By Meredith Dellorco, LCSW, Newport Healthcare’s National Family Therapy Specialist,
and Olivia Lynch, MS, LPC, Newport Healthcare’s EMDR Program Training and Development Manager
EMDR (Eye Movement Desensitization and Reprocessing) Therapy and ABFT (Attachment-Based Family Therapy) are both powerful, effective modalities in their own right, and we believe they can support each other in treating trauma and depression in adolescents and young adults. Newport Healthcare’s clinical model, which prioritizes family involvement and utilizes multiple therapeutic modalities, provides an environment in which we have been able to closely observe how combining these two approaches enhances treatment efficacy.
Our exploration of this intersection is inspired by our dedication to improving patient and family outcomes, and by Newport’s commitment to research and thought leadership, as evidenced by the establishment of the Newport Healthcare Center for Research and Innovation. Below we offer an overview of the individual modalities, followed by an explanation of how they can work together in the treatment setting.
View research by Meredith Dellorco, Olivia Lynch, and other Newport Healthcare thought leaders in the journal Family Process: Bolstering family therapy: Assimilating EMDR into ABFT in youth residential treatment
EMDR: Accessing the Mind-Body Connection for Healing
Based on the Adaptive Information Processing Model, EMDR was initially developed to treat post-traumatic stress disorder (PTSD), and multiple studies have demonstrated its efficacy in addressing psychological and somatic disorders resulting from adverse life experiences. Ongoing research also suggests that EMDR Therapy can also be helpful in treatment for disorders such as anxiety, depression, OCD, eating disorders, chronic pain, addictions, and other distressing life experiences.
In EMDR Therapy, the therapist and client work together to identify themes within the client’s life and prepare the client to target a specific memory connected to the theme they want to address. The client identifies a negative cognition that is associated with the memory, and also identifies a positive cognition that they would like to introduce in its place. The client moves into desensitization and reprocessing by briefly focusing on the traumatic or distressing memory while simultaneously being guided through bilateral movements, such as eye movements or tapping. This has been found to reduce the distress and emotions around the target memory. Once the distress is no longer present, the therapist works with the client to strengthen the positive cognition.
At Newport Healthcare, we utilize this evidence-based modality with adolescent and young adult clients, when indicated, and have found it to be consistently helpful in supporting them to reprocess their traumatic and distressing memories and integrate these experiences in an adaptive way. Furthermore, we have found that often when a target memory is reprocessed, the positive changes carry over to various facets of the client’s life, including their relationships with their family.
ABFT: Addressing Adolescent Depression Through Family Connection
ABFT is an empirically supported modality aimed at reducing emotional distress and symptomology. While EMDR functions on the individual level, ABFT reduces emotional distress by working within the family system to repair adolescents’ and young adults’ attachment with their parents. Bowlby’s Attachment Theory notes that when parents are available, responsive, and attuned to their child’s emotional needs, children feel more confident that they will be loved and protected, and that they are worthy of this love and protection. Often the reason adolescents/young adults struggle with depression, suicide risk, and behavioral issues is because they do not feel understood or worthy of that love and protection.
Through the ABFT process, the clinician explores the adolescent/young adult’s attachment ruptures in their relationship with their parents/caregivers, which often result in the child’s feeling unsafe, “not good enough,” unlovable, etc. As the clinician explores these themes with the child, they are simultaneously working with the parents to explore parents’ own attachment ruptures. This prepares parents to have greater understanding and empathy for their child. In the next stage of the ABFT process, the child shares their attachment wounds with their caregivers, who are now responding with empathy, validation, support, and curiosity. This reparative experience for the child begins to heal the attachment rupture.
When ABFT is implemented effectively, the child and their caregivers establish a firmer sense of trust and stability within the relationship and develop a new ability to openly communicate. This in turn allows the child to feel safe proactively going to their caregiver for support, guidance, love, and protection. In a study on the efficacy of ABFT for adolescents, 81 percent of those who received ABFT for 12 weeks no longer met the criteria for major depressive disorder (MDD). Moreover, 87 percent of those adolescents continued to not meet the criteria for MDD six months after treatment ended. These adolescents had a significant reduction in depression as they now felt understood, loved, and protected by their caregivers and were able to turn to them for support when experiencing feelings of distress.
How These Modalities Work Together
In working with clients and families at Newport Healthcare, we have seen how ABFT and EMDR can be partnered to provide a powerful intervention for the treatment of adolescent and young adult trauma and depression. When implementing these two modalities collaboratively, treatment is provided on both the individual and family system levels. During the ABFT treatment process, the client is asked to share their attachment ruptures (e.g., feeling unsafe, unloved, not good enough, etc.) with their caregivers. However, for many clients, even the thought of sharing these attachment ruptures can feel terrifying, to the extent that they may trigger a trauma response. By using EMDR, clinicians can target the relational trauma connected to attachment ruptures, reducing the client’s distress and emotional reactivity, and thus strengthening their ability to engage and progress in treatment, including ABFT sessions.
Moreover, the negative self-beliefs addressed in EMDR Therapy are often closely connected to unaddressed attachment wounds. For example, a client’s negative self-belief may be “I am not worthy” and their attachment theme may include “I am not good enough for my parent.” The EMDR clinician can engage the client in reprocessing around this negative self-belief, which in turn may reduce the client’s level of distress around the attachment theme, in addition to getting to the root of this negative belief, which likely surfaces in many other areas of their life. They are more likely to then believe a more adaptive and helpful cognition, such as “I am worthy.” This strengthens the client’s emotional regulation, confidence, and ability to share their ruptures with their caregivers—setting the stage for a more positive experience for the whole family.
A significant part of the ABFT treatment model also includes the clinician meeting with caregivers individually to explore their own attachment ruptures and to provide new emotion-coaching skills, with the goal of preparing them to respond appropriately when their child shares their ruptures. It is important that parents can listen, be present and empathetic, and have the capacity to learn to co-regulate with their child. Giving parents basic EMDR grounding techniques and introducing the language used in EMDR can help them regulate their own emotions and increase their mindfulness when interacting with their child and in general. For example, in EMDR Therapy, clients are often asked to pay attention to various experiences, such as thoughts, feelings, and body sensations, and are then asked, “What are you noticing?” Learning this language and being able to look through an EMDR lens can help parents be more aware and less judgmental during family sessions.
A Case Study
In a recent case, a 17-year-old boy was in teen residential treatment at Newport Healthcare for severe suicidality and depression. This adolescent was provided both EMDR and ABFT. When engaging in this treatment, it became apparent that he had significant attachment ruptures with his biological mother. He felt both unsafe and unloved. These attachment ruptures in turn were resulting in him pushing away and rejecting the love he was receiving from his father and stepmother.
The clinician providing ABFT noticed that the client became highly dysregulated when attempting to share his ruptures with his father and stepmother. The clinician was then able to implement EMDR to target the negative cognitions and trauma response associated with the memories of feeling unloved and unsafe with his biological mother.
After EMDR was successfully implemented, this boy was able to share his ruptures with both his father and stepmother. When they responded with their newly learned skills, including warmth, validation, and openness, the boy experienced a powerful moment of healing and attachment with them. This allowed him to feel safe opening his heart to both caregivers, which in turn resulted in him feeling safe, protected, and worthy of love. This naturally reduced his level of depression and increased his feelings of connection.
Discussion and Implications
In conclusion, incorporating EMDR Therapy with ABFT can benefit both the adolescent or young adult and the caregivers by helping to uncover and heal the root of a parent-child rupture and/or adverse life experience that is causing significant distress, depression, PTSD, and/or anxiety. EMDR can address the root of the issue and provide a foundation of stability and skills, allowing the client to be present, vulnerable, and emotionally regulated when engaging in the deep therapeutic work of ABFT. As a result, we have observed a positive impact on clients’ and families’ overall progress and satisfaction in treatment. We plan to continue exploration of pathways and innovations of care that can potentially increase efficacy in reducing mental health and behavioral disorders in adolescents and young adults.