Young adult vulnerability and parental responsiveness in attachment-based family therapy for LGBTQ+ young adults and their nonaccepting parents

Objective: Young adult vulnerability is thought to elicit parental responsiveness, and parental responsiveness is thought to facilitate young adult vulnerability. These moment-by-moment in-session processes are purported core change mechanisms in attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents (ABFT-SGM). This study examined whether young adult vulnerability predicted immediately subsequent parental responsiveness, and parental responsiveness predicted immediately subsequent young adult vulnerability, and whether the frequency of such sequences predicted treatment outcome. Method: Analyses were conducted on all conjoint attachment sessions (N = 146) from 26 cases treated in an open trial of ABFT-SGM. Over 16,000 young adult speech-turns were coded for vulnerability and over 27,000 parental speech-turns were coded for responsiveness. Results: Hierarchical linear modeling revealed that young adult vulnerability predicted immediately subsequent parental responsiveness, and that parental responsiveness predicted immediately subsequent young adult vulnerability. Frequency of vulnerability-responsiveness sequences, for the most part, did not predict changes in young adults’ perceived parental acceptance or rejection. Conclusions: Results support the bidirectional moment-by-moment effects of young adult vulnerability and parental responsiveness during conjoint ABFT-SGM sessions. The link between the simple frequency of vulnerability-responsiveness sequences and treatment outcome is tenuous.