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Conference Agenda

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Daily Overview

Session

Symposium 3.G - Attachment and family therapy across developmental phases: Current evidence, emerging developments, and mechanisms of change

Time:

Tuesday, 07/July/2026:

4:30pm - 6:00pm

Session Chair: Nadia van der Spek
Session Chair: Luana Gavan

Location: AV 04.17 - Lecture hall

AV Auditoriacomplex (122-20), Parkstraat 49, 3000 Leuven

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Presentations

4:30pm - 5:30pm

Attachment and family therapy across developmental phases: Current evidence, emerging developments, and mechanisms of change

Chair(s): Nadia van der Spek (Amsterdam UMC, The Netherlands), Luana Gavan (Amsterdam UMC, The Netherlands), Nele Bergers (KU Leuven, Belgium)

Discussant(s): Guy Bosmans (KU Leuven, Belgium)

Randomized controlled trials (RCTs) have demonstrated the effectiveness of family therapies in general, and Attachment-Based Family Therapy (ABFT) in particular, in reducing depression and suicidality. However, treatment outcomes vary, underscoring the need to better understand when, how, and for whom family interventions are most effective. This symposium brings together complementary perspectives on family therapy and ABFT, across developmental phases, with a focus on mechanisms of change and implications for mental health.

The first presentation examines the broader evidence base for family interventions by presenting preliminary findings from a meta-analysis of family therapy for depressive symptoms in adults. Across heterogeneous interventions, a medium overall effect size was observed alongside substantial variability, highlighting the relevance of involving family in psychological treatment beyond adolescence and the need for further research into mechanisms of change and long-term outcomes.

The second presentation introduces the protocol of an ongoing RCT investigating the (cost-)effectiveness of ABFT for suicidal emerging adults, outlining the theoretical rationale for extending ABFT beyond adolescence, study design, and early insights into feasibility and implementation into emerging adulthood.

The third presentation focuses on early therapeutic processes within ABFT, examining responsivity of adolescents and maternal caregivers to core interventions during the first therapy session. Using observational coding of videotaped sessions, drawn from an RCT, this study shows that greater maternal responsivity to the relational reframe and stronger agreement with the treatment contract are associated with greater reductions in adolescent depressive symptoms over the course of treatment.

Taken together, these presentations offer an integrated view of family therapy, from an overview of the current literature, to an ongoing trial, and finally an in-depth investigation of possible working mechanisms. The symposium invites discussion on how attachment theory can more coherently guide the development, evaluation, and refinement of family-based interventions for depression and suicidality across adolescence and adulthood.

Presentations of the Symposium

The effectiveness of family therapy for adults with depressive symptoms: A systematic review and meta-analysis

Ricardo Trinidad¹, Luana Gavan¹, David Turner², Guy Bosmans³, Claudi Bockting¹, Nadia van der Spek¹
¹Amsterdam UMC, The Netherlands, ²Vrije Universiteit Amsterdam, The Netherlands, ³KU Leuven, Belgium

Depression is among the most prevalent psychiatric disorders in adults worldwide, with a significant disease burden. In contrast to youth studies, existing research on psychotherapy for adult depression has been predominantly focused on individual or group therapy. Family therapy, defined as any intervention partly aimed at improving family relationships while actively involving family members in joint therapy sessions, might provide a new avenue for psychotherapeutic treatment. This systematic review and meta-analysis aims to investigate the effectiveness of family therapy for adult depression.

We systematically identified studies from multiple databases that compared family therapy with either active or non-active control conditions and reported on depression severity as either a primary or secondary outcome. Sixteen randomized controlled trials were included (N = 1239), with family interventions based on systemic, psychoeducational, and cognitive-behavioral frameworks. Our preliminary results showed a significant overall medium pooled estimate at post-treatment (g = 0.48, 95% CI [0.26-0.70]) and follow-up (k = 7, g = 0.68, 95% CI [0.08-1.27]) with family therapy being superior to both active and non-active control conditions. Heterogeneity was high in the full sample (I² = 69.5%) but negligible in the subsample of studies with depression as a primary diagnosis (I² = 0.8%), which had a markedly higher pooled effect size at post-treatment (k = 7, g = 0.68, 95% CI [0.51-0.84], p <.0001). Subgroup analyses for type of family therapy, control condition, and family members involved in therapy did not reveal significant differences. Risk of bias was moderate to high across the included trials.

Our preliminary results support the inclusion of family therapy in treatment guidelines for adult depression as either a stand-alone treatment or an add-on to other evidence-based treatments. Future research should focus on improving trial quality and follow-up length, as well as investigating mechanisms of change.

The (cost-)effectiveness of attachment-based family therapy for young adults with high suicidal ideation: protocol of a randomized controlled trial

Claudi Bockting¹, Guy Bosmans², Nele Bergers², Luana Gavan¹, Mickaël Hiligsmann³, Derek de Beurs⁴, Geert Molenberghs⁵, Ben Wijnen⁶, Joran Lokkerbol⁶, Nadia van der Spek¹
¹Amsterdam UMC, The Netherlands, ²KU Leuven, Belgium, ³Maastricht University, The Netherlands, ⁴University of Amsterdam, The Netherlands, ⁵Hasselt University, Belgium, ⁶Trimbos Instituut, The Netherlands

Young adult suicidality is worldwide a prevalent mental health problem and the number one cause of death, with profound consequences for individuals, families, and society. Despite this, currently recommended psychological and pharmacological treatments for high-risk youth show only modest effects. In line with the World Health Organization’s recommendation to involve families in treatment, attachment-based family therapy (ABFT) was developed. This 16-week attachment- and emotion-focused treatment has been increasingly implemented in routine mental health care across Europe. However, its effectiveness and cost-effectiveness have not yet been evaluated in emerging adults.

We describe a pragmatic, multicenter randomized controlled trial currently ongoing in the Netherlands and Belgium, comparing ABFT as an add-on to Treatment as Usual (TAU) with TAU only. A total of 142 participants aged 16 to 30 years and their caregivers are being recruited across 16 mental health care centers. The primary outcome is suicidality, assessed at baseline, post-treatment, and at multiple follow-up points up to 12 months after the intervention. Secondary outcomes include depressive symptoms, family functioning, autonomy, feelings of entrapment, and young adult attachment. In addition, the study evaluated the cost-effectiveness of ABFT relative to TAU in routine clinical practice.

By focusing on an understudied age group at high risk for suicide, this trial aims to address an important gap in the evidence base for family-based interventions in adult mental health care. This presentation will not only outline the trial design and rationale but also share practical insights from the ongoing implementation of ABFT in clinical settings, including recruitment, feasibility, and challenges encountered to date. Findings from this study are expected to inform future research, clinical guidelines, and policy decisions regarding the treatment of suicidal emerging adults.

Relational reframe and treatment contract in Attachment Based Family Therapy: associations with depression and suicidality outcomes

Nele Bergers¹, Tara Santens¹, Stephanie Krauthamer-Ewing², Daniel Vader², Suzanne Levy³, Guy Diamond⁴, Nadia van der Spek⁵, Claudi Bockting⁵, Guy Bosmans¹
¹KU Leuven, Belgium, ²Drexel University, United States, ³ABFT International Training Institute, United States, ⁴University of Pennsylvania School of Medicine, United States, ⁵Amsterdam UMC, The Netherlands

Attachment-Based Family Therapy (ABFT) is an evidence-based treatment for adolescent depression and suicidality. However, treatment outcomes vary across studies. Research shows that early therapeutic processes may contribute to different treatment outcomes or symptom trajectories. We tested whether responsivity of adolescents and maternal caregivers to two core therapeutic interventions during the first session of ABFT, relational reframe and treatment contract, are associated with differential depression and suicidal ideation outcomes in adolescents. Videotaped first-session relational reframe tasks from a randomized clinical trial of ABFT (N = 47) were coded for the 43 families in which a maternal caregiver was present, using an observational coding system assessing responsivity to the relational reframe and agreement with the treatment contract in terms of content and affect. Multilevel models indicated that greater maternal responsivity to the relational reframe (β = −0.029, SE = 0.014, p = .041) and higher maternal agreement with the treatment contract (β = −0.035, SE = 0.016, p = .031) were associated with greater reductions in depressive symptoms over treatment. In contrast, adolescent responsivity to the relational reframe and agreement with treatment contract were not associated with depressive symptom trajectories. For suicidal ideation, adolescent and maternal responsivity to the relational reframe and agreement with the treatment contract were not associated with changes in suicidal ideation over time. Sensitivity analyses restricted to families with a biological mother present (n = 40) yielded a largely consistent pattern of findings, with maternal agreement with treatment contract remaining a significant predictor of depressive symptom improvement (β = −0.038, SE = 0.016, p = .021). These findings suggest that early maternal engagement with the relational focus of ABFT may represent an important predictor of adolescent depression outcomes and highlight the potential value of examining early in-session processes as mechanisms of change in family-based treatments.

Discussant

Guy Bosmans
KU Leuven, Belgium

The discussant will provide an integrative commentary on the symposium, highlighting conceptual links between attachment theory, family-based interventions, and mental health outcomes across adolescence and adulthood.