An attachment-based intervention for parents of adolescents at risk: mechanisms of change

Abstract

Mechanisms that account for treatment effects are poorly understood. The current study examined processes that may underlie treatment outcomes of an attachment-based intervention (Connect) for parents of pre-teens and teens with serious behavior problems. Parents (N = 540) in a non-randomized trial reported on their teen's functioning prior to and following treatment. Results confirmed significant decreases in parents' reports of teens' externalizing and internalizing symptoms, replicating prior evaluations of this program. Reductions in parents' reports of teen attachment avoidance were associated with decreases in externalizing symptoms, while reductions in parents' reports of teen attachment anxiety were associated with decreases in internalizing symptoms. Parents' reports of improved teen affect regulation were also associated with decreases in both internalizing and externalizing symptoms. Results were comparable across gender and for parents of teens with pre-treatment externalizing symptoms in the clinical versus sub-clinical range. A model of therapeutic change in attachment-based parenting programs is discussed.

Introduction to the special issue: attachment-based treatments for adolescents

“…Treatments that target the caregiver's IWMs may focus either on the caregiver's attachment history, particularly those associated with unresolved loss and trauma (Madigan, Vaillancourt, McKibbon, & Benoit, 2015), or caregivers' IWMs of the adolescent (Moretti, Obsuth, Craig, & Bartolo, 2015;Scharf, Mayseless, & Kivenson-Baron, 2015). Interventions that focus on caregivers' attachment histories typically seek to access primary attachment emotions and shift the caregiver to a more empathic stance toward their adolescents' symptoms or problem behaviors (KrauthamerEwing et al, 2015).…”

“…Interventions that focus on caregivers' attachment histories typically seek to access primary attachment emotions and shift the caregiver to a more empathic stance toward their adolescents' symptoms or problem behaviors (KrauthamerEwing et al, 2015). ABTs that focus on the caregiver's model of the adolescent provides caregivers with an alternative and more positive model of attachment that alters their interpretations and responses to adolescents' problematic behaviors (Moretti et al, 2015). Narrating their interactions with their adolescents provide caregivers with the opportunity to step back and reevaluate their IWMs of the relationship (Kobak et al, 2015;Scharf et al, 2015).…”

“…Symptom reduction is an outcome common to all interventions, whether those focus on internalizing (e.g., depression, suicidality) or externalizing (e.g., aggression, delinquency). However, ABTs offer the opportunity to test the tenets of attachment theory by examining changes in attachment constructs that include changes caregiving context (Bevington et al, 2015), in caregivers' states of mind (Madigan et al, 2015), changes in the caregivers' working model of the child (Moretti et al, 2015;Scharf et al, 2015), changes in emotionally attuned communication , and, ultimately, change in the youth's internal working model of the caregiver . As Kobak et al (2015) articulate, all of these aspects of the attachment relationship represent components of a cycle that are dynamically linked with one another.…”

“…ABT's for adolescents also employ a spectrum of treatment elements (Kobak et al, 2015). The effectiveness of these elements in effecting change may differ depending on the nature of families' presenting problems and attachment difficulties (Moretti et al, 2015). Measuring change in attachment constructs, testing links in the secure cycle and evaluating treatment elements all offer promising and challenging directions for future research on ABTs for adolescents.…”

“…The challenge for ABTs is to measure these processes so that the relative effectiveness of different treatment targets and treatment elements can be evaluated for their effectiveness for increasing security in caregiver-adolescent attachment bonds. Moretti et al (2015) describe their group intervention for parents of at-risk antisocial teens, Connect, which focuses on revising caregivers' IWMs of the adolescent by enhancing reflective function, empathic sensitivity, sense of mutuality, and capacity for affect regulation. The Connect program uses a structured series of group sessions that provide caregivers with a normative model of secure adolescent attachments.…”