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Cognitive Behaviour Therapy for Children and Adolescents: Can Attachment Theory Contribute to Its Efficacy?

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Abstract

Meta-analyses consistently demonstrate that cognitive behaviour therapy (CBT) provides effective evidence-based treatment for children and adolescents with emotional and behaviour problems. Also consistent across meta-analyses is the observation that CBT treatment effects are often medium in size. This observation has instigated a search for factors that could help explain the limited treatment effects and that could be focused upon to enhance CBT treatment outcomes. The current qualitative review focuses on the parent–child attachment relationship as one factor that could be relevant to enhance CBT treatment effects. This review first acknowledges reasons why CBT has historically not been attracted to attachment theory and its postulates. Second, recent evidence is examined to evaluate whether attachment can be approached from a cognitive schema perspective. Subsequently, research is described showing how restoring attachment relationships could result in large treatment effects. Finally, this evidence is integrated in a model of attachment assessment and intervention that might be compatible with CBT. In sum, this review suggests that restoring trust in insecure parent–child attachment relationships can be integrated within CBT and could contribute to its treatment outcomes.

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Notes

  1. To ensure anonymity of patients, none of the cases reflect actual patients. The examples are drawn from clinical practice, but altered and combined in the two currently presented cases to provide readers with clinically relevant illustrations of the theory.

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Acknowledgments

This research was supported by Grants G.0934.12 and G.0774.15 of the Research Foundation Flanders (FWO), Grants OT/12/043 and CREA/12/004 from the Research Fund KULeuven, Belgium. The author would like to thank Laurence Claes for her extensive feedback on different versions of the manuscript.

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  1. Parenting and Special Education Research Group, KU Leuven, L. Vanderkelenstraat 32, 3000, Louvain, Belgium

    Guy Bosmans

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Bosmans, G. Cognitive Behaviour Therapy for Children and Adolescents: Can Attachment Theory Contribute to Its Efficacy?. Clin Child Fam Psychol Rev 19, 310–328 (2016). https://doi.org/10.1007/s10567-016-0212-3

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