Functional Family Therapy

James F Alexander, PhD FFT Founder and Principle Investigator Functional Family Therapy An integrative model for working with at risk adolescents and their families Sweden Presentations May, 2007 FFT LLC

The FFT Perspective Strengths, resources, abilities less apparent resources many times not currently in use in the presenting problem situation) Abilities that have carried the client successfully through difficult times/situations in the past Protective Factors Clinically significant/problematic most apparent weaknesses, challenges, deficits Past history Diagnosis Risk Factors

Successful FFT therapists see whole person (the sum total) noble intent behind all bad behavior Respectful attitude Working with ( empower ) Rather than working on ( manage )

So Where are Risk & Protective Factors We Address in FFT? 1.In the adolescent/parents 2.In the family (This is our initial focus) 3.In the social/environmental context.. And in the attitude we bring to the way we view them (FFT lens)

How Do We Maintain the Appropriate Focus? As a First Step We View Families and Clinical Problems Through The FFT Lens Clinical decisions (what you choose to do at each moment) Gender Personal History Other ntervention models Clinical Experience & Agency Tradition Cultural context Age Expectations of Referral agencies, etc Translated through the.. FFT Lens See families in relational, strength based, non-judgmental ways

Family problems are relational The family s s experiences lead them to enter therapy with a definition of what is the problem This definition is usually: focused on a a person (attribution component) has negativity attached (emotional component) is accompanied by blaming interactions that have become central to the relational patterns of the family (behavioral( component)

So.. What characterizes many (if not most) of the youth & families we want to help In FFT? Narcissistic, Comorbid, Hx of Betrayal, Abuse Limited Resources Depressed, Hopeless, Resentful, disrespectful, Angry Un (anti)- motivated, criminal / drug involvement History of Failure, High probability of re-occurrence

In your heart how do you find yourself reacting to each family member? Who are they? Victims Hurt, Hurt, Emotionally Damaged People Organic E.g. Fetal Alcohol Bad / Evil People Unfixable Primary Focus: Engage & Motivate around... Pain Pain & mis- perception Damage dis- perception Their Logic Behavior Change Goals Rescue Teach / Provide Corrective Experience & Beh l Options Structure / Reduce Behavioral Options Sanctions / Remove Behavioral Options We are not rescuers or controllers We Empower If rescue or control is necessary we refer to more appropriate resources we refer to more appropriate Not An FFT resources Focus

THE FFT CLINICAL MODEL: Phases of FFT Engagement Behavior Change Generalization Goal s Relational Assessment E & M Relationally based Interventions Goal s Behavioral Assessment Behavior Change Interventions Goal s Multisystems Assessment Ecosystemic Case Management Skills Skills Skills Motivation Behavior Change Generalization Early Middle Late Phase Task Analysis (PTA: Sexton, 1997)

The Phase Based FFT Model: Effective intervention involves. following this Systematic Change Model The process of therapy is one in which you understand phasic change and relentlessly pursue phase goals while working flexibly within the structured FFT phases responding contingently and respectfully to what you are presented with in in a way consistent with principles of understanding and matching families on their terms, understanding therapeutic intervention from a family system perspective

Reducing / eliminating the problem behavior(s) and modifying the family relationships that support it by developing individualized change plans that fit the family and increase competence in.. Parenting Communication Problem Engagement solving Behavior Change Conflict management (etc) Generalizing Goal (Multi-systemic focus) Goal Assessment In Terms of the Phasic FFT Model - Helping family generalize change & to become self reliant - Maintaining change by relapse prevention -Supporting changes by increasing Intervention the use of available Skills community resources Skills Motivation Early Behavior Change Generalization Goal Skills Engaging and motivating families to becoming part of and Generalization stay in therapy.. by Building alliance with everyone Middle Reducing negativity Late and blame while Time retaining responsibility Understanding systemically and Creating a family focus

Why is FFT Effective? (2):The Foundation of FFT is Respect For Diversity and Cultural Competence The outcome goals of FFT are not healthy families according to someone s s theory or ideal, but.. obtainable changes that will help this family function in more Adaptive, acceptable, productive ways with these resources and these value systems in this context THIS REQUIRES RELENTLESS EFFORT TO UNDERSTAND AND RESPECT THESE YOUTH AND FAMILIES ON THEIR OWN TERMS

Where do we start? Why FAMILY FIRST? Self-Control.70.24 Academic Self-Efficacy.19 Family Bonding Family Supervision Family and Peer Norms.59.40.88 Substance Use Social and Community Prevention.14 (N=8,576) (CSAP)

School Ecosystem Influences Community Peer Groups Clinically Significant Behavior Extended Family Intra Individual (Diathesis) Factors & Processes How do we accomplish our focus on Family First? In order to address and intervene successfully with the Individual and Ecosystemic nature of clinical problems

How Does FFT approach these factors? School Ecosystem Influences Community Peer Groups Clinically Significant Behavior Family First Extended Family Intra Individual (Diathesis) Factors & Processes

How Do We Understand These Family First Factors? Clinically Significant Behavior Family Relational Patterns Common behavior patterns, attitudes, and emotions that surround clinically significant problems Relational Functions (inferred) that serve to motivate and maintain stability in family relational patterns Theory specific / hypothesized constructs for understanding clinical problems: e. g. attachment bond disorders, traumatic events, reinforced behavior, cognitive thinking errors, archetypes, object introject processes

Understanding the problem/family/context as the organizing framework for change Begins with relational assessment (relatedness and hierarchy functions) BEGINS IMMEDIATELY Client/problem assessment - of the problem.. problem sequence MORE IMPORTANT AFTER A FEW SESSIONS AFTER SUCCESSFUL STRENGTH BASED RELATIONAL FOCUS HAS BEEN ESTABLISHED & AFTER SUCCESSFUL THEMES AND ORGANIZING THEMES functioning of individual, family, and role of context Risk and protective factors thus.. a multisystemic assessment/understanding of: Relationships MOST IMPORTANT Problem behaviors and sequences BECOMES MORE IMPORTANT DURING BEHAVIOR CHANGE Environmental social/cultural context ESPECIALLY IN GENERALIZATION

School Ecosystem Influences Community Peer Groups Intra Individual (Diathesis) Factors & Processes Clinically Significant Behavior Extended Family Family Relational Patterns Common behavior patterns that surround clinically significant problems Risk and protective patterns that increase/decrease likelihood of clinically significant behaviors Relational Functions (inferred) that serve to motivate and maintain stability in family relational patterns FFT Behavior Change & Generalization Using Relational Assessment in the process of change

Finally, successful FFT Therapists reflect specific interpersonal qualities (1) Relationship skills Warmth (contextually expressed), non-blaming, humor interpersonal sensitivity, respect for individual difference (2) Structuring skills provide direction within the sessions, match to the clinical model, locate resources out of the session These Relationship and Structuring skills count for more than the intellectual knowledge about the model yet without the model knowledge base we have no guiding principles or a means to be accountable to our families and our treatment systems (3) Conceptual skills -to assess/understand relational nature of problem -to monitor therapy process -to plan and think on your feet (4) Clinical & life experience (Be aware of it, use it, but don t t let it run your clinical decision making)

The Skill and Commitment to Adherence and Competence 35,0% 30,0% 25,0% 20,0% 15,0% 10,0% 5,0% 0,0% 6 month 12 months 18 months Adherent Non-Adherent Control 38%* reduction in felony crime 50%* reduction in violent crime $10.67 return for each $1 invested $2100 per family cost to implement * Statistically significant outcome

Functional Family Therapy Engagement and Motivation Engagement Phase Motivation

Implementing phases across sessions When does FFT begin? Before the first clinical contact Engagement/ Motivation And before, between, and after sessions, PLAN, THINK, CONSULT CSS & TEAM Behavior Change Generalization 1 2 3 4 5 6 7 8 9 10 11 12 Sessions Sessions

Engagement and Motivation Phase Engagement To engage and motivate families to becoming part of and stay in therapy.. Assessment by Intervention Our Goal Building balanced alliance - with everyone Reducing negativity & blame while Motivation retaining responsibility Creating a family focus for problems to open new solution avenue

Engagement Motivation ENGAGEMENT & MOTIVATION PHASE: Engagement For positive participation - involves building trust, respect, alliance Motivation Not only to participate in therapy, but to undertake the specific behavior change steps designated by therapist

The Staying Power of Motivational Forces Hype, Understanding SHAME Fear / Punishment Positive Alliance, Hope

Introduction to E & M Techniques Engagement/Motivation Interventions Engagement Intervention Motivation Interrupt & Divert -negative interaction patterns -blaming (stay busy) Change meaning through establishing a nonblaming relational focus Includes refocusing Individual issues as Relational issues, Sequencing / Pointing Process, Theme Hints, REFRAMING and providing THEMES And MATCHING Always MATCHING

MATCHING (a philosophy as much as a a technique ) is a fundamental requisite for effectively engaging and changing families Match to clients: We do what it takes for them to feel you are working hard to respect and understand them, their language, norms, etc Especially during E & M it is all about them

What is our initial focus? Who is negative? -hopeless? -seeing no solutions? -resisting? In Engagement and Motivation, we initially understanding phasic change. organize our energy on who is.. --the most likely (and able) to prevent positive change from being initiated Then make your focus relational ASAP

Levels of Process Techniques in E&M (in context of high negativity & blaming) Make it Relational & emphasize strength/positivity by 1 - Jumping into escalating hostility ASAP - somehow! 2a- Pointing Process (sequences in session) in non- blaming way, find way to see the strength in the process 2b- Sequencing (sequences outside the session) 3 Offering a Theme Hint 4- Beginning a process of Reframing 5- Beginning to develop Positive Themes -Jump into escalating denial somehow. ( OK,( so you all seem to be in agreement here. Is this new did this referral bring you all together or have you always been pretty much on the same page? )

The Flow of E & M Interventions At first, negativity, individual problem focus, blaming, and negative & hopelessness is high At first feelings of hope, positive attributions about self and each other, and a sense of family togetherness are low or absent

As E&M progresses, negativity decreases & Relational focus & strength based Attributions Increase, blaming decreases (but is still present)

As negativity, blame, and individual problem focus decreases The FFT therapist can begin to develop Relational Themes and ultimately Organizing Themes This escalates the reduction in negativity and the increase in positive relational focus, emerging hope

The Data: Impact of Therapist response to Negativity: The Frame-Reframe Continuum: Negativity Continues (56-70+%) PROMPT = REFRAME THEME HINT NONBLAME SEQUENCE, (MAKE IT RELATIONAL) + THEME -FRAME REFLECT Negativity begins To shift (-> 35%)

What is Reframing? Reframing is an Interpersonal Process in which the interventionist usually takes the lead in suggesting that a problem behavior, while bad (or worse), may not necessarily only have a malevolent motive; instead it could also include a more positive (but very misguided) intent.

Reframing Steps Acknowledge the negative Reframe intent, motive, meaning Evaluate the effect of the reframe Refine/Change

Reframing a a relentless process Therapist Family Listens for. -attribution of cause (who, what) -position values -metaphors Responds with. Family/relationally focused reattributing Validate-reframe Tells what is the matter -who, what, why -what it means, how I Feel about it-what I attribute the cause to be Explanation of event, problem, family, situation that is real for both therapist and family member(s)

What are Reframing Themes? Themes describe problematic patterns of behavior, and/or relationships, in a way that suggests they may be motivated by positive (but very misguided) intent(s). Themes provide new explanations of problematic and painful patterns that provide hope for the future and give family members a reason to stick with the difficult change processes which will ensue Hear themes.. think thematically respond to themes, and remember that themes can have origins in experiences that might have occurred long ago (e.g., eating difficulties in infancy, parents not knowing how to balance work and family, kids not understanding how desperate things were for Mom and / or Dad)

Dynamic nature of reframing Developing Themes Relational Strength based focus Interrupt But don t control Negativity Themes Add to..elaborate.. Link individuals to family Reframing Opportunity Validation --Reframe Listen--changeincorporate Continue New problem definition -explains problem in family focused way Organizing Theme Individuals linked to family Braided reframes Relational Strength based focus Reframing Opportunity Time Relational Strength based focus Over time the outcome Negativity & blame decreases Family focus increases Motivation increases Attributions change

Organizing Themes Everyone s responsibility is clear, but no one is to blame. blame. The family has become victim to an unfortunate (sad, tragic) way of being over time. They usually wanted the right thing but they didn t t know how to do it; they were misguided, in too much pain, too damaged. Often they didn t t even recognize their part in the process. Previous attempts to solve the family s s problems in fact made things worse, and created defensiveness and/or hopelessness in everyone.

Organizing Themes (2) As family members see themselves in the same boat they are more likely to experience temporary hope, compassion, openness. This is marked by: Spontaneous positivity Change in attributions Reduction in blame Nonverbal and verbal cues of hope and familyness And it signals a possibility that you can move into Behavior Change quickly Focusing on less volatile issues Remembering Relational Functions and protecting them while changing the negative / destructive ways they were expressed in the past

Engagement/Motivation Outcomes of these goals Family motivated to come back reduce dropout because they Different experience in therapy Not the same as home Lower negativity Decrease hopelessness A family-relational focus of the problem Worked with someone who helped who overcome obstacles to therapy was a credible helper

How Do We Understand Families? We need to understand and work with what drives them (what they bring to us).. And be able to use that knowledge to tailor our interventions during every phase so that the youth and family can and will follow them, change in a positive direction, and be able to maintain those positive changes Family (Relational) Assessment is our Primary Focus

Relational Functions When one family member relates to another, the typical relational pattern (behavioral sequence, emotions, beliefs about each other within the relationship) is characterized by degrees of: Relatedness. contact/closeness vs. distance / autonomy (psychological interdependence) Hierarchy. overt relational control/influence based on differential resources, power, role Attempting to change these basic motivational components of human behavior in just a few sessions is clinically impossible and (arguably) inappropriate ethically

Understanding the problem/family/context Conceptualize the family as a relational and social context through Relational assessment (relatedness and hierarchy functions) BEGINS IMMEDIATELY Client/problem assessment of the problem.. problem sequence MORE IMPORTANT AFTER A FEW SESSIONS AFTER SUCCESSFUL STRENGTH BASED RELATIONAL FOCUS HAS BEEN ESTABLISHED & AFTER SUCCESSFUL THEMES AND ORGANIZING THEMES functioning of individual, family, and role of context Risk and protective factors thus.. a multisystemic assessment/understanding of: Relationships MOST IMPORTANT Problem behaviors and sequences BECOMES MORE IMPORTANT DURING BEHAVIOR CHANGE Environmental social/cultural context ESPECIALLY IN GENERALIZATION

Relationship Patterns.. Again, Family First the space between Behavior Sequences organized., repetitive behavioral sequences that come to define the relationship Stable over time Rules roles.that define the ways of typically being together Relational Functions outcome of pattern for the individual motivator of future behavior in that relationship Glue that holds the behavior within relationship together

1 - Relational Connection, Interdependency When X relates to Y, the overt relational pattern over time (behavioral sequences in the relationship) of X s behavior is characterized by: My sense of psychological & emotional well being seems to not centered on you (Autonomy): Most of my connection is invested elsewhere High Autonomy & High Interdependency My connection with you seems to reflect both autonomy & Connection; there seems to be a balance (or conflict) of both Walling Off Pulling In My sense of psychological & emotional well being depends heavily on you : There is considerable intensity & investment in you; I m centered on you a great deal

Autonomy: distance independence separating, Low levels of psychological intensity (Fear of Enmeshment?) Interpersonal Relatedness Functions: When X relates to Y, the relational pattern (behavioral sequences in the relationship ) of X s X s behavior is characterized by: high low 1 2 3 Midpointing 4 5 low Contact: closeness, dependency, enmeshment, high levels of psychological intensity (Fear of abandonment?) high

Its not the specific behavior.. but the functional-relational pattern it represents.. behaviors and their possible interpersonal (relatedness) functions Autonomy: distance independence separating, Low levels of psychological intensity (Fear of Enmeshment?) high Adol Substance Abuse Having many jobs and (pseudo-individuation) Being cold, outside activities Borderline sarcastic, rejecting Teenage runaway Visible self mutilation Ideal balanced adult Withdrawing passively Focused, successful Double dating Being depressed Teenage runaway Giving considerable Nurturance, warm & loving low Positive Behaviors Having childhood phobias, Being insecure Contact: closeness, dependency, enmeshment, Negative Behaviors

Hierarchy refers to the pattern, over time, of relative influence based on power, position, and resources. Parent up(+) Parent down(+) Parent up Parent Symmetrical: (Exchange = Behaviors) Parent down

Relational factors: Hierarchy Functions - Hierarchy: PARENT VERY 1-UP 1 (1 UP+) Balance of influence very much in favor of parent Bad versions Parent is perping kid & kid can t t escape, Parent smothers and over- controls kid who complains loudly but can t influence parent to stop Good version parent is a trusted resource, provides high rate of structure & monitoring

Relational factors: Hierarchy PARENT UP Balance of influence in favor Bad versions in favor of parent versions Parent demands respect, controls coercively but is inconsistent in following through. Youth complains about parent but still depends more on parent than parent does on youth Good version version parent is a resource, provides structure & monitoring, youth asks rather than demands, youth requires parent justify position, but accepts it (even if grumbling).

Relational factors: Hierarchy PARENT SYMMETRICAL WITH YOUTH Balance of influence is equal/reciprocal Bad versions versions Competition, comparing lists of injuries and/or contributions, knocking heads re some behavioral issue Good version version trading responsibilities, lots of negotiation rather than setting rules

Relational factors: Hierarchy PARENT DOWN Balance of influence in favor youth Bad versions in favor of versions Youth is determining parent s s behavior more than parent is determining youth s; Parent complains but can t t influence youth to stop Good version youth is a trusted resource, provides positive structure, anticipates and responds without guidance from parent Good

Relational factors: Hierarchy PARENT DOWN + Balance of influence very much in favor of youth Bad versions versions Youth is perping parent & parent can t/won t/won t t escape; youth over-controls parent who complains loudly but can t t influence youth to stop; parent is resigned and uses PO as complaint resource Good version Youth Youth takes care of parent, provides resources and high rates of structure & monitoring

Assessing Relational Functions: Additional considerations (1) functions are sometimes not obvious, can be indirect (triangles) (2) functions are relationship specific (a parent can have different relational functions with different kids; a youth can have a different relational functions with each parent (boyfriend, extended family members, etc) (3) family members often mis-report (look at where the patterns typically end up not what they want [intend] but where they stand relative to one another. when the dust settles )

Behavior Change Phase

The FFT Clinical Map...systematic Changing the problem behavior by using the therapist skills of. Teaching, modeling, coaching, providing technical aids, and giving directives that help families improve their ability in Behavior Change Parenting & Youthing Communication Problem solving Assessment Conflict management Positive Compliance Intervention Changing the youth s s problem behavior by eliminating the dysfunctional Behavior behaviors Change (drug abuse, delinquency, violence, etc) and changing the processes that support it by developing individualized change plans that fit the family (values, relational functions, abilities), and increase competence

Goal: Behavior Change Phase develop and implement individual change plan that targets presenting problem by reducing family risk and building family protective factors Desired outcomes are improved... Developmentally appropriate 58... Monitoring and supervision Consequences/rewards/punishments Parenting skills Communication skills (parents & adolescent) Family conflict management Problem solving Compliance (by all family members)

Behavior change targets and implementation Client Assessment OQ YOQ/YOQ-SR Problem and other Sequences Target(s) Communication Problems solving Sequence interruption Implementation Match to How to present/do Reframe to use as context Relational Assessment Specific Session Intervention Plan Get it started Keep it on track Follow-up Organizing Theme(s) 59

Apply Behavior Change interventions. How to implement: Behavior change technologies (interventions) and therapist persuasion based on alliance, hope, and positivity In sessions Planned through teaching/using a client issue Opportunity through through an in session incident How Coaching, directing, teaching, using technical aids As homework Specific task that is accomplishable Clearly presented/understood High expectation of success Model Directly/indirectly demonstrated by the therapist

Behavior Change Technical Aids (examples( examples) tape recordings, therapist handouts reminder cards / post-it notes /charts, notes, message centers on refrigerators school-home home feedback systems answering machines, e-mail, e instant messages, text message pictures, corny sayings, symbols Interactive rituals (games, relaxation training) 61

Communication skills training: Elements of positive communication 1. Source responsibility 2. Directness 3. Brevity 4. Concreteness and behavior specificity 5. Congruence 6. Presenting alternatives 7. Active listening 8. Impact statements

Communication flow chart Assertion Validation Negotiation Want Behavioral Specificity/ alternatives Active Listening ( you want ) Source Responsibility + Directness Brevity ( you ) ( I ) Affect expression & regulation, validation, relationship building Feel Impact Statements Active Listening ( you feel )

Validation, Relationship Building FEELING WORD(S) Paraphrase NO FEELING WORD(S) Ask if feeling exists Synonym Guess about feeling Ask for more feeling info Avoid being defensive Avoid being defensive

Behavior Change Intervention Technology: Conflict management Avoid it Change reaction to early steps in the process Exactly what is the issue 2. 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? Contain it Present orientation Issue focused Time - out for transitions

Behavior Change Problem solving 1. Identify a problem.goals of the family in a specific incident/area/with a specific problem 2. Identify the outcome desired 3. 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 wrong 5. Come back and see if goals are met - accountability 66

Problem Solving (Continued) (Parent Perspective) 1 - Identify ONE problem (behavior, situation) 2 - Use principles of Positive Communication (e.g., Behavioral Specificity) 3 - Impact Statements (but no personal attacks) 4 - Ask / Invite youth re if s/he... understands how it is a problem for you (validate) wants to let you know why the problem occurred (in her/his own terms) has suggestions about how to solve the problem Prefers that you resolve it yourself

Behavior Change Interventions technologies Review & Additional Basic Parenting Principles/techniques 1. Contracting & Monitoring, Contingency Management w/ younger adolescents 2. Response-cost techniques / Action-related consequences / Time-out 3. Relationship building & Conflict Management 4. Challenging Pathogenic Beliefs (and linking them to interpersonal functions and reframes / themes)

Behavior change interventions require therapist To have a well thought out change plan Structure the session to accomplish it Contingently respond to what happens in the session hearing/seeing feedback Find ways to be flexible (creative) in order to meet behavior change goals:» Ignoring some things» Staying with it while responding interpersonally Monitor motivation throughout implementation (Backing up to engagement/motivation when needed) Follow through

Remember that resistance indicates that one or more members do not experience that the therapeutic process will benefit them OR Our interventions did not fit Interpersonal Functions OR We were sloppy!

Generalization Phase Assessment Intervention Early Middle Late

The FFT Clinical Map...systematic Engagement Desired Outcomes family stabilizing changes family using necessary community resources on their own family Behavior acting with Change self-reliance incorporate community systems into treatment Generalization Assessment Intervention Motivation Behavior Change Generalization Early Middle Late Time

Using Reframing in Generalization Validate Reframe Assess acceptability/fit Change/continue Maintain motivation when the felt need is gone using reframing Redefine challenge as keeping going despite the fact feel better Link to organizing theme

Generalization Phase Supporting Change Generalization Phase Functional Family Therapy Relevant Community Support Prosocial activities Monitoring/supervision Educational services Matched to the family Additional Professional Services Individual Therapy Parent Education Anger management

Maintaining Change 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: Attribute change to the family Responding to events they bring in by focusing on relapse prevention

Generalization Phase relapse prevention 1. Identify situations where problem may occur 2. Identify strategies to use when problem reoccurs 3. Predict the problem to recur.in order to build confidence that new skills will work in similar/different situations over time

Support Change resources in community Families are multisystemic Context will impact ability to support change in the long run Supporting change is aimed at: Becoming self-sufficient sufficient in using relevant/necessary community resources to help Using behavior change competencies to deal with the world around them Examples: Parenting class Individual therapy Rent assistance Special school program to help with academic issues Goal: Have the FAMILY do it.you help direct them

Generalization phase Supporting change..family Case Manager role FFT therapist role in generalization family case manager 1. Know the community Have current list of providers/agencies Know the transportation system Know the school system/contacts Know juvenile laws

Generalization phase Family Case Manager role 2. Develop contacts have specific referral persons in agencies (schools, mental health agencies, YMCA, boys/girls clubs) 3. Remember the ethics Confidentiality.Release of information Exceptions Reporting laws

FFT Phases of Change ENGAGEMENT - MOTIVATION BEHAVIOR CHANGE GENERALIZATION Create Therapeutic Alliance, Reduce Negativity & Hopelessness P H A S E G O A L S : Individualized Short & Long Term Positive Changes: Behavior, Attributions, Emotional Reactions Maintain &Generalize Positive Changes, Connect & Use Positive Community Resources M A J O R A S S E S S M E N T F O C U S Relationships and the Interpersonal Function of Behaviors, Emotions & Attributions Values, Behaviors, Sequences, Skills & Deficits MULTIPLE SYSTEM- COMMUNITY LINKS, Extrafamilial Risk & Protective Factors

FFT Phases of Change (cont) ENGAGEMENT -MOTIVATION: RELATIONAL BEHAVIOR CHANGE: GENERALIZATION: CASE STRUCTURING MANAGERIAL M A J O R C L I N I C A L F O C U S & T E C H N I Q U E S ulturally Respectful & Appropriate bh s, Positive Reframing, Nonblaming Themes, Relational Focus, Divert Blaming, Sequencing Direct,Teach,Model: Communication Training, Parenting Skills Training, Conflict Management, Relationship Skills, Problem Solving Family Case Management (Develop Community Resources), Relapse Prevention, Rehearse New Skills For Future

It isn t just a set of skills It isn t just an intervention (e. g. the right reframe) It is a systematic system of: Understanding, deciding, and.doing from within the model Therapist Reality process issues Change Process Expert Family Reality Experience in the room how do I feel about.? how does this fit with what I think about does this make sense to me? what does this mean I will have to do? alliance/outcome issues Life Expert Process Focus what phase am I in? what are the goals of the phase? what do I need to assess? how do I need to intervene to accomplish the goal how do I match to.. what do I need to know about...

Case Planning 1. Case Plan based on: what you know about individuals (parents/adolescent), family, context from both relational and risk and protect factor perspective how to match to Individualized change plan matched to clients relational needs, problem, and context 2. Session Plan based on: Goals of the phase, ways to get there that match client, thread of reframes used to organize the problem

Case Planning Protocol ( Big( Picture ) 1. How can we understand the family? Presenting problems, possible underlying strengths and motivations Risk and protective factors in family, individual, context Relational understanding of family 2. How does the problem function in the family relational system? 3. What are the major themes/reframes that organize therapy? 4. Individualized change plan...potential outcome sample Behavior change targets Implementation of behavior change plan 5. What are the multiple systems involved that impact maintenance and support of change

Session Planning Protocol (Specific plan) 1. What phase.? 2. Goals of that phase? (my process goals for this session) Which goals are important for this session? What progress have you made toward the goals? Process issues to address (e. g. negativity/resistance)? 3. What do I need to assess? (my assessment goals for this session) 4. What major theme/reframe organizing the case - What part to develop? How to add to it 5. How should I intervene?..targets for the session Which phase goals are targets for session?