Corrective attachment episodes in attachment-based family therapy: the power of enactment

Corrective attachment episodes, therapeutic enactments designed to increase openness and trust between young adults and their parents, are the purported primary change mechanism in attachment-based family therapy. This study examined whether sequences of therapist interventions, young adults' productive emotional processing, and parental behaviors thought to reflect corrective attachment episodes were characteristic of good versus poor outcome cases. Thirty conjoint attachment sessions were analyzed using the THEME algorithm. Results revealed that only in good outcome cases were there four-step sequences hypothesized to facilitate attachment. One sequence began with the therapist focusing on the young adult's primary adaptive emotions, followed by the young adult's productive emotional processing of their vulnerable emotions, followed by the therapist empathizing with and validating the parent, followed by parents' expressions of warmth toward their young adult. The second sequence began with the therapist focusing on the young adult's unmet attachment needs, followed by the young adult productively processing their vulnerable emotions, followed by the parent expressing a willingness to fulfill their young adult's attachment needs, followed by parents' expressions of warmth toward their young adult. Findings provide an empirically-based clinical map for conducting therapeutic enactments in family therapy and have implications for treatment development, therapist training and supervision.