Attachment-based family therapy

Domain V · Systemic, relational, group & community · Guy S. Diamond, Gary M. Diamond, Suzanne A. Levy · 2014

What it is

ABFT is a manualised, brief, trauma-informed, emotion-focused family therapy for adolescents and young adults (roughly 12–25; trainers use it from about 8 to 25+) with depression, suicidal ideation or behaviour, anxiety or family conflict, delivered to the young person plus at least one caregiver.…

Format

• The model is organised as five sequential treatment tasks rather than fixed sessions; the authors describe it as a "clear road map" that is structured but flexible.
• Format. Weekly sessions of 60–90 minutes, typically 12–16 weeks (can extend to 6–12 months); twice weekly may be needed in Tasks 2–3 (and, in suicidal cases, early on). Therapist meets the family together and the youth and caregivers separately. No homework. Settings: outpatient, home-based,…

Who practises it, and how they are trained or regulated

• Session counts differ by source (version followed: CEBC/ABFT Training Program figures; others in brackets).
• Notes on versions: one 2023 Training Program deck labels the later phase as building the family's suicide safety net (sharing the suicide narrative with caregivers, daily caregiver check-ins) while elsewhere naming Task V as promoting autonomy; this guide treats the safety-net work as part of safety planning and Task 5. The 2014 manual's chapter titles are Task I Relational reframe, Task II Adolescent alliance, Task…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Escalation: interrupt and coach. Working: the pair sustain the exchange.
• Monosyllabic, guarded youth: stay with interests longer. Working: the youth starts volunteering material.
• Check-ins turning into surveillance or conflict. Working: the youth reports distress early to a caregiver.
• Emotional flooding; therapist rushing to soothe. Working: the speaker names a specific feeling and need, and voice and pace change.
• Defensiveness about blame; caregiver depression needing its own referral. Working: the parent talks about themselves, not only the child.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.