Attachment-Based Family Therapy

Mental Health Promising

Attachment-Based Family Therapy (ABFT) is a mental health program designed to treat depression in adolescents and young adults. ABFT aims to repair trust between adolescents and their parent(s) and re-establish parents as a source of support for the adolescent. By promoting secure relationships (i.e., attachment) between an adolescent and their parents, ABFT aims to help adolescents regulate emotional distress and promote autonomy. 

 

The ABFT model consists of five treatment tasks. In Task 1, the relational reframe task, the adolescent and parents meet with the therapist with the goal of shifting the focus from the adolescent’s behavior to improving family relationships. In Task 2, the adolescent alliance-building task, the adolescent meets with the therapist to assess what has damaged trust and impaired the adolescent’s attachment to their parents. In Task 3, the parent alliance-building task, one or both parents meet with the therapist to discuss how current stressors and the parents’ own attachment history affects their parenting. In Task 4, the repairing attachment task, the adolescent and parents meet with the therapist to discuss issues of trust, betrayal, and commitment. The adolescent describes unmet needs, and the therapist guides the parents on how to be supportive and empathetic. In Task 5, the promoting autonomy task, the family, which may include siblings and other supportive people in the adolescent’s life, meets with the therapist to practice problem-solving skills, such as handling peer conflicts. The family negotiates solutions to difficult day-to-day challenges that promote autonomy while maintaining attachment.  


ABFT is rated as a promising practice because at least one study achieved a rating of moderate or high on study design and execution and demonstrated a favorable effect on a target outcome.


Date Research Evidence Last Reviewed: Jul 2023


Sources

The following sources informed the program or service description, target population, and program or service delivery and implementation information: the program or service manual, the program or service developer’s website, and the studies reviewed.


This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the Review Process page or download the Handbook.

Target Population

ABFT is designed for adolescents and young adults with depression and their parent(s).  

Dosage

Therapists deliver ABFT over 12–16 weeks. Sessions are 60–90 minutes each. Task 1 involves one session, Task 2 involves 2–4 sessions, Task 3 involves 2–3 sessions, Task 4 involves 1–3 sessions, and Task 5 involves 8–9 sessions.

Location/Delivery Setting
Recommended Locations/Delivery Settings

Therapists can deliver ABFT in person in outpatient, inpatient, and community settings, or online.  

Location/Delivery Settings Observed in the Research

  • Hospital/Medical Center

Education, Certifications and Training

Therapists must have at least a master’s degree in social work, mental health counseling, clinical or counseling psychology, or couples and family therapy. The ABFT manual recommends that therapists have basic knowledge of and experience with family therapy.  

The ABFT program offers three levels of training, with the third level culminating in certification. To achieve Level I status, therapists must complete a 3-day introductory workshop available online or in person that provides an overview of ABFT’s model and its procedures and process. Once participants achieve Level I status, they can describe themselves as an ABFT Trained (not certified) Therapist and begin to apply ABFT to their current cases.  

To become a Level II Trained ABFT Therapist, therapists must complete supervision and an additional 3-day advanced workshop, available online or in person. Supervision involves 22 sessions of 60-minute individual or group case consultation video-conferencing with an ABFT-certified consultant. At the 3-day advanced workshop, participants discuss therapist issues, learn about the use of emotion-deepening skills, role-play, and receive supervision from a certified ABFT trainer. Other actions required for Level II include presenting at least four cases, showing two video excerpts of their cases, and completing the ABFT exam with a score of 80% or higher.  

To achieve Level III status and become an official ABFT Certified Therapist, therapists submit a minimum of 10 video recordings of ABFT sessions they have conducted to ABFT Certified Supervisors. Therapists must also provide a case write-up for each submission with self-reflective feedback on how they might have improved the sessions and self-ratings of each session’s adherence to ABFT interventions. ABFT Certified Supervisors review the recordings and provide in-depth written feedback, rate session recordings on adherence to ABFT interventions, and if needed they offer a 20-minute phone consultation.  

Program or Service Documentation
Book/Manual/Available documentation used for review

Diamond, G. S., Diamond, G. M., & Levy, S. A. (2014). Attachment-Based Family Therapy for depressed adolescents. American Psychological Association. 

Available languages

ABFT materials are available in English.


Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.

Results of Search and Review Number of Studies Identified and Reviewed for Attachment-Based Family Therapy
Identified in Search 9
Eligible for Review 4
Rated High 2
Rated Moderate 0
Rated Low 2
Reviewed Only for Risk of Harm 0
Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings
Child well-being: Behavioral and emotional functioning 0.62
23
2 (9) 92 Favorable: 5
No Effect: 4
Unfavorable: 0
Adult well-being: Family functioning 0.09
3
2 (9) 92 Favorable: 0
No Effect: 9
Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.

Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured
Months after treatment when outcome measured more info
Child well-being: Behavioral and emotional functioning 0.62
23
2 (9) 92 Favorable: 5
No Effect: 4
Unfavorable: 0
-
Study 14745 - Attachment Based Family Therapy vs. Waitlist Comparison Group (Diamond, 2002)
Beck Depression Inventory: Total Score 0.16
6
- 32 - 0
Beck Depression Inventory (% in Non-Clinical Range BDI ≤ 9) 1.56 *
44
- 32 - 0
Study 14747 - Attachment-Based Family Therapy (ABFT) vs. Enhanced Usual Care (Diamond, 2010)
Suicide Ideation Questionnaire – Junior 0.70 *
25
- 60 - 0
Suicide Ideation Questionnaire – Junior 0.86 *
30
- 57 - 3
Scale for Suicidal Ideation (6 Weeks Mid-Treatment) 0.16
6
- 60 - 0
Scale for Suicidal Ideation 0.89 *
31
- 60 - 0
Beck Depression Inventory – 2 (6 Weeks Mid-Treatment) 0.54 *
20
- 60 - 0
Beck Depression Inventory – 2 0.28
11
- 60 - 0
Beck Depression Inventory – 2 0.22
8
- 57 - 3
Adult well-being: Family functioning 0.09
3
2 (9) 92 Favorable: 0
No Effect: 9
Unfavorable: 0
-
Study 14745 - Attachment Based Family Therapy vs. Waitlist Comparison Group (Diamond, 2002)
Self-Report of Family Functioning: Expressiveness -0.12
-4
- 32 - 0
Self-Report of Family Functioning: Cohesion -0.04
-1
- 32 - 0
Self-Report of Family Functioning: Conflict 0.74
27
- 32 - 0
Study 14747 - Attachment-Based Family Therapy (ABFT) vs. Enhanced Usual Care (Diamond, 2012)
Self-Report of Family Functioning: Cohesion (6 Weeks Mid-Treatment) 0.12
4
- 60 - 0
Self-Report of Family Functioning: Cohesion 0.37
14
- 60 - 0
Self-Report of Family Functioning: Cohesion 0.00
0
- 60 - 3
Self-Report of Family Functioning: Conflict (6 Weeks Mid-Treatment) -0.25
-9
- 60 - 0
Self-Report of Family Functioning: Conflict 0.14
5
- 60 - 0
Self-Report of Family Functioning: Conflict -0.19
-7
- 60 - 3

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.

Studies Rated High

Study 14745

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 and Adolescent Psychiatry, 41(10), 1190-1196. https://doi.org/10.1097/00004583-200210000-00008

Study 14747

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 and Adolescent Psychiatry, 49(2), 122-131. https://doi.org/10.1097/00004583-201002000-00006

Diamond, G., Creed, T., Gillham, J., Gallop, R., & Hamilton, J. L. (2012). Sexual trauma history does not moderate treatment outcome in Attachment-Based Family Therapy (ABFT) for adolescents with suicide ideation. Journal of Family Psychology, 26(4), 595-605. https://doi.org/10.1037/a0028414



Studies Rated Low

Study 14758

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(1), 8. https://doi.org/10.1186/s13034-021-00361-x

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

Rognli, E. W., Waraan, L., Czajkowski, N. O., & Aalberg, M. (2020). Moderation of treatment effects by parent-adolescent conflict in a randomised controlled trial of Attachment-Based Family Therapy for adolescent depression. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 8, 110-122. https://doi.org/10.21307/sjcapp-2020-011

Rognli, E. W., Waraan, L., Czajkowski, N. O., & Aalberg, A. (2021). Erratum: Moderation of treatment effects by parent-adolescent conflict in a randomised controlled trial of Attachment Based Family Therapy for adolescent depression. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 9, 27-29. https://doi.org/10.21307/sjcapp-2021-004

This study received a low rating because baseline equivalence of the intervention and comparison groups was necessary and not demonstrated.
Study 14753

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

This study received a low rating because the standards for addressing missing data were not met.


Studies Not Eligible for Review

Study 14746 

Diamond, G. M., Diamond, G. S., & Hogue, A. (2007). Attachment-Based Family Therapy: Adherence and differentiation. Journal of Marital and Family Therapy, 33(2), 177-191. https://doi.org/10.1111/j.1752-0606.2007.00015.x 

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 14748 

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. https://doi.org/10.1037/a0026247

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 14749

Diamond, G. M., Shahar, B., Sabo, D., & Tsvieli, N. (2016). Attachment-Based Family Therapy and Emotion-Focused Therapy for unresolved anger: The role of productive emotional processing. Psychotherapy, 53(1), 34-44. https://doi.org/10.1037/pst0000025

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 14750

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 and Adolescent Psychiatry, 58(7), 721-731. https://doi.org/10.1016/j.jaac.2018.10.006 

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 14757

Siqueland, L., Rynn, M., & Diamond, G. S. (2005). Cognitive behavioral and Attachment Based Family Therapy for anxious adolescents: Phase I and II studies. Journal of Anxiety Disorders, 19(4), 361-381. https://doi.org/10.1016/j.janxdis.2004.04.006

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).