Attachment-Based Family Therapy

Mother plays chess with teenager at tableAttachment-based family therapy (ABFT) is a type of family therapy in which a mental health professional aims to help a parent and a child repair ruptures in their relationship and work to develop or rebuild an emotionally secure relationship.

This approach, which is grounded in attachment theory, has been empirically supported as an effective treatment for adolescents experiencing suicidal ideation and/or depression

Development and Theory

ABFT is heavily influenced by John Bowlby’s attachment theory, which posits that humans have an inherent, biological desire for meaningful relationships. According to attachment theory, a secure attachment develops when parents are sensitive to the needs of their children and consistently available. Secure attachment is likely to have a positive effect on the child's development, as securely attached children are more likely to have good emotion regulation skills and feelings of confidence and self-worth. 

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However, when certain experiences and relationship processes such as abandonment, neglect, criticism, or detachment occur, the child's trust in the relationship is likely to be damaged, and insecure attachments may result. ABFT is designed to increase the security of the attachment between a parent and child so the relationship can provide a supportive foundation to protect against depression and suicide. 

The developers of ABFT describe it as an interpersonal, process-oriented, and emotionally-focused approach. As such, it incorporates components from other family therapy models, such as multidimensional family therapy, emotionally focused therapy, and Salvador Minuchin’s structural family therapy​.

This treatment was manualized by Guy Diamond, Gary Diamond, and Suzanne Levy in the book Attachment-Based Family Therapy for Depressed Adolescents. It is the only manualized, empirically supported family therapy model designed specifically to address family relationships as a way to treat and prevent depression and suicide in adolescents.

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Techniques Used in ABFT

Because it is a manualized therapy, ABFT offers a clear structure for therapists who use it to follow. ABFT consists of five therapeutic tasks that are addressed and completed as the course of therapy progresses.

The first task is the relational reframe, which typically takes one session to complete. The relational reframe is designed to shift the focus away from the identified symptoms and toward the improvement of the relationship between parent and child. The goal of this task is for family members to begin to understand that the initial purpose of treatment is to discover what damaged the trust in the relationship. 

The second and third tasks center on alliance building. The adolescent alliance-building task, which typically takes two to four sessions, involves the therapist working to develop the therapeutic alliance with the adolescent in individual sessions by learning about the adolescent’s strengths and interests and also by helping the adolescent to understand and articulate the ruptures that occurred in the relationship with their parents. The third task is for the therapist to build an alliance with the parents (in sessions without the adolescent present) by offering empathy and support and by exploring any attachment issues the parents may have and the ways those issues may affect their parenting skills. 

After therapeutic alliances are built, the adolescent and parents come back together to discuss the adolescent’s concerns. The fourth task, resolving attachment ruptures, is the central mechanism of ABFT. In working toward the completion of this task, which may take between one and four sessions, the therapist guides the adolescent in expressing any concerns and grievances in a mature, emotionally-regulated way while encouraging the parents to express empathy and understanding. This task is meant to provide a corrective attachment experience and lay the foundation for a more securely attached relationship between parent and child. The final task is to promote autonomy in the adolescent and to help the parents find a balance between providing support to their child and allowing the child to make—and take appropriate responsibility for—their own behaviors and choices. 

Training for ABFT

ABFT training consists of three levels, which include workshops (Levels 1 and 2), supervision (Level 2), and certification (Level 3). Because this type of therapy is manualized, therapists who want to be certified in ABFT must prove they are following the manual and completing the therapeutic tasks by submitting tapes of themselves to trained supervisors for coding.

ABFT training may be appropriate for a wide range of people in helping professions, including counselors, psychiatrists, psychologists, family therapists, and social workers. Training, which is conducted by the developers and their colleagues, is currently available in eight countries. 

How Can ABFT Help?

ABFT is specifically designed to treat depression and suicide in adolescents (typically youth between the ages of 12 and 18). While other types of therapy, such as cognitive behavioral therapy, are commonly used to treat depression, ABFT is unique in that it uses family interventions as a way to address depression, suicidality, and trauma in adolescents. ABFT is the only manualized, empirically supported family therapy model designed specifically to address family relationships as a way to treat and prevent depression and suicidality in adolescents.

The developers of ABFT believe the approach changes family interactions in a positive way that could also be helpful for other mental health concerns, but the vast majority of the research on ABFT thus far has focused on its efficacy as a treatment for adolescents experiencing depression and/or thoughts of suicide. One study also found that ABFT helped reduce anxiety among adolescent participants.    

Therapists who use ABFT also focus on core conflicts between family members, the misunderstandings and failures that happen in relationships between family members, and vulnerable emotions that occur both in session and outside of sessions. They emphasize the instinctual desire that people have to feel securely attached to others and use that attachment as the primary mechanism for change. Thus, families who participate in this treatment may find that the family relationship begins to improve overall. 

Concerns and Limitations

ABFT is an empirically supported treatment that has been included on the National Registry of Empirically Proven Practices. However, as with all types of therapy, it also has some limitations. Most of the research has been conducted with adolescents from low-income, minority families, and it is not yet clear how this intervention will generalize to other populations.

More thorough study of the therapeutic tasks may also be needed, as it may be beneficial for researchers and providers of ABFT to better understand how these tasks work in order to discover any potential pitfalls that may occur and learn how to address them in therapy. 

Another potential concern is that therapists using ABFT may not follow the manual for the treatment, which may then negatively impact the outcome of the intervention. The developrs of ABFT have tried to combat this concern by studying therapist adherence to ABFT and by implementing an adherence measure for each of the five therapeutic tasks to ensure therapists are adequately addressing each.  

References: 

  1. ABFT training program: Overview. (n.d.). Retrieved from http://www.drexel.edu/familyintervention/abft-training-program/overview
  2. Attachment-based family therapy research: Overview. (n.d.). Retrieved from http://www.drexel.edu/familyintervention/attachment-based-family-therapy/overview
  3. Diamond, G., Russon, J., & Levy, S. (2016). Attachment-based family therapy: A review of the empirical support. Family Process, 55(3), p. 595-610. 

 

Last updated: 11-16-2016

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