DISSORDER THERAPY FOR DEPRESSED ADOLESCENTS

Dissorder Therapy for Depressed Adolescents



Attachiment-Based family Therapy for Depressed Adolescents

Introduction

Recent epidemiological evidence suggests that the occurrence of disorders related to depression in adolescent population is getting higher and higher. Biology, cognitions, social skills, parental psychopathology, and environmental stressors may all contribute to the onset and maintenance of childhood depression. Although ABFT does not ignore this complexity, it focuses primarily on the interpersonal risk factors and processes associated with depression. Many interpersonal theories of depression have emerged in recent years that focus on sociophysiology, feminist theory, family interaction, and transactional models to name a few.These theories are supported by a growing body of empirical research suggesting that depression can be caused, maintained, o exacerbated by interpersonal relationships . For example, parental depression, marital conflict, ineffective parenting practices, unmet attachment needs, loss, and negative parent-child interaction have repeatedly been associated with the etiology and reinforcement of depression. Even the cognitive aspects of depression (e.g., negative selfschema, learned helplessness) may have their origins in interpersonal (i.e., family) relationships. One interpersonal view on depression proposes that adolescent depression may be associated with an adolescent's failure to negotiate autonomy from parents while maintaining closeness and intimacy. (Smetana 2002 )

This view is founded on the empirically supported contemporary view that healthy individuation depends on relational continuity in the parent-child relationship. To accomplish this, families must tolerate moderate levels of conflict while the adolescent increases assertions of autonomy. Neither extreme conflict, nor the lack of conflict, facilitates this developmental task. Unfortunately, depressed adolescents and perhaps girls in particular, tend to be irritable (leading to harsh conflict) yet overly dependent. Adolescents with this “agitated submissiveness” who live in a family with low conflict tolerance (i.e., avoid negotiation of differences) are at higher risk for developing and maintaining depression.

Origin of the Theory

Attachment theory provides both a theoretical understanding of the attachment/autonomy task and provides direction for clinical intervention. Attachment theory rests on the assumption that humans innately strive for connection with others.When a parent appropriately responds to this need, children generally develop a secure attachment style. Although attachment research has mostly focused on infants and young children, the importance of appropriate attachment during adolescence has been well documented. Although secure attachment supports healthy development, insecure attachment has repeatedly been associated with depression in adolescents. Having a secure attachment during adolescence depends on three factors. The adolescent must have open communication with the primary caregivers, these caregivers are accessible, and they will provide protection and help if needed. (Stark 2000 )

When these conditions are met, adolescents maintain a felt sense of security and report greater autonomy seeking behavior, positive peer relations, and higher self-esteem. Within this relational context, adolescents freely express negative emotions (e.g., fear, anger, distress) with the expectation of acceptance and comfort, rather than the fear of criticism and abandonment. Secure attachment leads to more direct communication, which fosters perspective taking and problem-solving skills, the essential skills needed to negotiate autonomy and ...