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Kula O, Machluf R, Shahar B, Greenberg LS, Bar-Kalifa E. The effect of therapists' enactment interventions in promoting vulnerability sharing in emotion focused couple therapy. Psychother Res 2024; 34:748-759. [PMID: 37611202 DOI: 10.1080/10503307.2023.2245961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/18/2023] [Accepted: 07/29/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE The primary purported change process in emotion-focused therapy for couples (EFT-C) involves partners accessing and revealing their underlying vulnerable emotions and responding empathically when their partners disclose their vulnerable emotions. One main intervention to facilitate vulnerability sharing is enactment - guiding partners to interact directly with each other. The objective of the current study was to identify interventions therapists can use to help partners share vulnerability in the context of enactment. The primary hypothesis of this study was that promoting these interventions would lead to more vulnerability expressions during enactments. METHOD One hundred and five vulnerability enactment events were identified from videod therapy sessions of 33 couples dealing with a significant emotional injury who received 12 sessions of EFT-C. Four therapists' interventions were coded: setting a meaningful systemic context, promoting the revealing partner's emotional engagement, preparing the revealing partner for enactment, and promoting the listening partner's emotional engagement in the enactment. In addition, vulnerability expression was coded. RESULTS Multilevel regression models showed that two interventions were significantly associated with greater levels of expressed vulnerability: setting a meaningful systemic context, and preparing the revealing partner for enactment. CONCLUSION These findings suggest that therapists can facilitated vulnerability sharing using specific preparatory interventions.
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Affiliation(s)
- Ofra Kula
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reut Machluf
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ben Shahar
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Eran Bar-Kalifa
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Stern RS, King AA, Diamond G. Repairing attachment in families with depressed adolescents: A task analysis. J Clin Psychol 2023; 79:201-209. [PMID: 35751901 DOI: 10.1002/jclp.23399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/25/2022] [Accepted: 05/28/2022] [Indexed: 12/14/2022]
Abstract
AIMS This exploratory pilot study (N = 3 sessions, 793 speech units) used task analysis to refine an early model of the attachment task in attachment-based family therapy (ABFT). The attachment task aims to repair long-standing parent-adolescent relational ruptures that inhibit parents from being a resource for adolescents recovering from depression and/or suicidality. METHODS Video recordings of three attachment task sessions with strong adherence to the model were selected for intensive study. Two sessions were rated as successful (i.e., attachment was repaired) and one as unsuccessful (i.e., attachment repair did not occur). Sessions were then coded using Structural Analysis of Social Behavior (SASB). RESULTS The current SASB analysis provided empirical support for our previous clinical impression that the task involves three parts: (I) adolescent disclosure of attachment rupture, (II) parent disclosure, and (III) a more mutual conversation. SASB also provided insights into more subtle elements of the model. CONCLUSION Successful attachment sessions were associated with high parent affiliation and autonomy-both while affirming the adolescent's story and when disclosing their own experience. Unsuccessful task attempts were associated with parental enmeshment and hostile belittling, blaming, and distancing. An enhanced model of ideal parent behaviors during the attachment task is offered, including space for parent disclosure-perhaps even apology-that is both warm and independent, leading to a more mutual parent-adolescent conversation. Clinically, the findings support the importance of the therapist focusing on the process and quality of parent-child interactions to facilitate attachment repair.
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Affiliation(s)
- Richard S Stern
- Center for Family Intervention Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ashley A King
- Center for Family Intervention Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Guy Diamond
- Center for Family Intervention Science, Drexel University, Philadelphia, Pennsylvania, USA
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Strifler Y, Zisenwine T, Diamond GM. Parents' reflective functioning and their agreement on treatment goals in attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:982-997. [PMID: 35018657 DOI: 10.1111/jmft.12581] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/22/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
This study examined the trajectories of parents' reflective functioning over the course of individual preparatory sessions with the therapist in attachment-based family therapy (ABFT) for Israeli sexual minority young adults and their nonaccepting parents, and whether such reflective functioning was associated with parents' agreement on the goals for subsequent conjoint corrective attachment sessions. Three parents with good agreement on treatment goals were compared to three parents with poor agreement on treatment goals. Parents' in-session reflectivity regarding their child's experience of nonacceptance, and regarding the quality of their relationship with their child, was observationally measured at the session level. Reflective functioning increased over time among those parents who reported good agreement with the treatment goals. There were no changes in parents' reflective functioning in the poor agreement group. Findings suggest the potential importance of facilitating parents' reflective functioning in ABFT, before conducting conjoint corrective attachment sessions. Research and clinical implications are discussed.
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Affiliation(s)
- Yotam Strifler
- Department of Psychology, Ben-Gurion University, Beer-Sheva, Israel
| | - Tamar Zisenwine
- Department of Psychology, Ben-Gurion University, Beer-Sheva, Israel
| | - Gary M Diamond
- Department of Psychology, Ben-Gurion University, Beer-Sheva, Israel
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Young G. Psychotherapeutic Change Mechanisms and Causal Psychotherapy: Applications to Child Abuse and Trauma. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:911-923. [PMID: 35958715 PMCID: PMC9360301 DOI: 10.1007/s40653-022-00438-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 05/07/2023]
Abstract
The study of change mechanisms in psychotherapy needs to be integrated with the causality of behavior, which leads to the concept of causal psychotherapy. Causal psychotherapy is posited as a useful adjunct to standard, evidence based psychotherapies for child and youth victims of abuse and trauma. The article illustrates six processes that could be involved in causal psychotherapy in this context, from the distal to the proximal. They include the distal mechanism of activation-inhibition coordination. The most proximal one relates to executive function. The intermediate levels include ones related to co-regulation (e.g., self control), analysis-synthesis, objectivity-subjectivity, and psychological reserve, which is a new concept in the domain of psychological change mechanisms. Each of the variables can vary from high to low, with the low end being more problematic. Psychotherapy can aim to bring the patient toward adaptive levels. The literature review focuses on psychotherapeutic change mechanisms, and standard psychotherapies for child/youth abuse/trauma, especially trauma-focused cognitive behavior therapy (TF-CBT). Then, it considers causal aspects of child/youth abuse and trauma, including PTSD. The discussion relates causal therapy to the question of unifying psychology and psychotherapy under the rubric of causality as a core integrative mechanism.
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Affiliation(s)
- Gerald Young
- Glendon College, York University, Toronto, Canada
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Hunt QA, Krauthamer Ewing ES, Weiler LM, Ogbaselase FA, Mendenhall T, McGuire JK, Monet M, Kobak R, Diamond GS. Family relationships and the interpersonal theory of suicide in a clinically suicidal sample of adolescents. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:798-811. [PMID: 34608653 DOI: 10.1111/jmft.12549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
In a sample of suicidal adolescents (N = 117), we sought to identify how adolescents' attachment to their parents related to a key mechanism of suicide from the Interpersonal Theory of Suicide (IPTS). We tested both attachment-anxiety and attachment-avoidance, to both mother- and father-figures as correlates of the IPTS construct, perceived burdensomeness (PB). In addition, we tested PB as a mediator between these attachment variables and adolescent suicide ideation in a path analysis. Our path analysis indicated both mother- and father-related attachment anxiety were associated with PB and PB was related to suicide ideation. We also found an indirect effect of father-related attachment anxiety on suicide ideation. This study provides empirical support for earlier systemic work that proposes how family relationships may influence an adolescent's suicidal ideation. Finally, we provide practical clinical suggestions for how therapists may implement a systemic framework to address a suicidal adolescent and their family relationships.
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Affiliation(s)
- Quintin A Hunt
- Marriage and Family Therapy Program, Brigham Young University, Provo, Utah, USA
| | | | - Lindsey M Weiler
- Couple and Family Therapy Program, University of Minnesota, St. Paul, Minnesota, USA
| | | | - Tai Mendenhall
- Couple and Family Therapy Program, University of Minnesota, St. Paul, Minnesota, USA
| | - Jenifer K McGuire
- Family Social Science Program, University of Minnesota, St. Paul, Minnesota, USA
| | - Morgan Monet
- Marriage and Family Therapy Program, Brigham Young University, Provo, Utah, USA
| | - Roger Kobak
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Guy S Diamond
- Center for Family Intervention Science, Drexel University, Philadelphia, Pennsylvania, USA
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Diamond GM, Boruchovitz‐Zamir R, Nir‐Gotlieb O, Gat I, Bar‐Kalifa E, Fitoussi P, Katz S. Attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents. FAMILY PROCESS 2022; 61:530-548. [PMID: 35362553 PMCID: PMC9325072 DOI: 10.1111/famp.12770] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 05/26/2023]
Abstract
This pilot open trial examined the efficacy of attachment-based family therapy (ABFT) for Israeli sexual and gender minority (SGM) young adults and their persistently nonaccepting parents. Thirty families received up to 26 weeks of treatment, with parental rejection, parental acceptance, and young adults' attachment avoidance and attachment anxiety assessed at baseline, 8, 16, 24, and 36 weeks (three months post-treatment). Analyses using multilevel growth models revealed that both young adults and their mothers independently reported increases in mothers' acceptance of their young adult's same-sex orientation or noncisgender identity. In addition, young adults reported decreases in both parents' levels of rejection. Also, mothers, but not fathers, reported decreases in their own level of rejection. Finally, young adults reported a decrease in attachment avoidance in their relationships with both mothers and fathers, but not a decrease in attachment anxiety. Importantly, these treatment gains were maintained three months after the end of treatment. Together, these results suggest that ABFT-SGM, a manualized, affirmative, experiential, family-based treatment, may be effective in reducing long-standing parental rejection, promoting parental acceptance, and improving the quality of LGBTQ+ young adults' relationships with their parents. These findings are encouraging in light of the urgent need for efficacious interventions to reduce family generated minority stress and promote safer, more supportive environments for sexual and gender minority people.
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Affiliation(s)
- Gary M. Diamond
- Department of PsychologyBen‐Gurion UniversityBeer‐ShevaIsrael
| | | | | | - Inbal Gat
- Department of PsychologyBen‐Gurion UniversityBeer‐ShevaIsrael
| | - Eran Bar‐Kalifa
- Department of PsychologyBen‐Gurion UniversityBeer‐ShevaIsrael
| | | | - Shira Katz
- Department of PsychologyBen‐Gurion UniversityBeer‐ShevaIsrael
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Increased family cohesion mediates therapist adherence to the attachment task and depression outcomes in attachment-based family therapy. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09539-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Diamond G, Diamond GM, Levy S. Attachment-based family therapy: Theory, clinical model, outcomes, and process research. J Affect Disord 2021; 294:286-295. [PMID: 34304083 PMCID: PMC8489519 DOI: 10.1016/j.jad.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Guy Diamond
- Drexel University, Philadelphia, PA, 19072 USA.
| | - Gary M Diamond
- Ben-Gurion University of the Negev P.O.B. 653, Beer-Sheva, Israel 84105
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