strongest empirical base. Mounting evidence also supports the use of CBT and interpersonal therapy (IPT) as monotherapies for depressed youth. CBT for depression involves identifying and challenging cognitive distortions, behavioral activation, problem solving, and emotion regulation, while IPT aims to reduce interpersonal conflict via interpersonal problem-solving and communication skills. For pediatric bipolar disorders, family psychoeducation about the etiology, course, and treatment of mood disorders, plus skill building (problem solving, CBT, communication, emotion regulation), should be employed adjunctive to pharmacotherapy. Finally, for anxiety disorders, various forms of CBT have demonstrated efficacy. Typically, use of SSRIs concurrently with CBT offers additional benefit for anxious youth. Though the format and focus of CBT varies depending on the specific anxiety disorder, most interventions involve psychoeducation, emotion identification and management strategies, cognitive restructuring, exposure, and familial involvement. Recent preliminary research also supports the use of other psychotherapies (e.g., attachment-based family therapy, parent-child interaction therapy, attention bias modification training) and healthy lifestyle changes (e.g., sleep, diet, exercise). In conclusion, CBT-based treatments currently have the most empirical support, and should be considered first-line psychosocial interventions for pediatric internalizing disorders.

"Attachment-based family therapy for suicidal lesbian, gay, and bisexual adolescents: A treatment development study and open trial with preliminary findings": Correction to Diamond et al. (2011).

"Attachment-based family therapy for suicidal lesbian, gay, and bisexual adolescents: A treatment development study and open trial with preliminary findings": Correction to Diamond et al. (2011).

Attachment-based family therapy for suicidal lesbian, gay, and bisexual adolescents: A treatment development study and open trial with preliminary findings.

The objective of this paper is to adapt attachment-based family therapy (ABFT) for use with suicidal lesbian, gay, and bisexual (LGB) adolescents and to obtain preliminary data on the feasibility and efficacy of the treatment with this population. In Phase I, a treatment development team modified ABFT to meet the unique needs of LGB suicidal youth. In Phase II, 10 suicidal LGB youth were offered 12 weeks of LGB sensitive ABFT. Adolescents' report of suicidal ideation, depressive symptoms, and maternal attachment-related anxiety and avoidance were gathered at pretreatment, 6 weeks, and 12 weeks (posttreatment). In Phase I, the treatment was adapted to: (a) include more individual time working with parents in order to process their disappointments, pain, anger, and fears related to their adolescent's minority sexual orientation; (b) address the meaning, implications, and process of acceptance; and (c) heighten parents' awareness of subtle yet potent invalidating responses to their adolescents' sexual orientation. Results of Phase II suggest this population can be recruited and successfully treated with a family based therapy, evidenced by high levels of treatment retention and significant decreases in suicidal ideation, depressive symptoms, and maternal attachment-related anxiety and avoidance. This is the first family-based treatment adapted and tested specifically for suicidal LGB adolescents. Though promising, the results are preliminary and more research on larger samples is warranted.