Functional Family Therapy

International Certification Program

Introduction to Behavior Change Phase

(webinar 5)

Thomas L. Sexton, Ph.D., ABPPFunctional Family Therapy Associates

To be successful with youth and their families FFT relies on…

• Viewed through the Lens

• After Engagement & Motivation

• Take advantage of the successes of that phase

• Before Generalization

• Need to set the stage

• Done in ways that “matches to the family”

Thinking Through the Lens

Therapeutic change process

Cultural/Ethnic/Racial “Context”

Family

Sibling(s)

Parent(s)

Adolescent

Behavior becomes of worryTo parents/the system

• Biological• Historical• Relational

Individual Risk and Protective Factors

Community

Peer GroupsValues/Norms

Socioeconomic StatusRisk and Protective Factors

• Values/customs/relational styles/• Rules, rituals

• Expectations/norms

• Unique “whole”• Central Family relational patterns

problem “fit”/”functions” within• Relational “outcomes”

FFT….

“The Current Problem”-Cognitive aspect

(Understanding/attributions of the “problem”--definition)

-Emotional response-Behavioral response to the perceived problem

aimed atsolve problem it

Mom/mother figure

Dad/father figure

Adolescent

RELTIONAL PATTERNS• Core family/dyad stable

relational patterns• Relational sequences/problem

sequences• Relationship defining

• Maintains the problem behavior• Promotes certain protective/risk

behaviors• “personality” of the family

•Central Focus of FFT

Individual Behaviors

Relational Patterns

Anja: “ Peter have you done…””you know you are getting behind”….”you need to take some responsibility” (esclating the longer he doesn’t answer)

Peter: “Whatever….later, I am going out…., I’ll be home…..”

Anja: “there is no going out for you….it just isn’t good for you…..you know you can’t say no to those friends of yours…”

Peter: “At least I have friends…later…” he goes out.

Anja: (to her husband)…”I can’t do anything with him…and you don’t help. I would at least like your support

Anja: is hurt by his comment…goes to her room…watches TV…worries and “feels” bad about her situation……

Stepfather: …continues watching the football game…worries about his wife…gets angry with Peter…..”

Peter: (comes home 5 hours late. Comes in the house and goes upstairs…on the stairs his mother comes out of her room…

Stepfather: …”I am tired of this…what is the matter with you…don’t 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 can’t take this any more…”

Peter: “I am sorry Mom…but, I can handle it”

Anja: “I just worry about you” (she feels comforted that he understands)

Peter: “I can handle it Mom…just 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 say…”what do you want me to do…he wasn’t raised right…”

Figure 7.1

Functional Family Therapy

Clinical Model

Motivation

Intervention

Assessment

Engagement Behavior Change

Behavior Change

Generalization

Generalization

Early Middle Late

Outcomes• Alliance between family

with therapist• Family/relationally

based problem problem focus• Reduced family member

negativity/blame• Increased motivation

Outcomes• Increase behavioral competency of all/family

• Consistent performance of competency in “real” problem situation

Outcomes• 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

A family Focus

…developing a relational thread

Presenting Problem

Redefined “problem”

Reframing

He is manipulative…he just says/gives you the lines you want to hear when we are here…what he really needs is “crack you head open therapy”…responsibility needs to be put with him…I am just tired, I don’t want to be a parent anymore

He is having a very difficult time learning how to be a man (have values and know what is right), I

can’t find a way to get him to do what he needs to do..., I am just really hurt by it all

Organizing ThemeIndividuals linked to family

“Braided” reframes

Time

Reframing Opportunity

Validation --ReframeListen--change-incorporate

Continue

Themes

Overtime…the outcome• Negativity decreases• Family focus increases• Motivation increases• Blaming decreases• Attributions change

New problemdefinition

-explains problem infamily focused way

Reframing Opportunity

Reframing Opportunity

ThemesAdd to..Elaborate..Link individuals to

familyReframing

Opportunity Validation --Reframe

Listen--change-incorporateContinue

Reframing Opportunity

Outcome: Motivation through family focused relational themes

• Themes….that identify the noble intention• “He is independent……and has mistakes”• “Independent but safe• “Parents to help him be so….and

protect him and teach him in the process”

• “Parents with a lot going on……trying to find way to help…..an independent youth”

• Themes function to:– Stay out of the details….break relational

patterns– Reduce negativity & blame– Increase a family focus– Empower the family: Focus on the “Nobel

intention”

Behavior Change Phase

Early Middle Late

Intervention

Assessment

Behavior change sessions

Goals• Specify the

behavior change targets as family prosocial skills:

• Link BC targets to the organizing theme to build relevance and

motivation

• Build compliance

• match to the client

• check if the BC target works to solve conflict

Assessment• Identifying prosocial

family based skill that fits youth/family

problem sequence

• Find barriers to adoption of BC skill

• Determine if the target is being

performed (compliance)

Interventions

• reframing • Modeling• Teaching• Overcome barriers/adapt

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:

Work out problems…our

focus is on their process of doing so

Parent Adolescent

With components of….to individualize to the family

Targets of FFT Behavior Change: How they go about working together

Problem Solving

Implementing BC Phase

BC PhaseFunctional Family Therapy

New ProblemSituation

New ProblemSituation

New ProblemSituation

Target a new skillthat fits the specific problem that

brought them to therapyChanges the Problem sequencecentral to way family functionsUses new “skills” in problems

that come up

Target a new skillthat fits the specific problem that

brought them to therapyChanges the Problem sequencecentral to way family functionsUses new “skills” in problems

that come up

Target a new skillthat fits the specific problem that

brought them to therapyChanges the Problem sequencecentral to way family functionsUses new “skills” in problems

that come up

New ProblemSituation

Techniques of Behavior Change

• Reframing• Helps direct family to shared, family

focused action• Helps link behavior change to organizing

theme…stay focused• Helps reduce negativity that arises• Challenge that promotes motivation

• Building family competencies…so that the risk patterns central to family change….

• Communication • Problem solving/negotiation• Conflict management• Parenting (monitoring supervising)

Promoting new Behavioral competencies

• Not a “curriculum approach”

• 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

• Implemented within session in ways that match:

• Relational functions• Situation• Theme

• Individualized change plan

Behavior Change…

Interventions technologies/targets

• Communication skills training: principles of positive communication…1. Source responsibility2. Directness3. Brevity4. Concreteness and behavior specificity5. Congruence6. Presenting alternatives7. Active listening8. Impact statements

Behavior Change…

Interventions technologies

• Problem Solving…method for adolescent and parents to work together to jointly solve” problems1. Identify a problem….goals of the family in a

specific incident/area/with a specific problem2. Identify the outcome desired3. Agree on what it takes to “do” it

– Sub goals….who has what part– Contracts/negotiations etc.

4. Identify all the ways it can go wrong5. Come back and see if goals are met

accountability

Behavior Change…

Interventions technologies

• Conflict management….for those “problems” that can’t be solved in other ways– Avoid it…..change reaction to early triggers– Principles to use in trying to contain it…

– Present orientation– Issue focused– Adopt a conciliatory set

1. Exactly what is the issue2. Exactly what would satisfy me?3. Is the goal important?4. Have I tried to get what I want through problem

solving?5. How much conflict am I willing to risk to get what

I desire?• Time-out for transitions

Discussion focused on:

-what is most relevant to this family….most

important topic

Conflict Management

Communication-direct and concrete

communication

Parenting-monitoring and supervising

Where they use:

Goal: Work out problems…our

focus is on their process of doing so

Parent Adolescent

With components of….to individualize to the family

Individualized Change Plan…..

Problem Solving

• Case Example……Siemone.

Behavior change interventions require therapist…

– To have a well thought out change plan– Structuring the session to accomplish it – Contingently responding to what happens in the

session…hearing/seeing feedback• Ignoring…some things• Finding ways to use other things to fit behavior change

goals• Staying with it…while responding interpersonally

– Monitoring of motivation through out implementation

• Backing up to engagement/motivation when needed….

– Follow through– Match to….the family relational functions

Behavior Change interventions….

How to implement Behavior Change

In sessions• Planned through teaching/using a client issue• Opportunity…through an in session incident• How…

– Coaching, directing, teaching, aids

– As “homework”…Specific task that is accomplishable..one issue

• Clearly presented/understood• High expectation of success….define success as doing it

– How…• Within couple…as way to strengthen/change couple

• Case Example…….what happened with Siemone?