The development of an attachment-focused family therapy for child mental health: Using a coding system to inform treatment

Irene Serfaty

Attachment theory helps to explain psychopathology, however the clinical applications of such theory within the treatment of child mental health problems are limited. This dissertation aimed to address critical gaps within the translation of attachment and family systems theory into clinical assessment and psychological treatment for child psychopathology. This involved the development and evaluation of Attachment-focused Family Therapy (AFT), using both quantitative and qualitative methods. AFT is the latest adaptation of an existing intervention, Behaviour Exchange Systems Therapy (BEST). The first empirical study outlines the development of AFT’s assessment protocol comprising of a discourse-based coding system, the Caregiver Attachment Discourse Scale (CADS), which is applied to an attachment-based interview for caregivers. Based on a selection of interview transcripts (N = 10), interrater reliability data are presented, with analysis indicating good to excellent reliability. The second empirical study evaluated the efficacy of AFT compared to cognitive behavioural therapy (CBT) in a single-blind pilot randomised controlled trial at a community-based clinic, for children experiencing internalising and externalising problems and their families (N = 30). Findings indicated that AFT elicited significantly greater improvements in internalising (d = 0.85) and externalising symptoms (d = 0.85), relative to controls (internalising d = 0.56; externalising d = 0.52), in addition to improved caregiving behaviours and family functioning. The final study presents translational research, whereby exploration of facilitators and barriers to the dissemination of AFT occurred through interviewing child and family therapeutic services in the community (N = 6). Qualitative analysis revealed broad acceptability of the treatment and enthusiasm of agencies to implement AFT, alongside several key barriers at client, clinician, and organisational levels. Altogether, the implications of our overall findings underscore the value of applying attachment and family systems theory within the assessment and treatment of child psychopathology.

The development of an attachment-focused family therapy for child mental health: Using a coding system to inform treatment

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