Suicide is a serious, growing, and multidimensional public health problem in the United States. It is particularly serious in children and adolescents, where it is the second leading cause of death for 15-to-24-year-olds, and the fourth leading cause of death for 5-to-14-year-olds (Hoyert, 2012). In 2011, an estimated 12.1% of adolescents contemplated suicide, 4.0% made a plan, 4.1% made an attempt, and 4,688 adolescents died by suicide (Nock et al., 2013; Hoyert, 2012). LGBTQIA+ youth are particularly at risk (Liu & Mustanksi, 2012; Price et al., 2017). These adolescents report higher rates of both suicidal ideation and suicide attempts than their heterosexual (Fergusson, Horwood, & Beautrais, 2005; Haas et al., 2011; Russell & Joyner, 2001; Russell, 2003) and cisgender counterparts (James et al., 2016). While the majority of LGBTQIA+ youth are healthy, functioning, and resilient (Savin-Williams, 2005), between 15% and 40% make a suicide attempt each year (Fergusson, Horwood, & Beautrais, 2005; Liu et al., 2020; Russell & Joyner, 2001; Russell, 2003; Zhao et al., 2010). The Minority stress theory may help explain why LGBTQIA+ youth are more vulnerable to suicide (Meyer, 2003). These stressors, high in this population, include gender dysphoria, family rejection, identity-based victimization, bullying, stigma, discrimination, and abuse (Aranmolate et al., 2017; Hall, 2018; Russon et al., 2021). Given the high risk of suicide in this population, effective suicide interventions are needed.
Surprisingly, few therapies designed to address suicidal thoughts and behaviors have focused on this population. Attachment-based family therapy (ABFT) is one empirically-supported psychotherapy approach that has been modified and tested specifically for sexual and gender minority youth with suicidal thoughts and behaviors (STB). ABFT (Diamond et al., 2014) is an empirically-supported treatment designed to treat adolescents and young adults struggling with depression symptoms and/or suicidal ideation and behaviors. Using five treatment tasks, ABFT aims to repair ruptures in the caregiver- child relationship and establish or resuscitate the secure base that can reduce family stress or buffer against stressors outside the home (e.g. bullying, stigma). Task one focuses on establishing improvement in family relationships as the first goal of therapy. Task two (adolescent alone) helps the adolescent identify and articulate their perceived experience of the attachment failures and prepare to discuss them with their caregivers. Task three (caregivers alone) encourages caregivers to consider how current stressors and/or their own intergenerational attachment legacies affect their parenting style. This softens caregivers and makes them more receptive to learning new parenting skills. Task four, the adolescent and caregiver discuss these past attachment ruptures. As caregivers acknowledge adolescents’ thoughts, feelings and memories, adolescents become more emotionally regulated and cooperative. Task five focuses on using the caregivers as a secure base to support the adolescents’ exploration of autonomy.
ABFT outcome studies have demonstrated treatment efficacy, and process studies have elucidated and tested its proposed mechanisms of change (see Diamond, et al., 2016 for a review). As the core mechanism of ABFT is the strengthening of relationships, the model translates well across diverse populations and needs. Further, ABFT is not a rigid approach. The model, although manualized, offers a flexible set of guiding principles and processes to be individualized to specific families, presenting issues and cultures. Indeed, ABFT has been successful with youth struggling with a history of sexual abuse, caregiver depression, and caregiver rejection of sexual identity (Diamond et al., 2012). It has also been adapted and implemented in a variety of settings, in countries around the world.
The CE presentation: Affirmative Attachment-Based Family Therapy for LGBTQIA+ Youth with Suicidal Thoughts and Behavior presents an adaptation of ABFT (informed by Diamond et al., 2012; Russon et al., 2021) that aims to repair past and present ruptures from their caregivers that LGBTQIA+ youth witness on the basis of their sexual orientation and/or gender identity. Although many LGBTQIA+ youth live in affirming and supportive family environments, there are a large percentage who experience intolerance, rejection and hostility in their family relationships. Affirmative ABFT supports families of LGBTQIA+ youth with STB in becoming advocates for their child. In the presentation, we illustrate how the ABFT adaptations have been applied with LGBTQIA+ youth and their families with special consideration to issues of outness, macro/microaggressions, and working with caregivers who are rejecting, intolerant and/or ambivalent.
