Attachment-based Family Therapy
Attachment-Based Family Therapy is an empirically supported treatment approach for working with depressed and suicidal adolescents. The 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). An initial randomized clinical trial has demonstrated its effectiveness, and several process studies have explored the proposed mechanisms of change (Diamond G.S., Siqueland, L., & Diamond, G.M., 2003). Two large clinical trials are currently underway; one with suicidal adolescents presenting in primary care as well as a multi-site, primary care study with depressed adolescents.
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. "Re-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.
ABFT is listed on the Promising Practices Network as a "Proven" treatment. http://www.promisingpractices.net/program.asp?programid=274
Feedback from Individuals at Workshops:
It gave me both a clear idea about why this kind of therapy works/why I should work this way and how to do it, what to say, how to meet the families. – Gothenburg, Sweden 5.2011 workshop attendee
[This workshop], gave me a way to work with both the adolescent and parents and to focus on the relationship in a way that will both be inspiring and helpful for the family – Gothenburg, Sweden 5.2011 workshop attendee
[This workshop] gave me new perspective in dealing with resistance from both parents and adolescents. – Lynchburg, Virginia 6.2011 workshop attendee
[This workshop may change my practice in that I am] better prepared to use the clinical skills to motivate and move clients toward change. - Lynchburg, Virginia 6.2011 workshop attendee
This model provides a useful paradigm for understanding family problems. - Lynchburg, Virginia 6.2011 workshop attendee
High quality training for staff who are both experienced and those new to the field. Can't wait to get started! - Lynchburg, Virginia 6.2011 workshop attendee
Dr. Dan said... Great workshop today! Dr. Suzanne Levy from the Center for Family Intervention Science at the Children's Hospital of Philadelphia talked about Attachment Based Family Therapy (ABFT). Although her workshops are usually one or two days, she managed to squeeze into three hours, enough information to intrigue me to obtain more education about this topic. Dr. Levy's presentation was dynamic and she was very knowledgeable. I especially enjoyed her brief explanation of the research and the theory behind this approach to family therapy. As I looked around the room, I noticed several folks whose training began in the 1960's and early 1970's, much as mine did. As she spoke, I recalled those early days with Dr. Sal Minuchin at the Child Guidance Clinic and the introduction of "Structured Family Therapy", with nostalgia. Dr. Levy's discussion of the research reminded us that family therapy techniques, enhanced with attachment theory etc, have evolved into an "empirically based" treatment approach.
I thought that Dr. Levy did a nice job of presenting the ABFT overview, with both benefits and risks of the family described as factors in the treatment. Although not intending to make the audience experts in ABFT, her presentation of the "Five Tasks" hit the mark to help us appreciate the "guidance" provided by the Blogger: Dr Dan's Blog - Post a Comment http://www.blogger.com/comment.g?blogID=1523033524295919767&postID=1895796018939617484 (2 of 2)3/23/2011 11:02:33 AM model, without the "cook-book" approach of other empirically based psychotherapy techniques (Honestly, do you always follow the rules of your "theory" of choice?). Dr. Levy's emphasis on intentionality at each session to stay focused on the goals, allows use of clinical judgment (and the many years of training) to choose the appropriate strategies to reach the goals. I don't know about you, but this point helps me feel more like a professional and less like a technician.
Dr. Levy was not trying to "sell" this technique to all. She acknowledged that the research supports success with this approach to a selected, but very large population of families (including single parent, alternate caregivers and other nontraditional families) with adolescents. Research is being conducted with families of younger children. Dr. Levy was quick to acknowledge that this technique is not for everyone. My understanding of her comments excluded adolescents or parents with intellectual disability or other developmental problems, serious mental illness, drug or alcohol addiction, and families where physical abuse is prevalent. In short, this treatment approach appears most effective when both the adolescent and the caregiver are capable of insight. Also, limited to therapists with a tolerance of raw emotions.
I can always tell when the audience is satisfied with a workshop by the quiet attending to the speaker and the appropriateness of questions. The audience was quiet throughout her talk. Questions were relevant and did not detract from her presentation. She responded to all questions thoroughly and checked back with each person to make sure. The audience appeared satisfied with Dr. Levy's Presentation presentation.
March 2, 2011 2:55 PM