Therapist Interventions Associated with Productive Emotional Processing in the Context of Attachment-Based Family Therapy for Depressed and Suicidal Adolescents

Productive emotional processing is considered a key change mechanism in attachment-based family therapy (ABFT). This study examined the impact of attachment-based family therapy therapist interventions aimed to promote productive emotional processing of primary adaptive emotions in a sample of 30 depressed and suicidal adolescents who had participated in a larger randomized clinical trial. Results of sequential analyses revealed that relational reframes and therapists’ focus on primary adaptive emotions were associated with the subsequent initiation of adolescents’ productive emotional processing of primary adaptive emotions. In contrast, interpretations, reassurances, and therapists’ focus on adolescents’ rejecting anger toward their parents were all followed by the discontinuation of adolescents’ emotional processing that had already begun. Finally, therapists’ general encouragement of affect and focus on adolescents’ unmet attachment/identity needs were associated with both the initiation of adolescents’ productive emotional processing, and with the discontinuation of such processing once it had already begun. Theoretical and clinical implications are discussed.