functional family therapy

Question 1

information about the impact of functional family therapy

Answer 1

Most recognized and evidence supported kind of therapy, taking concepts from other therapies and putting them in a more regulated way, have done experiments to see if there are positive outcomes

Question 2

why is it called “functional”

Answer 2

Each behavior serves a function.
-It serves a purpose for the family if I help them remove it, I better come up with some sort of alternative

All behaviors are, in a manner, adaptive (rather than being good or bad)

There are interpersonal payoffs to the behavior
-Contact/closeness (merging)
-Distance/independence (separating)
-Combination of the two (mid-pointing)

Question 3

externalizing behaviors

Answer 3

-Most common clinical referrals among adolescents are for a broad range of externalizing disorders

Question 4

information about functional family therapy

Answer 4

-One of the few systematic, family-based models with significant evidence of success with this difficult population.
-Evidence spans 3 decades and includes a rich history of clinically based research.
-In the last decade FFT has been designed as a model program and an evidence-based program in numerous independent reviews.
-Implemented as the primary intervention model in over 120 community sites in more than 26 states. Approximately 750 therapists work with approximately 20,000 families each year.
-Clinical contact is tracked for quality assurance to maximize positive outcomes for these high-risk youth and their families

Question 5

evidence support for FFT

Answer 5

-Positive Outcome-multiple settings, diverse clients
-Works well with many externalizing behaviors
-Effective in engaging youth and reduced dropout.
-Best results when family is at high risk.
-Sexton, 2011(FFT in clinical practice; Routledge)
-Duncan, Davey & Davey, 2011 (The Family Journal)

Question 6

what is FFT researched and supported for

Answer 6

-School problems
-Drug Use and abuse
-Violence
-Delinquency
-Oppositional behavior

Question 7

how does FFT comprehend why behavior exists

Answer 7

-The therapist examines the interpersonal payoff
-What does one person’s behavior offer every other member of the family?
-Once this is determined, it is not the function that is changed, but the behavior itself is changed.
-E.g. While a child’s behavior may assist the function of bringing the parents together, the new behavior should continue to do the same.

Question 8

explain what the phases of FFT are

Answer 8

-3 phases, Each has a goal
-8-12 sessions
-Supported manualized interventions combined with supported clinical expertise
-Different than CBT following something word for word, each step involves core principles

Question 9

core principles of FFT

Answer 9

Central Role of Family
-What individuals bring is relevant

Umbrella of Community and Culture
-Multi-systemic

Clinical Problems are seen as Relational

Assess Risk and Protective Factors

Track Central Relational Patterns

Relational Functions: The Glue

Question 10

how is FFT a good example of evidence based therapeutic models being attentive to the transactional process

Answer 10

FFT is a good example of ways in which evidence-based therapeutic model can also be attentive to the transactional process (if not the art) of therapy as a unique individual encounter between skilled therapist and a family struggling to find solutions. This unique encounter requires the creativity and skills of the therapist in applying the FFT model in a way that fits the family

Question 11

change mechanisms in FFT

Answer 11

Change is predicated on alliance-based motivation

Behavior change requires meaning change-Reframe

Change must fit with culture, abilities and living context
-There is not a single reality, all families are contextualized

Strategies are tailored

Question 12

explain individuals and motivating families

Answer 12

Reduce negativity and blame (be systemic)
-Reframes, primary interventions

Develop family-focus for the problem

Support the family, generate hope

Reduce within-family risk factors

Lower within-family blame and negativity

Increase within-family alliance and focus
-(engage each other, create common concern)

Question 13

goal one of FFT

Answer 13

reducing intra-family member negativity and blame while trying to develop a family focus on problems presented by the family, and developing alliances (therapist to family; family to family)

Question 14

phase one of FFT

Answer 14

(engagement and motivation)

Desired outcome: family develops motivation by experiencing a sense of support for their current emotions and concerns.

Instill: hope that the problem can change.

Belief: the therapist and the therapy can help promote that change.

Alliance: each family member believes that the therapist supports and understands his or her position, beliefs, and values.

Everyone has a different and unique contribution to the primary concerns, everyone shares in the emotional struggle.

Question 15

what is the therapist doing in FFT phase 1

Answer 15

-Systemic Assessment
-Determine Sequence
-Define Relational Functions

Create a Theme for Problem, Reframe, Support, Redirect, Structure & Interrupt Problematic Interactions
-Changing interactions so they are not what they were

Question 16

explain reframing your idea of reframe

Answer 16

In most intervention models reframing is viewed as an intervention event, in which the therapist delivers an alternative frame of reference to the clients in hopes that the clients will buy or accept the new interpretation and will ultimately change.

In FFT, reframing has a much expanded and richer interpersonal meaning. It is an ongoing relational process involving validation of the client-presented perspective.

Reframing is a relational process between the therapist and the family. The goal: reducing negativity and blame in a way that develops alliance, refocuses the responsibility to include the speaker, and reduces attributional and emotional focuses on others as the source of the problem.

Question 17

phase 2 in FFT

Answer 17

behavior change

The therapist refocuses the therapeutic goals toward changing specific behavioral skills of family members, thereby increasing their ability to more competently perform the myriad of tasks that contribute to successful family functioning.

The behavior change phase is accomplished by identifying factors that contribute to a specific problem behavior for which the family was referred and help change these in a way that matches the relational dynamics that underlie the dysfunctional patterns.

Question 18

unique interventions in phase two FFT

Answer 18

-While the targets of behavior change plan are the risk factors common in many families of at-risk adolescents, the way in which those changes are made must be uniquely crafted to fit the relational functioning of the individual family in treatment.
-There is not a single intervention; instead, the therapist understands the principles of successful communication, the principles of negotiation and problem solving, and the principles for successful conflict management.

Question 19

phase three in FFT

Answer 19

generalization

Aims to generalize, maintain, and support the changes the family has made during the behavior change phase.

The therapist refocuses the therapeutic conversation from within family change to ways in which the family will respond to other similar and future changes

Question 20

explain community connections in FFT

Answer 20

The goal of supporting change is usually accomplished by integrating the necessary community resources to support the family.

Question 21

what is behavioral change in FFT

Answer 21

-How might communication be improved?

Are parenting skills up-to-date and “fit” with the child’s characteristics
-PMT or CPS

Is there a way in which problem-solving skills need to be improved?

How might the family manage conflict better?

Question 22

what might be a useful assignment for the therapist

Answer 22

Look at the case, what assigned behavior might serve to shift:
o Structure
o Perception
o Interaction

Question 23

explain supporting generalizing and maintaining change

Answer 23

• What might be another area of the family in which the change can be generalized to?
• What would be helpful in keeping the focus and assisting family to not relapse?
• What outside resources can not be incorporated to maintain the family at the current level?
• How can change be attributed to the family’s effort?
• Identify likely future struggles.