Attachment-based family therapy for depressed and suicidal adolescents: theory, clinical model and empirical support

Abstract

Attachment-Based Family Therapy (ABFT) is a manualized family-based intervention designed for working with depressed adolescents, including those at risk for suicide, and their families. It is an empirically informed and supported treatment. ABFT has its theoretical underpinnings in attachment theory and clinical roots in structural family therapy and emotion focused therapies. ABFT relies on a transactional model that aims to transform the quality of adolescent-parent attachment, as a means of providing the adolescent with a more secure relationship that can support them during challenging times generally, and the crises related to suicidal thinking and behavior, specifically. This article reviews: (1) the theoretical foundations of ABFT (attachment theory, models of emotional development); (2) the ABFT clinical model, including training and supervision factors; and (3) empirical support.

Childhood abuse and neglect, attachment states of mind, and non-suicidal self-injury

“…Indeed, results of the limited clinical research in this regard support this supposition, showing that methods such as transference focused psychotherapy (TFP)—in which individuals are taught to reframe their ways of thinking about and reflecting upon experiences within important interpersonal relationships—result in decreased attachment preoccupation regarding childhood caregivers and corresponding decreases in frequency of self-injuring across a 1-year treatment period (Levy, Yeomans, & Diamond, 2007; see also Levy et al, 2006). Although research regarding the impact of TFP on attachment states of mind and NSSI have primarily involved patients diagnosed with borderline personality disorder, and results are based on small samples, these findings align with the broader expanse of research supporting the utility of similar attachment-base3d interventions to reduce suicidal ideation, a common comorbid pathology accompanying NSSI, in adolescents and young adults (Ewing, Diamond, & Levy, 2015; Sheftall, Mathias, Furr, & Dougherty, 2013). Additional studies employing TFP with individuals who engage in NSSI without personality pathology, and with larger samples, are required to assess the generalizability of reported treatment outcomes.…”

Attachment and Chronic Pain in Children and Adolescents

“…These interventions have been used to increase security in the caregiver-adolescent attachment bond, while targeting a range of specific groups, such as depressed and suicidal adolescents [73], hard-to-reach youth [74], and pregnant adolescents [75]. An earlier review was carried out overviewing the attachment-based treatments for use with young children [76].…”

The neuroscience and context of adolescent depression

“…A few theoretically sound psychological treatment strategies have emerged and are showing preliminary promising results. These treatments include attachment-based family therapy (70), interpersonal psychotherapy (71), acceptance commitment therapy (72), thinking about reward in young people (16), game-based digital interventions (73) and Internet and computer-based therapy (74). However, on the basis of the findings reviewed in this paper, we promote the development of neuroscientifically informed, contextually aware and ecologically sustainable ways to treat adolescent depression in a manner that simultaneously empowers, informs and prepares the young generation for a future with rapidly changing living conditions.…”