Attachment-Based Family Therapy (ABFT)

Reviewed by the HeyPsych Medical Review Board

Board-certified psychiatrists and mental health professionals

Indications

Primary Indications

Major Depressive DisorderSuicidal IdeationFamily ConflictGeneralized Anxiety Disorder

Mechanism

ABFT is based on attachment theory and posits that ruptures in parent–child attachment relationships contribute to adolescent depression and suicidality. The therapy strengthens emotional bonds through structured, emotionally focused sessions. By repairing attachment ruptures and fostering parental responsiveness, adolescents gain a secure base that reduces distress and promotes resilience.

Protocol

Preparation

Assessment of family dynamics, attachment ruptures, and adolescent clinical presentation.

Procedure

Initial alliance building with adolescent and parents.
Relational reframing of the adolescent’s symptoms as signals of relational distress.
Parent sessions to increase sensitivity, attunement, and reduce blame.
Adolescent sessions to prepare for expressing vulnerability.
Family sessions focused on repairing attachment ruptures and fostering secure communication.

Frequency: Weekly sessions

Duration: 16–20 sessions

Total Treatment Time: 4–6 months

Equipment

No special equipment required.

Session Structure

pre session: Therapist prepares by reviewing family dynamics and identifying relational ruptures.

treatment phase: Structured sequence of individual and family sessions focusing on attachment repair and emotional communication.

post session: Therapist and family summarize progress and reinforce attachment-focused communication.

home practice: Encouragement of ongoing emotional openness and conflict resolution outside of sessions.

Expected Outcomes

Immediate

Increased openness in communication
Improved parental responsiveness

Short Term

Reduction in depressive symptoms
Decrease in suicidal ideation
Lower family conflict

Long Term

Secure parent–child attachment bonds
Increased resilience
Sustained emotional regulation

Side Effects

common

Emotional discomfort when discussing painful experiences

uncommon

Resistance from parents or adolescents

rare

Increased conflict if emotions are not well managed in therapy

Contraindications

absolute

Active abuse in the household

relative

Parental psychopathology preventing engagement

special considerations

Family willingness to engage is essential for success

Patient Selection

ideal candidates

Adolescents with depression or suicidal ideation
Families experiencing relational disconnection
Parents motivated to repair attachment

screening required

Assessment for safety and readiness to engage in family therapy

Training Requirements

practitioner

Licensed family therapists, psychologists, or social workers trained in ABFT

facility

Outpatient clinics
Private practice
Community mental health centers

Research Evidence

studies

Diamond, G.S. et al. (2002). Attachment-based family therapy for depressed adolescents: A treatment development study.
Diamond, G.S. et al. (2010). Attachment-based family therapy for adolescents with suicidal ideation: A randomized controlled trial.
Israel, P. et al. (2017). Attachment-based family therapy: A review of empirical support.

limitations: Most research is focused on adolescents; adaptations for adults and other populations need further validation.

Cost Considerations

typical session cost: $120–$250 per session

total treatment cost: Varies; typically $2,000–$5,000 depending on session length and frequency

insurance coverage: Commonly covered under family therapy benefits

cost effectiveness: Cost-effective compared to hospitalization for suicidal adolescents

ux display: undefined

collapsible: undefined

heading: undefined

Integration Support

concurrent therapies

Medication management if needed
Individual therapy for adolescent
School-based supports

lifestyle recommendations

Open family communication routines
Supportive parenting practices

Special Populations

👶Pregnancy

Not directly applicable

Clinical Notes

ABFT is a structured, manualized treatment with a strong evidence base.
Most effective with motivated families willing to engage emotionally.
Therapists require specialized training and supervision.

References

Diamond, G.S. et al. (2002). Attachment-based family therapy for depressed adolescents: A treatment development study.Diamond, G.S. et al. (2010). Attachment-based family therapy for adolescents with suicidal ideation: A randomized controlled trial.Israel, P. et al. (2017). Attachment-based family therapy: A review of empirical support.

This information about therapy approaches is for educational purposes only. Therapy should be conducted by licensed mental health professionals. The effectiveness of therapy varies by individual and condition. Consult with a qualified therapist to determine the best approach for your needs.

Interested in this treatment?

This information is for educational purposes. Always consult with a qualified healthcare provider before starting any new treatment.

Locate Psychiatrists