Attachment-Based Family Therapy to Address LGBT Teen Suicide

LGBT Teens and Suicide Risk

A recent article in Rolling Stone magazine highlights the pressures felt by gay and lesbian high school students in a Georgia private school.  The students worry about being ostracized by peers, family members, and religious organizations, sometimes because they've seen it happen to other students at their school. 

Because of external pressures like these, gay and lesbian teenagers are at higher risk than other groups for attempting suicide.  Different studies estimate that 15-40% of gay adolescents may attempt suicide. 

One important predictor of risk is family acceptance, and a recent study explored how family therapy can help increase family acceptance and reduce suicide risk.

Parental Support Moderates Risk

Teens who felt rejected by their families attempt suicide at eight times the rate of teens who report feeling accepted.  When he or she lacks family support, or worse experience family rejection, the teen can intensify feelings of isolation and self-loathing and create an impression that there is no one to turn to for help.

Most parents want to accept their child and want to provide assistance, but many parents fear the same sorts of judgments and social rejection that their gay children worry about.  These fears along with popular stereotypes and misconceptions about sexual orientation sometimes mean that parents can be hesitant to show support.  Other parents may want to show support, but don't know for certain how to demonstrate it.  The parents' past has often not prepared them for having a gay or lesbian child.

Attachment-Based Family Therapy (ABFT)

Psychologist Gary Diamond and colleagues Attachment-Based Family Therapy (ABFT) with families of gay and lesbian youth.  Their preliminary results indicate that an amended method of ABFT increases positive parental support of gay youths, reduces the teenagers anxiety and depression levels, and leads to a reduced likelihood of attempted suicide.

Standard ABFT consists of five steps:

Step 1: Relational Reframe.  The first goal of the intervention is to reduce criticism and hostility in the parent/teen relationship so that the adolescent feels more comfortable expressing concerns and seeking support from his or her family.

Step 2: Alliance Building with Adolescent.  When tensions decrease, the adolescent can begin to express her or his needs and concerns.  Family members can be seen as a source of support.

Step 3: Alliance Building Task with Parent(s). Concerns of parents are also very important to the process and need to be expressed, heard, and understood empathically.  The therapist works with the parents to explore effective styles of expression that can enhance relationships.

Step 4: Reattachment.  Experiences from the past may have hurt the bonds of trust between parent and child.  ABFT provides an opportunity to resolve these old wounds and build new experiences where adolescents feel heard, cared about, and taken care or.  

Step 5: Competency Promoting.  The parents and their son or daughter practice regulating emotion and articulating feelings.  Bonds are strengthened and patterns of withdrawal are minimized.  The knowledge that families are a source of support is strengthened.

ABFT for Families of Gay and Lesbian Teens

In applying the program to a small sample of gay and lesbian teenagers and their families, Diamond and colleagues found that a few modifications to their standard program were required.   

  1. Parents needed on average five sessions with just the therapist to express and work through their worries, fears, anger, and other feelings related to their child's coming out. Five sessions is longer than the number of sessions recommended for ABFT when dealing with other family issues, but the extra time allowed parents to empathize with their son's or daughter's concerns and develop the ability to hear and attend to their child's needs.
  2. Parents and teenagers should collaboratively discuss what acceptance looks like.   Open and respectful back and forth conversation prevents misunderstandings, builds bonds, and lets the teenager know his or her parents are a source of loving support.
  3. Therapy should also discuss the meaning of microaggressions that send unintended messages between children, including those specifically related to sexual orientation.  Parents may not be aware of the messages their children are receiving, and open discussion can clear the air.

Despite the rapid increases in understanding and acceptance of gay and lesbian people in the US over the last generation, gay and lesbian teenagers still face significant prejudice and pressures both in society and in the home.  While most parents absolutely want to be supportive of their children, in some cases they are unprepared for the news, worry about the pressures the family might face, or may not be entirely sure yet how to show support for their child. 

With help, the LGBT teen can feel secure that there is someone at home they can turn to for help  and support.