Generalization Phase:maintenance, generalization, & support

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

Goals

• Specific Focus on:

• Goals and focus of generalization phase

• Specifically….

• Generalization and relapse prevention to empower families

• Case Study

Internal World

Biological Substrate/Learning

History/individual traits

Clinical Symptoms/Behaviors

Family Relational System

Ecosystemic SystemPeer/school/community/extended family

Ecosystemic SystemPeer/school/community/extended family(Sexton, 2010)

The Multisystemic Focus of Functional Family Therapy

Primary entry/focus

Point of immediate,

relevant, and lasting change

Functional Orientation-inside out

conceptualization

Initial Presenting Problem Definition

-attribution aspect-emotional valence

-related behavioral patterns

Comes from:Each individuals unique

History/experience with problem,

natural attempts to understand/make sense, solve the problem

AdolescentInitial Presenting Problem Definition

-attribution aspect-emotional valence

-related behavioral patterns

MotherInitial Presenting Problem Definition

-attribution aspect-emotional valence

-related behavioral patterns

FatherInitial Presenting Problem Definition

-attribution 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 familyfocused” definition

That is -different from

each individual definition- common to all

- Where all have responsibility- No one has bla

Not compromisingmediating

or negotiating

Family FocusedProblem definition

The Outcome:Motivation, negativity reduction,

Family to family alliance, Therapist to family alliance

Discussion focused on:-drug use-defiance

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

Targets of FFT Behavior Change

Problem Solving

What is next in the change process

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.

• To be successful the family needs to be consistent over time and learns to handle the emotional discouragement of “relapses.”

What it takes

Families can be successful when they can:• Keep it up• Handle more and different problems• Be consistent• Adapt and adjust when things come up• Address other bigger issues • Be realistic

Logic of change

• These changes often don’t happen naturally

• Therapy can provide specific strategies for:• generalizing new skills, • maintaining change, and• supporting those changes

• Reduces:• Revolving door of treatment• Relapse• Future positive changes

“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.

Shifting Focus for the Therapist

• focus of therapy moves from inside the family to the “interface” between the family and those systems that surround it.

• It requires a shift in direction for the therapist in regard to clinical assessment and intervention. • respond to the “events” in the family with a primary

goal of helping them become ultimately self-sufficient and empowered in their interaction with the surrounding context.

• Shift attention away from helping the family solve immediate problems to a discussion about the role of peer, school, and extended family and community interactions as they relate to the family’s ability to continue reducing the probability of future problems.

Ecosystemic SystemPeer/school/community/extended family

Ecosystemic SystemPeer/school/community/extended family(Sexton, 2010)

The Multisystemic Focus of Functional Family Therapy

Clinical Symptoms/Behaviors

Family Relational System

Ecosystemic SystemPeer/school/community/extended family

Ecosystemic SystemPeer/school/community/extended family(Sexton, 2010)

Court system involvement

SchoolStruggles

Extended Family/com

munity

Peer GroupPressure

Involvement

Intervening to Create Long-Term Empowerment

Tasks of the Generalization Phase

Focus of the Generalization

• Generalize change to other problems/issues

• Focus is on generalizing BC skill

• Maintain Change

• Individual & family risk factors and relapse prevention strategies

• Support Change

• Relevant and reliable support for changes

So…they are empowered to handle the next problem themselves

Generalizing Change

Fighting(between Mother

& Daughter)

Going outWith friends

Homework

Time withboyfriend

Help family adopt the

Behavior Change Plan in different areas of either

conflict or risk’s

Behavior change Plan• Linked to a spot in the relational

pattern• Matched to functions & the

theme• Involves everyone

This is not their only problem…

• More within family areas of struggle

• Risk areas….yet to be addressed

Generalizing & Maintaining Change

• Change process is a up and down experience• Families faced with ongoing problems

• Often the down feels as if it is a failure

• The goal….• Keep it up• Handle more and different problems• Be consistent• Adapt and adjust when things come up• Address other bigger issues • Be realistic

In light of remaining challenges and difficulties

Generalization Goals

• Handle more and different problems…more likely when…

• when they confront a new problem….they can see it as solvable with skills they learned

• Know how to apply the approach/skill

• How to implement it in their family using the “organizing theme”

• They will be most successful if they can apply the small steps of behavior change to an increasingly wider range of issues in daily life.

Generalizing Change

• Keep it up. This most likely to occur if they know:• Think about the problem as a family problem• Know what to try• Know it won’t be each• Keep alliance focus

• How we can help:

• Reframing each new situation to be linked to the central theme of the family

• Build collaboration and alliance between them

• Maintain a family focus

• Be consistent• How we can help:

• Resist the temptation to add more skills…focus on keeping it up in a consistent way

• Adapt and adjust when things come up• How we can help:

• Help them find their own style• Focus on process not on outcomes• Adjust

• Be proactive and address other bigger issues

• Peers• School & other community issues• Legal requirements• Extended family challenges

• How we can help:

• Reframing the discussion as protection

• Initiate discussion on existing risk areas

• Be realistic

• If the belief includes knowing that things will happen again, that it won’t be fun, but, with effort, there is an alternative, which creates the motivation to initiate new behaviors and put effort into persisting at them.

• The belief needs to be realistic, not one that sets them up for failure by being too positive.

What about the future: Relapse Prevention

Successful relapse prevention requires that the therapist take the initiative and direct a discussion that helps to:

1. Identify high-risk situations• Areas known to occur within the family

(within family risk areas• These are things you have already seen and know

• Family may not now identify them

• External risk factors that you identify• School• Peers• Extended family

Relapse Prevention

2. Learn alternate ways use the already established behavior change skills to these new situations:

• cope with the negative emotions that arise around these situations

• Using problems solving skills

• determining ways to deal with interpersonal conflict by applying conflict management principles

• discovering strategies to cope with social pressure that may result outside systems

3. Reduce unnecessary stressors

4. Develop a support system• Friends, family and community links that

provide:• Instrumental support • Emotional support (empathy and

caring)• Informational support

Medical Evaluation

Psyc Intervention

Community/School-direct and concrete

communication

Extended Family-monitoring and supervising

Parent Adolescent

Support Systems

Types of support from each:• Instrumental• Emotional

• Informational

• David, his mom Alice and his grandmother