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Category: Project

Description: Background The prevalence of mental health problems of children and adolescents worldwide is substantial with 10-20% (Kieling et al., 2011). Attachment related emotion regulation is considered an important transdiagnostic process (Insell et al., 2010) underlying mental health problems in adolescents. Emotionally Focused Family Therapy (EFFT) aims at the development of secure attachment between parents and their children in order to reduce the child’s vulnerability for mental health problems and enhance resilience (Furrow et al., 2019). Intervention The current pilot study is a first test of the newly developed protocol of structured EFFT. It consists of 4 phases and 16-21 sessions: phase 1 (1-2 sessions with the whole family) reframing the individual adolescent’s problem as related to insecure attachment relations with the parents; phase 2A (4-6 sessions with the parents) and phase 2B (3 sessions with the adolescent) are delivered in parallel fashion and aim to prepare them to phase 3 by exploring insecure attachment relations and unfulfilled attachment needs; phase 3 (3 sessions with parents and adolescent) is focused on development of secure attachment relations between parents and adolescent; phase 4 (3 sessions with the whole family) consolidation of secure attachment and additional interventions for residual psychopathology; and finally a booster session with the whole family. Treatment adherence will be assessed with a check list by independent raters of sound recordings of random sessions. Participants We will include families with (a) adolescents (12-18 years of age) as the ‘identified’ patient, and (b) their families. We will exclude: (a) blended families; (b) families with severe trauma such as sexual and physical abuse and severe neglect; and (c) families of which the parents or children are diagnosed with severe DSM disorders (substance abuse or psychosis). Exclusion criteria will be determined with unstructured clinical interviews by experienced clinicians. For this pilot study we aim at 15-20 included families who will be recruited and treated by five experienced family therapists supervised by one ICEEFT certified psychotherapist. Design and method A within-subjects design, without randomized control group, with three waves will be applied: (1) waiting period of 2 months, (2) treatment phase 3-4 months, and (3) 2 months follow-up period concluded with a booster session. Comparing change during the waiting period vs. change during treatment will provide a clear indication of spontaneous remission vs. treatment-related change. The study will use a multi-method approach: quantitative for the effectiveness part (multilevel analyses of questionnaires) and qualitative for the feasibility part (semi-structured interviews). Treatment adherence will be assessed with sound recording of random sessions. Dependent variables will be: (1) negative interaction patterns (4 item Relationship Dynamics Scale; Stanley et al., 2001); (2) accessibility and responsiveness of the attachment figures (6 item version of the Accessibility, Responsiveness, Emotional Engagement questionnaire; Johnson, 2008); (3) Emotional Availability and Discipline (14 item Self-Efficacy for Parenting Tasks Index Toddler Scale; Coleman & Karraker, 2003); (4) Attachment (9 item Experiences in Close Relationships - Relationship Structures questionnaire; Fraley et al., 2011); (5) Relationship Satisfaction (4 item Couple Satisfaction Index; Funk & Rogge, 2007); and (6) the adolescent’s complaints (20 item Strengths and Difficulties Questionnaire; Goodman, 1997). These dependent variables are measured at five time points: pre-waiting period, pre-treatment, prior to phase 3 of EFFT (all questionnaires except for the SDQ), post treatment and prior to the booster session. Finally, feasibility will be assessed by semi-structured interviews. Hypotheses Concerning the effectiveness of structured EFFT we anticipate that, if limited power of this pilot study yields significant differences, outcomes will show: (1) no, or less change during the waiting period compared with the treatment phase; (2) gain during the treatment phase; (3) and substantial maintenance during follow-up. Hypotheses will be tested with multi-level analyses. Feasibility will be explored.