What is Attachment-Based Family Therapy (ABFT)?
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. ABFT emerges from interpersonal theories that suggest adolescent and young adult internalizing disorders (e.g., depression, suicide, trauma, anxiety) can be precipitated, exacerbated or buffered against by the quality of interpersonal relationships in families. It has also been used where family conflict is a contributor to the presenting problem. It is a trust-based, emotion-focused psychotherapy model that aims to repair interpersonal ruptures and rebuild an emotionally protective, secure-based parent–child relationship.
Treatment is characterized by five treatment tasks:
- Reframing the therapy to focus on interpersonal development
- Building alliance with the adolescent
- Building alliance with the parents
- Facilitating conversations to resolve attachment ruptures
- Promoting autonomy and competency in the adolescent
The ABFT model grows out of the Structural Family Therapy tradition (Minuchin, 1974) but is informed by more contemporary systemic approaches such as Multidimensional Family Therapy (Liddle, 1999) and Emotionally-focused therapy (Greenberg and Johnson, 1988). Attachment theory (Bowlby, 1969) 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 adolescents. The impact of these family processes is compounded when parents fail to comfort, support and help their adolescent identify, discuss and work through these disturbing experiences. Conversely, when adolescents perceive their parents as caring, protective and autonomy-granting, the family provides a secure base helping the adolescent to withstand and grow from life’s stressors.
ABFT aims to repair ruptures in the attachment relationship, and establish or resuscitate the secure base so important for adolescent development. “Repairing attachment” occurs by first helping family members to access their longing for greater closeness and adopt the idea of rebuilding trust. Then adolescents, in individual sessions, are helped to identify and articulate their perceived experiences of attachment failures, and commit to a discussion of these experiences with their parents. Then parents, also in individual sessions, are encouraged to consider how their own intergenerational legacies affect their parenting style – which typically leads to their developing greater empathy for their adolescent’s experiences. When adolescents and parents are ready, the therapist brings them back together to discuss the adolescent’s concerns. As adolescents get these thoughts, feelings and memories “off their chests” and receive acknowledgement and empathy from their parents, they become more willing to consider their own contributions to family conflict. Although not all issues are necessarily addressed or resolved, this mutually respectful and often emotionally-laden dialogue serves as a “corrective attachment experience” that can set in motion a renewed sense of trust and commitment. As tension and conflict diffuse at home, therapists encourage adolescents to pursue pro-social activities outside the home that will promote competency and autonomy. Parents serve as the secure base from which adolescents seek comfort, advice, support and encouragement in exploring these new opportunities.
ABFT is a flexible yet programmatic approach to facilitating these processes. Although not prescriptive, the treatment manual provides a clear ‘road map’ of how to accomplish this “shuttle diplomacy” thereby allowing these profound and reparative conversations to occur quickly in therapy. Therapists are taught to rapidly focus on core family conflicts, relational failure, vulnerable emotions and the instinctual desire for giving and receiving attachment security.
Empirically Supported Therapy Lists
ABFT is listed on several national and international recommended treatment lists:
- United States
- Listed in the Substance Abuse and Mental Health Services Administration (SAMHSA): Evidence-Based Resource Guide for Treatment for Suicidal Ideation, Self-harm, and Suicide Attempts Among Youth
- 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
- ABFT is classified as a “proven practice” on the Promising Practices Network (PPN) run by the Rand Corporation
- The California Evidence-Based Clearinghouse (CEBC) for Child Welfare has rated ABFT as a treatment with promising research evidence for adolescent depression
- Listed in the CDC – Preventing Suicide: A Technical Package of Policy, Programs, and Practices
- Listed in the Zero Suicide Care Training Options
- Listed in the Suicide Prevention Resource Center (SPRC) Best Practice Registry
- Listed in the Swedish Guidelines for treatment of depression
- CYP IAPT recommended evidenced based treatment in England