How ANT Works

An integrative approach

ANT brings together attachment theory, narrative and systemic family therapy, and current understanding of the neurobiology of trauma. It recognises that change happens at multiple representational levels (procedural, sensory, semantic, episodic and integrative), and so makes active use of activities, visual material, drawing, objects and play-based approaches.

Developing curiosity and collaborative formulations is central to the work. Formulations are shared with families in plain everyday language to communicate attachment, narrative and systemic ideas, using a reflecting format that encourages curiosity and invites suggestions for change in a continual, collaborative process.

Many of the families seen in this work have not experienced secure attachments, and many are influenced by histories of trauma. While initial formulations broadly draw on deactivating (dismissing) and hyper-activating (pre-occupied) strategies, in practice family members often rely on more complex, self-protective mixed strategies shaped by trauma.

The four phases of ANT

ANT is broadly organised into four phases. These are not distinct: they overlap, and there is no clear line between exploration and change, since each can prompt the other.

• Co-creating a secure base.
• Exploring strengths and difficulties.
• Contemplating and attempting change.
• Maintaining changes, contemplating the future and ending therapy.

Phase 1: Co-creating a secure base

Attending family therapy can be anxiety provoking, and a focus on safety runs throughout ANT. Early engagement includes greeting each family member and explaining the session, its structure and the reflecting-team process; problem-free social talk about interests; and a gentle exploration of the reasons for attending.

Formats used at this stage include the family attachment genogram and tracking a pleasurable activity or a moment that went well. An initial formulation begins to take shape, considering each member's preferred self-protective strategies and who it is most important to build a strong therapeutic relationship with. The phase closes with reflective feedback in both directions and, if welcomed, suggestions for between-session activities.

Phase 2: Exploring strengths and difficulties

Sessions begin with feedback from the family, including any observations or activities between sessions. The Formats are used recursively to enrich the family's narratives, starting with behaviours before moving to feelings and thoughts.

Formats commonly used here are tracking a problematic sequence, sculpting relationships with objects, corrective and replicative intentions, and work on transitions, partings and separations. The formulation develops to consider triadic processes, core attachment dilemmas, and the patterns of giving and receiving comfort within the family.

Phase 3: Contemplating and attempting change

Building on the exploration of Phase 2, the Formats now turn towards change. Tracking a problematic sequence shifts to how the difficult parts of a cycle might be done differently, often using role play and between-session experiments. Sculpting and work on intentions focus on altering dynamics such as triangulation, and on how we can be pulled into repeating patterns despite our intentions.

The formulation continues to develop, considering what is enabling or holding back change, and the attachment conflicts and traumas that may be fuelling difficulties.

Phase 4: Maintaining changes, contemplating the future and ending

As sessions begin to reduce or draw to a close, there is space to reflect on how the family approaches endings and separations, and on future opportunities and challenges. Sculpting is used to look at how relationships have changed over time and to map future relationships, and work on transitions and separations reflects on how the ending of therapy compares with past endings.

Attention turns to what the family will take away, what the family and therapist will hold in mind about one another, and how the activities might help the family manage future challenges, including any follow-up contact.

Formats for Exploration

The Formats for Exploration are the practical, visual and activity-based tools at the heart of ANT.

The family attachment genogram

A visual family tree, drawn on a large sheet of paper, that children can enjoy helping to create. Once drawn, it opens up exploration of who is close to whom, who people turn to for support, the dangers families have faced across generations, and the traditions and changes in how people manage feelings and distress.

Tracking a problematic or positive sequence

Working from a specific, recent example, one family member describes the episode, beginning with actions, before others comment. The exploration then identifies the thoughts and feelings involved, focuses on the critical part of the pattern, considers alternative responses, and looks for trans-generational connections to similar or different patterns in family histories.

Sculpting relationships with objects

Using buttons, stones, coins or figures, the family maps current, past and future attachment patterns, who looks after whom, and how it feels to be at the centre, on the edge, or between others. This helps identify attachment dilemmas such as triangulation and conflicting loyalties.

Corrective and replicative intentions

An exploration of the key ways family members wish to repeat or change aspects of their parenting, or how they relate to one another as a couple, and of how we can be drawn into repeating patterns despite our best intentions.

Transitions, partings and separations

Connecting with the family life cycle, this format explores significant changes and separations, such as starting school, leaving home, the end of relationships, divorce and loss. It considers how these were prepared for, discussed and understood, and what people would like to do similarly or differently in future.