This program is for adolescents who are 12 to 18 years old with depression or suicidal tendencies and their families.

Attachment-Based Family Therapy (ABFT), a community-based depression and suicide-intervention family-treatment program, is designed to rebuild trust, restore and strengthen the parent-child relationship, and promote adolescent competency and autonomy.

Several internal randomized control trials (RCTs) have been conducted that measure the effectiveness of ABFT. Collectively, these studies indicated statistically significant reductions in adolescent depression, anxiety, and suicidal ideation compared to wait-list, enhanced usual care, or treatment as usual (TAU) conditions. Preliminary results also suggest program effects for parents' use of psychological control and autonomy granting. However, some of these studies had small samples, and all of the studies lacked follow-up data or had incomplete follow-up data. One external RCT has been conducted among a group of primarily female adolescents with major depressive disorder. Participants were randomized to ABFT or TAU for 16 weeks, and posttest results indicated significant reductions in suicidal ideation and depressive symptoms in both groups, and there were no differences between groups. However, the majority of participants were still in the clinical range after treatment, and ABFT was not associated with more favorable outcomes than TAU.

ABFT focuses on repairing core family processes. The program consists of the following consecutive tasks:

• Relational Reframe - Families learn to understand and agree that strengthening their relationships is essential to treating depression and suicidal ideation.
• Adolescent Alliance - The therapist and the adolescent work together to determine relationship issues in the family and examine how these issues are associated with depression. The therapist encourages the adolescent to discuss these issues with the parent.
• Parent Alliance - The therapist and the parent work together to determine parental sources of stress and relationship issues that occurred in the parent's past. The goal is to solidify the parent's feeling of love for the child and motivate the parent to use the skills and techniques taught in the program.
• Attachment - A family meeting is conducted in which the adolescent discusses his or her thoughts and feelings with the parent. The parent is responsive and works with the adolescent to help him or her identify and explore the adolescent's thoughts and feelings.
• Autonomy - The parent and adolescent work together to solidify their strengthened relationship. The parent serves as a guide to the adolescent, and the adolescent works to develop a healthy balance of connection to and autonomy from the parent.

Since its inception in 1996, ABFT has been used in four U.S. states and in several countries throughout the world, including Australia, Belgium, Israel, Norway, and Sweden. The program has served over 500 families.

ABFT must be conducted by a therapist with at least a master's degree in social work; clinical, mental health, or counseling psychology; or couples and family therapy. There are three levels of training, and completion of the final level leads to certification. Level one training consists of a 1-day and 3-day workshop. Level two consists of 22 weeks of supervision and a 3-day advanced workshop. Level three consists of tape review. Workshops may be conducted in person on-site or off-site or online. Please visit https://drexel.edu/familyintervention/abft-training-program/abft-training/ for more information.

Considerations for implementing this program include obtaining agency administrative support, locating key partners and stakeholders (e.g., insurance companies, referring agencies) and possible funding sources, acquiring participant buy-in, finding a suitable therapist to facilitate the sessions and making arrangements for them to complete training, ensuring program sessions are delivered with fidelity, and locating and determining convenient times to hold sessions.

The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

If you are interested in implementing ABFT, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu

ABFT is implemented over a 12- to 16-week period. Sessions are delivered once per week for 60 to 90 minutes depending on the participant's needs.

The treatment manual costs $69.95. Other implementation costs will include training, credentialing, and ongoing supervision. ABFT assists agencies in working with possible funding sources, including Medicaid and federal, state, foundation, and training grants. Please use details in the Contact section for more information.

To move ABFT to the Promising category on the Clearinghouse Continuum of Evidence, at least one evaluation must be performed demonstrating positive effects lasting at least one year from the beginning of the program or at least six months from program completion.

The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185    Email: Clearinghouse@psu.edu

You may also contact Dr. Suzanne Levy by phone 1-215-571-3415 or email slevy@drexel.edu or visit https://drexel.edu/familyintervention/attachment-based-family-therapy/overview/

https://drexel.edu/familyintervention/attachment-based-family-therapy/overview/ and https://www.goodtherapy.org/learn-about-therapy/types/attachment-based-family-therapy

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. https://doi.org/10.1016/j.jaac.2018.10.006

Diamond, G. S., Reis, B. F., Diamond, G. M., Siqueland, L., & Isaacs, L. (2002). Attachment-based family therapy for depressed adolescents: A treatment development study. Journal of the American Academy of Child & Adolescent Psychiatry, 41(10), 1190-1196. https://doi.org/10.1097/00004583-200210000-00008

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. https://doi.org/10.1097/00004583-201002000-00006

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. https://doi.org/10.1177/1359104512455811

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, 271-283. https://doi.org/10.1111/j.1752-0606.2012.00295.x

Waraan, L., Rognli, E. W., Czajkowski, N. O., Aalberg, M., & Mehlum, L. (2021). Effectiveness of attachment-based family therapy compared to treatment as usual for depressed adolescents in community mental health clinics. Child and Adolescent Psychiatry and Mental Health, 15, 14. https://doi.org/10.1186/s13034-021-00361-

Waraan, L., Rognli, E. W., Czajkowski, N. O., Mehlum, L., & Aalberg, M. (2021). Efficacy of attachment-based family therapy compared to treatment as usual for suicidal ideation in adolescents with MDD. Clinical Child Psychology and Psychiatry, 26(2), 464-474. https://doi.org/10.1177/1359104520980776