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Attachment-based family therapy (ABFT; Diamond G.S. et al., 2014 ) is an empirically supported treatment designed to capitalize on the innate, biologically based, caregiving instinct and adolescent need for attachment security. This therapy is grounded in attachment and emotional processing theory and provides an interpersonal, process-oriented, trauma-informed approach to treating adolescents struggling with suicide and associated problems such as depression and trauma. ABFT offers a clear structure and road map to help therapists quickly address the attachment ruptures that lie at the core of family conflict, which can fuel adolescent distress. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanisms of change. In this paper, we provide an overview of the theories underlying the model, the clinical strategies that guide the treatment, the outcome research that demonstrates efficacy, and the process research that explores the proposed mechanisms of change.

The COVID‐19 pandemic has transformed so many aspects of our lives. For psychotherapists, telehealth is likely a permanent part of the future mental health landscape. For family therapists using a manualized treatment, this brings unique challenges and creative opportunities. In this article, we describe the adaptation of attachment‐based family therapy (ABFT) in the context of telehealth and COVID‐19. ABFT is an empirically supported treatment model designed for adolescents and young adults struggling with depression, anxiety, trauma, and suicide. ABFT is a semi‐structured, process‐oriented, and trauma‐informed family therapy model which presents its own unique challenges and benefits in telehealth environments. We present our adaptations based on years of telehealth clinical experience and address how this model supports the impact of COVID‐19 on families.

Suicide is a growing public health issue among adolescents. While the majority of transgender and gender diverse (TGD) youth are healthy, many experience suicidal thoughts and behavior (STB). Due to discrimination and stigma, TGD youth attempt suicide at higher rates then heterosexual, cisgender and even cisgender, LGBQ youth. Despite this vulnerability to suicide, few treatments have been developed and tested for this population. One treatment, attachment-based family therapy (ABFT) has been adapted to work with LGBQ youth and may be promising for TGD adolescents at risk for suicide. This article provides an overview of our ABFT modifications for TGD youth with thoughts of suicide. Specifically, we illustrate how treatment outcomes, in a single case study, relate to processes within clinical treatment tasks. The case study demonstrates the application of these ABFT modifications with a self-identified, gender nonconforming adolescent (who had recently attempted suicide) and his caregivers. Treatment evaluation measures were collected over the course of 24 weeks to illustrate the youth's clinical progress. The youth's suicidal symptoms diminished markedly by the end of treatment. Further, the family reported an increased ability for problem solving and more open communication by treatment conclusion.El suicidio es un problema de salud pública cada vez mayor entre los adolescentes. Si bien la mayoría de los jóvenes transgénero y de géneros diversos (TGD) son saludables, muchos tienen pensamientos y conductas suicidas. Debido a la discriminación y al estigma, los índices de intento de suicidio en los jóvenes TGD son más altos que en los jóvenes heterosexuales, cisgénero e incluso LGBQ cisgénero. A pesar de esta vulnerabilidad al suicidio, se han desarrollado y se han evaluado pocos tratamientos para esta población. Un tratamiento, la terapia familiar basada en el apego (TFBA), se ha adaptado para trabajar con jóvenes LGBQ y puede ser prometedor para adolescentes TGD en riesgo de suicidio. Este artículo ofrece un resumen de nuestras modificaciones a la TFBA para los jóvenes TGD con pensamientos de suicidio. Específicamente, ilustramos cómo los resultados del tratamiento, en un solo caso práctico, se relacionan con los procesos dentro de las tareas del tratamiento clínico. El caso práctico demuestra la aplicación de estas modificaciones de la TFBA con un adolescente que se identificó como de género no conforme (y que recientemente había intentado suicidarse) y sus cuidadores. Se recopilaron las valoraciones de una evaluación del tratamiento durante el transcurso de 24 semanas para ilustrar el avance clínico del joven. Los síntomas de suicidio del joven disminuyeron notablemente al final del tratamiento. Además, la familia informó una mayor capacidad para resolver problemas y una comunicación más abierta al concluir el tratamiento.自杀是青少年中一个日益严重的公共卫生问题。虽然大多数变性和性别多样化（TGD）的青少年是健康的，但许多人经历过有自杀的念头和有自杀行为（STB）出现的时候。由于歧视和感到被污名化，TGD青少年试图自杀的比例高于异性恋、双性恋，还有双性恋的LGBQ青少年。尽管这类人群很容易有自杀的可能性，但针对这一人群的治疗方法很少被开发和试验出来。有一种治疗方法，即基于依恋的家庭治疗（ABFT）已被应用于针对LGBQ青少年的治疗方法，并可能对有自杀风险的TGD青少年有帮助。本文概述了我们对有自杀想法的TGD青少年进行干预的ABFT的实践。具体来说，我们在一个单一的案例研究中，说明了治疗结果与临床治疗任务的过程之间的关系。该案例研究展示了这些ABFT调适之后的应用，对象是一个自我认同的、性别不一致的青少年（他最近曾试图自杀）和他的照顾者。在24周的时间里，治疗评估措施都被汇总，以说明该青少年的临床进展。在治疗结束时，该青少年的自杀症状明显减少了。此外，家庭报告说，在治疗结束时，其解决问题的能力有所提高，沟通也更加开放。.

Objective: To evaluate the efficacy of attachment-based family therapy (ABFT) compared with a family-enhanced nondirective supportive therapy (FE-NST) for decreasing adolescents’ suicide ideation and depressive symptoms. Method: A randomized controlled trial of 129 adolescents who are suicidal ages 12- to 18-years-old (49% were African American) were randomized to ABFT (n = 66) or FE-NST (n = 63) for 16 weeks of treatment. Assessments occurred at baseline and 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and depressive symptoms. Results: There was no significant between-group difference in the rate of change in self-reported ideation (Suicidal Ideation Questionnaire-Jr; F1,127 = 181, p = .18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed a significant decrease in suicide ideation (t127 = 12.61, p < .0001; effect size, d = 2.24). Adolescents receiving FE-NST showed a similar significant decrease (t127 = 10.88, p < .0001; effect size, d = 1.93). Response rates (ie, ≥50% decrease in suicide ideation symptoms from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST. Conclusion: Contrary to expectations, ABFT did not perform better than FE-NST. The 2 treatments produced substantial decreases in suicidal ideation and depressive symptoms that were comparable to or better than those reported in other more intensive, multicomponent treatments. The equivalent outcomes could be attributed to common treatment elements, different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators and mediators. Clinical trial registration information: Attachment-Based Family Therapy for Suicidal Adolescents; http://clinicaltrials.gov; NCT01537419. Published (Publication status)

Child welfare systems (CWSs) worldwide show increased interest in adopting empirically informed clinical strategies to increase treatment effectiveness. Many empirically supported treatments (ESTs) exist, but little is known about EST implementation barriers and facilitators in CWS. This study explored CWS providers' experiences of implementing attachment-based family therapy (ABFT) in home-based services of the Flemish CWS (in Belgium). Sixteen CWS providers (twelve counselors and four supervisors) involved in three home-based services were interviewed. The Consolidated Framework for Implementation Research (CFIR) was used to guide collection, coding, and analysis of interview data. Findings revealed that implementation success was related to ABFT's fit with the CWS's mission, philosophy, and existing practices. CWS providers' belief in the compatibility between ABFT and CWS increased investment in implementation efforts and persistence to overcome challenges and setbacks. Some barriers pertained to the learning of ABFT and some barriers pertained to systems level challenges such as lack of leadership and support, poor coordination with referral sources and other youth care partners, and lack of policy support. For successful expansion of ESTs into CWS settings, various barriers at multiple systemic levels need to be addressed.Los sistemas de asistencia de menores de todo el mundo demuestran cada vez más interés en adoptar estrategias clínicas empíricamente informadas para aumentar la eficacia de los tratamientos. Existen muchos tratamientos respaldados empíricamente, pero se sabe poco acerca de los elementos obstaculizadores y facilitadores para la implementación de dichos tratamientos en los sistemas de asistencia de menores. Este estudio analizó las experiencias de los prestadores de sistemas de asistencia de menores a la hora de implementar la terapia familiar basada en el apego en los servicios domiciliarios del sistema flamenco de asistencia de menores (en Bélgica). Se entrevistó a dieciséis prestadores de sistemas de asistencia de menores (doce terapeutas y cuatro supervisores) implicados en tres servicios domiciliarios. Se utilizó el “Marco Consolidado para la Investigación de Implementación” (Consolidated Framework for Implementation Research,CFIR) para guiar la recopilación, la codificación y el análisis de los datos de las entrevistas. Los resultados revelaron que el éxito de la implementación estuvo relacionado con la adecuación de la terapia familiar basada en el apego con la misión, la filosofía y las prácticas existentes de los sistemas de asistencia de menores. La confianza de los prestadores de sistemas de asistencia de menores en la compatibilidad entre la terapia familiar basada en el apego y los sistemas de asistencia de menores aumentó la inversión en los esfuerzos de implementación y en la perseverancia para superar dificultades y contratiempos. Algunos obstáculos estuvieron relacionados con el aprendizaje de la terapia familiar basada en el apego y algunos otros con dificultades a nivel de los sistemas, como la falta de liderazgo y apoyo, la mala coordinación con fuentes de derivaciones y con otros acompañantes en el cuidado de los jóvenes, y con la falta de apoyo a las políticas. Para diseminar satisfactoriamente los tratamientos respaldados empíricamente en el marco de los sistemas de asistencia de mejores es necesario abordar diferentes obstáculos en múltiples niveles sistémicos.世界儿童福利系统(CWSs)的研究表明越来越多研究者把兴趣放在采用经验主义的临床策略来增加治疗的有效性。已有很多实证支持的治疗方法(ESTs)为人所知,但是人们对于EST在实施过程中遇到哪些障碍和哪些起到促进作用还知之甚少。本研究探索的是比利时的以弗兰德人家庭为基础的服务中,CWS供应者实施的以情感依恋为基础的家庭治疗(ABFT)的经验。服务于三家以家庭为基础的服务机构的16位CWS供应者(12位咨询师和4位管理者)接受了采访。在采访数据搜集,解码和分析过程中使用了实践研究强化框架(CFIR)来给予指导。研究结果表明实施成功与否和ABFT是否与CWS的使命,哲学和已有的措施有关联。 CWS提供者越来越相信ABFT和CWS的相互兼容性,这有助于执行过程中的不断付出和在遭遇挑战和挫折时仍能坚持应对。 有些障碍是和ABFT的学习有关, 有些是和系统水平的挑战有关,比如缺乏领导力和支持,外推的转诊资源和青少年医疗合作者之间协调不得力,缺乏政策支持等。对于ESTs成功得拓展应用到CWS情境中,还有不同系统层面的各种障碍有待于探索解决方法。.

Attachment-based family therapy is an empirically supported manualized treatment that was developed to reduce depression and suicide ideation in adolescents and young adults. This process-oriented, trauma-informed approach aims to identify and resolve family conflicts that have damaged trust between parents and adolescents. Attachment theory provides the theoretical framework that guides specific stages of the treatment course. Five treatment tasks provide structure and scaffolding that keep the treatment focused on attachment and brief in its delivery. Although this is a family systems therapy, several modern psychodynamic attachment-based principles characterize some of the hypothesized treatment mechanisms. These include coherent attachment narratives, reflective functioning, and goal-corrected partnership. The chapter provides an overview of the theory, treatment structure, and core mechanisms of change; 20 years of empirical research; and a case study demonstrating the treatment approach.

The majority of sexual minority adolescents are well-adjusted and healthy, however, on average, 28% report suicidal ideation and between 15% and 40% make a suicide attempt each year. These rates are two to seven times higher than those found among heterosexual youths. Research has shown the protective function of parental support and acceptance, as well as the deleterious effects of parental criticism, invalidation, and rejection on the mental health of sexual minority adolescents. Given these risk and protective factors, these adolescents might benefit from an intervention that targets family relationships. Toward this goal, Attachment-Based Family Therapy (ABFT) specifically aims to improve the quality of adolescent–parent relationships. In prior treatment developmental work, ABFT was adapted and pilot tested for depressed and suicidal lesbian, gay, and bisexual (LGB) adolescents. By adopting an evidence-based case study format, this paper provides a case summary to illustrate how the therapy was conducted. The case study consists of a vignette, followed by therapy task descriptions and illustrative transcripts. Examples of key therapeutic moments in ABFT, for depressed and suicidal LGB adolescents, are discussed in the context of the case. Published (Publication status)

Adolescent anorexia nervosa (AN) has a significant and long-standing impact for the health and well being of young people and their families. The determinants of illness are multi-factorial, however, adolescent AN has been consistently associated with parental distress (e.g., depression, anxiety, alcoholism), family conflict, and low parental warmth toward the adolescent. Whilst Family Based Therapy (FBT) for adolescent AN is the recommended first line of treatment, a substantial proportion of patients do not experience remission by the end of therapy or may relapse following remission. Although a range of adjuncts to FBT have been proposed, no preferred model has emerged. In this paper, we compare and contrast Attachment-Based Family Therapy (ABFT) with FBT, and argue that ABFT’s focus on relationships, rather than behaviours, could make a substantive contribution to the practice of FBT. We present a case study to demonstrate how ABFT may help to alleviate some of the maintaining factors of adolescent AN through the repair of parent–child relational ruptures. Published (Publication status)

In Australia the movement toward evidence based practice was supported by the first National Mental Health Strategy. For mental health clinicians the shift from evaluating process to outcome measurement also brought greater focus on specific disorders and targeted interventions, raising questions about the efficacy and effectiveness of treatment. The gap between research and practice is well documented, and has engendered much debate particularly in regard to empirically supported treatments (ESTs) and the technologies to widely disseminate practice whilst supporting treatment adherence. In this paper we first, describe the Attachment Based Family Therapy (ABFT) model before giving consideration to the criticisms of ESTs, and reviewing the dissemination of ABFT in Australia, and the perspectives of Australian clinicians in respect to the model and its relevance to their practice. Finally, we turn to the mission of this Special Issue which is to increase the awareness of ABFT primarily amongst practicing clinicians as we introduce the selected papers that demonstrate the application of the model to a variety of clinical presentations, and clinical settings.

Suicide is the primary cause of death in Australia for youth between the ages of 15 and 24. This is common worldwide as well. Unfortunately, very few treatments have been developed, tested, and successful for treating this difficult clinical problem. Attachment-Based Family Therapy (ABFT) is one of the therapies demonstrating a significant decrease in suicide ideation and attempts. The effectiveness of this model may rest on the fact that ABFT targets the clinical context (e.g., family, trauma, etc.) of this problem as well as intrapsychic processes. Based on attachment theory, the model aims to help adolescents recover a more secure attachment relationship with parents so that secure-based parenting can help protect the adolescent from future stress and self-harm. A case study is used to demonstrate how the model unfolds, systemically seeking to repair the attachment relationships while also keeping the adolescent safe from suicidal thoughts and behaviours.

Attachment-Based Family Therapy (ABFT) is a manualized family-based intervention designed for working with depressed adolescents, including those at risk for suicide, and their families. It is an empirically informed and supported treatment. ABFT has its theoretical underpinnings in attachment theory and clinical roots in structural family therapy and emotion focused therapies. ABFT relies on a transactional model that aims to transform the quality of adolescent-parent attachment, as a means of providing the adolescent with a more secure relationship that can support them during challenging times generally, and the crises related to suicidal thinking and behavior, specifically. This article reviews: (1) the theoretical foundations of ABFT (attachment theory, models of emotional development); (2) the ABFT clinical model, including training and supervision factors; and (3) empirical support.

Attachment-based family therapy (ABFT) is an empirically supported treatment designed to capitalize on the innate, biological desire for meaningful and secure relationships. The therapy is grounded in attachment theory and provides an interpersonal, process-oriented, trauma-focused approach to treating adolescent depression, suicidality, and trauma. Although a process-oriented therapy, ABFT offers a clear structure and road map to help therapists quickly address attachment ruptures that lie at the core of family conflict. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanism of change. This article provides an overview of the clinical model and the existing empirical support for ABFT. Published (Publication status)

The objective of this paper is to adapt attachment-based family therapy (ABFT) for use with suicidal lesbian, gay, and bisexual (LGB) adolescents and to obtain preliminary data on the feasibility and efficacy of the treatment with this population. In Phase I, a treatment development team modified ABFT to meet the unique needs of LGB suicidal youth. In Phase II, 10 suicidal LGB youth were offered 12 weeks of LGB sensitive ABFT. Adolescents' report of suicidal ideation, depressive symptoms, and maternal attachment-related anxiety and avoidance were gathered at pretreatment, 6 weeks, and 12 weeks (posttreatment). In Phase I, the treatment was adapted to: (a) include more individual time working with parents in order to process their disappointments, pain, anger, and fears related to their adolescent's minority sexual orientation; (b) address the meaning, implications, and process of acceptance; and (c) heighten parents' awareness of subtle yet potent invalidating responses to their adolescents' sexual orientation. Results of Phase II suggest this population can be recruited and successfully treated with a family based therapy, evidenced by high levels of treatment retention and significant decreases in suicidal ideation, depressive symptoms, and maternal attachment-related anxiety and avoidance. This is the first family-based treatment adapted and tested specifically for suicidal LGB adolescents. Though promising, the results are preliminary and more research on larger samples is warranted.

Introduction: Better understanding of effective parent-adolescent communication regarding tobacco use could inform smoking cessation intervention. Methods: Semistructured interviews related to communication about smoking were conducted with 15 depressed adolescent smokers and their parents, primarily from urban areas. This study, conducted in 2006-2008, was funded by the Pennsylvania Department of Health. Interview transcripts (N = 30) were coded in QSR N6. Results: Quality of communication, rather than content, seemed to determine whether parental communication was effective. Parents reactivity to, or avoidance of, adolescent smoking presented a barrier to effective communication. In this sample, parents and adolescents were more concerned about problems, such as depression, than smoking. Discussion: Involving parents in adolescent smoking cessation programs may be promising. Parental involvement may include teaching parent-child communication skills, building stronger relational bonds, or helping parents quit simultaneously. Further research is needed to explore whether coupling smoking cessation with depression treatment increases parent and adolescent treatment engagement and effectiveness. Despite decreases in rates of adolescent cigarette smoking and development of effective cessation programs (National Institute on Drug Abuse, 2003; Stanton & Smith, 2002; Sussman, Sun, & Dent, 2006), smokers are increasingly resistant to cessation efforts (Augustson & Marcus, 2004). One group particularly resistant to intervention is smokers with depression, who comprise 22%-61% of adolescent smokers (e.g., Wilhelm, Wedgwood, Niven, & Kay-Lambkin, 2006). Depression likely increases the risk of smoking initiation and is associated with both regular and heavy smoking (Duncan & Rees, 2005; Escobedo, Reddy, Giovino, 1998; Fleming, Kim, Harachi, & Catalano, 2002; Patton et al., 1998; Windle & Windle, 2001). Furthermore, depression may inhibit adolescent cessation efforts (e.g., Burgess et al., 2002; Thompson et al., 2007). Thus, depressed adolescents are at increased risk of suffering the negative health consequences of cigarette smoking. Adolescence may be an opportune time to intervene, given that smoking and depression commonly onset during adolescence (Vogel, Hurford, Smith, & Cole, 2003). Adolescence also presents a prime time to intervene because the quality of parent-adolescent relationships is known to exacerbate or buffer against adolescent risk-taking behaviors, including smoking (Ary, Duncan, Duncan, & Hops, 1999). Parents influence smoking through antismoking socialization, restrictive home smoking rules, modeling nonsmoking behaviors, monitoring of adolescents, restricting cigarette access, and positive parenting (Castrucci & Gerlach, 2006; Chassin, Presson, Todd, Rose, & Sherman,1998; Chilcoat & Anthony,1996; Griesler & Kandel,1998; Jackson & Henriksen, 1997; Kegler, Cleaver, & Yazzie-Valencia, 2000; Kegler et al., 2002; Komro, McCarty, Forster, Blaine, & Chen, 2003; Proescholdbell, Chassin, & MacKinnon, 2000). Most research focuses on how parents influence smoking initiation rather than cessation. While this can inform prevention efforts, it may be less informative for intervention development. Parent and adolescent communication about cessation is an area of particular interest for intervention researchers. For depressed teens, improved communication has been shown to influence the course of their depression, and consequently, parents have increasingly been involved in depression treatment (Restifo & Bogels, 2009; Sheeber, Hops, & Davis, 2001). Better understanding of parent-adolescent communication around smoking cessation might lead to similar intervention developments.

Objective: To apply a modern psychometric approach to validate the Behavioral Health Screen (BHS) Depression, Anxiety, and Suicidal Risk Scales among adolescents in primary care. Methods: Psychomet- ric analyses were conducted using data collected from 426 adolescents aged 12 to 21 years (mean 15.8, SD 2.2). Rasch-Masters partial credit models were fit to the data to determine whether items supported the comprehensive measurement of internalizing symptoms with minimal gaps and redundancies. Results: Scales were reduced to ensure that they measured singular dimensions of generalized anxiety, depressed affect, and suicidal risk both comprehensively and efficiently. Although gender bias was observed for some depression and anxiety items, differential item functioning did not impact overall subscale scores. Future revisions to the BHS should include additional items that assess low-level internalizing symptoms. Conclusions: The BHS is an accurate and efficient tool for identifying adolescents with internalizing symptoms in primary care settings. Access to psychometrically sound and cost-effective behavioral health screening tools is essential for meeting the increasing demands for adolescent behavioral health screening in primary/ambulatory care. (J Dev Behav Pediatr 33:283-290, 2012) Index terms: screening, depression, anxiety, suicide, adolescents.