Anatomy of the Relational Reframe in Attachment-Based Family Therapy.

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.