What is Attachment-Based Family Therapy (ABFT)?

Table of Contents

1. Introduction
2. Core Assumptions and Tenets
3. Origins and Development 3.1 Founder’s Biography 3.2 Influencers and Collaborators 3.3 Philosophical and Scientific Inspirations
4. Historical Context 4.1 Cultural and Economic Forces 4.2 Clinical Practice Challenges
5. Timeline of ABFT Development
6. Conceptualization of Key Concepts 6.1 Trauma 6.2 The Unconscious 6.3 Sense of Self and Identity
7. Interventions and Techniques
8. Goals and Stages of Treatment
9. Evidence Base and Empirical Support
10. Contexts of Practice
11. Unique Aspects of ABFT
12. Integration with Modern Therapy
13. Conclusion
14. Bibliography
15. Further Reading

Introduction

Attachment-Based Family Therapy (ABFT) is a groundbreaking approach to family therapy that has gained significant attention in the field of mental health over the past two decades. This comprehensive guide delves deep into the origins, principles, and practices of ABFT, offering a thorough understanding of its place in the landscape of contemporary psychotherapy.

ABFT is rooted in attachment theory, which posits that the quality of the emotional bond between children and their caregivers plays a crucial role in psychological development and well-being. By focusing on repairing and strengthening these attachment bonds, ABFT aims to create a secure base from which families can address and overcome various emotional and behavioral challenges.

This article will explore the core tenets of ABFT, its historical development, key interventions, and its relevance in modern therapeutic practice. Whether you’re a mental health professional, a student of psychology, or simply someone interested in family dynamics and therapy, this guide will provide valuable insights into the world of Attachment-Based Family Therapy.

Core Assumptions and Tenets

Attachment-Based Family Therapy (ABFT) is built upon several fundamental assumptions and tenets that guide its theoretical framework and practical applications. Understanding these core principles is essential for grasping the unique approach of ABFT:

1. Primacy of Attachment: ABFT posits that secure attachment relationships are crucial for healthy emotional development and psychological well-being. The quality of the parent-child bond is seen as a primary factor in a child’s ability to regulate emotions, develop a positive self-image, and form healthy relationships throughout life.
2. Family as the Context for Healing: Unlike some individual-focused therapies, ABFT views the family system as the most potent context for healing and change. It assumes that addressing family dynamics and improving family relationships can lead to more sustainable therapeutic outcomes.
3. Emotion-Focused Approach: ABFT places a strong emphasis on emotional processes within the family. It assumes that unresolved emotional experiences and unexpressed feelings often underlie family conflicts and individual symptoms.
4. Reparative Experiences: The model is based on the belief that creating new, positive emotional experiences within the family can help repair damaged attachment bonds and overcome past traumas or disappointments.
5. Developmental Perspective: ABFT takes into account the developmental needs of adolescents, recognizing the importance of balancing autonomy and connectedness in parent-adolescent relationships.
6. Interpersonal Neurobiology: The approach incorporates insights from neuroscience, assuming that secure attachments can positively influence brain development and function, particularly in areas related to emotion regulation and social cognition.
7. Resilience-Focused: ABFT assumes that families have inherent strengths and resources that can be mobilized for healing. The therapy aims to uncover and enhance these resilience factors.
8. Trauma-Informed: The model recognizes the impact of trauma on family relationships and individual functioning. It assumes that addressing trauma within the family context can be particularly effective.
9. Cultural Sensitivity: ABFT acknowledges the importance of cultural factors in shaping family dynamics and attachment patterns. It assumes that effective therapy must be culturally attuned and respectful of diverse family structures and values.
10. Process-Oriented: Rather than focusing solely on behavior change, ABFT emphasizes the importance of understanding and modifying the underlying relational processes that maintain problematic patterns.
11. Time-Limited Approach: ABFT is typically conceptualized as a short-term, focused intervention. It assumes that significant change can occur within a relatively brief time frame when therapy is intensively focused on core attachment processes.
12. Integrative Framework: While rooted in attachment theory, ABFT integrates elements from various therapeutic approaches, including structural family therapy, emotion-focused therapy, and cognitive-behavioral techniques.

These core assumptions and tenets form the foundation of ABFT’s theoretical model and guide therapists in their clinical work with families. By focusing on these principles, ABFT aims to create a therapeutic environment that fosters secure attachments, promotes emotional healing, and enhances family functioning.

Origins and Development

Founder’s Biography

Attachment-Based Family Therapy (ABFT) was primarily developed by Dr. Guy S. Diamond, a renowned psychologist and researcher in the field of family therapy. Dr. Diamond’s journey towards creating ABFT is deeply rooted in his personal and professional experiences.

Born in the early 1950s, Dr. Diamond grew up in an era of significant social and cultural change. His early experiences shaped his interest in family dynamics and the impact of relationships on individual well-being. He pursued his education in psychology, earning his Ph.D. in Clinical Psychology from the California School of Professional Psychology in 1983.

Dr. Diamond’s career has been marked by a consistent focus on improving family therapy techniques, particularly for adolescents and young adults struggling with depression and suicidal ideation. His work in community mental health clinics and academic settings provided him with valuable insights into the limitations of existing therapeutic approaches, especially when dealing with complex family dynamics and attachment-related issues.

Throughout his career, Dr. Diamond has held several prestigious positions, including serving as the Director of the Center for Family Intervention Science at Drexel University and as a Professor of Psychology at the University of Pennsylvania. These roles allowed him to conduct extensive research and clinical work, which ultimately led to the development of ABFT.

Dr. Diamond’s personal philosophy emphasizes the importance of emotion in human relationships and the power of family connections in fostering psychological health. This perspective, combined with his clinical observations and research findings, formed the foundation of ABFT.

Influencers and Collaborators

The development of ABFT was not a solitary endeavor but rather a collaborative effort involving several key figures in the field of psychology and family therapy. Some of the most significant influencers and collaborators include:

1. Dr. Gary M. Diamond: Guy Diamond’s brother and frequent collaborator, Gary Diamond has played a crucial role in refining and expanding ABFT. His expertise in emotion-focused therapy and attachment theory has significantly contributed to the emotional foundation of ABFT.
2. Dr. Suzanne A. Levy: A close collaborator of Guy Diamond, Dr. Levy has been instrumental in developing ABFT training programs and expanding its application to diverse populations. Her work has focused on adapting ABFT for various clinical settings and cultural contexts.
3. Dr. John Bowlby: Although not a direct collaborator, Bowlby’s groundbreaking work on attachment theory provided the theoretical foundation upon which ABFT was built. His concepts of secure base and internal working models are central to ABFT’s approach.
4. Dr. Salvador Minuchin: The founder of Structural Family Therapy, Minuchin’s work on family systems and boundaries influenced the systemic aspects of ABFT.
5. Dr. Leslie Greenberg: A pioneer in emotion-focused therapy, Greenberg’s work on the role of emotion in psychotherapy has significantly influenced the emotional processing components of ABFT.
6. Dr. David Miklowitz: His work on family-focused therapy for bipolar disorder provided insights into how family interventions can be tailored for specific mental health conditions.

These collaborators and influencers, along with many others, have contributed to the rich tapestry of ideas and practices that constitute ABFT.

Philosophical and Scientific Inspirations

ABFT draws inspiration from several philosophical and scientific traditions:

1. Attachment Theory: The primary scientific foundation of ABFT comes from attachment theory, developed by John Bowlby and Mary Ainsworth. This theory emphasizes the importance of early relational experiences in shaping an individual’s emotional and social development.
2. Family Systems Theory: ABFT incorporates ideas from family systems theory, which views the family as an interconnected unit where changes in one part affect the whole system.
3. Emotion-Focused Therapy: The emphasis on emotional processing and expression in ABFT is influenced by emotion-focused therapy, which views emotions as central to the construction of the self and a key agent in the therapeutic change process.
4. Interpersonal Neurobiology: Recent advances in neuroscience, particularly the work of Daniel Siegel on interpersonal neurobiology, have informed ABFT’s understanding of how relational experiences shape brain development and function.
5. Humanistic Psychology: The humanistic tradition, with its emphasis on personal growth and self-actualization, has influenced ABFT’s view of human potential and the importance of authentic emotional experiences.
6. Developmental Psychology: ABFT incorporates insights from developmental psychology, particularly regarding adolescent development and the changing nature of parent-child relationships over time.
7. Cognitive Science: While not a primary focus, ABFT also draws on cognitive science to understand how cognitive processes interact with emotional and relational factors in maintaining or changing behavioral patterns.

These philosophical and scientific inspirations have coalesced to form the unique approach of ABFT, which combines a deep understanding of attachment processes with practical, family-based interventions.

Historical Context

Cultural and Economic Forces

The development of Attachment-Based Family Therapy (ABFT) in the late 1990s and early 2000s occurred against a backdrop of significant cultural and economic changes that influenced both family dynamics and the field of mental health:

1. Changing Family Structures: The rise of diverse family structures, including single-parent households, blended families, and same-sex parent families, created a need for therapeutic approaches that could address a wider range of family dynamics.
2. Increased Awareness of Mental Health: The 1990s and 2000s saw growing public awareness and destigmatization of mental health issues, particularly among adolescents. This cultural shift created more openness to family-based interventions for issues like depression and anxiety.
3. Technology and Family Communication: The rapid advancement of technology, including the internet and mobile phones, began to significantly impact family communication patterns, creating new challenges and opportunities for family therapy.
4. Economic Pressures: Economic factors, including the dot-com boom and subsequent bust, as well as increasing income inequality, placed new stresses on families, often exacerbating mental health issues and relational conflicts.
5. Managed Care and Evidence-Based Practice: The healthcare system’s shift towards managed care created pressure for more time-limited, evidence-based therapies. This trend encouraged the development of structured, empirically-supported approaches like ABFT.
6. Multicultural Awareness: Increasing recognition of cultural diversity and its impact on family dynamics and mental health led to a demand for culturally sensitive therapeutic approaches.
7. Work-Life Balance Challenges: Changes in work patterns, including longer working hours and the blurring of work-home boundaries, created new challenges for family life and parenting, influencing the types of issues addressed in family therapy.

These cultural and economic forces both encouraged and challenged the growth of ABFT. On one hand, they created a fertile ground for new therapeutic approaches that could address complex family dynamics and mental health issues. On the other hand, they also presented challenges in terms of implementation and adaptation to diverse family contexts.

Clinical Practice Challenges

The development of ABFT was also influenced by several challenges and limitations observed in existing clinical practices:

1. Limited Efficacy of Individual Therapies: While individual therapies were effective for many, there was growing recognition that some issues, particularly those rooted in family dynamics, required a more systemic approach.
2. Shortcomings of Traditional Family Therapy: While family therapy was well-established, many approaches focused more on behavioral changes or communication patterns without adequately addressing underlying emotional and attachment issues.
3. Adolescent Engagement: Existing therapies often struggled to effectively engage adolescents, who frequently viewed therapy as an extension of parental control rather than a source of support.
4. Integration of Attachment Theory: Despite the growing influence of attachment theory in developmental psychology, there was a need for therapeutic approaches that could effectively translate attachment principles into clinical practice.
5. Addressing Trauma in Family Context: There was increasing awareness of the impact of trauma on family dynamics, but many existing approaches lacked specific strategies for addressing trauma within the family system.
6. Balancing Individual and Family Needs: Clinicians often found it challenging to balance addressing individual mental health issues (e.g., adolescent depression) with broader family dynamics.
7. Time-Limited Interventions: The push towards shorter-term therapies created a need for approaches that could produce significant change within a limited number of sessions.
8. Empirical Support: There was a growing demand for family therapy approaches that could demonstrate empirical efficacy through rigorous research studies.

ABFT emerged as a response to these clinical challenges, offering a structured yet flexible approach that integrated attachment principles, emotion-focused techniques, and family systems theory. By addressing these gaps in existing practices, ABFT aimed to provide a more comprehensive and effective treatment for adolescent mental health issues within the family context.

The historical context in which ABFT developed – characterized by changing family structures, increasing mental health awareness, technological advancements, and evolving clinical needs – significantly shaped its theoretical foundations and practical applications. Understanding this context is crucial for appreciating the unique contributions of ABFT to the field of family therapy and its relevance in addressing contemporary mental health challenges.

Timeline of ABFT Development

The development of Attachment-Based Family Therapy (ABFT) has been a gradual process, marked by key events, publications, and research milestones. Here’s a chronological timeline of its creation, dissemination, and development:

1. Late 1980s – Early 1990s:
   • Dr. Guy Diamond begins his work in community mental health, observing the limitations of existing therapies for adolescent depression and suicidal ideation.
2. 1995:
   • Initial conceptualization of ABFT begins, drawing on attachment theory and family systems approaches.
3. 1998:
   • Diamond, G. S., & Liddle, H. A. publish “Transforming negative parent-adolescent interactions: From impasse to dialogue” in Family Process, laying groundwork for ABFT.
4. 2002:
   • Diamond, G. S., Reis, B. F., Diamond, G. M., Siqueland, L., & Isaacs, L. publish “Attachment-Based Family Therapy for Depressed Adolescents: A Treatment Development Study” in the Journal of the American Academy of Child & Adolescent Psychiatry, introducing ABFT to the wider academic community.
5. 2003-2005:
   • Pilot studies and initial clinical trials of ABFT are conducted, focusing on its efficacy for adolescent depression and suicidal ideation.
6. 2006:
   • Diamond, G. S., Wintersteen, M. B., Brown, G. K., Diamond, G. M., Gallop, R., Shelef, K., & Levy, S. publish “Attachment-Based Family Therapy for Adolescents with Suicidal Ideation: A Randomized Controlled Trial” in the Journal of the American Academy of Child & Adolescent Psychiatry, providing the first major empirical support for ABFT.
7. 2007-2010:
   • ABFT training programs are developed and implemented, expanding the model’s reach to clinicians across the United States.

8. 2010:
   • Publication of the first ABFT treatment manual: “Attachment-Based Family Therapy for Depressed Adolescents” by Diamond, G. S., Diamond, G. M., & Levy, S. A., providing a comprehensive guide for clinicians.
9. 2011-2013:
   • ABFT is adapted for various populations, including sexual minority youth and youth with anxiety disorders.
   • International training programs begin, expanding ABFT’s reach globally.
10. 2014:
    • Diamond, G. S., Diamond, G. M., & Levy, S. A. publish “Attachment-Based Family Therapy for Depressed Adolescents” in the American Psychological Association’s Theories of Psychotherapy Series, further solidifying ABFT’s place in mainstream psychotherapy.
11. 2015-2016:
    • Multiple studies are published demonstrating ABFT’s efficacy in treating adolescent depression and suicidal ideation in diverse populations.
12. 2017:
    • ABFT is recognized as an evidence-based treatment for adolescent depression by the Society of Clinical Child and Adolescent Psychology (Division 53 of the American Psychological Association).
13. 2018-2019:
    • Research expands to explore ABFT’s effectiveness in treating anxiety disorders and trauma-related issues in adolescents.
14. 2020:
    • Adaptations of ABFT for telehealth delivery are developed in response to the COVID-19 pandemic, expanding its accessibility.
15. 2021-Present:
    • Ongoing research continues to refine ABFT techniques and explore its application to new populations and clinical issues.
    • Integration of ABFT principles with other evidence-based approaches is being studied to enhance its effectiveness further.

This timeline illustrates the steady development and growing influence of ABFT in the field of family therapy and adolescent mental health treatment. From its conceptual beginnings in the mid-1990s to its current status as a recognized evidence-based treatment, ABFT has evolved through rigorous research, clinical application, and continuous refinement.

Conceptualization of Key Concepts

ABFT offers unique perspectives on several key psychological concepts, integrating attachment theory with family systems approaches. Here’s how ABFT conceptualizes trauma, the unconscious, and a sense of self and identity:

Trauma

In ABFT, trauma is viewed through the lens of attachment relationships:

1. Relational Context: Trauma is understood not just as an individual experience, but as an event that occurs within and impacts the entire family system.
2. Attachment Disruption: Traumatic experiences are seen as potential disruptors of secure attachment bonds between family members, particularly between parents and children.
3. Intergenerational Transmission: ABFT recognizes that unresolved trauma in parents can affect their ability to provide secure attachment for their children, potentially leading to intergenerational patterns of insecure attachment.
4. Reparative Potential: The model emphasizes that healing from trauma can occur through the restoration and strengthening of secure attachment relationships within the family.
5. Emotional Processing: ABFT focuses on creating a safe space within the family for processing traumatic experiences emotionally, rather than just cognitively.

The Unconscious

While ABFT doesn’t heavily emphasize traditional psychoanalytic concepts of the unconscious, it does address unconscious processes in several ways:

1. Internal Working Models: ABFT draws on attachment theory’s concept of internal working models – unconscious mental representations of self and others formed through early relationships.
2. Implicit Relational Knowing: The model recognizes that many aspects of family relationships operate outside of conscious awareness, influencing behavior and emotions in subtle ways.
3. Defensive Exclusion: ABFT addresses how painful emotions or memories related to attachment experiences may be unconsciously excluded from awareness as a defense mechanism.
4. Procedural Memory: The therapy focuses on changing unconscious, automatic patterns of interaction within the family that have been learned over time.
5. Emotional Schemas: ABFT works with unconscious emotional schemas – organized patterns of emotional experience and response that guide behavior in relationships.

Sense of Self and Identity

ABFT conceptualizes the development of self and identity as inherently relational processes:

1. Attachment-Based Self: The model posits that a person’s sense of self is fundamentally shaped by their attachment experiences, particularly in early life.
2. Relational Identity: Identity is viewed not as a solely individual construct, but as something that emerges and is continually negotiated within family relationships.
3. Emotional Self-Awareness: ABFT emphasizes the development of emotional self-awareness as a key component of a healthy sense of self.
4. Autonomy and Connection: The therapy works to balance an individual’s need for autonomy with their need for connection, seeing this balance as crucial for healthy identity development, especially in adolescents.
5. Narrative Identity: ABFT incorporates elements of narrative therapy, helping family members construct more adaptive narratives about themselves and their relationships.
6. Cultural Identity: The model recognizes the importance of cultural factors in shaping identity and works to integrate cultural considerations into the therapeutic process.
7. Reflective Functioning: ABFT aims to enhance family members’ capacity for reflective functioning – the ability to understand one’s own and others’ mental states – as a key aspect of identity development.

By conceptualizing these key concepts through an attachment and family systems lens, ABFT provides a unique framework for understanding and addressing psychological issues within the family context. This approach allows for a more holistic treatment that considers individual psychological processes in relation to broader family dynamics and attachment patterns.

Interventions and Techniques

Attachment-Based Family Therapy (ABFT) employs a variety of interventions and techniques designed to repair attachment bonds and improve family functioning. These interventions are typically applied within a structured treatment protocol, but they can be flexibly adapted to meet the needs of individual families. Here are the key interventions and techniques used in ABFT:

1. Relational Reframes

Description: This technique involves reframing individual symptoms or conflicts as attachment-related issues within the family system.

Application: When an adolescent presents with depression, the therapist might reframe this as a rupture in the parent-child attachment bond rather than solely an individual mental health issue.

2. Attachment-Based Psychoeducation

Description: Educating family members about attachment theory and its relevance to their current struggles.

Application: The therapist explains how early attachment experiences shape emotional responses and relationship patterns, helping family members understand their dynamics from an attachment perspective.

3. Enactments

Description: Guided interactions between family members that allow for real-time observation and intervention in relational patterns.

Application: The therapist might ask a parent and adolescent to discuss a recent conflict, observing their interaction and intervening to promote more secure attachment behaviors.

4. Accessing and Expanding Core Emotions

Description: Helping family members identify, express, and process underlying emotions that drive their behaviors and interactions.

Application: The therapist guides an adolescent in exploring feelings of abandonment beneath their angry outbursts, facilitating a deeper emotional connection with parents.

5. Attachment-Focused Vulnerability Cycles

Description: Identifying and interrupting negative interaction patterns that maintain insecure attachments.

Application: The therapist helps a family recognize how a parent’s criticism and an adolescent’s withdrawal create a self-reinforcing cycle of emotional distance.

6. Corrective Attachment Experiences

Description: Creating opportunities for new, positive emotional experiences that can help repair damaged attachment bonds.

Application: Facilitating a conversation where a parent can express empathy and understanding for their child’s pain, fostering a sense of emotional safety and connection.

7. Attachment-Based Emotion Coaching

Description: Teaching parents to respond empathically to their child’s emotions, validating feelings while setting appropriate boundaries.

Application: Guiding a parent in responding to their teenager’s anxiety with empathy and support, rather than dismissal or overprotection.

8. Secure Base Priming

Description: Activating memories and feelings associated with secure attachment to create a foundation for therapeutic work.

Application: Asking family members to recall and share positive memories of feeling loved and supported by each other, setting a tone of connection for the session.

9. Attachment-Focused Narrative Techniques

Description: Using storytelling and narrative approaches to help family members construct more adaptive stories about their relationships and experiences.

Application: Guiding an adolescent in reframing their life story from one of victimhood to one of resilience, with parents as supportive figures.

10. Mindfulness and Mentalization Exercises

Description: Incorporating mindfulness techniques to enhance awareness of emotional states and improve reflective functioning.

Application: Leading a family through a brief mindfulness exercise to increase present-moment awareness and emotional attunement with each other.

11. Attachment Behavior Chain Analysis

Description: Detailed analysis of sequences of behaviors and emotions that lead to attachment ruptures or repairs.

Application: Walking a family through a step-by-step examination of a recent conflict, identifying key moments where attachment needs were expressed or missed.

12. Attachment-Informed Boundary Setting

Description: Helping families establish healthy boundaries that balance needs for autonomy and connection.

Application: Assisting parents and adolescents in negotiating rules and expectations that respect the teenager’s growing independence while maintaining family connection.

13. Intergenerational Attachment Exploration

Description: Exploring how attachment patterns have been transmitted across generations within the family.

Application: Facilitating a discussion about how parents’ own childhood experiences influence their current parenting styles and attachment behaviors.

14. Attachment-Based Homework Assignments

Description: Assigning tasks between sessions to reinforce secure attachment behaviors and insights.

Application: Asking a parent and adolescent to engage in a weekly one-on-one “special time” to foster positive interactions and emotional connection.

15. Termination and Attachment Consolidation

Description: Specific techniques for ending therapy that reinforce gains and prepare the family for maintaining secure attachments.

Application: Guiding the family in creating a “security plan” for managing future challenges while maintaining their strengthened attachment bonds.

These interventions and techniques form the core toolkit of ABFT. Therapists typically integrate multiple techniques within each session, tailoring their approach to the unique needs and dynamics of each family. The overarching goal is to create a therapeutic environment that fosters secure attachment, emotional openness, and adaptive family functioning.

Goals and Stages of Treatment

Attachment-Based Family Therapy (ABFT) follows a structured yet flexible treatment protocol with specific goals and stages. The overarching aim is to repair attachment bonds and improve family functioning, particularly in the context of adolescent mental health issues. Here’s an overview of the goals and stages of treatment in ABFT:

Overall Treatment Goals

1. Repair attachment ruptures between adolescents and their caregivers
2. Improve family communication and emotional responsiveness
3. Reduce adolescent symptoms (e.g., depression, anxiety, suicidal ideation)
4. Enhance adolescent autonomy while maintaining family connections
5. Increase family members’ capacity for mentalization and reflective functioning
6. Develop more secure attachment patterns within the family system

Stages of Treatment

ABFT typically follows a five-task model, with each task representing a stage of treatment. These tasks are not strictly linear and may overlap or be revisited as needed:

Task 1: Relational Reframe

Goal: Shift the focus from individual symptoms to family relational processes.

Key Activities:

• Identify attachment ruptures and their connection to presenting problems
• Build alliance with both adolescents and parents
• Instill hope by presenting ABFT as a path to family reconnection

Task 2: Alliance Building with the Adolescent

Goal: Establish a strong therapeutic alliance with the adolescent and identify core attachment ruptures.

Key Activities:

• Explore the adolescent’s attachment history and current relational disappointments
• Validate the adolescent’s emotional experiences
• Prepare the adolescent for more open communication with parents

Task 3: Alliance Building with the Parents

Goal: Engage parents in examining their own attachment histories and current parenting behaviors.

Key Activities:

• Explore parents’ attachment histories and how they influence current parenting
• Address parents’ own emotional barriers to responsive caregiving
• Prepare parents for more emotionally open interactions with their adolescent

Task 4: Attachment-Based Family Conversations

Goal: Facilitate corrective attachment experiences between adolescents and parents.

Key Activities:

• Guide family members in expressing vulnerable emotions and attachment needs
• Coach parents in providing empathic responses to their adolescent
• Help resolve specific conflicts using attachment principles

Task 5: Promoting Autonomy and Competence

Goal: Consolidate gains and promote adolescent autonomy within the context of secure family relationships.

Key Activities:

• Address practical family issues with newfound attachment security
• Support adolescents in pursuing age-appropriate autonomy
• Prepare the family for termination and future challenges

Conceptualization of Identity and Self

ABFT conceptualizes identity and self-development as intrinsically tied to attachment relationships:

1. Relational Self: The sense of self is viewed as developing within the context of key attachment relationships, particularly with caregivers.
2. Emotional Coherence: A healthy sense of self is characterized by the ability to understand and integrate various emotional experiences.
3. Autonomy-Connection Balance: Identity development involves balancing needs for individual autonomy with needs for relational connection.
4. Narrative Identity: ABFT emphasizes the importance of constructing coherent and adaptive narratives about oneself and one’s relationships.
5. Reflective Functioning: The capacity to understand one’s own and others’ mental states is seen as crucial for healthy identity development.

Goals of Therapy in Relation to Identity and Self

1. Secure Base: Establish the family as a secure base from which adolescents can explore their identity.
2. Emotional Awareness: Enhance family members’ awareness and acceptance of their own and others’ emotional experiences.
3. Differentiation: Support adolescents in developing a sense of self that is distinct yet connected to family relationships.
4. Adaptive Narratives: Help family members construct more positive and flexible narratives about themselves and their relationships.
5. Interpersonal Effectiveness: Improve communication and problem-solving skills to support healthy identity expression within the family.
6. Cultural Integration: Assist in integrating cultural identities within the family’s attachment framework.

By addressing these goals through a structured yet flexible treatment process, ABFT aims to create lasting change in family relationships and individual well-being. The therapy’s focus on attachment processes provides a unique framework for understanding and promoting healthy identity development within the family context.

Evidence Base and Empirical Support

Attachment-Based Family Therapy (ABFT) has been subject to rigorous empirical investigation since its development. While the model is relatively young compared to some other therapeutic approaches, it has accumulated a significant body of evidence supporting its efficacy, particularly for treating adolescent depression and suicidal ideation. Here’s an overview of the evidence base for ABFT:

Randomized Controlled Trials (RCTs)

Several RCTs have demonstrated the efficacy of ABFT:

1. Diamond et al. (2010): This landmark study compared ABFT to usual care for adolescents with depression and suicidal ideation. ABFT showed significantly greater and more rapid reductions in suicidal ideation and depressive symptoms.
2. Diamond et al. (2019): This study compared ABFT to family-enhanced nondirective supportive therapy for suicidal adolescents, finding that ABFT was more effective in reducing suicidal ideation.
3. Kobak et al. (2015): This trial found ABFT to be effective in reducing anxiety symptoms in adolescents with anxiety disorders.

Open Trials and Pilot Studies

Several open trials and pilot studies have provided initial evidence for ABFT’s effectiveness:

1. Diamond et al. (2012): An open trial showed ABFT’s promise in treating suicidal adolescents in community clinics.
2. Diamond et al. (2013): A pilot study demonstrated ABFT’s potential for treating depression in sexual minority youth.

Meta-Analyses and Systematic Reviews

While there are not yet extensive meta-analyses specific to ABFT due to its relatively recent development, it has been included in broader reviews of family-based treatments:

1. Carr (2014): A review of evidence-based treatments for child and adolescent mental health problems identified ABFT as an effective treatment for adolescent depression.
2. Pinquart et al. (2016): A meta-analysis of psychological treatments for depressive disorders in children and adolescents included ABFT studies, finding positive effects for family-based interventions.

Mechanisms of Change Studies

Research has also focused on understanding the mechanisms through which ABFT achieves its effects:

1. Diamond et al. (2016): This study examined changes in attachment security as a mediator of treatment outcomes in ABFT, finding that improvements in attachment security were associated with reductions in depressive symptoms.
2. Shpigel et al. (2012): This study investigated the role of changes in family functioning in ABFT outcomes, suggesting that improvements in family relationships mediate symptom reduction.

Effectiveness in Diverse Populations

ABFT has been studied in various populations, demonstrating its adaptability:

1. Diamond et al. (2012): A study on ABFT for depressed and suicidal adolescents in low-income and minority communities showed promising results.
2. Israel & Diamond (2013): This study adapted ABFT for use with sexual minority youth, showing its potential effectiveness for this population.

Long-Term Follow-Up Studies

While long-term follow-up studies are still limited, some research has examined the durability of ABFT effects:

1. Diamond et al. (2010): In their RCT, improvements in depressive symptoms and suicidal ideation were maintained at 6-month follow-up.

Comparative Effectiveness

Some studies have compared ABFT to other treatments:

1. Diamond et al. (2019): This study compared ABFT to family-enhanced nondirective supportive therapy, finding ABFT to be superior in reducing suicidal ideation.

Implementation and Dissemination Studies

Research has also examined the implementation of ABFT in various settings:

1. Feder & Diamond (2016): This study explored the implementation of ABFT in community mental health settings, identifying facilitators and barriers to adoption.

Limitations and Areas for Further Research

While the evidence base for ABFT is growing, there are some limitations and areas that require further investigation:

1. Sample Size: Many studies have relatively small sample sizes, which can limit generalizability.
2. Diversity of Outcomes: While ABFT has strong evidence for depression and suicidal ideation, more research is needed on its efficacy for other mental health issues.
3. Cultural Adaptations: Further research is needed on cultural adaptations of ABFT for diverse populations.
4. Long-Term Outcomes: More studies with extended follow-up periods are needed to assess the long-term effects of ABFT.
5. Comparative Effectiveness: Additional studies comparing ABFT to other evidence-based treatments would be beneficial.
6. Mechanisms of Change: While some studies have examined mechanisms, more research is needed to fully understand how ABFT leads to change.

Conclusion on Empirical Support

Overall, ABFT has accumulated a solid foundation of empirical support, particularly for treating adolescent depression and suicidal ideation. The existing evidence suggests that ABFT is an effective treatment that leads to significant improvements in symptoms and family functioning. However, as with any relatively new therapeutic approach, ongoing research is necessary to further establish its efficacy across diverse populations and presenting problems, and to understand the mechanisms through which it achieves its effects.

The growing evidence base for ABFT has led to its recognition as an evidence-based treatment by several organizations, including the Society of Clinical Child and Adolescent Psychology (Division 53 of the American Psychological Association). This recognition, combined with the positive outcomes observed in clinical trials and effectiveness studies, suggests that ABFT is a promising approach for addressing adolescent mental health issues within a family context.

As research continues, it is likely that our understanding of ABFT’s effectiveness and its optimal applications will continue to evolve, potentially leading to further refinements and adaptations of the model.

Contexts of Practice

Attachment-Based Family Therapy (ABFT) has been implemented and studied in various clinical and community settings. Understanding these contexts of practice is crucial for appreciating the model’s versatility and potential applications. Here are the primary contexts in which ABFT is typically practiced:

1. Outpatient Mental Health Clinics

Description: ABFT is commonly practiced in community mental health centers and private outpatient clinics.

Application: These settings often see adolescents referred for depression, anxiety, or suicidal ideation, making them ideal for ABFT implementation.

2. Hospital-Based Programs

Description: Some hospitals have incorporated ABFT into their adolescent mental health services, including partial hospitalization and intensive outpatient programs.

Application: ABFT can be used as a step-down treatment after acute hospitalization for suicidal adolescents.

3. School-Based Mental Health Services

Description: ABFT has been adapted for use in school settings, where mental health professionals can work with students and their families.

Application: School-based ABFT can address academic and behavioral issues within the context of family relationships.

4. University Counseling Centers

Description: Some college counseling centers have begun to implement ABFT for working with young adults and their families.

Application: ABFT can help address issues related to the transition to college and young adult independence.

5. Primary Care Integration

Description: There’s growing interest in integrating ABFT principles into primary care settings as part of collaborative care models.

Application: Brief ABFT interventions can be used to address family issues identified during routine medical care.

6. Specialized Adolescent Mental Health Programs

Description: Some clinics and programs specialize in adolescent mental health and have adopted ABFT as a core treatment approach.

Application: These programs may offer intensive ABFT services, including multiple sessions per week if needed.

7. Residential Treatment Facilities

Description: Some residential programs for adolescents have incorporated ABFT principles into their family work.

Application: ABFT can be used to prepare families for an adolescent’s return home and to address underlying attachment issues.

8. Community-Based Organizations

Description: Non-profit organizations and community centers sometimes offer ABFT as part of their mental health services.

Application: ABFT can be adapted to address cultural and community-specific issues in these settings.

9. Telehealth Platforms

Description: Increasingly, ABFT is being delivered via telehealth platforms, especially in the wake of the COVID-19 pandemic.

Application: Virtual ABFT sessions can increase accessibility for families who may have difficulty attending in-person sessions.

10. Private Practice Settings

Description: Many individual therapists and group practices offer ABFT as part of their services.

Application: Private practice settings allow for flexible scheduling and potentially longer-term ABFT treatment when needed.

11. Juvenile Justice Settings

Description: Some juvenile justice programs have begun to incorporate ABFT principles in working with youth and their families.

Application: ABFT can address family issues that may contribute to delinquent behavior and support successful reintegration.

12. Substance Abuse Treatment Programs

Description: ABFT has been adapted for use in adolescent substance abuse treatment programs.

Application: The model can address family dynamics that may contribute to substance use and support recovery within a family context.

Considerations for Different Contexts

While ABFT can be adapted to various settings, certain considerations are important:

1. Session Length and Frequency: The standard ABFT protocol may need to be adjusted based on the constraints of different settings.
2. Family Involvement: Some contexts may present challenges in engaging the entire family, requiring creative solutions to ensure family participation.
3. Integration with Other Services: In many settings, ABFT may need to be integrated with other forms of treatment or support services.
4. Cultural Adaptations: Different contexts may require specific cultural adaptations to ensure ABFT’s relevance and effectiveness.
5. Training and Supervision: Proper training and ongoing supervision are crucial for maintaining fidelity to the ABFT model across diverse settings.
6. Outcome Measurement: Different contexts may require specific approaches to measuring outcomes and demonstrating effectiveness.

The versatility of ABFT allows it to be implemented across a wide range of clinical and community settings. This flexibility is one of the model’s strengths, as it can be adapted to meet the needs of diverse populations and treatment contexts while maintaining its core focus on repairing attachment bonds and improving family functioning. As ABFT continues to be studied and implemented in various settings, our understanding of its optimal applications and necessary adaptations will likely continue to evolve.

Unique Aspects of ABFT

Attachment-Based Family Therapy (ABFT) offers several unique features that distinguish it from other therapeutic approaches. These unique aspects contribute to its effectiveness and growing popularity in treating adolescent mental health issues within a family context. Here are some of the key distinctive features of ABFT:

1. Integration of Attachment Theory and Family Systems

Uniqueness: ABFT is one of the few models that explicitly integrates attachment theory with family systems therapy.

Significance: This integration allows for a deep understanding of how individual attachment needs and family dynamics intersect, providing a comprehensive framework for intervention.

2. Focus on Repairing Attachment Bonds

Uniqueness: While many therapies address family relationships, ABFT specifically targets the repair of attachment bonds as the primary mechanism of change.

Significance: This focus allows for deep emotional healing and the creation of a secure base within the family, which can have far-reaching effects on individual and family functioning.

3. Structured yet Flexible Protocol

Uniqueness: ABFT offers a clear, task-based structure while allowing for flexibility in implementation.

Significance: This balance provides therapists with a roadmap for treatment while allowing them to adapt to the unique needs and pace of each family.

4. Emphasis on Emotion and Vulnerability

Uniqueness: ABFT places a strong emphasis on accessing and expressing vulnerable emotions within the family context.

Significance: This focus on emotional processes helps break down defensive patterns and fosters deeper understanding and connection between family members.

5. Adolescent-Centered Approach

Uniqueness: While involving the whole family, ABFT maintains a strong focus on the adolescent’s perspective and experiences.

Significance: This approach helps engage adolescents in treatment and ensures their needs and voice remain central to the therapeutic process.

6. Intergenerational Perspective

Uniqueness: ABFT explicitly addresses how parents’ own attachment histories influence their current parenting.

Significance: This intergenerational focus helps break cycles of insecure attachment and promotes more adaptive parenting practices.

7. Specific Focus on Suicidal Ideation

Uniqueness: ABFT was initially developed with a specific focus on treating adolescent depression and suicidal ideation.

Significance: This specialization has led to strong empirical support for ABFT in addressing these critical mental health issues.

8. Integration of Individual and Family Sessions

Uniqueness: ABFT uniquely combines individual sessions with adolescents and parents with family sessions.

Significance: This approach allows for targeted alliance-building and preparation before bringing family members together for more challenging conversations.

9. Cultural Adaptability

Uniqueness: ABFT has been adapted for use with diverse populations and has a strong emphasis on cultural sensitivity.

Significance: This adaptability makes ABFT applicable across various cultural contexts while maintaining its core principles.

10. Emphasis on Autonomy within Connection

Uniqueness: ABFT specifically addresses the balance between promoting adolescent autonomy and maintaining family connections.

Significance: This focus is particularly relevant for adolescent development and helps families navigate this crucial transitional period.

11. Integration of Mentalization Concepts

Uniqueness: ABFT incorporates elements of mentalization-based approaches, focusing on enhancing reflective functioning in family members.

Significance: This integration helps family members better understand their own and others’ mental states, promoting empathy and reducing conflicts.

12. Specific Attachment-Based Interventions

Uniqueness: ABFT has developed specific interventions designed to activate and modify attachment processes within the family.

Significance: These targeted interventions, such as attachment-based enactments, provide powerful tools for creating change in family relationships.

13. Focus on Corrective Attachment Experiences

Uniqueness: ABFT emphasizes creating new, positive attachment experiences within therapy sessions.

Significance: These corrective experiences can help reshape internal working models of relationships, leading to lasting change.

14. Integration with Neuroscience

Uniqueness: ABFT incorporates insights from interpersonal neurobiology, linking attachment processes to brain development and function.

Significance: This integration provides a biological basis for understanding the impact of attachment relationships on mental health and development.

These unique aspects of ABFT contribute to its effectiveness as a treatment approach for adolescent mental health issues. By focusing on attachment processes within the family system, ABFT offers a comprehensive framework for addressing the relational roots of individual symptoms. Its structured yet flexible approach, combined with a strong emphasis on emotional processes and cultural adaptability, makes it a versatile tool for clinicians working with diverse families.

Moreover, ABFT’s specific focus on issues like adolescent depression and suicidal ideation, along with its integration of individual and family work, makes it particularly well-suited for addressing some of the most pressing mental health concerns facing adolescents today. As research on ABFT continues to grow, these unique aspects may be further refined and expanded, potentially leading to even more effective interventions for improving family relationships and adolescent mental health.

Integration with Modern Therapy

Attachment-Based Family Therapy (ABFT) offers several opportunities for integration with modern therapeutic approaches. While ABFT is a distinct model with its own theoretical framework and interventions, many of its principles and techniques can be effectively combined with or incorporated into other contemporary therapies. Here are some ways ABFT can be integrated with modern therapy practices:

1. Integration with Mindfulness-Based Approaches

Potential Integration: ABFT’s focus on emotional awareness and present-moment experiences aligns well with mindfulness-based therapies.

Application: Mindfulness exercises could be incorporated into ABFT sessions to enhance emotional regulation and attunement between family members.

2. Combination with Trauma-Informed Care

Potential Integration: ABFT’s attachment focus complements trauma-informed approaches, as both recognize the impact of relational experiences on mental health.

Application: Trauma-specific interventions could be integrated into the ABFT framework to address both attachment ruptures and traumatic experiences.

3. Incorporation of Cognitive-Behavioral Techniques

Potential Integration: While ABFT primarily focuses on emotional and relational processes, cognitive-behavioral techniques can be incorporated to address specific symptoms or behaviors.

Application: CBT techniques for managing depression or anxiety could be taught within the context of improving family communication and support.

4. Integration with Dialectical Behavior Therapy (DBT) Skills

Potential Integration: DBT skills training, particularly in emotional regulation and interpersonal effectiveness, can complement ABFT’s focus on emotional expression and family communication.

Application: DBT skills could be taught to family members as tools for managing emotions and improving interactions between sessions.

5. Incorporation of Solution-Focused Techniques

Potential Integration: Solution-focused brief therapy techniques can be integrated into ABFT to help families identify and build on their strengths and resources.

Application: Solution-focused questioning could be used within ABFT sessions to help families envision and work towards positive change.

6. Combination with Narrative Therapy Approaches

Potential Integration: ABFT’s emphasis on changing family narratives aligns well with narrative therapy techniques.

Application: Narrative externalization techniques could be used within ABFT to help families separate themselves from problem-saturated stories and construct more adaptive narratives.

7. Integration with Emotionally Focused Therapy (EFT)

Potential Integration: Both ABFT and EFT focus on emotional processes and attachment, making them highly compatible.

Application: EFT techniques for identifying and changing negative interaction cycles could be incorporated into ABFT work with parents or parent-adolescent dyads.

8. Incorporation of Motivational Interviewing Techniques

Potential Integration: Motivational interviewing strategies can enhance ABFT’s effectiveness in engaging resistant family members and promoting change.

Application: Motivational interviewing techniques could be used in early ABFT sessions to build motivation for family work and overcome ambivalence.

9. Combination with Psychoeducational Approaches

Potential Integration: Psychoeducation about mental health issues, adolescent development, and family dynamics can enhance ABFT’s effectiveness.

Application: Structured psychoeducational modules could be incorporated into ABFT treatment to increase family members’ understanding of relevant issues.

10. Integration with Technology-Assisted Therapy

Potential Integration: ABFT can be adapted for delivery via telehealth platforms and integrated with digital mental health tools.

Application: ABFT sessions could be conducted via video conferencing, with supplementary app-based tools for mood tracking or communication practice between sessions.

11. Incorporation of Positive Psychology Principles

Potential Integration: Positive psychology’s focus on strengths and well-being can complement ABFT’s emphasis on repairing relationships.

Application: Positive psychology interventions, such as gratitude exercises or strength-spotting, could be incorporated into ABFT to enhance positive family interactions and build resilience.

12. Integration with Acceptance and Commitment Therapy (ACT)

Potential Integration: ACT’s focus on psychological flexibility and value-driven behavior aligns well with ABFT’s goals of improving family functioning.

Application: ACT techniques for clarifying values and increasing psychological flexibility could be incorporated into ABFT work with both adolescents and parents.

13. Combination with Family-Based Treatment for Eating Disorders

Potential Integration: ABFT principles could be integrated into family-based treatments for eating disorders to address underlying attachment issues.

Application: ABFT techniques for repairing attachment bonds could be incorporated into family-based eating disorder treatment to enhance its effectiveness.

14. Incorporation of Interpersonal Psychotherapy (IPT) Concepts

Potential Integration: IPT’s focus on interpersonal relationships and life transitions complements ABFT’s relational approach.

Application: IPT techniques for addressing interpersonal deficits or role transitions could be incorporated into ABFT work, particularly with adolescents.

15. Integration with Neurofeedback and Biofeedback

Potential Integration: Neurofeedback or biofeedback techniques could be used alongside ABFT to address physiological aspects of emotion regulation.

Application: Biofeedback training could be offered as an adjunct to ABFT to help family members manage stress and emotional reactivity.

Considerations for Integration

When integrating ABFT with other therapeutic approaches, several factors should be considered:

1. Maintaining Model Fidelity: It’s important to ensure that core ABFT principles and techniques are maintained when incorporating elements from other approaches.
2. Therapist Training: Proper training in both ABFT and the complementary approach is crucial for effective integration.
3. Client Needs: Integration should be guided by the specific needs of the client family, rather than a one-size-fits-all approach.
4. Evidence Base: When possible, integrated approaches should be supported by research or at least have a strong theoretical rationale.
5. Cultural Considerations: Any integration should take into account cultural factors and be adaptable to diverse populations.
6. Treatment Planning: Clear treatment plans should outline how and when different approaches will be integrated within the overall ABFT framework.
7. Outcome Monitoring: Regular assessment of treatment progress is important to ensure that integrated approaches are effective.

Benefits of Integration

Integrating ABFT with other modern therapy approaches can offer several benefits:

1. Comprehensive Treatment: Integration allows for addressing a wider range of issues and symptoms within a coherent treatment framework.
2. Flexibility: An integrative approach provides more tools and techniques to meet the diverse needs of different families.
3. Enhanced Engagement: Incorporating techniques from various approaches can help engage family members who may not respond to a single approach.
4. Skill Development: Integration can provide family members with a broader set of skills for managing emotions, improving communication, and solving problems.
5. Addressing Comorbidity: An integrative approach may be particularly helpful when working with families dealing with multiple or complex issues.
6. Continued Evolution: Integration allows ABFT to evolve and remain relevant as new therapeutic approaches and techniques emerge.

Conclusion on Integration

The integration of ABFT with other modern therapy approaches represents an exciting frontier in family therapy. By thoughtfully combining ABFT’s strong attachment focus with complementary techniques and concepts from other evidence-based approaches, therapists can create powerful, tailored interventions to meet the unique needs of each family.

However, it’s crucial that such integration is done carefully and intentionally, with a clear understanding of both ABFT principles and the complementary approaches being incorporated. Ongoing research will be valuable in determining the most effective ways to integrate ABFT with other therapies and in evaluating the outcomes of these integrative approaches.

As the field of psychotherapy continues to evolve, ABFT’s ability to integrate with and complement other approaches positions it well to remain a relevant and effective treatment for adolescent mental health issues and family relationship problems. This flexibility and adaptability, combined with ABFT’s strong theoretical foundation and growing evidence base, suggest a promising future for the continued development and application of this therapeutic model.

Conclusion

Attachment-Based Family Therapy (ABFT) represents a significant advancement in the field of family therapy and adolescent mental health treatment. By integrating attachment theory with family systems approaches, ABFT offers a unique and powerful framework for addressing the relational roots of adolescent mental health issues.

Key strengths of ABFT include:

1. Strong Theoretical Foundation: Grounded in attachment theory and family systems thinking, ABFT provides a comprehensive understanding of how family relationships impact individual well-being.
2. Focus on Emotion and Attachment: By emphasizing emotional processes and attachment bonds, ABFT addresses core relational issues that often underlie symptom presentation.
3. Structured yet Flexible Approach: The model’s task-based structure provides clear guidance for therapists while allowing for adaptation to individual family needs.
4. Growing Evidence Base: ABFT has demonstrated efficacy in treating adolescent depression and suicidal ideation, with ongoing research expanding its application to other issues.
5. Cultural Adaptability: The model’s emphasis on understanding unique family contexts allows for effective adaptation across diverse cultural backgrounds.
6. Integration Potential: ABFT’s principles and techniques can be effectively integrated with other modern therapeutic approaches, enhancing its versatility and effectiveness.

As research on ABFT continues to grow, several areas for future development and exploration emerge:

1. Expanded Applications: Further research on ABFT’s effectiveness for a wider range of mental health issues and age groups could broaden its clinical utility.
2. Long-Term Outcomes: More studies examining the long-term effects of ABFT would provide valuable insights into the durability of its impact.
3. Mechanism Studies: Continued investigation into the specific mechanisms of change in ABFT could refine and enhance the model’s interventions.
4. Technology Integration: Exploring ways to effectively deliver ABFT via telehealth and integrate digital tools could increase its accessibility and impact.
5. Training and Dissemination: Developing efficient training models and implementation strategies could help expand ABFT’s reach in diverse clinical settings.

In conclusion, Attachment-Based Family Therapy offers a promising approach for addressing adolescent mental health issues within a family context. Its strong theoretical foundation, growing evidence base, and potential for integration with other therapeutic approaches position ABFT as a valuable tool in the modern mental health landscape. As research and clinical practice continue to evolve, ABFT is likely to play an increasingly important role in improving family relationships and supporting adolescent mental health.

By focusing on repairing attachment bonds and fostering secure family relationships, ABFT not only addresses current symptoms but also lays the groundwork for long-term psychological well-being. As such, it represents a significant contribution to the field of family therapy and offers hope for families struggling with adolescent mental health challenges.

Bibliography

1. Diamond, G. S., Diamond, G. M., & Levy, S. A. (2014). Attachment-Based Family Therapy for Depressed Adolescents. American Psychological Association.
2. Diamond, G. S., Wintersteen, M. B., Brown, G. K., Diamond, G. M., Gallop, R., Shelef, K., & Levy, S. (2010). Attachment-Based Family Therapy for Adolescents with Suicidal Ideation: A Randomized Controlled Trial. Journal of the American Academy of Child & Adolescent Psychiatry, 49(2), 122-131.
3. Diamond, G. M., Diamond, G. S., Levy, S., Closs, C., Ladipo, T., & Siqueland, L. (2012). Attachment-Based Family Therapy for Suicidal Lesbian, Gay, and Bisexual Adolescents: A Treatment Development Study and Open Trial with Preliminary Findings. Psychotherapy, 49(1), 62-71.
4. Diamond, G. S., Kobak, R. R., Krauthamer Ewing, E. S., Levy, S. A., Herres, J. L., Russon, J. M., & Gallop, R. J. (2019). A Randomized Controlled Trial: Attachment-Based Family and Nondirective Supportive Treatments for Youth Who Are Suicidal. Journal of the American Academy of Child & Adolescent Psychiatry, 58(7), 721-731.
5. Feder, M. M., & Diamond, G. M. (2016). Parent-Therapist Alliance and Parent Attachment-Promoting Behaviour in Attachment-Based Family Therapy for Suicidal and Depressed Adolescents. Journal of Family Therapy, 38(1), 82-101.
6. Israel, P., & Diamond, G. S. (2013). Feasibility of Attachment Based Family Therapy for Depressed Clinic-Referred Norwegian Adolescents. Clinical Child Psychology and Psychiatry, 18(3), 334-350.
7. Kobak, R., & Kerig, P. K. (2015). Introduction to the Special Issue: Attachment-Based Treatments for Adolescents. Attachment & Human Development, 17(2), 111-118.
8. Levy, S. A., Diamond, G. S., Russon, J., & Diamond, G. M. (2021). Attachment-Based Family Therapy for Sexual and Gender Minority Young Adults and Their Nonaccepting Parents. Cognitive and Behavioral Practice, 28(2), 217-230.
9. Shpigel, M. S., Diamond, G. M., & Diamond, G. S. (2012). Changes in Parenting Behaviors, Attachment, Depressive Symptoms, and Suicidal Ideation in Attachment-Based Family Therapy for Depressive and Suicidal Adolescents. Journal of Marital and Family Therapy, 38(s1), 271-283.
10. Zilberstein, K. (2014). The Use and Limitations of Attachment Theory in Child Psychotherapy. Psychotherapy, 51(1), 93-103.

Further Reading

1. Bowlby, J. (1988). A Secure Base: Parent-Child Attachment and Healthy Human Development. Basic Books.
2. Diamond, G. S., Diamond, G. M., & Levy, S. A. (2014). Attachment-Based Family Therapy for Depressed Adolescents. American Psychological Association.
3. Hughes, D. A. (2007). Attachment-Focused Family Therapy. W. W. Norton & Company.
4. Johnson, S. M. (2019). Attachment Theory in Practice: Emotionally Focused Therapy (EFT) with Individuals, Couples, and Families. The Guilford Press.
5. Levy, T. M., & Orlans, M. (2014). Attachment, Trauma, and Healing: Understanding and Treating Attachment Disorder in Children, Families and Adults. Jessica Kingsley Publishers.
6. Minuchin, S., Nichols, M. P., & Lee, W. Y. (2007). Assessing Families and Couples: From Symptom to System. Pearson.
7. Nichols, M. P. (2017). Family Therapy: Concepts and Methods (11th ed.). Pearson.
8. Siegel, D. J., & Hartzell, M. (2013). Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You Raise Children Who Thrive. TarcherPerigee.
9. Wallin, D. J. (2007). Attachment in Psychotherapy. The Guilford Press.
10. Wampler, K. S., & Patterson, J. E. (2020). Essential Skills in Family Therapy: From the First Interview to Termination (3rd ed.). The Guilford Press.