Attachment-Based Family Therapy
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
 and Implied Percentile Effect
|
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
and Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
Months after treatment when outcome measured
|
|---|---|---|---|---|---|
| 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.
The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtassoc.com.
The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.
For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.
| Characteristics of the Participants in the Studies with Moderate or High Ratings | ||||||
|---|---|---|---|---|---|---|
|
Study Location
|
Study Year
|
Age or Grade-level
|
Race, Ethnicity, Nationality
|
Gender
|
Populations of Interest*
|
Household Socioeconomic Status
|
| Study 14745 - Attachment Based Family Therapy vs. Waitlist Comparison Group | ||||||
| Characteristics of the Children and Youth | ||||||
| -- | -- | Average age: 14.9 years |
69% African American 31% White |
78% Female |
100% had a DSM-III-R primary diagnosis of major depressive disorder; 19% had unwanted sexual experiences |
69% Less than $30,000 annual income 34% Less than or equal to $20,000 annual income |
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| -- | -- | -- | -- | -- |
80% Single-parent families; Parents reported clinical levels of depression (42%) and anxiety (47%) |
-- |
| Study 14747 - Attachment-Based Family Therapy (ABFT) vs. Enhanced Usual Care | ||||||
| Characteristics of the Children and Youth | ||||||
| Philadelphia, PA, USA | 2005 | Average age: 15.1 years | 74% African American | 83% Female |
67% Met criteria for anxiety disorder, 57% Met criteria for externalizing disorder (i.e., ADHD, oppositional, or conduct disorder), 47% Met criteria for depressive disorder; 62% Reported a past suicide attempt, 45% Reported multiple suicide attempts; 45% Reported a history of sexual abuse, none of the participating parents were the perpetrator of the sexual abuse |
-- |
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| Philadelphia, PA, USA | 2005 | -- | -- | -- | -- | 41% Income under $30,000 |
“--” indicates information not reported in the study.
* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.
Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.
Studies Rated High
Study 14745Diamond, 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
This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)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
This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)Studies Rated Low
Study 14758Waraan, 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).