Parent‐therapist alliance and parent attachment‐promoting behaviour in attachment‐based family therapy for suicidal and depressed adolescents

Abstract

This study examines whether the strength of the parent-therapist alliance, measured during the task of alliance building with parents alone, predicted the extent of parents' attachment-promoting behaviour in the subsequent conjoint parent-adolescent attachment task in the context of attachment-based family therapy (ABFT). Nineteen suicidal and depressed adolescents and their parents received 12 weeks of ABFT. The parent-therapist alliance and parents' attachment-promoting behaviour were each measured observationally by two separate and independent groups of raters. The findings show that the strength of the parenttherapist alliance predicted parents' subsequent attachment-promoting behaviour. However, parents' attachment-promoting behaviour did not predict the post-treatment outcomes. Clinical and methodological implications are discussed. Practitioner Points• Good parent-therapist alliances are linked to parents being empathic, curious and non-defensive during emotional conversations with their suicidal and depressed adolescents. • Parental attachment-promoting behaviour, including attunement, empathy, and active listening, may not always be sufficient curative factors. • Once the parent-adolescent attachment relationship improves, parents may support their adolescent as they cope with school and peer conflict.

Attachment‐Based Family Therapy: A Review of the Empirical Support

“…Finally, in a recent study on Task 3 and Task 4, it was found that the strength of the parent–therapist alliance formed during alliance‐building sessions alone with the parents predicted the degree to which parents were able to subsequently employ new and productive parenting skills in subsequent conjoint sessions (Feder & Diamond, ). This research on the processes surrounding parental change, and its impact on adolescent change, has emphasized the importance of engaging parents in this therapy.…”

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

“…Variation was also noted within treatment interventions (Table 6). For example, ABFT was provided for 16 weeks in one study (Winley et al, 2016), and for 12 weeks in another study (Feder & Diamond, 2016). Further, some studies comparing family therapy to other treatments use different dosages; however.…”

Alliance and Treatment Outcome in Family-Involved Treatment for Youth Problems: A Three-Level Meta-analysis

“… Y VTAS-R E O R, YS EOT, FU Y, P, OM 68 66 11 Dauber ( 2004 ) a1 25 MDFT n.r. Y VTAS-R E O YS EOT, FU Y 63 61 6 Escudero et al ( 2008 ) f 24 FT C Y + P SOFTA-O E, M O GT DT Y, P 37 82 16 F SOFTA-O E, M O GT DT Y, P 82 Feder and Diamond (2016) 20 ABFT C P VTAS-R M O YS EOT Y 19 19 2 Flicker et al ( 2008 ) f 22 …”

“… 83 50 Dauber ( 2004 ) 1 63 Substance abuse Mx 15.3 79 n.r. 81 60 Escudero et al ( 2008 ) 37 Mixed HS 15.0 40 36 0 0 Feder and Diamond (2016) 19 Internalizing problems HS 15.5 5 16 74 0 Flicker et al ( 2008 ) 86 Substance abuse Mx 15.7 84 n.r. 50 33 Forsberg et al ( 2014 ) 2 38 Eating disorders HS 14.0 13 41 24 n.r.…”

“…First, treatment models differ in the extent to which alliance building aspects of treatment are specified. Some treatment models explicitly describe alliance building stages of treatment (ABFT, Feder and Diamond 2016 ) or therapeutic practices to build multiple alliances (FFT, Sexton and Alexander, 2004 ; MDFT, Liddle 2002 ). For other treatment models, such as family-based CBT (Freeman et al 2003 ), no specific alliance building stages or techniques are described.…”