Treatment Modalities

Attachment Based Family Therapy

Consists of secure, anxious, avoidant, and disorganized attachment

Secure Attachment

• is a basic trust in the availability of help and emotional support from the people in one’s social network

• characteristics

  • Emotional flexibility

  • Ability to self-reflect and to see relationship conflicts from multiple perspectives

  • Valuing relationships

  • Capacity to be trusting and vulnerable

  • Ability to express emotional needs and confront conflict in a coherent and direct manner

  • Freedom to express a full range of emotions with the ability to return to equilibrium on receiving comfort and care

  • Perception by others as being emotionally vital (i.e., fresh, engaged/engaging, energetic, spontaneous, and relatable)

Anxious Attachment

• desperately want to participate in the social world yet consistently find themselves in drama, chaotic situations, and overall uneasiness

• characteristics

  • Heightened emotions around relationships and a high level of emotional sensitivity (especially around abandonment and past disappointments)

  • Difficulty returning to emotional baseline after conflict

  • Marked anger or indications of vigilance against anger (e.g., extremely meek, indirect, highly anxious and inarticulate when confronted)

  • History of volatile relationships

  • Perception by others as emotionally “hot” or “overheated”

Avoidant Attachment

• see social participation as pointless and foolhardy. They resign themselves to living at the margins of society. People with avoidant attachment gravitate towards people and situations they can control.

• characteristics

  • Sees self as a lone wolf and lacks a collaborative mentality with others

  • Devalues relationships and minimizes own dependency needs

  • Expresses very few emotions

  • Exhibits limited awareness of feelings and poor ability to elaborate and reflect on negative emotional states

  • Sees others as soft or weak

  • Perceived by others as emotionally “cold” (especially in the sense of being withdrawn and rigid)

Disorganized Attachment

• is the most extreme form of insecure attachment. This level of attachment is frequently born from disruptive childhood experiences, like abuse, neglect, and other traumas.

• characteristics

  • A strong need to fit in

  • A strong need to survive

  • A fear of the primary caregiver and limited trust in relationships

  • A fear of rejection

  • Negative emotions like shame, anxiety, confusion, and doubt

ABFT Core Principles

• Attachment-first approach

  • Therapy begins by identifying and addressing attachment ruptures (e.g., abuse, high conflict, low warmth) that prevent adolescents from seeking help when distressed

• Trust based, emotion focused

  • Builds a safe therapeutic environment where adolescents feel safe to express emotions and seek support

• Trauma Informed

  • Recognizes the impact of trauma on attachment and emotional regulation

• Flexible but structured

  • Balances adaptability to family dynamics with a clear therapeutic roadmap

ABFT Treatment Tasks

• Identify and discuss attachment ruptures in the family

• Repair interpersonal ruptures to restore trust and emotional safety

• Improve emotional regulation in adolescents and caregivers

• Enhance problem-solving skills for family interactions

• Foster a secure base attachment where adolescents feel supported and valued

ABFT Clinical Process

• Phase 1: Assess attachment history and current relational patterns

• Phase 2: Repair ruptures through targeted interventions (e.g., reconnection, emotional validation)

• Phase 3: Integrate new coping skills and parenting practices into daily life

• Phase 4: Sustain secure attachment and prevent relapse

Narrative Therapy

• An individual with a problem is not a problematic individual, meaning that we are not defined by our mistakes, issues, or challenges—every client is worthy of respect and dignity.

• The client is the expert in their own life, and the therapist is an ally in the process of reshaping perspectives and behaviors.

• Having a clear narrative helps us to organize and understand our reality, making sense of our experiences

• There is no “right” direction a narrative can take, and curiosity and a willingness to explore unknowns are essential to narrative therapy.

• By helping clients develop their own narrative or story, therapists can help them to find new meanings in their experiences and “re-author” their perspective.

Developing a story (Narrative Therapy)

• By directing a conversation and asking questions, a therapist can help a client establish or re-establish their identity and see experiences from different perspectives

• Also called “re-authoring” or “re-storying”, this approach can help clients see parts of their story from new angles, find new meaning, and reach conclusions that better fit their sense of self.

Externalization (Narrative Therapy)

This technique is grounded in the idea that it is easier to make changes to your behaviors or attitudes than it is to change core parts of your personality. Therefore, clients are encouraged to view their problem as external to themselves, even characterizing it as a separate thing or person.

Deconstruction (Narrative Therapy)

Refers to the breaking down of a scenario into the specific problems a client is experiencing, enabling them to see the “big picture” more clearly. In doing so, solutions can become more clearly available to the client.

Identifying Unique Outcomes (Narrative Therapy)

To explore unique outcomes, clients are encouraged to entertain new possibilities for the storyline they build about their own life. As they rework their narrative, clients may identify outcomes not originally predicted by their dominant storyline and that may vary from their typical self-perception.

Existentialism (Narrative Therapy)

Therapy is all about developing your own story with meaning and purpose, rather than seeking absolute truth, existentialist concepts are well-aligned with the approach.

Narrative Exercises

Journaling

Art

Visualization

Puppets

Tree of Life

Solution Focused Brief Therapy (SFBT)

• If it’s not broken don’t fix it

• If it doesn’t work, don’t do it again, do something different

• Once you know what works, do more of it

• Shifting from Problem-Talk to Solution-Talk

• Utilization of Miracle questions, exception questions, and scaling questions

Multisystemic Family Therapy

• Focus on Strengths and Resources

• Target Specific Risk Factors

• Behavior Change in Natural Environments

• Parental Empowerment

• Flexible and Adaptive Approach

Focus on Strengths and Resources

Therapists identify and mobilize the family’s existing strengths and community resources, such as schools, social services, and religious organizations

Target Specific Risk Factors

Interventions are tailored to address the factors maintaining problematic behaviors, including family conflict, peer influence, academic difficulties, and substance use

Behavior Change in Natural Environments

MST emphasizes applying interventions in the settings where behaviors occur, such as home, school, and community

Parental Empowerment

Caregivers are trained to improve parenting practices, discipline strategies, and family interactions, enhancing their ability to manage, current and future behavioral issues

Flexible and Adaptive Approach

Treatment plans are continuously monitored and adjusted based on the adolescent’s progress and changing needs

Bowen Family Systems Theory

• Relationship in families between the overall level of anxiety and the level of differentiation

• Work with family members to explore patterns that have happened in past generations and that are displaying themselves in the present

• Therapist acts as a coach to help family gain insight

Differentiation of Self (Bowen)

tendency of a person to grow and be an emotionally separate person

Triangles

how people are connected to multiple individuals

Nuclear Family Emotional System

how 2 generations come together and impact one another

Family Projection Process

how parents transmit their level of differentiation onto 1 or more children

Multigenerational Transmission Process

functioning of people is tied to functioning of ancestors

Emotional Cutoff

one person distancing themselves from family

Sibling Position

functional position within the family (tied to birth order, but not always)

Societal Emotional Process

everything that has been presented happens in systems outside the family

Tree of Life (Narrative Therapy)

• Roots - Where do you and your family come from? Has your perception of your roots changed over time? Does your past influence your current identity?

• Ground - What is your present life like? Is the “ground” fairly stable or more dynamic? What impacts you on a daily basis?

• Trunk - What talents, abilities, and coping skills do you have? How do you feel others perceive your skills? What strengths do you value in others?

• Branches - What hopes and personal goals are prominent in your life? What needs to happen in order to achieve them? Do they feel attainable?

• Leaves - Who are the most important people in your life? How have they influenced your life, and how do you think you’ve influenced theirs? Where do you see your relationship going in the future?

• Fruit - What kinds of gifts or lessons have important people bestowed upon you? How have they helped you? What have you given them in return?

• Storms - What challenges have you experienced in the past, and how are you managing current “storms?” What storms could you see in the future?

Cognitive Behavior Therapy

EBP that focuses on changing emotions, thought patterns, and behavioral patterns.

• Assessment & Engagement

• Formulation

• Active Intervention

• Maintenance and Relapse Prevention

• Termination and Evaluation

Dialectical Behavior Therapy

a type of CBT that focuses on the psychosocial aspects of therapy, emphasizing the importance of a collaborative relationship, support for the client, and the development of skills for dealing with highly emotional situations

Emotional Regulation Model (DBT)

• Many clients who participate in DBT are struggling with personality or mood disorders and can benefit immensely from emotion regulation skills.

• Some of these skills that can help clients deal with their emotions include:

  • Identifying and labeling emotions;

  • Identifying obstacles to changing emotions;

  • Reducing vulnerability to “emotion mind;”

  • Increasing positive emotional events;

  • Increasing mindfulness to current emotions;

  • Taking the opposite action;

  • Applying distress tolerance techniques

Interpersonal Effectiveness Module (DBT)

• The skills in this module are related to interacting with others, especially in difficult or potentially damaging situations

• These skills are intended to help clients function effectively when trying to change something (e.g., making a request) or in trying to resist changes (e.g., refusing a request). The intention is to aid the client in meeting their goals in each situation while avoiding any damage to the relationship or to the client’s self-respect

Objectiveness Effectiveness “DEAR MAN” Skills (Interpersonal Skills DBT)

Describe

Express

Assert

Reinforce

Mindful

Appear confident

Negotiate

Relationship Effectiveness “GIVE” Skills (Interpersonal Skills DBT)

Gentile

Interested

Validate

Easy Manner

Self-Respect Effectiveness “FAST” Skills (Interpersonal Skills DBT)

Fair

Apologies / no apologies

Stick to value

Truthful

Distress Tolerance Module (DBT)

• This module includes skills that are extremely important yet often overlooked: skills relating to accepting, tolerating, and learning from suffering.

• Many other mental health treatment regimens focus on avoiding pain, changing difficult situations, or walking away from circumstances that cause suffering, but the distress tolerance skills taught through Dialectical Behavior Therapy focus on dealing with the pain and suffering that is inevitable to the human condition.

Four survival strategies (Distress Tolerance of DBT)

• Distracting;

• Self-soothing;

• Improving the moment;

• Thinking of pros and cons.

Improve the Moment “IMPROVE” Skills (DBT Distress Tolerance)

Imagery

Meaning

Prayer

Relaxation

One thing at a time

Vacation

Encouragement

Crisis Survival “ACCEPTS” Skills (DBT Distress Tolerance)

Activities

Contributing

Comparisons

Emotions

Pushing away

Thoughts

Sensation

Self-Soothing Skills (DBT Distress Tolerance)

Taste

Smell

See

Hear

Touch

Mindfullness Module (DBT)

• These skills include “what” skills or skills that answer the question “What do I do to practice core mindfulness skills?” like observing, describing, and participating. There are also “how” skills or skills that answer the question “How do I practice core mindfulness skills?”, like non-judgment and practicing “One-mindfully” effectively.

• Many of these mindfulness skills feed into skills from the other modules; for example, the nonjudgment encouraged in mindfulness is also encouraged in distress tolerance, and the observing and describing skills can be helpful in identifying and labeling emotions.

Distress Tolerance Skills

Pros and Cons / Accepting Reality Skills

• Willingness

• Turning your mind

• Radical acceptance

Emotional Regulation Skills

Reducing Vulnerability Skills

• Treat physical illness

• Eating

• Altering drugs (only those prescribed by a doctor)

• Sleep

• Exercise

Build Mastery Skills

• Build positive experiences

• Be mindful of current emotion

• Opposite to emotion action

Mindfulness Skills

“What” skills

• Observe

• Describe

• Participate

“How” skills

• Non-judgmentally

• One-mindfully

• Effectively