Attachment-Based Family Therapy - Dr. Guy Diamond

Attachment-based family therapy (ABFT) is a manualized, trauma focused, process oriented brief, organized but flexible treatment. The model aims to strengthen or repair parent-adolescent attachment bonds and improve family communication and interpersonal problem solving so that parents become a secure base from which adolescents can use to cope with mental health issues, experience competency, and explore autonomy. ABFT is the only brief, empirically supported, manualized family treatment approach for adolescents struggling with depression, trauma, suicide and general anxiety.

ABFT presumes that relational ruptures such as family conflict, detachment, harsh criticism or more insidious traumas (e.g., abandonment, neglect, abuse) can cause, maintain and/or exacerbate depression, suicidal ideation, and/or general anxiety in adolescents. The impact of these processes is compounded when parents fail to comfort, support and help their adolescent identify, discuss and work through stressful experiences. Conversely, when adolescents perceive their parents as caring, protective and autonomy-granting, the family provides support for the adolescent to develop effective emotion regulation and problem-solving skills needed to withstand and grow from life's stressors. The treatment has been empirically tested with adolescents struggling with depression, history of sexual abuse, anxiety, and suicide.

Treatment follows a semi-structured protocol consisting of five therapy tasks:

  • The Relational Reframe Task, with the adolescent and parent(s) together, sets the foundation of therapy by helping family members to access their longing for greater closeness and adopt the idea of rebuilding trust (1 session).
  • The Adolescent Alliance Task, with the adolescent alone, helps the adolescent to identify and articulate their perceived experiences of attachment failures, and commit to discussing these experiences with their parents (2 to 4 sessions)
  • The Parent Alliance Task, with the parent(s) alone, explores their current stressors and own history of attachment to activate parental caregiving instincts to motivate parents to learn and use new attachment-promoting parenting skills to protect their child (2 to 4 sessions).
  • The Attachment Task, with the adolescent and parents together, creates an opportunity for a “corrective attachment experience” wherein an adolescent directly expresses his/her thoughts and feelings about relational injustices and parent(s) respond with empathy and caring thus revising the adolescent expectation of parental support and care. (1 to 4 sessions)
  • The Autonomy Task, with the adolescent and parents together, uses the parents as a secure base to help the adolescent address other factors contributing to his/her emotional distress and promote autonomy and engagement in normative, development promoting tasks of adolescence.

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 receiving attachment security (adolescent) and giving caregiving love and protection (parent).

ABFT was developed by Guy S. Diamond, Ph.D., Gary M. Diamond, Ph.D., and Suzanne Levy, Ph.D.