Functional Family Therapy International Certification Program
Clinical Training 1 Thomas L. Sexton, Ph.D., ABPP Indiana
University
Slide 2
Conflict of Interest The presenter of this information is
required by Indiana University to reveal a potential conflict of
interest. He is an owner of a training program that receives income
from that activity, his primary writing and scholarly work is in
this area, and he promotes this particular model of therapy. The
presenter of this information is required by Indiana University to
reveal a potential conflict of interest. He is an owner of a
training program that receives income from that activity, his
primary writing and scholarly work is in this area, and he promotes
this particular model of therapy.
Slide 3
FFT is unique in the EBP World and evidence based treatment
that is: Purposefully Creativity Purposefully Creativity Flexibly
Structured Flexibly Structured Model focused and Client Centered
Model focused and Client Centered Change that is guided by the
model.driven by the Familywith respect for how the family functions
Change that is guided by the model.driven by the Familywith respect
for how the family functions inside out approach inside out
approach Requiring a creative therapist Requiring a creative
therapist Aided by. Aided by.
Slide 4
The FFT Story Evolution in Theory Evolution in Theory Evolution
Through Practice Evolution Through Practice Diverse
cultures/communities (African American, Hispanic, Vietnamese,
Chinese, Haitian, Dutch) Diverse cultures/communities (African
American, Hispanic, Vietnamese, Chinese, Haitian, Dutch) Diverse
clients and therapists Diverse clients and therapists Multiple
Languages (8 different languages: English, Spanish, Mandarin,
Creole, Dutch, Moroccan, Turkish, Sudanese, Russian) Multiple
Languages (8 different languages: English, Spanish, Mandarin,
Creole, Dutch, Moroccan, Turkish, Sudanese, Russian) Urban/Rural
Urban/Rural Evolution through Science Evolution through Science
Clinical outcome studiesdoes it work? Clinical outcome studiesdoes
it work? Process studieswhat works? How does it work? Process
studieswhat works? How does it work?
Slide 5
Common Factors FFT Principles of Good Practice Common Factors
-therapeutic relationship -hope/expectation -ritual of practice
Unique Features - Clinical Protocol -relationally focused process
-specific change mechanisms -for specific problems
Slide 6
To be successful with youth and their families FFT relies on
1.Guiding Theoretical Principles Conceptual, philosophical, and
emotional center of the model Conceptual, philosophical, and
emotional center of the model Parameters within which FFT occurs
Parameters within which FFT occurs 2.A Clinical Map Systematic
process of therapeutic change Systematic process of therapeutic
change Specific goals, objectives, and therapist activities
Specific goals, objectives, and therapist activities Mechanisms of
change Mechanisms of change 3.System Support Systematic, model
based clinical supervision Accountability Quality assurance methods
Management/treatment responsibility/supervision/clinical decisions
FFT based (FFT/CFS) Management/treatment
responsibility/supervision/clinical decisions FFT based
(FFT/CFS)
Slide 7
How we do training In ways that match adult learning theory
research In ways that match adult learning theory research Diverse
methods Diverse methods Sequenced over time Sequenced over time
Repeated within increasing specificity Repeated within increasing
specificity Goal: adherence & competency in FFT Goal: adherence
& competency in FFT Thinking through the lens Thinking through
the lens Following the map Following the map Creativity within the
structure Creativity within the structure
Slide 8
38%* reduction in felony crime38%* reduction in felony crime
50%* reduction in violent crime50%* reduction in violent crime
$10.67 return for each $1 invested$10.67 return for each $1
invested $2100 per$2100 per family cost to implement Clinical
Outcomes & Model Adherence Washington State Project *
Statistically significant outcome Adherence to the Model as a
vehicle to Meet the needs of the client
Slide 9
Training Process Phase I: Learning the Clinical Model Phase I:
Learning the Clinical Model Clinical Training Clinical Training
Ongoing Consultation/Supervision Ongoing Consultation/Supervision
Continuous Quality Improvement (Q-System use) Continuous Quality
Improvement (Q-System use) practical training/observation practical
training/observation Phase II: Site Clinical Supervisor Training
Phase II: Site Clinical Supervisor Training Site supervisor Site
supervisor Training to prevent model drift Training to prevent
model drift Continuous Quality Improvement (Q-System use)
Continuous Quality Improvement (Q-System use)
Slide 10
Functional Family Therapy is unique
Slide 11
The LENS of FFT Systemic foundation Systemic foundation
Pragmatic focus on how the family functions Pragmatic focus on how
the family functions Our inside out approach Our inside out
approach
Slide 12
Lens are.. Explicit or implicit, Principles /theory that
explain Explicit or implicit, Principles /theory that explain
clients, therapy, and change, and a systematic clients, therapy,
and change, and a systematic how clients function, how clients
function, how psychological problems develop, how psychological
problems develop, how to help people change, how to help people
change, and the interrelationship among these factors and the
interrelationship among these factors FFT tries to make these
principles explicit, practical, and relevant to clinical change FFT
tries to make these principles explicit, practical, and relevant to
clinical change
Slide 13
Internal World Biological Substrate/Learning History/individual
traits Clinical Symptoms/Behaviors Family Relational System
Ecosystemic System Peer/school/community/extended family
Ecosystemic System Peer/school/community/extended family ( Sexton,
2010 ) The Multisystemic Focus of Functional Family Therapy Change
the probably of future behavior problems Primary entry/ focus Point
of immediate, relevant, and lasting change Functional Orientation -
inside out conceptualization
Slide 14
Systemic Foundation Basic Unit of Analysis Family Child
Mother/Figure Child Father/ Figure Finding the function of the
symptom in the relational system Relational patterns Relational
patterns Coalitions/alliance within patterns Relational information
and its movement through the system Relational information and its
movement through the system What is the root cause Physical
(genetics/brain function) Physical (genetics/brain function)
History (trauma/background) Learning History Learning History
Etc.
Slide 15
A matter of figure & ground
Slide 16
Systemic Foundation Relational Patterns Mo m Son Dad Relational
Patterns are common ways of working in families that involve
everyone Relational Patterns are common ways of working in families
that involve everyone Problem sequences.are are common across
content Problem sequences.are are common across content Maintain
and support the problem behavior Maintain and support the problem
behavior Point of intervention and change Point of intervention and
change
Slide 17
Anja: Peter have you doneyou know you are getting behind.you
need to take some responsibility (escalating the longer he doest
answer) Peter: Whatever.later, I am going out., Iall be home..
Anja: there is no going out for you.it just inst good for you..you
know you cant say no to those friends of yours Peter: At least I
have friendslater he goes out. Anja: (to her husband)I cant do
anything with himand you dont help. I would at least like your
support Anja: is hurt by his commentgoes to her roomwatches
TVworries and feels bad about her situation Stepfather: continues
watching the football gameworries about his wifegets angry with
Peter.. Peter: (comes home 5 hours late. Comes in the house and
goes upstairson the stairs his mother comes out of her room
Stepfather: I am tired of thiswhat is the matter with youdont you
know how this hurts your mother? Peter : Fuck off.. the typical
argument ensues until Peter goes to his room Anja: What are we
going to do..I cant take this any more Peter: I am sorry Mombut, I
can handle it Anja: I just worry about you (she feels comforted
that he understands) Peter: I can handle it Momjust keep that
bastard away from me (he feels better about his Mom.he directs his
anger at his step father.). The next night he goes out again.
Stepfather: When she talks, he continues to watch to TV..he listens
quietly and saywhat do you want me to dohe wanst raised right
Slide 18
Mom/mother figure Dad/father figure Adolescent Problem Behavior
Problem definition -what/who the problem is Emotional Reactions
(negativity) -why its an important problem Behaviors -what should
be done about it Problem definition -what/who the problem is
Emotional Reactions (negativity) -why its an important problem
Behaviors -what should be done about it Problem definition
-what/who the problem is Emotional Reactions (negativity) -why its
an important problem Behaviors -what should be done about it
Slide 19
Relational Functions Functional outcomes of these patterns
Relational glue Stable and consistent Mom/mother figure Dad/father
figureAdolescent Clinical Symptoms Match to The goal. Reduce the
future Probability of the problem behavior Targets of Change
-underlying patterns of FAMILY behavior
Slide 20
Relational Functions Goal..understand and use Attempting to
change these basic motivational components of human behavior in
just a few sessions is clinically impossible and ethically
inappropriate When X relates to Y, the typical relational pattern
(behavioral sequence within the relationship ) is characterized by
degrees of: Relatedness .contact vs. distance (psychological
interdependence) Hierarchy .relational control/influence
Slide 21
When X relates to Y, the relational pattern (behavioral
sequences in the relationship ) of Xs behavior is characterized by:
RelationalIndependenceAutonomy:distance,Independence,disengagement
(Fear of Enmeshment?) highlow Interdependency: closeness,
dependency, enmeshment (Fear of abandonment?) lowhigh 1 2 45 3 Mid-
pointing 3 Mid- pointing
Slide 22
Its not the specific behavior.. but the functional-relational
pattern it represents.behaviors and their possible interpersonal
(relatedness) functions
RelationalIndependenceAutonomy:distance,Independence,disengagement
high low high Withdrawing passively Being cold, sarcastic,
rejecting Substance Abuse Having childhood phobias, Being insecure
Being depressed Double dating Being hysterical Teenage runaway
Contact: closeness, dependency, enmeshment, (Fear of abandonment?)
Visible self mutilation ideal balanced adult Having many jobs and
outside activities Giving considerable Nurturance, warm &
loving Focused/successful professional Positive Behaviors Negative
Behaviors
Slide 23
P A P A P P A A P P A A One-upOne-up Symmetrical Relational
Hierarchy pattern of relationship determination over time When X
relates to Y, the relational pattern (behavioral sequences in the
relationship ) of Xs behavior is characterized by: Degree to which
on person Determines the relationship Degree to which on person
determines the relationship Symmetrical: Exchange = Behaviors 1-up
+ 1-up P P A A
Slide 24
Relational factors...What to do about relatedness functions
Goal: identify relational functions.use these as Pathways to
changeways to implement behavior changes Goal: identify relational
functions.use these as Pathways to changeways to implement behavior
changes Match to.relational functions Match to.relational functions
To do so To do so discrepant functions are accommodated all
functions are accepted as legitimate generally dont change
functions.. ..change the behavior, affect, and
cognitive/attributions related to the expression of the function
goal is to provide alternative ways of expression Use to match to
behavior change interventionoutcome sample
Slide 25
Use of Relational Functions Matching to the family in Matching
to the family in Reframing Organizing themes Behavior change
implementation How to generalize, maintain, & support
changes
Slide 26
Mom/mother figure Dad/father figure Adolescent Current behavior
makes sense in light of Current behavior makes sense in light of
What people bring with them What people bring with them Where
people come from (relational context) Where people come from
(relational context) Types of relationshipswith parents/family What
people are made of .(biological context) What people are made of
.(biological context) The environment in which they live (
ecosystemic context) The environment in which they live (
ecosystemic context) Peers/schools/mental health system/community
Interactional Relationships Core family/dyad stable relational
patterns Relational sequences/problem sequences What people bring
to relational systems
Slide 27
When you know what families bring You can: You can: Better
understand what is important Understand family reactions to events
Acknowledge and reframe Organizing themes that match to them Find a
way to make therapy relevant
Slide 28
When you think relationally Clinical problems are NOT because
of: Clinical problems are NOT because of: the family/youths anger
the family/youths lack of motivation We expect them to be
discouraged, lack motivation, angry, unhappy with the systems We
expect them to be discouraged, lack motivation, angry, unhappy with
the systems history or biology peers bad choices inability to just
say no mental health issues Drug abuse
Slide 29
Based on the individuals problem definition Based on the
individuals problem definition Comes from Family has been
functioning for some time.encountered problem that has become part
of the family.now functions as a central part of how they relate
Family has been functioning for some time.encountered problem that
has become part of the family.now functions as a central part of
how they relate Not what they want Not what they need They way in
which they have come to be in response to the problem Clinical
Problems
Slide 30
Family problems are relational problems In their attempt to
solve/deal with the problems. Family come to therapy with a
definition of what is the problem Family come to therapy with a
definition of what is the problem Result of each family members
experience and thinking/working to understand their life/problems
Natural part of finding a solution This definition is usually: This
definition is usually: focused on a person ( attributional
component ) has negativity attached( emotional component ) is
accompanied by blaming interactions that have become central to the
relational patterns of the family ( behavioral component )
Slide 31
What therapy changes Individual Mom/mother figure Dad/father
figure Adolescent 1. Most critical issue solvedand 2. Prepared for
the next problem -cope/deal with in a new way -empowered with a way
To solve future
Slide 32
The MAP The Clinical Protocol The Clinical Protocol Goals,
Directions Goals, Directions Pathway of change Pathway of change
Relational & process focus Relational & process focus
Slide 33
Clinical Model Motivation Intervention Assessment Engagement
Behavior Change Generalization Generalization EarlyMiddleLate Goals
Alliance between family with therapist Family/relationally based
problem problem focus Reduced family member negativity/blame
Increased motivation Goals Increase behavioral competency of
all/family Consistent performance of competency in real problem
situation Goals Generalize new view and experience of problem with
new problem that arise Maintain new skill - working together with
new problems Support changes by using relevant outside
resources
Slide 34
Engagement & Motivation Phase
Slide 35
Motivation Goals : 1.lower within family blame and negativity
2. Increase within family alliance 3.family focus to the presenting
problem Intervention Assessment Engagement Early Outcomes When they
Interact and solve problems it is with: Alliance Alliance
Family/relationally based problem problem focus Family/relationally
based problem problem focus Reduced negativity/blame Reduced
negativity/blame Shared responsibility and ownership Shared
responsibility and ownership Engagement/Motivation Phase
Slide 36
Engagement For positive participation a discussion that is
relevant (about what is important) that involves trust, respect and
alliance (e.g., core relational skills, acknowledgement) Motivation
Not only to participate in therapy, but to undertake the specific
behavior change steps designated by therapist ( e.g., Reframing,
Theme Developing Skills)
Slide 37
Engagement/Motivation Sessions Goals reduce within family blame
reduce within family blame reduce within family negativity reduce
within family negativity build therapeutic alliance build
therapeutic alliance redefine problem as family focused redefine
problem as family focused increase hope/expectation for change
increase hope/expectation for change Assessment problem definitions
problem definitions Problem sequence Problem sequence How they
function or work together How they function or work together
Interventions reframing reframing Develop an organizing theme that
is family focused Develop an organizing theme that is family
focused diverting and interrupting diverting and interrupting
structuring session to discuss relevant topics structuring session
to discuss relevant topics
Slide 38
Implementing Engagement/Motivation Phase E/M Phase Functional
Family Therapy Goal Engagement in therapy Motivation to try
something new/engage in change Family focused
experience/understanding of the problem New Problem Situation New
Problem Situation New Problem Situation Help the family develop a
climate of working together to solve problem -Individual
responsibility for some Part of/role in the problem -new
definition/understanding of the problem -reduction in negative
feelings blaming H Help the family develop a climate of working
together to solve problem -Individual responsibility for some Part
of/role in the problem -new definition/understanding of the problem
-reduction in negative feelings blaming Help the family develop a
climate of working together to solve problem -Individual
responsibility for some Part of/role in the problem -new
definition/understanding of the problem -reduction in negative
feelings blaming New Problem Situation
Slide 39
What to hear FFT therapists try to hear something different :
FFT therapists try to hear something different : 1.Hear
attribution, emotion, and behavioral pattern as central element
underlying the presenting problem 2.Hear risk and protective
factors embedded in this pattern that increase the likelihood of
clinical problems 3.Think.family relational pattern Common/central
pattern that is at the foundation of the many different presenting
problems Common/central pattern that is at the foundation of the
many different presenting problems
Slide 40
Engagement/Motivation Goals Developing motivation and alliance
Creating a family focus to the presenting problem Creating a family
focus to the presenting problem Redefine the problem (away from
presenting one) Family enters with problem definition that is part
of what has them stuck Family enters with problem definition that
is part of what has them stuck New problem definition that is less
blaming, negative, and individually focused New problem definition
that is less blaming, negative, and individually focused Create a
relational focus--a family focus for the problem Create a
relational focus--a family focus for the problem Each family member
has a part (responsibility without blame)everyone involved in some
way Each family member has a part (responsibility without
blame)everyone involved in some way Each part linked to the
challenge that the family currently faces (family focused) Each
part linked to the challenge that the family currently faces
(family focused) Sets the stage for different solutions (behavior
change) Sets the stage for different solutions (behavior change)
thus, minimize hopelessness, ready family to take responsibility
for trying new skills and making behavioral changes
Slide 41
Initial Presenting Problem Definition - attributional aspect
-emotional valence -related behavioral patterns Comes from: Each
individuals unique History/experience with problem, natural
attempts to understand/ make sense, solve the problem Adolescent
Initial Presenting Problem Definition - attributional aspect
-emotional valence -related behavioral patterns Mother Initial
Presenting Problem Definition - attributional aspect -emotional
valence -related behavioral patterns Father Initial Presenting
Problem Definition - attributional aspect -emotional valence
-related behavioral patterns Each feels misunderstood, blames the
other, Thinks the other is the problem, works toward a different
solution Goal: Redefine each toward a common family focused
definition That is - different from each individual definition
-common to all -Where all have responsibility -No one has blame Not
compromising mediating or negotiating Family Focused Problem
definition Accomplished Through relentless relational Reframing The
Outcome: Motivation, negativity reduction, Family to family
alliance, Therapist to family alliance Accomplished Through
relentless relational Reframing Accomplished Through relentless
relational Reframing
Slide 42
Two direction ways to reduce negativity and blame Change the
meaning of the behavior of the other Change the meaning of the
behavior of the other Build Responsibility in the speaker/blamer
Build Responsibility in the speaker/blamer
Slide 43
Engagement/Motivation Phase purposeful, therapeutic
conversations Individual Responsibility Time.. Family Therapist
Between family member negativity/blame Personal conversation that
is direct about the most important issues to the family
Therapist
Slide 44
Relational Process of Reframing Acknowledge Reframe Impact
Assess acceptability/fit Change/continue Making it fit the
client
Slide 45
Relational Process of Reframing Acknowledgment of: - exhibited
emotion -participation, effort Description of: - current
behavior/event taking place between people/ between people/ with
one person in the session --reported event/behavior either between
family or of one person Identification of: -important values,
beliefs, desires Themes: 1.Hurt behind the anger 2.Protection
3.Anger is loss 4.Speaking out represents Independence .as
beginning points to understanding of Persons, situations, etc.
1.Meaning - attribution -event-emotion (reduces negativity/blame)
2.Find the Noble Intent 3.Link family members together together
members together In struggle/problem (builds family focus/
Interdependence) Listenlistenlisten Acknowledge Reframe Impact
Build on/continue Building theme that fits Theme hint ( best
guess/hypothesis) Description, statement, question Suggesting
alternative theme Theme A new explanation based on 1.Changed
Meaning 2.Reduced negativity/ blame possibilities for change
3.Linked together in Problem and future solution as all having some
responsibility/ownership for the problem and solution
Slide 46
Why Reframes & Themes Work Respect based Reframing
Acknowledge (yes.) Acknowledge (yes.) What they just said is
important.. frames the situation/problem/event that is the target
What they just said is important.. frames the
situation/problem/event that is the target Specifically/directly
what happened ( yes that is what is happened here) Identifies a
specific event, emotionbehavior that has happened in the room of
what has been reported What you guess to be important to them What
you guess to be important to them What you guess to be the most
important value/aspect of what happened Determined from what they
bring to the table Comes from what you heardassumedguessed about
the reason this is so important to them
Slide 47
Why Reframes & Themes Work Respect based Reframing Reframe
(and.)what you add to the session Reframe (and.)what you add to the
session Alternative meaning for what was acknowledged Alternative
meaning for what was acknowledged what might be behind or the
reason what might be behind or the reason Focus Focus Person
focused (their part) Family focused (all of the parts) ( yes that
is what is important here) Non-blamingjust an alternative
description Non-blamingjust an alternative description
Non-interpretative Non-interpretative Doesnt explain awayor
excuse.DESCRIBES theme hintjust a guess theme hintjust a guess
Based on what you have heard, what you know about them, what is
common to adolescents Over time. Built a theme about the family
that is more inclusive than this one event/situation Over time.
Built a theme about the family that is more inclusive than this one
event/situation
Slide 48
Some examples Hurt behind the anger Hurt behind the anger Anger
is hurt Anger is hurt Control is protection Control is protection
Etc. Etc. How would you say it..(acknowledge & reframe) He is
independentand has mistakes He is independentand has mistakes
Independent but safe Independent but safe Parents to help him be
so.and protect him and teach him in the process Parents to help him
be so.and protect him and teach him in the process Parents with a
lot going ontrying to find way to help..an independent youth
Parents with a lot going ontrying to find way to help..an
independent youth
Slide 49
Some examples A boys is very angry A boys is very angry A girl
is . A girl is . A mother is hopeless. A mother is hopeless. The
youth is quiet. The youth is quiet. The family is in chaos.. The
family is in chaos.. Acknowledge & Reframe Acknowledge &
Reframe
Slide 50
Mom/mother figure Dad/father figure Adolescent Clinical
Symptoms Problem definition -what the problem is, why its an
important problem -what should be done about it Behaviors -role in
the problem sequence, the part they play -their responsibility
Problem definition -what the problem is, why its an important
problem -what should be done about it Behaviors -role in the
problem sequence, the part they play -their responsibility Problem
definition -what the problem is, why its an important problem -what
should be done about it Behaviors -role in the problem sequence,
the part they play -their responsibility Mother Therapist -Frame
this is important. -Acknowledge this is what is important to you?
-Reframe (and it means (theme hint) -change the meaning of what was
framed -individual responsibility -linked to the pattern -different
intention/ Meaning behind Tells what is important -about what you
said -about what you didnt Say -About the problem definition
Adolescent Therapist -Frame this is important. -Acknowledge this is
what is important to you? -Reframe (and it means (theme hint)
-change the meaning of what was framed -individual responsibility
-linked to the pattern -different intention/ Meaning behind Tells
what is important -about what you said -about what you didnt Say
-About the problem definition Father Therapist -Frame this is
important. -Acknowledge this is what is important to you? -Reframe
Tells what is important -about what you said -about what you didnt
Say -About the problem definition
Slide 51
Organizing Theme Frame Frame you are you are this is a family.
this is a family. Specific behavior/pattern Problem sequence
Specific behavior/pattern Problem sequence Reframe Reframe
Explanationgives different meaning of how they work and what is
going on between them reframes put together reframes put together
New story about what is going on in the family (describes different
reason for problem sequence) New story about what is going on in
the family (describes different reason for problem sequence) each
person.the familyhow linked together your part.what it means.how it
linked with othe rfamily members Complete, includes what is most
important to family, personal, specific in way that is individual
Complete, includes what is most important to family, personal,
specific in way that is individual
Slide 52
Engagement/Motivation Interventions reframing Reframing a
response to a CLIENT statement Reframing a response to a CLIENT
statement Acknowledge (acceptance/support of the intent, the
position, the values) of the client.. not agreementnot empathy. not
agreementnot empathy. Personal not general Personal not general
Reattribution of that statement (change in meaning) Building Themes
..reframing a CLIENT statement to: Building Themes ..reframing a
CLIENT statement to: Your hypotheses of a theme (theme hint) An
existing theme in the conversation Organizing Theme ..a theme that
describes: Organizing Theme ..a theme that describes: Each persons
motivate in non negative ways Links everyone in the family
together.to a common problem, challenge, of situation
Slide 53
What makes reframing work 1.feel the reframe Therapist able to
be the client and know what is importantthe nobel intention behind
the behavior Therapist able to be the client and know what is
importantthe nobel intention behind the behavior 2.believe the
reframe It is how you understand them It is how you understand them
3.linked to everyone else 4.Presented in a way that is With
acknolwedgement With acknolwedgement Respectful Respectful
Slide 54
Outcome Themes. Themes. 1. identify the noble intention 2. Set
the goals of therapy 3. Help you stay our of the weeds (details) 4.
Break negative relational patters 5. Provide positive attribution
6. Build a family focus (it is all of us)
Slide 55
Behavior Change Phase
Slide 56
Behavior Change Phase based Treatment Goals: 1.Build behavioral
competencies that fit the family 2. Target the most relevant,
obtainable, and maintainable competencies 3. Match competencies to
relational functions Intervention Assessment Behavior Change Middle
Outcomes Increase behavioral competency of all/family Increase
behavioral competency of all/family Consistent performance of
competency Consistent performance of competency in real problem
situation Behavior Change Phase
Slide 57
Behavior change sessions Goals Specify the behavior change
individualized plan Specify the behavior change individualized plan
Link BC targets to the organizing theme to build relevance and
motivation Link BC targets to the organizing theme to build
relevance and motivation Build compliance Build compliance match to
the client match to the client check if the BC target works to
solve conflict check if the BC target works to solve conflict
Assessment Identifying prosocial family based skill that fits
youth/family problem sequence Identifying prosocial family based
skill that fits youth/family problem sequence Find barriers to
adoption of BC skill Find barriers to adoption of BC skill
Determine if the target is being performed (compliance) Determine
if the target is being performed (compliance) Interventions
reframing reframing Modeling Modeling Teaching Teaching Overcome
barriers/adapt Overcome barriers/adapt
Slide 58
Discussion focused on: - homework, going out with peers, curfew
-specific spot in the sequence Problem Solving Communication -
direct and concrete communication Parenting - monitoring and
supervising Where they use: Work out problemsour focus is on their
process of doing so Parent Adolescent With components of. to
individualize to the family Targets of FFT Behavior Change
ConflictManagement
Slide 59
Implementing BC Phase BC Session New Problem Situation New
Problem Situation New Problem Situation Target a new skill that
fits the specific problem that brought them to therapy Changes the
Problem sequence central to way family functions Uses new skills in
problems that come up Target a new skill Target a new skill that
fits the specific problem that brought them to therapy Changes the
Problem sequence central to way family functions Uses new skills in
problems that come up Target a new skill that fits the specific
problem that brought them to therapy Changes the Problem sequence
central to way family functions Uses new skills in problems that
come up New Problem Situation
Slide 60
Behavior Change Targets 1.Is it Relevant? What would feel to
the family like success What make a difference 2.Is it Obtainable?
Can they do it Will it derail therapy because it is to hard 3.Does
it fit them Relational functions Organizing them
Slide 61
Techniques of Behavior Change Reframing Reframing Helps direct
family to shared, family focused action Helps direct family to
shared, family focused action Helps link behavior change to
organizing themestay focused Helps link behavior change to
organizing themestay focused Helps reduce negativity that arises
Helps reduce negativity that arises Building family competencies so
that the risk patterns central to family change. Building family
competencies so that the risk patterns central to family change.
Communication Communication Problem solving/negotiation Problem
solving/negotiation Conflict management Conflict management
Parenting (monitoring supervising) Parenting (monitoring
supervising) Single, individualized behavior change plan Single,
individualized behavior change plan Combination of individual
skills Combination of individual skills
Slide 62
Promoting new Behavioral competencies Not a curriculum approach
Not a curriculum approach Set of principles (in each area) that
serve as the basis of assessment of and and target development Set
of principles (in each area) that serve as the basis of assessment
of and and target development Principles used by the therapist to
construct a set of targets that match the unique family Principles
used by the therapist to construct a set of targets that match the
unique family Implemented within session in ways that match:
Implemented within session in ways that match: Relational functions
Relational functions Situation Situation Theme Theme
Slide 63
Discussion focused on: - homework, going out with peers, curfew
- -specific spot in the sequence Conflict Management Communication
- direct and concrete communication Parenting - monitoring and
supervising Where they use: Negotiating/ Problem Solving as a
family based resource Parent Adolescent With components of. to
individualize to the family Targets of FFT Behavior Change
Slide 64
Behavior Change interventions. How to implement behavior change
In sessions Planned through teaching/using a client issue Planned
through teaching/using a client issue Opportunitythrough an in
session incident Opportunitythrough an in session incident How How
Coaching, directing, teaching, aids As homeworka way to prevent in
the future
Slide 65
Generalization Phase
Slide 66
Generalization Phase Based Treatment Goals: 1.Reduce within
family risk factors 2. Lower within family blame and negativity 3.
Increase within family alliance & family focus Intervention
Assessment Generalization Late Outcomes Increase behavioral
competency of all/family Increase behavioral competency of
all/family Consistent performance of competency Consistent
performance of competency in real problem situation Generalization
Phase
Slide 67
Generalization Sessions Goals Generalize the BC target skills
to other areas Generalize the BC target skills to other areas
Maintain change through relapse prevention Maintain change through
relapse prevention Access external resources to support change
Access external resources to support change Interventions Relapse
prevention (if the family is falling back into problem behaviors)
Relapse prevention (if the family is falling back into problem
behaviors) Linking new problem situation to BC skill Linking new
problem situation to BC skill Linking family to relevant outside
resources Linking family to relevant outside resourcesAssessment
Identify external family systems to apply BC skills Identify
external family systems to apply BC skills Identify contextual
barriers to maintaining the BC target Identify contextual barriers
to maintaining the BC target Find areas to generalize Find areas to
generalize Identify relapse points Identify relapse points
Slide 68
Generalization Phase shifting focus In generalization two
points of attention Within the family: Within the family: Relapse
preventionRelapse prevention Generalization of
competenciesGeneralization of competencies Maintenance of
allianceMaintenance of alliance Outside the family: Outside the
family: family--environment interaction(interface)where the family
interacts with the community/environmentfamily--environment
interaction(interface)where the family interacts with the
community/environment Relationships between family (individual and
whole) and the communityRelationships between family (individual
and whole) and the community Use of behavioral competencies in
these relationshipsUse of behavioral competencies in these
relationships In order to use relevant available resources to
support changesIn order to use relevant available resources to
support changes
Slide 69
Ecosystemic System Peer/school/community/extended family
Ecosystemic System Peer/school/community/extended family ( Sexton,
2010 ) The Multisystemic Focus of Functional Family Therapy
Clinical Symptoms/Behaviors Family Relational System
Slide 70
Why the Generalization phase families take two steps when
making changes that are lasting: 1.Families change the relational
interactions and adopt alliance-based skills in their daily
interactions. 2.Families bring this same attitude and skill set to
other naturally occurring issues that confront the family. In this
step, the successful family becomes consistent over time and learns
to handle the emotional discouragement of relapses. In this step,
the successful family becomes consistent over time and learns to
handle the emotional discouragement of relapses.
Slide 71
Logic of Generalization Small changes can have a multisystemic
effect Small changes can have a multisystemic effect These changes
often dont happen naturally These changes often dont happen
naturally Specific strategies for: Specific strategies for:
generalizing new skills, generalizing new skills, maintaining
change, maintaining change, and supporting those changes with the
aid of informal and formal community support systems helps create
the necessary system change for long term success. and supporting
those changes with the aid of informal and formal community support
systems helps create the necessary system change for long term
success. Reduces: Reduces: Revolving door of treatment Revolving
door of treatment Relapse Relapse Future positive changes Future
positive changes
Slide 72
Give a man a fish and you feed him for a day; teach him to fish
and he feeds himself for life. Give a man a fish and you feed him
for a day; teach him to fish and he feeds himself for life. learn
to dig for the bait so that they can have the resources necessary
to be self-sufficient in managing the normal challenges of family
life.
Slide 73
Generalizing Change Primary Target Area/content focused on: -
homework, going out with peers, etc. New area Behavior Change Built
a competency to reduce a risk pattern -communication/problem
solving/ etc. Move competency to a new content area Move competency
to a new content area Going out With friends Homework Relationship
With sibling Time with boyfriend
Slide 74
Discussion focused on: How to maintain, support, and generalize
new climate, alliance, behavior changes MedicalEvaluation Psyc
Intervention Community/School - direct and concrete communication
Extended Family - monitoring and supervising Parent Adolescent Area
to support changes, add to changes, and places to generalize and
extend change Supporting Change
Slide 75
Maintaining Change Change process is a up and down experience
Change process is a up and down experience Often the down feels as
if it is a failure Goal is to reframe it as a normal experience in
the change process The goal.despite the current
failure/discouragement to begin the behavior changes again Build
confidence/efficacy in their ability to maintain changes.by: Build
confidence/efficacy in their ability to maintain changes.by:
Attribute change to the family Attribute change to the family
Responding to events they bring in by focusing on relapse
prevention Responding to events they bring in by focusing on
relapse prevention
Slide 76
Clinical Art Creativity within the structure Creativity within
the structure Therapists as translators Therapists as translators
Family based change through reliable change processes Family based
change through reliable change processes
Slide 77
Bringing Creativity to the Structure Client Centered Client
Centered Responsive to clients Responsive to client needs fit to a
client Artfully applied Artfully applied Require clinical
creativity and expertise
Slide 78
Contingent nature of phases...
Slide 79
Slide 80
Matching to. Match to.guides therapist clinical interventions
behavior Match to.guides therapist clinical interventions behavior
Model sets the process goal .match to helps us individualize how we
get to that goal to the unique family in front of us Match therapy
to family .How those goals are accomplished Unique solutions within
a structure model Unique solutions within a structure model
Slide 81
What does it take? A therapist that Looks through a lens Looks
through a lens Follows a Modelfollow the map Follows a Modelfollow
the map Creates and implements a unique case plan for each family
Creates and implements a unique case plan for each family Use in
the room experiences to promote change (change mechanisms) Use in
the room experiences to promote change (change mechanisms)
Creatively Adapt..... Creatively Adapt..... Matching to the client
Matching to the client adapting next response to adapting next
response to match client/context match client/context add what was
not understood/missed add what was not understood/missed Access
change....did it work? Access change....did it work?
Slide 82
Matching? Matching means Matching means Matching interventions
to family presentations Change meaning in ways consistent and
respectful of all family members Change meaning in ways consistent
and respectful of all family members Themes to generate hope Themes
to generate hope Working within families existing structures
Relational function matching Relational function matching Changing
patterns but not relational functions during Behavior Change
Changing patterns but not relational functions during Behavior
Change Making sure family links to external resources maintain
relational functions Making sure family links to external resources
maintain relational functions Ensuring all of this done in a manner
that fits the developmental, cognitive, and physical abilities of
all family members
Slide 83
Creativity within the Structure Continuous Quality Improvement
Progress notes, Session Plans & Process/Outcome Measures
FFT/CFS & model specific Feedback
Slide 84
Slide 85
FFT/CFS quality improvement system for Functional Family
Therapy Clinical Feedback tool. Clinical Feedback tool. Bring
information to youat a glance to help plan sessions Allows client a
voice in the progress Lets you know how to match to the family
Domains: Domains: Service delivery (the profile of how units of
service are delivered in FFT) Treatment planning (case
conceptualization and session planning) Model Specific Adherence
(treatment fidelity) FFT treatment progress & Process (impact
of treatment on client Outcomes ( Client reported outcomes of the
FFT treatment episode)
Slide 86
FFT/CFS continuous quality improvement system for Functional
Family Therapy Clinical Decisions & Adaptations that match to
immediate client needs immediate client needs Promote the most
efficient delivery of FFT Promote the most efficient delivery of
FFT FFT/CFS Clinical Markers Real Time Feedback Treatment Planning
(Progress Notes) Session Planning (Session Planning Guide) Client
Session Impact (immediat e family changes) Caregiver Strain
Questionnair e-Short Form (CGSQ-SF) TherapeuticAlliance(TA) Youth
Symptom and Functioning (SFSS) Session Baseline Family Functioni ng
(Com-R) Post Treatment Family Functionin g Measure (Com-R) (Com-R)
Model Specific Adherence (CQP) Motivation Engagement Behavior
Change Generalization Generalization Session