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Joanna Smith

on 6 August 2014

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What is FFT?
Engagement/Motivation Phase Interventions
Goal: To change the problem behaviors by using therapist use of teaching, modeling, coaching & giving directives
Generalization Phase Goal
Family Will:
1. Improve their ability to manage relapses
2. Improve their ability to respond to "new" situations
3. Follow through with linkages to resources
History of FFT
Criteria for Participation
Client: 11-18 years old
Caregiver must agree to attend "ALL" family sessions (siblings & other family members are encouraged to attend)
Behaviors that are impacting home, school, social, community functioning (i.e. violence, defiance, depression, inattention, running away, truancy, poor academic functioning, SI)

Why was FFT Created?
In 1969 ,researchers at the University of Utah’s Psychology Department Family Clinic developed FFT to serve diverse populations of under served and at-risk adolescents and their families. These populations lacked resources, were difficult to treat,and often were perceived by helping professionals as not motivated to change.The developers of FFT recognized that successful treatment of these populations required service providers who were sensitive to the needs of these diverse families and competent to work with them, and who understood why the families had traditionally resisted treatment.

FFT LLC. was formed in 1998 for the purpose of leading the systematic replication of Functional Family Therapy (FFT) and assisting and collaborating in the on-going scientific inquiry into the model. It has retained its core principles while adding clinical features that improve successful outcomes in the diverse communities
Evidence Behind FFT
FFT significantly reduces potential new offending for siblings of treated adolescents that when compared with no treatment, other family therapy interventions, and traditional juvenile court services (e.g., probation)
FFT can reduce adolescent rearrests by 20–60 percent.
50% reduction in violent felony crimes
Significant reduction in drug use as compared to CBT, psycho-education and group treatment
Improved family functioning
Significant cost effectiveness (up to $14.87 return for each dollar spent
Implementation of FFT
PHASE 1: $46,750
3 day Clinical Training
3 2-day Onsite Visits
Supervisor Consultations

PHASE 2: $23,500
2 day Supervision Training
Twice-Monthly FFT National Consultation Calls with the Site Supervisor

PHASE 3: $8000
(Quality Assurance/Quality Improvement) On-Going Partnership
Monthly FFT National Consultation Calls with the Statewide Consultants

What are the Strengths & Weaknesses of FFT
It has been researched for over 30 years, with more recent studies having a significant fidelity protocol.
FFT has also been shown to work with both pre-delinquent youth (preventative) as well as those with very serious issues and crime records (intervention).
This model utilizes a great deal of supervision to support clinicians in their work with families
Given the high costs of incarceration and court services, FFT can be a cost-effective alternative for communities with decreased recidivism rates

Implementation and training costs of FFT can be very high
There are only a handful of studies available that show model effectiveness.
It does not appear as if FFT has been studied with families of youth with SED.
Strict adherence to the model is imperative or the clinician can do more harm than good.
What will Therapy Sessions Look Like?
Session Time: 60-90 minutes
Frequency: Sessions 1-3 week
Length of Tx: 8-15 sessions (26 for severe cases)
Phases of FFT
Making a Good 1st Impression
Contact the referral source
Contact the Family (be relentless & flexible)
Let the family know what will happen the 1st session (family focus)
Past Assessment Review
Purpose: In order to understand as much as possible about the context in which intervention is to occur
Purpose of Engagement/Motivation Phase
Therapists must be attuned to their own unique qualities and how they might be affecting a family member
PURPOSE: Building alliance immediately & reducing negativity and hopelessness
It helps families experience that they can change based on who they are rather than who they "should be"
For Example: We don't attempt to change a parents relational function (or need) for control; instead we change the "means" through which the parent achieves the control; replacing negative behaviors with positive & prosocial parenting behaviors.
Functions are the motivated patterns families engage with one another in. FFT does not focus on attempting to change the relational functions
For Example: If a chile acts out to "get attention" FFT does not work hard to eliminate that person's need for attention. Instead we change the means through which this attention is elicited.
Relational Hierarchy
Relational Functions
Autonomy/ Distance
i.e. independence, separating
(+) seen as able to raise the type of teen that can be trusted
(-) seen as uninvolved or uninterested
example: enmeshment, fear of abandonment
(+) seen as emotionally & physically close
(-) seen as overbearing, overcontrolling, co-dependent
example: mixture of both autonomy/contacting
(+) seen as a parent that can give their child a balance of closeness & autonomy
(-) seen as a "hot/cold" parent who sends mixed messages
The pattern of relative influence parent & youth have over each other in terms of "controlling" each others' behaviors.
FFT works hard to create processes where youth are influenced by parent(s) because they "love" the parent & want to please them as opposed to being influenced or "controlled" by the parent because it will lead to consequences.
Parent 1 UP
Parent Symmetrical
Parent 1 DOWN
(-) Example: Parent demands respect, "controls" but is inconsistent in following through. Youth complains about parent but still depends more on parent that parent does on youth
(+) Example: Parent is a resource, provides structure & monitoring, youth asks rather than demands, youth requires parent to justify their position, but accepts it (even if grumbling)
(-) Example: Youth is determining parent's behavior more than parent is determining youth's; parent complains but can't influence youth to stop
(+) Example: Youth is trusted resource, provides positive structure, anticipates and responds without guidance from parent
(-) Example: Competition, comparing lists of injuries and/or contributions, "knocking heads" re: some behavioral issue
(+) Example: Trading responsibilities, lots of negotiation rather than setting rules
Balanced Alliance
Decreased Negativity/Blame
Increased Family Relational Focus
Increase in Hope
Interrupt & Divert
Point Process
Strength Based Statements
Disrupt families negative interactional sequence, in order to redirect focus of discussion
Point out interactions & behaviors noticed in order to provide an alternative explanation
Used to assess what happens & who does what within a family. Purpose is to identify an outcome that can be tied to a theme or function of the family.
Seeing the positive side of apparently negative relational patterns. Creates a more relational focus.
Change Meaning Techniques
Acknowledgment of the negative & proposal of a possible alternative/noble intention
Provides an alternative label for a specific behavior. i.e. My mom "flipped out" on me. Therapist: So your mom let you know she had an issue with you.
Develop themes to link the negative experiences of the past to a possibly hopeful experience of what they may mean. We offer an alternative meaning to painful past relational patterns.
Let's review a case to practice using Engagement/Motivation Interventions
Purpose of E/M Phase
Family Will:
1. Attempt positive changes
2. Accomplish positive changes
3. Practice new skills at home
Therapist Must...
1. Have a well thought out behavior plan
2. Structure sessions
3. Hearing/Seeing Feedback
4. Monitoring Motivation
5. Follow through
6. Match to relational functions
Problem Solving
Conflict Resolution
Skill Development
FFT Therapists see the whole person with "noble but misguided intent" behind all "bad" behavior.
FFT works "with" the client/family (empower) rather than working "on" (manage)
Why are Risk & Protective Factors so Important?
What is going to interfere with progress
Reasons for referral
What will support the changes
Risk Factors?
Protective Factors?
1. Lets identify their pattern!
3. Lets identify the relational functions
Autonomous Midpointing Connecting
4. What hierarchy Functions do you observe in the family?
1 UP Parent 1 Down Parent Symmetrical
5. What are the Risk & Protective Factors
6. How would you use the FFT techniques?
Matching Interrupting/Diverting Sequencing
Point Processing Reframining Strength Based Statements
2. What Themes do you see
Matching the Skills to the Function/ Hierarchy
If family does not feel more hopeful or experiencing each other different, then they won't be motivated for change.
Justify reason for behavioral plan to family to gain their buy in
I Appreciate, It's hard for me too..I Need for you to...
Situation Cards
Family Check In
Praise Statements
Self Care Practices
Deep Breathing
Coping Skills
Walk Away Technique
Positive Self Talk Skills
How to Ask Questions
Assert self (do you want me to listen or give advice)
I statements
I need statements
Listen 1st then talk 2nd
Ask "what can I do to help"
Collaborative problem solving
Choices (If/Then)
High/Low Point of the week Talk
Planned ignoring
Must Practice the skill in session
Give Feedback/Modify if needed
Examine family's follow through
Session Interventions
Role Plays
Team Building
Practice the skill
•ISOLATION: you detach from emotions or each other in order to survive/cope but have forgotten how to reattach.
•NOT TALKING: It’s your way of protecting yourself, but it makes it hard for your parents to know how to help
•NEGATIVE BEHAVIORS: Although her running away is scary because it’s not safe, it gives you something to worry about and distract you from your sadness
•AVOIDANCE: You spend time away from family because you see a risk of getting close to people because of fear of losing each other
•NAGGING: you focus on the negative bxs of your child (acknowledge the neg) because you feel hopeless (theme) and in hopes that the approach will motivate him to change (noble intention). But as a result it is pushing him further away.
•DEFIANCE: You struggle with listening to your mom, because you want to show her that you can do it on your own
•IGNORING: You don’t respond to your mother because of fear (theme) of saying something hurtful. You walk away from your mom to be respectful because you don’t want to be combative.
•POOR DECISIONS: It seems like the decisions you have been making for yourself lately have gotten you into a lot of trouble, but it seems like it means a lot to you to prove to people you can do it on your own
•LYING: You lie to your parents due to not wanting to disappoint them
•WITHDRAWN: when a problem arises you keep to yourself in order to solve on own which worries your parents.
•EXPECTATIONS: I can see that you set those expectations because you want to help because of fear of your child making a mistake & wanting to prepare him for the harsh world. BUT the way you are going about it is not getting you heard.
•KEEPING FEELINGS INSIDE: You don’t communicate what is bothering you because you don’t want to worry your mother.
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