Attachment-based family therapy (ABFT) is a manualized, empirically supported family therapy model specifically designed to target family and individual processes associated with adolescent suicide and depression. It has also been used with youth with a history of trauma, anxiety, as well as an adjunct to eating disorders treatment.

ABFT is grounded in interpersonal theories that propose the quality of family relationships can significantly influence adolescent and young adult internalizing disorders, such as depression, suicide, trauma, and anxiety. These relationships may either precipitate, exacerbate, or buffer against such conditions. ABFT has also been applied in cases where family conflict contributes to the presenting problem. This trust-based, emotion-focused psychotherapy model seeks to repair interpersonal ruptures and foster a secure, emotionally protective parent–child relationship.

Treatment is characterized by five treatment tasks:

1. Reframing the therapy to focus on interpersonal development
2. Building alliance with the adolescent
3. Building alliance with the parents
4. Facilitating conversations to resolve attachment ruptures
5. Promoting autonomy and competency in the adolescent

ABFT focuses on repairing ruptures in the attachment relationship and re-establishing the secure base essential for healthy adolescent and young adult development. The process of “repairing attachment” begins by helping family members access their desire for greater closeness and embrace the goal of rebuilding trust.

In individual sessions, adolescents or young adults are guided to identify and express their experiences of attachment failures and prepare to discuss these with their caregivers. Concurrently, caregivers explore how their own intergenerational experiences have shaped their parenting style, fostering greater empathy for their youth’s perspective.

When both youth and caregivers are ready, the therapist facilitates joint sessions where the youth shares their concerns. Through open and empathetic dialogue, youth unburden themselves of these thoughts and feelings, while caregivers acknowledge and validate their experiences. This emotionally charged yet respectful exchange often becomes a “corrective attachment experience,” initiating a renewed sense of trust and commitment within the family.

As familial tensions ease, therapists encourage youth to engage in pro-social activities that build competency and autonomy. Caregivers continue to serve as a secure base, offering comfort, guidance, and support as youth explore these new opportunities.

Evidence-Based Treatment

With over 20 years of research, ABFT has established robust empirical support, demonstrating the efficacy of the model, as well as preliminary data regarding effectiveness for depressed and/or suicidal youth and their families. ABFT has also been adapted for several different populations, with good initial results. Additionally, ABFT’s extensive process research has shed light on the micro-changes within therapeutic conversations that influence treatment success or failure.

ABFT is listed on several national and international recommended treatment lists:

• United States
  
  • Substance Abuse and Mental Health Services Administration (SAMHSA): Evidence-Based Resource Guide for Treatment for Suicidal Ideation, Self-harm, and Suicide Attempts Among Youth
  • SPRC’s Best Practice Registry
  • CDC – Preventing Suicide: A Technical Package of Policy, Programs, and Practices
  • The (former) National Registry of Evidence-based Programs and Practices (NREPP) determined that ABFT is a program with effective outcomes for suicidal thoughts and behaviors and depression symptoms
  • The California Evidence-Based Clearinghouse (CEBC) for Child Welfare has rated ABFT as a treatment with promising research evidence for adolescent depression
  • Zero Suicide Care Training Options
  • ABFT is classified as a “proven practice” on the Promising Practices Network (PPN) run by the Rand Corporation
• International
  
  • Listed in the Swedish Guidelines for treatment of depression
  • CYP IAPT recommended evidenced based treatment in England

Rooted in Attachment Theory

The ABFT model grows out of the Structural Family Therapy tradition, but is informed by more contemporary systemic approaches, such as Multidimensional Family Therapy and Emotionally-focused therapy.

Attachment theory provides the over-arching framework for understanding and intervening in the clinical process. Without ignoring biological factors, ABFT therapists presume that family conflict, detachment, harsh criticism or more insidious family traumas (e.g., abandonment, neglect abuse) can cause, maintain and/or exacerbate depression in young people. The impact of these family processes is compounded when caregivers fail to comfort, support and help their youth identify, discuss and work through these painful experiences. Conversely, when youth perceive their caregivers as caring, protective and autonomy-granting, the family provides a secure base that fosters resilience and growth amid life’s challenges.

Flexible and Structured

ABFT is a flexible yet programmatic approach to facilitating these processes. Although not prescriptive, the treatment manual provides a clear road map for accomplishing this “shuttle diplomacy,” enabling profound and reparative conversations to occur quickly in therapy. Therapists are trained to rapidly focus on core family conflicts, relational failures, vulnerable emotions, and the innate desire for attachment security.