ABFT is the only family-based psychotherapy with empirical support for reducing suicidal ideation in youth. In today's interview, Dr. Diamond and Dr. Levy discuss the theory and practice of Attachment-Based Family Therapy. Dr. Diamond mostly covers theory and concepts, and Dr. Levy addresses the question of "what does the therapist actually do in the therapy room."
If you're interested in learning more about ABFT, you can buy the treatment manual Attachment Based Family Therapy for Depressed Adolescents, watch a free webinar http://youtu.be/KcwHznzq-S4, or attend a workshop.
- Upcoming Workshops
- April 9th, 2015 – Bentley Conference Center, Boston MA – registration: https://afsp.wufoo.com/forms/mqhhnp711wr1b9/, For more information contact Kerry Lassaux at KLassaux@afsp.org
- April 22-24 in Philadelphia. More information and registration can be found here: https://www.drexel.edu/cnhp/academics/continuing-education/Health-Professions-CE-Programs/ABFT/
- May 15, 2015 – Hotel Phillips, Kansas City MO – registration: https://afsp.wufoo.com/forms/mqhhnp711wr1b9/ , For more information contact Barb Nelson at email@example.com
"Attachment-Based Family Therapy (ABFT) is a treatment for adolescents ages 12-18 that is designed to treat clinically diagnosed major depressive disorder, eliminate suicidal ideation, and reduce dispositional anxiety. The model is based on an interpersonal theory of depression, which proposes that the quality of family relationships may precipitate, exacerbate, or prevent depression and suicidal ideation. In this model, ruptures in family relationships, such as those due to abandonment, neglect, or abuse or a harsh and negative parenting environment, influence the development of adolescent depression. Families with these attachment ruptures lack the normative secure base and safe haven context needed for an adolescent's healthy development, including the development of emotion regulation and problem-solving skills. These adolescents may experience depression resulting from the attachment ruptures themselves or from their inability to turn to the family for support in the face of trauma outside the home. ABFT aims to strengthen or repair parent-adolescent attachment bonds and improve family communication. As the normative secure base is restored, parents become a resource to help the adolescent cope with stress, experience competency, and explore autonomy.
ABFT is typically delivered in 60- to 90-minute sessions conducted weekly for 12-16 weeks. Treatment follows a semistructured protocol consisting of five sequential therapy tasks, each of which has clearly outlined processes and goals:
- Task 1: The Relational Reframe Task, with the adolescent and parents (or parent) together, sets the foundation of the therapy. After an assessment of the history and nature of the depression, the therapist focuses on relational ruptures. This shift pivots on the therapeutic question, "When you feel so depressed or suicidal, why don't you go to your parents for help?" The progression of this conversation leads parents and the adolescent to agree that improving the quality of their relationship would be a good starting point for treatment.
- Task 2: The Adolescent Alliance Task, with the adolescent alone, identifies relational ruptures in the family and links them to the depression. The adolescent is encouraged and prepared to discuss these often avoided feelings and memories with his or her parents.
- Task 3: The Parent Alliance Task, with the parents alone, explores their current stressors and their own history of attachment disappointments. These conversations activate parental caregiving instincts to behaviorally and emotionally protect their child, which helps motivate parents to learn and use new attachment-promoting parenting skills.
- Task 4: The Attachment Task, with the adolescent and parents together, creates an opportunity for the adolescent to directly express his or her thoughts and feelings about past and current relational injustices. Rather than defending themselves, parents help the adolescent fully express and explore these emotionally charged topics. This conversation helps the adolescent work through trauma, address negative patterns in the relationship, and practice new conflict resolution and emotion regulation skills.
- Task 5: The Autonomy Task, with the adolescent and parents together, helps consolidate the new secure base. In solving day-to-day problems, parents provide support and expectations and the adolescent seeks to develop autonomy while remaining appropriately attached to his or her parents." (http://nrepp.samhsa.gov/ViewIntervention.aspx?id=314)