Attachment-Based Family Therapy with Adolescents

Adolescent 'behavioural problems' are a huge source of referrals for local authority children's services across the country, after parents and teachers struggle to find strategies that work. However, what is sometimes overlooked is that many rebellious and unhealthy behaviours or attitudes in teenagers can actually be indications of depression. The following are just some of the ways in which teens “act out” or “act in” in an attempt to cope with their emotional pain:

• Problems at school. Depression can cause low energy and concentration difficulties. At school, this may lead to truancy, a drop in academic attainment, or frustration with school work in a formerly able pupil.
• Missing from home. Many depressed teenagers run away from home or talk about running away. Such attempts are usually a cry for help.
• Drug and alcohol abuse. Teenagers may use alcohol or drugs in an attempt to “self-medicate” their depression. Unfortunately, substance abuse only makes things worse.
• Low self-esteem. Depression can trigger and intensify feelings of ugliness, shame, failure, and unworthiness.
• Internet addiction. Teenagers may go online to escape their problems, but excessive computer use only increases their isolation, making them more depressed.
• Reckless behaviour. Depressed teenagers may engage in dangerous or high-risk behaviours, such as reckless driving, out-of-control drinking, and unsafe sex.
• Violence. Some depressed teenagers can become violent either within or outside of the home.

The Child and Adolescent Mental Health Service (CAMHS) has been the traditional route for support in the UK. However, waiting times and thresholds are at an all time high. More and more services are commissioned only for those children presenting with the signs and symptoms of a diagnosable disorder or condition which means that those struggling with less obviously acute or harder-to-label problems are often not eligible for treatment. As a result Children’s Social Workers are increasingly working to help families through what can be a very distressing time, and there is a renewed focus on specialised training to meet this need.

Attachment Based Family Therapy (ABFT) is a manualised, empirically informed, family therapy model specifically designed to target family and individual processes associated with adolescent depression. However, I have found it has strong applicability when working with all families with teenagers. It was first developed by Prof. Guy Diamond, Suzanne Levy and Gary Diamond; all of whom have received international acclaim for their work in this area. 

The model is emotionally focused and provides structure and goals; thus, increasing the Social Workers intentionality and focus. It has emerged from interpersonal theories that suggest teenage depression can be precipitated, exacerbated, or buffered against by the quality of interpersonal relationships in families. It is a trust-based, emotion focused model that aims to repair interpersonal ruptures and rebuild an emotionally protective, secure-based, parent-child relationship. 

Teenagers may experience depression resulting from the attachment ruptures themselves or from their inability to turn to the family for support in the face of trauma outside the home. The aim of ABFT is to strengthen or repair parent-child attachment bonds and improve family communication. As the normative secure base is restored, parents become a resource to help their child cope with stress, experience competency, and explore autonomy.

I believe it should be integrated into the practice of all children’s social workers. If you’d like to learn more you can buy the latest book, Attachment-Based Family Therapy for Depressed Adolescents, here. 

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