Does Acceptance of the Relational Reframe Predict Adolescent Depression and Suicidal Ideation Outcomes?

Attachment-based family therapy (ABFT) is an evidence-based systemic treatment for adolescent depression and suicidality. The first session focuses on shifting therapy goals from behavior management to relational repair. This study explores whether making this shift is associated with adolescent treatment outcomes. First-session recordings from an ABFT randomized controlled trial were coded for shifts in content (from an individual to a relational understanding of symptoms) and affect (from defensive to vulnerable emotions or hopefulness). Greater maternal responsivity to the relational reframe and stronger maternal acceptance of the relational contract were associated with greater reductions in adolescents' depressive symptoms. In contrast, adolescent scores on these measures were not associated with depressive symptom change, and although suicidal ideation decreased in the overall study, neither adolescent nor maternal scores on these measures predicted changes in suicidal ideation. Findings suggest that early maternal engagement with the relational focus of ABFT may be an indicator of subsequent improvement in adolescent depression.