Have you heard of attachment-based family therapy, a treatment approach initially developed for adolescents? It’s based on the very influential Attachment Theory underlying much of contemporary practices in child-rearing, therapy and understanding young adult and adult attachment styles. Explore more about this highly effective approach to working with young adults and their families.
The Connection Between Attachment and Mental Health
Attachment theory, first developed in the 1950s by John Bowlby, and further developed by Mary Ainsworth, provides a way of understanding the connections between early childhood development, interpersonal relationships, stress and mental health. It maintains that young adult and adult attachment styles are predictors of mental health.
According to Bowlby, infants are biologically wired to form attachments which serve as a survival strategy. These attachments play a key role in shaping the child’s future emotional health and relationships. Inconsistencies or disruptions in these early attachments could potentially lead to a variety of behavioral or mental health problems later in life [1].
Attachment Theory
According to Attachment Theory, there are four main types of attachment style, under two main categories: Secure and Insecure:
| SECURE | You feel comfortable with both intimacy and space from your former loved ones |
| INSECURE | This form of attachment has three types: |
| Preoccupied | You may feel worried about others leaving you, have an intense fear of rejection, or wish for the approval of others |
| Dismissive-avoidant | You may feel uncomfortable getting close to others, have difficulty expressing your feelings, or have a strong desire for alone time |
| Disorganized | You may oscillate between an intense desire to be emotionally close to others and a need to take space from them |
Our attachment and developmental history play a crucial role in helping people understand how they regulate their emotions. The primary caregiver’s (for Bowlby, the mother, but now inclusive of others) emotional availability and consistent presence are vital in developing secure attachments. Emotionally responsive caregivers who are attuned to the child’s needs help the child develop a positive internal working model of relationships which influences their future interactions and relationships
Secure vs Insecure Attachment
Insecure attachment can show in different ways:
- Avoidant behavior
- Resistant behavior
- Disorganized behavior
Recognize the Signs
A key concept in Attachment Theory is the difference between secure and insecure attachment as summarized in this table:
| Secure | Insecure |
| The child is confident in the caregiver’s availability and responsiveness | The child lacks confidence in the caregiver’s availability and responsiveness |
| The child feels safe to explore its environment | The child is insecure about its environment |
| The child shows distress when separated from the caregiver | The child may avoid or ignore the caregiver |
| The child shows joy when the caregiver returns | The child may resist contact with the caregiver |
These different attachment styles impact a person’s ability to regulate their emotions, form healthy relationships and cope with stress. Those with secure attachments generally have better emotional regulation abilities and healthier relationships compared to those with insecure attachments.
Those with insecure attachments may struggle with emotional regulation and have difficulty forming stable, healthy relationships. They may also be prone to mental health issues such as anxiety and depression.
How Attachment-Based Family Therapy Works
Studies show that family relationships are both a risk factor and protective factor in preventing teen suicide. Attachment-based family therapy (ABFT), grounded in attachment theory, was originally developed for adolescents with depression or at risk for suicide, and their parents.
Subsequently, this approach has been used with LGBTQ+ adolescents and young adults and their non-accepting parents, with teenagers with unresolved anger issues towards their parents, and adolescents with eating disorders.
ABFT helps families explore and understand their emotional responses, identify patterns, and develop healthier ways of coping with emotions. Developed by Diamond and others, attachment-based family therapy is an empirically supported treatment approach designed to capitalize on the innate, biologically based, caregiving instinct and adolescent need for attachment security [2].
Diamond summarizes this approach as “ABFT aims to repair interpersonal ruptures and rebuild emotionally protective, secure relationships between family members. With its unique emphasis on the adolescent’s developmental need for attachment and autonomy, ABFT aims to facilitate corrective attachment experiences within the therapy session.
“…Although the model is trauma-focused and process-oriented, it provides a clear structure for this reparative process … From an attachment perspective, ABFT aims to restore or refurbish healthy, trustworthy, reliable and emotionally sensitive caregiver-child relationships.”
ABFT therapists presume that family conflict, detachment, harsh criticism or other family traumas such as abandonment, neglect or abuse, can cause, maintain or worsen 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.
On the other hand, when adolescents perceive their parents as caring, protective and autonomy-granting, the family provides a secure base helping the adolescents to withstand and grow from life’s stressors [3].
The Phases of Attachment-Based Family Therapy
There are five treatment tasks (phases) in the ABFT model:
- Reframing the therapy to focus on interpersonal development
- “Repairing attachment” occurs by first helping family members to access their longing for greater closeness and adopt the idea of rebuilding trust
- Building alliance with the adolescent or young adult
- In individual sessions, adolescents or young adults are helped to identify and articulate their perceived experiences of attachment failures, and commit to a discussion of these experiences with their parents
- Building alliance with the parents
- In individual sessions, parents are encouraged to consider how their own intergenerational legacies affect their parenting style, which typically leads to their developing greater empathy for their adolescent experiences
- Facilitating conversations to resolve attachment ruptures
- When ready, the therapist brings adolescents and parents together again to discuss their adolescent’s concerns. As adolescents get these thoughts, feelings and memories “off their chests” and receive acknowledgment and empathy from their parents, they become more willing to consider their own contributions to family conflict. This serves as a “corrective attachment experience” which can set in motion a renewed sense of trust and commitment.
- Promoting autonomy and competency in the adolescent or young adult
- As tension and conflict diffuse at home, therapists encourage adolescents to pursue pro-social activities outside the home that will promote competency and autonomy. Parents serve as the secure base from which adolescents seek comfort, advice, support, and encouragement in exploring these new opportunities.
Attachment-Based Therapy in Utah
Engage Young Adult Transitions is a transitional living program and therapeutic community that assists young adults on their path to independence. Using attachment theory, we provide a foundation for forming connections, getting involved with the community, managing mental health, and building life skills for long-term success.
Located just steps from Southern Utah University in Cedar City, we offer access to services seven days a week, including academic support, vocational training and career guidance, life skill coaching, mental health therapies, and recreational activities.
Our community offers high levels of therapeutic support that honors autonomy and independence while guiding young adults to a life of freedom, emotional wellness, and success. Get involved with the Engage Transitions community today!
Sources
[1] Main, P. 2023. Bowlby’s Attachment Theory. Structural-learning.com
[2] Diamond G, Diamond GM, Levy S. Attachment-based family therapy: Theory, clinical model, outcomes, and process research. J Affect Disord. 2021 Nov 1;294:286-295.
[3] What is Attachment-Based Family Therapy (ABFT)? abftinternational.com