Attachment‐based family therapy for sexual and gender minority young adults and their nonaccepting parents

“…30 families were invited to our clinic for a more comprehensive screening, during which they underwent an abbreviated version of the Mini- International Neuropsychiatric Interview (MINI; Lecrubier et al., 1997) to rule out psychotic disorders, bipolar disorder, and severe suicidal ideation.”

“The ECR- RS is a revised version of the Experiences in Close Relationships Scale (Brennan et al., 1998; Fraley et al., 2000) and contains nine short statements rated on a 5- point scale, ranging from 1 (strongly disagree) to 5 (strongly agree).”

“…for future gay- related rejection by others (Pachankis et al., 2008), increased risk for depression and suicidal ideation (Haas et al., 2010; Ryan et al., 2009; VanBergen & Love, 2022), and higher levels of drug and alcohol consumption (D’Amico & Julien, 2012; Padilla et al., 2010; Rothman…”

“…levels of attachment avoidance or anxiety in their relationship with their nonaccepting parent, as measured by the parent version of the Experience in Close Relationships— Relationship Structures Questionnaire (ECR- RS; Fraley et al., 2011); and (d) not be currently living with their parents.”

“…recent studies have successfully tested affirmative individual cognitive behavioral therapy to target sexual minorities’ mental and physical health (Pachankis et al., 2015, 2020), this is the first study to empirically examine the efficacy of a family- based treatment specifically designed to…”

“…identity is associated with greater self- esteem and perceived social support, and has been found to buffer against psychopathology (D’augelli, 2002; Eisenberg & Resnick, 2006; Elizur & Ziv, 2001; Evans 1We use the acronym LGBTQ+ to reflect all minority sexual and gender identities including, but…”

“These include internalized homophobia, expectations for future gay- related rejection by others (Pachankis et al., 2008), increased risk for depression and suicidal ideation (Haas et al., 2010; Ryan et al., 2009; VanBergen & Love, 2022), and higher levels of drug and alcohol consumption (D’Amico &…”

“…therapy, gay, gender minority, lesbian, parental acceptance, parental rejection et al., 2004; Feinstein et al., 2014; Floyd et al., 1999; Grossman et al., 2005; Haas et al., 2010; Hershberger & D’Augelli, 1995; Needham & Austin, 2010; Ryan et al., 2010; Savin- Williams, 1989; Shilo & Savaya, 2011).”

“At the same time, Israelis also place a premium on family belonging, resulting in more frequent and intense contact between parents and their young adults (Lavee & Katz, 2003; Mayseless & Scharf, 2003).”

“The TBRS has been found to be reliable in a number of previous studies (Diamond et al., 2007; Hogue et al., 2008).”

“…therapy, gay, gender minority, lesbian, parental acceptance, parental rejection et al., 2004; Feinstein et al., 2014; Floyd et al., 1999; Grossman et al., 2005; Haas et al., 2010; Hershberger & D’Augelli, 1995; Needham & Austin, 2010; Ryan et al., 2010; Savin- Williams, 1989; Shilo & Savaya, 2011).”

“…recent studies have successfully tested affirmative individual cognitive behavioral therapy to target sexual minorities’ mental and physical health (Pachankis et al., 2015, 2020), this is the first study to empirically examine the efficacy of a family- based treatment specifically designed to…”

“…family therapy, gay, gender minority, lesbian, parental acceptance, parental rejection et al., 2004; Feinstein et al., 2014; Floyd et al., 1999; Grossman et al., 2005; Haas et al., 2010; Hershberger & D’Augelli, 1995; Needham & Austin, 2010; Ryan et al., 2010; Savin- Williams, 1989; Shilo &…”

“At the same time, Israelis also place a premium on family belonging, resulting in more frequent and intense contact between parents and their young adults (Lavee & Katz, 2003; Mayseless & Scharf, 2003).”

“…gay- related rejection by others (Pachankis et al., 2008), increased risk for depression and suicidal ideation (Haas et al., 2010; Ryan et al., 2009; VanBergen & Love, 2022), and higher levels of drug and alcohol consumption (D’Amico & Julien, 2012; Padilla et al., 2010; Rothman et al., 2012).”

“Public opinion of transgender rights in the United States.”

“…attachment avoidance, and attachment anxiety would decrease linearly from pretreatment to follow- up based on findings from previous studies of family therapy showing continued improvement in symptoms and family functioning through follow- up assessments (Butler et al., 2011; Liddle et al., 2001).”

“Second, young adults have typically identified as a sexual or gender minority person longer than adolescents (Calzo et al., 2011), making parents' questions regarding the validity and changeability of their young adult's identity less salient.”

“In addition, to reduce concerns regarding Type 1 error, we ran a secondary set of analyses: two additional multivariate models (Baldwin et al., 2014).”

“…greater self- esteem and perceived social support, and has been found to buffer against psychopathology (D’augelli, 2002; Eisenberg & Resnick, 2006; Elizur & Ziv, 2001; Evans 1We use the acronym LGBTQ+ to reflect all minority sexual and gender identities including, but not only, gay, lesbian,…”

“Three randomized clinical trials conducted in the United States have shown ABFT to be efficacious in treating depressed and suicidal adolescents (Diamond et al., 2002, 2010; Diamond, Kobak et al., 2019).”

“Given the negative impact of parental rejection, and the positive impact of parental acceptance, on sexual and gender minority individuals, the development and testing of family- based interventions is warranted (Pachankis & Goldfried, 2004; Parker et al., 2018).”

“Given the negative impact of parental rejection, and the positive impact of parental acceptance, on sexual and gender minority individuals, the development and testing of family- based interventions is warranted (Pachankis & Goldfried, 2004; Parker et al., 2018).”

“K E Y W O R D S bisexual, family therapy, gay, gender minority, lesbian, parental acceptance, parental rejection et al., 2004; Feinstein et al., 2014; Floyd et al., 1999; Grossman et al., 2005; Haas et al., 2010; Hershberger & D’Augelli, 1995; Needham & Austin, 2010; Ryan et al., 2010; Savin-…”

“…gay- related rejection by others (Pachankis et al., 2008), increased risk for depression and suicidal ideation (Haas et al., 2010; Ryan et al., 2009; VanBergen & Love, 2022), and higher levels of drug and alcohol consumption (D’Amico & Julien, 2012; Padilla et al., 2010; Rothman et al., 2012).”

“Effect sizes were estimated following the procedure outlined in Arntz et al. (2013); see also Shahar et al., (2017).”

“Not surprisingly, LGBTQ+ young adults report that their parents’ support is important to them, and that they want their parents’ genuine acceptance and active involvement in their lives (Denes & Afifi, 2014; Roe, 2016).”

“…gay- related rejection by others (Pachankis et al., 2008), increased risk for depression and suicidal ideation (Haas et al., 2010; Ryan et al., 2009; VanBergen & Love, 2022), and higher levels of drug and alcohol consumption (D’Amico & Julien, 2012; Padilla et al., 2010; Rothman et al., 2012).”

“Based on previous research on ABFT and other family- based treatments (Diamond et al., 2021; Friedlander et al., 2021; Liddle et al., 2001), we expected these gains to be maintained when measured three months post- treatment.”

“…accept their child's same- sex orientation or gender identity, while at the same time refuse to meet their child's romantic partner, or ask their child to continue to conceal their sexual orientation or gender identity from others (Johnson et al., 2020; Livingston & Fourie, 2016; Martin, 2016).”

“…E Y W O R D S bisexual, family therapy, gay, gender minority, lesbian, parental acceptance, parental rejection et al., 2004; Feinstein et al., 2014; Floyd et al., 1999; Grossman et al., 2005; Haas et al., 2010; Hershberger & D’Augelli, 1995; Needham & Austin, 2010; Ryan et al., 2010; Savin-…”

“…studies lend support for many of the model's purported change mechanisms, including emotional processing (Diamond et al., 2016; Lifshitz et al., 2020), increases in parental psychological autonomy granting behaviors (Shpigel et al., 2012) and corrective attachment episodes (Tsvieli et al., 2021).”

“They differed from most parents, who tend to become more accepting over time even without therapy (Beals & Peplau, 2006; Grossman et al., 2005; Samarova et al., 2014; Savin- Williams & Ream, 2003).”

“Therefore, Israeli young adults face the challenge of negotiating their increased autonomy within the context of ongoing relationships with their parents and other family members (Shulman et al., 2005).”

“Not surprisingly, LGBTQ+ young adults report that their parents’ support is important to them, and that they want their parents’ genuine acceptance and active involvement in their lives (Denes & Afifi, 2014; Roe, 2016).”

“The TBRS has been found to be reliable in a number of previous studies (Diamond et al., 2007; Hogue et al., 2008).”

“During the training, therapists read the ABFT- SGM manual (Diamond & Boruchovitz- Zamir, in press; Diamond, Boruchovitz- Zamir, et al., 2019), and clinical papers on working with SGM young adults and their persistently nonaccepting parents (Diamond & Shpigel, 2014).”

“Importantly, although parental rejection and acceptance are related constructs, they are distinct (Kibrik et al., 2019; Perrin et al., 2004; Roe, 2016).”

“ABFT has also been adapted for, and successfully tested with, LGBTQ+ suicidal and depressed adolescents in the United States (Diamond et al., 2012; Russon et al., 2021) and Israeli young adults suffering from unresolved anger toward a parent (Diamond et al., 2016).”

“ABFT has also been adapted for, and successfully tested with, LGBTQ+ suicidal and depressed adolescents in the United States (Diamond et al., 2012; Russon et al., 2021) and Israeli young adults suffering from unresolved anger toward a parent (Diamond et al., 2016).”

“…accept their child's same- sex orientation or gender identity, while at the same time refuse to meet their child's romantic partner, or ask their child to continue to conceal their sexual orientation or gender identity from others (Johnson et al., 2020; Livingston & Fourie, 2016; Martin, 2016).”

“…studies lend support for many of the model's purported change mechanisms, including emotional processing (Diamond et al., 2016; Lifshitz et al., 2020), increases in parental psychological autonomy granting behaviors (Shpigel et al., 2012) and corrective attachment episodes (Tsvieli et al., 2021).”

“…of process research studies lend support for many of the model's purported change mechanisms, including emotional processing (Diamond et al., 2016; Lifshitz et al., 2020), increases in parental psychological autonomy granting behaviors (Shpigel et al., 2012) and corrective attachment episodes…”

“…accept their child's same- sex orientation or gender identity, while at the same time refuse to meet their child's romantic partner, or ask their child to continue to conceal their sexual orientation or gender identity from others (Johnson et al., 2020; Livingston & Fourie, 2016; Martin, 2016).”

“The public health, mental health, and higher education (and K-12) communities are urged to act by supporting the hiring of professionals with training and expertise in LGBTQ+, antiracism, intersectionality, and social justice concerns as well as the dissemination of existing minority stress reduction (26,27) and famil…”

“Target­ ing Attachment-Based Family Therapy at high-yield subgroups, e.g., LGBTQI+ youth with non-accepting parents, could thus be beneficial (G. M. Diamond et al., 2022; Russon et al., 2023).”

“45 Adaptations of this type of intervention could be promising for MSM in China.”

“Interventions are needed to prevent sexual minority youths ’ early and ongoing experiences of threats to social safety, such as bullying (Earn-shaw et al., 2016), discrimination (Hatzenbuehler and Pachankis, 2016), and parental non-acceptance (Diamond and Aspinwall, 2003; Diamond et al., 2022).”

“ABFT provides opportunities for the therapist to work with the parents of teens who identify as SGMs to process any fears and worries they may have for their teen and themselves, possibly grieve lost social support, reduce rejecting behavior, and increase accepting behaviors, if possible (50, 61, 74).”

“In addition, ABFT has increased parental acceptance, decreased rejection, and improved adolescents’ attachment avoidance amongst sexual and gender minority young adults with non-accepting parents [38].”

“…2022; National Association of Diversity Officers in Higher Education [NADOHE], 2021) in higher education spaces; and (c) increase dissemination of family acceptance resources, such as attachment-based family therapy for LGBTQ + young adults and their nonaccepting parents (Diamond et al., 2022).”

“Diamond et al., 2022)”

“Multiple studies have shown high acceptability and feasibility of ABFT for both adolescents and emerging adults [20, 24–27].”

“…family therapy that specifically addresses the dynamics or stressors related to a child’s LGBTQ + identity, providing psychoeducation on LGBTQ + issues, and helping parents and caregivers navigate their emotional responses to their child’s identity (e.g., Diamond et al., 2022; Russon et al., 2021).”

“In a previous analysis of the entire sample from the open clinical trial, linear models showed the best fit for young adults' reports of perceived parental acceptance and rejection (Diamond et al. 2022).”

“As the father‒son relationship plays a particularly important role in shaping the psychosocial characteristics and mental health of sons [15–17], especially in China, where fathers serve not only as emotional supporters but also as primary transmitters of traditional values and gender role norms…”

“Data was drawn from 26 families who had received 6 months of ABFT-SGM as part of a previous open clinical trial conducted in Israel (Diamond et al., 2022).”