Systemic practitioners and their clients often come to therapy with very different views about the pathway to change, especially when one member is showing highly dysregulated behaviours towards themselves or others. Parents of highly suicidal or violent adolescents are eager for a rapid and directed solution, while practitioners will focus on interrupting the family relational patterns that are constraining change. Managing this initial dissonance is crucial to future success.
Shifting the Treatment Goals
The relational reframe, where the focus shifts from the individual to relationships, has a long history in family therapy and is a central focus of the first session of Attachment Based Family Therapy, a model which integrates attachment and emotional processing theories into a structural family therapy foundation. The focus is on repair of parent-child ruptures produced by family relationship processes like high conflict and low warmth or family events including abuse, neglect, abandonment, loss or betrayal. The first session is overtly focussed on reframing the goal of therapy from ‘fixing’ the problematic member to repairing ruptures and enhancing security. The process of reframing has four phases; joining, problem definition, reframing, and contracting.
A Study to Understand this Process Better
Authors Santen et al (2025) undertook to discover if relational reframing works, for whom it works and how it works, by studying 47 families who were engaged in Attachment Based Family Therapy for their depressed and suicidal adolescents. For both parents and adolescents ‘success of the intervention was defined as a high degree of acceptance of the relational contract: improving relationships rather than controlling behavior.’
What Did They Find?
The authors demonstrated that it was possible to operationalise and code all four phases of the relational reframe task which was important for research purposes but also to identify common factors for teaching the approach.
For adolescents readiness to engage in conversation about rupture, the reframe process, and accepting the therapeutic contract to address relationships was not significant, suggesting that practitioners should persist with a relational approach even when a young person appears less engaged. By contrast parents who engaged in the content and affect of the reframe process were more likely to accept the relational contract.
Adolescent attachment orientation, adolescent-reported family conflict, and parents’ reported depressive symptoms, ‘predicted adolescents’ receptivity to the relational reframe process and acceptance of the relational contract.’ Adolescents with a dismissive attachment style were less willing to discuss relational disappointments or accept a therapy focused on repair. Those with a pre-occupied attachment were willing to engage in conversation about relational rupture but less accepting of the therapeutic contract.
Higher family conflict, as reported by the adolescent, was associated with greater unwillingness by young people to accept the relational contract. This was not the case for parents.
Parental depression was also linked to the adolescents willingness to engage in conversation about rupture in the reframe phase, perhaps because the therapeutic context provided a safe place and permission to express their concerns.
In Conclusion
Opening the space to discuss painful, shameful and difficult family maters that are directly connected to the symptoms of a young person is challenging for families and practitioners. Processes to promote the conversation which reframes an individual’s ‘madness or badness’ to a relational frame is a crucial early step to achieve this. While this paper demonstrates one approach the protocols of bower(note) which utilise both word and image provide another successful pathway to this end.
Santens, T., Chu-Chun,C., Levy, S., Diamond, G., Bosmans, G.,Anatomy of the Relational Reframe in Attachment-Based Family Therapy Family Process Vol 65(2) p
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