Attachment Based Family Therapy (ABFT)

ABFT is the only manualized, empirically informed 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 depression and suicide can be precipitated, exacerbated or buffered against by the quality of interpersonal relationships in families. 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.

Five studies have demonstrated that ABFT can reduce adolescent suicide and/or depression better than wait list controls and/or treatment as usual (Diamond et al., 2002; Diamond et al, 2010; (Diamond, G.M, Diamond, G.S., & Levy, S., 2011). Further, preliminary data suggests that ABFT is effective for more severely depressed adolescents and those with a history of sexual abuse, both predictors of poor response in TORDIA, an earlier CBT study, and TADS (Arsanow et al., 2009; Barbe et al., 2004; Curry et al., 2006). ABFT has also been adapted for use with suicidal GLB adolescent in a pilot study with 10, 14-17 year olds (Diamond, G.M, Diamond, G.S., & Levy, S., 2011).Finally, several process studies have explored the proposed mechanisms of change (Diamond G.S., Siqueland, L., & Diamond, G.M., 2003). A large clinical trial comparing ABFT to non-directive supportive therapy for suicidal adolescents is currently underway.

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. 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.

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.

For information on the ABFT Workshops,

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