Although adolescent attachment to both mothers and fathers should be considered conjointly to fully understand adolescents’ emotional problems, more research is needed to examine their associations. This study aimed to extend the recent study by Rivers et al.’s (2022), which conducted response surface analyses in a clinical sample of adolescents, by applying the same methodology to an Iranian sample of female adolescents. The results of Rivers et al.’s (2022) study demonstrated that for attachment anxiety, attachment to the mother is a stronger predictor of depressive symptoms than attachment to the father. For attachment avoidance, they found that attachment toward mothers and fathers more equally explained and interacted in the explanation of depressive symptoms. The current study further extended that prior study by conducting similar analyses in a community sample and within a different cultural context (Iran). Analyses were conducted on a sample of 586 female adolescents aged between 15 and 18 years (M = 16.35, SD = 0.77). The findings of the current study closely align with those of Rivers et al. (2022), indicating that, regarding anxious attachment, the association between adolescents’ depressive symptoms and attachment anxiety toward mothers was weaker when attachment anxiety toward fathers was high (and vice versa). For avoidant attachment, the association between adolescents’ depressive symptoms and attachment avoidance toward fathers was weaker when attachment avoidance toward mothers was high (and vice versa). These patterns of results appear comparable across at least two different cultures, suggesting potential cross-cultural similarities, though further research with more diverse samples is needed.

While much research exists on alignment between parent–child reporting on adolescent mental health symptoms, little exists on parent–child agreement in perceptions of general functioning, or the day-to-day ability to engage in adaptive activities, which may be a better measure for treatment progression and outcomes. Understanding these agreements or disagreements also has implications for assessment and treatment planning, especially in intensive settings like psychiatric residential care. We sought to explore parent–child agreement across six functional domains – family engagement, familial trust, school engagement, prosocial friendships, emotional regulation and future goals – using the Newport Functional Assessment in a sample of youth (N = 321) admitted to psychiatric residential care. Both mothers and fathers consistently perceived lower adolescent functioning in every domain. There were some differences in disagreement based on adolescent age and gender. Interestingly, for some domains, higher parent–child disagreement was present for adolescents with lower insecure attachment to the target parent. Patients who felt they did not need to be in treatment disagreed more with mothers, but not fathers. Limitations and clinical implications are discussed. These findings underscore the importance of including both adolescent and parent perspectives of general functioning and how attachment dynamics and readiness for treatment may influence how adolescents assess their own functioning relative to their caregivers’ views.

Attachment-based family therapy (ABFT) is an evidence-based systemic treatment for adolescent depression and suicidality. The first session focuses on shifting therapy goals from behavior management to relational repair. This study explores whether making this shift is associated with adolescent treatment outcomes. First-session recordings from an ABFT randomized controlled trial were coded for shifts in content (from an individual to a relational understanding of symptoms) and affect (from defensive to vulnerable emotions or hopefulness). Greater maternal responsivity to the relational reframe and stronger maternal acceptance of the relational contract were associated with greater reductions in adolescents' depressive symptoms. In contrast, adolescent scores on these measures were not associated with depressive symptom change, and although suicidal ideation decreased in the overall study, neither adolescent nor maternal scores on these measures predicted changes in suicidal ideation. Findings suggest that early maternal engagement with the relational focus of ABFT may be an indicator of subsequent improvement in adolescent depression.

In attachment-based family therapy (ABFT), shifting the treatment goal from the adolescent as the problem to strengthening family relationships as the solution is the critical first task. No research has explored whether this "relational reframe" works, how it works, and for whom it works. We evaluated the relational reframe for 47 families receiving ABFT for depressed and suicidal adolescents. We coded markers to identify the reframing and contracting phases of the reframe intervention. We coded two key process elements: content and affect. We evaluated whether the degree to which family members discussed the themes of the reframe phase (relational ruptures and softer emotions) were associated with acceptance of the contracting goal. We explored if attachment style and self-reported parental depression and adolescent-reported family conflict were associated with accepting the contract for a relational focused therapy. Markers for the beginning of the reframe and contracting phase could be reliably identified. The degree to which adolescents and parents engaged in discussion about the reframe themes was associated with parents' acceptance of the contracting goal. Adolescents' dismissive attachment style was not associated with engagement in the reframe themes, but was associated with adolescents' reduced acceptance of the contract goal. Adolescents' preoccupied attachment style was associated with greater engagement in the reframing themes, but not associated with acceptance of the contract goals. Parental depression and adolescent- reported family conflict were not linked with acceptance of the relational reframe. This study should help therapist understand specific strategies for creating a relational repair frame for therapy and encourage researchers to study the subtle processes involved in effective therapy.

Assessment of general functioning provides a full picture of youth mental health, but little work has been done on assessing functioning within the high-risk population of adolescents in residential treatment. A new composite measure was created based on key domains identified from expert interviews and literature review and was tested in a sample of 626 adolescents in residential care. Results indicated that the causal indicator model supported the proposed measure. Individual items showed unique patterns of association with specific types of functioning (i.e. school, family). A composite score was calculated from the individual items and was associated with well-being, depression and anxiety. Differences based on sexual orientation were found. Limitations and clinical and research implications are discussed.

De hechtingstheorie en de emotiewetenschap vormen een sterke basis voor interventies op gezinstherapeutisch niveau. De vier therapievormen Hechtingsgerichte Gezinstherapie, Emotiegerichte Gezinstherapie, Dyadische Ontwikkelingspsychotherapie en Emotioneel Gerichte Gezinstherapie illustreren hoe een brede én precieze benadering van hechtingsrelaties en emoties, toegepast binnen een relationeel en empathisch kader, kan leiden tot effectieve interventies voor uiteenlopende problemen. Dit artikel is een voortzetting van een gesprek dat startte tijdens de Conferentie voor Hechting en Emotie in Gezinstherapie in 2021, met als doel openheid, samenwerking en bevestiging te bevorderen tussen vier verschillende gezinstherapeutische modellen met een gedeelde theoretische basis. De sprekers van de Conferentie en de auteurs van dit artikel zien de overeenkomsten tussen deze modellen als een bekrachtiging- en de verschillen als een kans om meer gezinnen op een passende te helpen, waarbij de betrokkenen kunnen leren van elkaars creativiteit, zodat gezinnen ook in de toekomst effectiever geholpen kunnen worden. In dit artikel wordt uiteengezet wat het belang is van de hechtingstheorie en de emotiewetenschap voor de gezinstherapie. Daarnaast maken de auteurs hierin duidelijk hoe belangrijk het is om te leren van verschillende modellen met een gedeelde theoretische basis. Vervolgens geven zij een beknopt overzicht van de vier therapiemodellen die tijdens de Conferentie zijn gepresenteerd en vergelijken zij de overeenkomsten en complementaire verschillen tussen deze modellen. Tot slot vertellen de sprekers van de Conferentie over hun beste ervaringen.

Hoewel de structureel-strategische gezinstherapie (FT) een evidence-based benadering is voor gedragsproblemen bij adolescenten, worden geprotocolleerde modellen voor gezinstherapie niet overal in de praktijk toegepast vanwege de trainings- en implementatiehulpmiddelen die daarvoor vereist zijn. In dit artikel wordt een competentieraamwerk gepresenteerd dat bedoeld is om gezinssamenwerking bij adolescentcasussen te bevorderen. Als eerste wordt besproken welke uitdagingen gepaard gaan met de invoering van FT in de standaardhulpverlening en wordt de kernelementen-strategie gepresenteerd. Vervolgens worden drie ‘vertakkingen’ geïntroduceerd die samen een continuüm van gezinsbetrokkenheid vormen – gezinssamenwerking, vaardigheidstraining bij het gezin en systemische gezinstherapie – waarbij de rationale en procedures voor het toepassen van de competentierichtlijnen voor gezinssamenwerking specifiek worden beschreven. Daarna worden de basistechnieken en de competentierichtlijnen voor zes kernelementen van gezinssamenwerking besproken: Outreachend werken met gezinssystemen, Ecosysteem van de adolescent, Locatie van het zelf, Doelen stellen, Gezinsparticipatie, Consultatie van de verzorger en Management van de gezinssessie. Het artikel wordt afgesloten met een bespreking van toekomstige richtingen voor dit raamwerk en de ontwikkeling van aanvullende competenties voor de andere vertakkingen. Hoewel er verder onderzoek nodig is om de werkzaamheid van de behandelvertakkingen en de bijbehorende competentiestandaarden te testen, biedt dit artikel een vernieuwende aanpak voor het betrekken van gezinsleden bij de hulpverlening, met toegankelijke competentierichtlijnen.

Obsessive-compulsive disorder (OCD) is a debilitating, often chronic condition with symptoms that are time-consuming and can cause distress or impairment. OCD can involve and have a significant impact on families. Although calls for family-inclusive treatment for OCD exist, results on its effectiveness are mixed. This case report presents Jane, a young adult with OCD in psychiatric residential treatment, and how her symptoms were profoundly affected and maintained in part by maladaptive family processes. Attachment-based family therapy is used in conjunction with exposure and response prevention to reduce Jane's symptoms, minimize family accommodations, address underlying family processes, and improve family dynamics. Treatment outcomes were assessed through standardized tools, clinician observations, and patient self-reports. By the conclusion of treatment, Jane saw reductions in OCD, anxiety, and depressive symptoms, an increase in well-being, and improved family communication. Implications and recommendations will be discussed.

Depression is a highly prevalent and consequential mental health disorder that affects hundreds of millions of people worldwide. Unfortunately, rates of depression among youth ages 12 to 17 have continued to increase, especially when compared to older age groups. For some youth seeking treatment, a 24-hour, intensive, and multimodal treatment experience, such as those found in residential treatment centers, may be beneficial. However, limited studies have investigated changes in depressive symptoms in patients admitted into these programs. Therefore, the present study aimed to investigate change in depressive symptoms over time, as well as explore potential baseline characteristics that may be associated with intake depressive symptoms and changes in depressive symptoms throughout adolescent residential treatment. All patients (N = 3,562) were admitted between January 2020 and January 2023 and were given a battery of assessments at intake and every two weeks until discharge. This assessment asked about demographics, depressive and anxiety symptoms, and suicidal thoughts and behaviors. Results from the growth curve model indicated that depressive symptoms decreased over the course of treatment. Specifically, scores decreased faster at the beginning, and slower as time in treatment progressed. Additionally, there were sociodemographic and psychological comorbid predictors of intake depressive symptoms and change over time, including differences by age, race, length of stay, gender, anxiety symptoms at intake, and suicidal thoughts and behaviors. Our findings highlighted that adolescent residential treatment can produce decreases in depressive symptoms over time, even among a high-risk population, and that demographic and co-occurring psychological problems may be influential.

OBJECTIVE:Self-harm is common in adolescents and a major public health concern. Evidence for effective interventions that stop repetition is lacking. This individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs) aimed to provide robust estimates of therapeutic intervention effects and explore which treatments are best suited to different subgroups. METHOD:Databases and trial registers to January 2022 were searched. RCTs compared therapeutic intervention to control, targeted adolescents ages 11 to 18 with a history of self-harm and receiving clinical care, and reported on outcomes related to self-harm or suicide attempt. Primary outcome was repetition of self-harm 12 months after randomization. Two-stage random-effects IPD meta-analyses were conducted overall and by intervention. Secondary analyses incorporated aggregate data from RCTs without IPD. RESULTS:The search identified 39 eligible studies; 26 provided IPD (3,448 participants), and 7 provided aggregate data (698 participants). There was no evidence that interventions were more or less effective than controls at preventing repeat self-harm by 12 months in IPD (odds ratio 1.06 [95% CI 0.86, 1.31], 20 studies, 2,949 participants) or IPD and aggregate data (odds ratio 1.02 [95% CI 0.82, 1.27], 22 studies, 3,117 participants) meta-analyses and no evidence of heterogeneity of treatment effects on study and treatment factors. Across all interventions, participants with multiple prior self-harm episodes showed evidence of improved treatment effect on self-harm repetition 6 to 12 months after randomization (odds ratio 0.33 [95% CI 0.12, 0.94], 9 studies, 1,771 participants). CONCLUSION:This large-scale meta-analysis of RCTs provided no evidence that therapeutic intervention was more, or less, effective than control for reducing repeat self-harm. Evidence indicating more effective interventions in youth with 2 or more self-harm incidents was observed. Funders and researchers need to agree on a core set of outcome measures to include in subsequent studies. PLAIN LANGUAGE SUMMARY:Self-harm is common in adolescents and linked to higher risks of repeated self-harm and suicide. This meta-analysis of 33 randomized controlled trials involving 4,146 adolescents found that therapeutic interventions were no more effective than standard care at preventing repeat self-harm at 12 months. However, interventions were more effective in youth with 2 or more self-harm incidents. The authors discuss limitations posed by the lack of uniform outcome measures for self-harm. CLINICAL GUIDANCE:STUDY PREREGISTRATION INFORMATION: Reducing Self-harm in Adolescents: An Individual Participant Data Meta-analysis; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=152119.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth who experience family rejection are at increased risk for depression and suicide. Attachment-Based Family Therapy (ABFT) demonstrates promising results for reducing this risk with LGBTQ youth. This community-participatory, mixed-method study piloted the use of ABFT with LGBTQ youth. Fourteen families completed treatment with adolescent youth, pre- and post-individual and family interviews, and a measure of youth mental health. Post-therapy, 80% of youth showed a significant reduction in psychological distress. The qualitative thematic analysis constructed four themes describing how families present to therapy with emotional distress, caregiver support needed during ABFT, how caregivers acquired new listening and communication skills, and LGBTQ youth experiences of finding freedom to explore and talk about sexual and gender identities. Implications from the study suggest the need to challenge heteronormative emotional structures of families for increasing emotional support of fathers with their LGBTQ children.

Youth with severe mental and behavioral health symptoms often require high levels of care, such as residential placement. Given the acuity of the residential population, the high cost of services, and the separation of children from their families, remarkably little research exists on engagement, mechanisms, and outcomes. Treatment satisfaction is a critical process and outcome indicator but is not always assessed in residential care. When satisfaction is assessed, the quality of the assessment tools varies and is rarely assessed as part of treatment progress, so little is known about how and if it might change during treatment. This study aimed to examine the psychometric properties of the newly developed Client Satisfaction Scale (CSS) for youth in residential psychiatric care. The CSS was administered to all patients in the current study (N = 2,933, Mage = 15.36, SD = 1.35). Results of exploratory and confirmatory factor and item response theory analysis support evidence of structural validity, and bivariate correlation and regression supported evidence of concurrent and predictive validity, respectively. Findings suggested the CSS scale may be a viable tool for assessing youth satisfaction with treatment outcome and services at residential treatment centers.

There are many factors to consider when treating adolescents with psychiatric challenges, including whether they are willing and interested in participating in treatment. This study aimed to explore how treatment readiness impacts treatment experience for adolescents in psychiatric residential care who came into treatment with moderate to severe depression. All participants (N = 1,624; Mage = 15.58, SD = 1.46) were admitted to a large, multi-state psychiatric residential system between January 2020 and March 2022. Patients were 95.6

Every year, numerous youths seeking mental health services are placed in psychiatric residential treatment programs, often leaving their families for extended periods of time. The clinical and policy community has become increasingly interested in incorporating families into the treatment process, which may have a positive impact on care. Despite this interest, limited work has reviewed the impact of family factors across the entire treatment process (before admission, during treatment, and after discharge), or on barriers to implementing family-centered care practices to improve family engagement. To better understand the research in this domain, we conducted a narrative review on family involvement in residential care throughout the treatment process, with special attention paid to barriers and possible solutions. In general, family involvement in residential care remains underdeveloped and understudied. Given the youth mental health crisis, and the higher acuity of youth patients in residential treatment, greater exploration into how families can potentiate outcomes is warranted.

Eetstoornissen in het eetbuispectrum (boulimia nervosa, eetbuistoornis) ontstaan vaak tijdens de adolescentie en deze gaan gepaard met ernstige psychische en lichamelijke gevolgen. De huidige behandelingen voor adolescenten zijn sterk gedragstherapeutisch georiënteerd, en hoewel deze behandelingen werkzaam zijn, herstellen veel patiënten niet volledig van hun eetstoornis, een aanwijzing dat een belangrijke instandhoudende factor met deze therapieën niet wordt aangepakt. Een potentiële instandhoudende factor is een slecht gezinsfunctioneren. Met name hoge mates van conflicten in het gezin (bijv. ruzies, kritische opmerkingen) en een lage gezinscohesie (bijv. warmte en steun) staan bekend als factoren die eetstoornisgedragingen in stand houden. Een slecht gezinsfunctioneren kan (1) het gebruik van eetstoornisgedragingen als methode van coping met stress veroorzaken of verergeren en/of (2) ouders belemmeren om tijdens de behandeling van de eetstoornis een bron van steun te zijn voor hun adolescent. ‘Attachment-Based Family Therapy’ (ABFT; gezinstherapie met gehechtheidsrelaties als uitgangspunt, red.) is specifiek ontwikkeld voor het verbeteren van het gezinsfunctioneren en kan daarom een waardevolle aanvulling zijn op gedragstherapeutische interventiestrategieën voor eetstoornissen. ABFT is echter nog niet onderzocht bij adolescenten met een eetstoornis in het eetbuispectrum. Het hier beschreven onderzoek is dus de eerste studie waarin een 16 weken durende aangepaste ABFT-behandeling voor adolescenten met eetstoornissen wordt geëvalueerd (N = 8, Mleeftijd = 16,00, 71,43

Attachment theory and the science of emotion provide a strong foundation for intervention at the family system level. Four therapeutic models in particular, Attachment-Based Family Therapy, Emotion-Focused Family Therapy, Dyadic Developmental Psychotherapy, and Emotionally Focused Family Therapy, demonstrate how a broad and accurate view of attachment relationships and emotion can be utilized to effectively intervene for a variety of presenting problems in a relational and empathic way for all involved. This paper continues a conversation that began at the Summit for Attachment and Emotion in Family Therapy in 2021 and aims to foster openness, collaboration, and affirmation between four different models of family therapy with shared theoretical roots. The presenters at the Summit and the authors of this paper view similarities across these models as validating and differences as opportunities to serve more families in unique ways, learning from one another's creativity to promote healing within families in the most effective and efficient ways possible. The paper frames the value of attachment theory and emotion science for family therapy, discusses the importance of learning from a variety of models with shared theoretical roots, presents brief summaries of the four models presented at the Summit, compares the models for similarities and complementarities, and shares highlights from each of the presenters from the Summit.

The psychotherapy field has a long history of integration to improve treatment effectiveness. One type, assimilative integration, offers innovative opportunities to family therapy to incorporate the clinical and research contributions of different approaches. This paper contributes to the literature on integration by exploring how Eye Movement Desensitization and Reprocessing (EMDR) can be assimilated into Attachment-Based Family Therapy (ABFT) for youth in residential psychiatric treatment. ABFT seeks to improve attachment security to parental figures by asking adolescents and young adults to discuss attachment ruptures. This process, specially designed for patients with internalizing disorders, can provoke anxiety, particularly for a patient population that commonly has a history of trauma and adverse life experiences. EMDR is a first-line therapy for post-traumatic stress disorder and has the potential to be effective in treating various other mental health conditions. When patient emotional withdrawal or dysregulation due to breaches in trust between child and parent emerges in ABFT, EMDR may help desensitize associated memories and bolster the family therapy process. The authors provide an overview of both models, and a detailed case study as an example. The paper concludes with a discussion on implications, integration efforts, and limitations.