Attachment-Based Family Therapy for Adolescent Substance Use: A Move to the Level of Systems

Abstract

This paper provides an account of the theoretical basis of a family-based intervention called Behaviour Exchange and Systems Therapy (BEST). The model described here has also been applied to adolescents with substance abuse and other mental health problems such as depression and anxiety disorders in both children and adolescents. Evaluative studies of the model have been published including randomised clinical trials as well as qualitative analyses. The current paper discusses a theory of the family system as a discourse and represents an integration of aspects of attachment, psychoanalytic, and systems theories. Key concepts elaborated are the attachment-family system, the family as a single discourse, the use of segregation as a defense in relation to trauma and loss and its manifestation in a family narrative, and the role of the family secure base in affect regulation. The paper also briefly describes specific treatment techniques that are derived from the theoretical model. Our approach has wide application as a discourse focused treatment for children and adolescents using a family systems approach. Future work requires the comparison of this model to similar attachment-based models of intervention for children and families, further development and validation of measures able to be used for whole families in a clinical setting, and further empirical demonstration of treatment efficacy in a variety of clinical settings.

“Bumps in the Road”: A Pilot Study of a Therapeutic Technique for the Integration of Unresolved Family Loss and Trauma

“…The background of the current study is a model of attachment conceptualised as an "attachment-family system, " which reflects an attempt to integrate attachment and family systems theories via the concept of defensive processes occurring in discursive patterns (Lewis, 2020). The attachment-family system operates as a family discourse: a single discursive system which informs each family members' speech acts as well as how they are interpreted and responded to within that family system (Lewis, 2020). Accordingly, significant incoherence in the family discourse may impede effective communication and connection at points of stress or rupture and thereby perpetuate conflictual or withdrawn interactions.…”

“…Accordingly, significant incoherence in the family discourse may impede effective communication and connection at points of stress or rupture and thereby perpetuate conflictual or withdrawn interactions. Discursive impasses are likely to be accompanied by incongruent expressions of affect or triggered re-enactments of unresolved traumatic experiences (Lewis, 2020). The coherence of the attachment-family system is conceived as existing on a continuum, with the ultimate goal of the Bumps in the Road task being to enhance overall discourse coherence and thereby assist families to resolve challenges using less conflict and greater mutual regulation of affect.…”

“…The current study attempts to advance such efforts by presenting current work developing a family based therapeutic task called Bumps in the Road. This task involves the whole family and is a drawing task that is embedded within a manualised intervention called Behaviour Exchange and Systems Therapy (BEST) (Poole et al, 2017;Lewis, 2020). It is designed to facilitate a discussion that allows a co-construction and integration of family members' narratives in an effort to address developmental trauma and complicated grief reactions.…”

“…The task encourages the family to work through their account of challenging family events or circumstances ("bumps") which may consist of traumas, losses, and major setbacks, in a way that is supported, facilitated and explored by the therapist. The goal is to integrate fragments of memories held by different family members, bringing together possibly incompatible, incomplete or inconsistent accounts of major family events (Lewis, 2020).…”

Managing, Profiling and Family Support of Malaysian Women Drug Abuse Inmates

“…The different findings from this study may be due to cultural differences, trends and current lifestyle changes in line with the rapidly expanding national development. Positive family relationships not only create harmony but also prevent negative behaviour tendencies (Kumpfer et al, 2003;Lewis, 2020).…”