Functional Family Therapy

Clinical Model

FFT is a short-term, high quality intervention program with an average of 12 to 14 sessions over three to five months. FFT works primarily with 11- to 18-year-old youth who have been referred for behavioural or emotional problems by the juvenile justice, mental health, school or social care. Services are conducted in both clinic and home settings, and can also be provided in schools, child welfare facilities, Youth Offending Services and mental health facilities.

FFT is a strength-based model built on a foundation of acceptance and respect. At its core is a focus on assessment and intervention to address risk and protective factors that occur within and outside of the family.

FFT consists of five major components: engagement, motivation, relational assessment, behaviour change and generalisation. Each of these components has its own goals, focus and intervention strategies and techniques.

Engagement

The goals of this phase involve enhancing family members' perceptions of therapist responsiveness and credibility. Therapists work hard to demonstrate a sincere desire to listen, help, respect and "match" to family members in a way that is sensitive and respectful of individual, family and cultural beliefs, perspectives and values. The therapist's focus is on immediate responsiveness to family needs and maintaining a strength-based relational focus. Activities include high availability, telephone outreach, appropriate language and dress, contact with as many family members as possible, "matching" and a respectful attitude.

Motivation

The goals of this phase include creating a positive motivational context by decreasing family hostility, conflict and blame, increasing hope and building balanced alliances with family members. Therapists work to change the meaning of family relationships by emphasizing possible hopeful alternatives, maintaining a non-judgmental approach and conveying acceptance and sensitivity to diversity. The therapist's focus is on the relationship process, separating blame from responsibility while remaining strength-based. Activities include the interruption of highly negative interaction patterns, changing meaning through a strength-based relational focus, pointing process, sequencing and reframing of the themes by validating negative impact of behaviour while introducing possible benign/ noble (but misguided) motives for behaviour. The introduction of themes and sequences that imply a positive future are important activities of this phase.

Relational Assessment

The goal of this phase is to identify the patterns of interaction within the family to understand the relational "functions" or interpersonal payoffs for individual family members' behaviours. The therapist focuses on eliciting and analyzing information pertaining to relational processes, and assess each dyad in the family using perception and understanding of relational processes. The focus is directed to intrafamily and extrafamily context and capacities (e.g., values, attributions, functions, interaction patterns, sources of resistance, resources and limitations). Therapist activities involve observation, questioning, inferences regarding the functions of negative behaviours, and switching from an individual problem focus to a relational perspective. This sets the stage for planning in Behaviour change and Generalization, where all interventions are matched to the families' relational functions.

Behaviour Change

The goal of this phase is to reduce or eliminate referral problems by improving family functioning and individual skill development. Behaviour Change often includes formal behaviour change strategies that specifically address relevant family processes, individual skills or clinical domains (such as depression, truancy, substance use). Skills such as structuring, teaching, organizing and understanding behavioural assessment are required. Therapists focus on communication training, using technical aids, assigning tasks, and training in conflict resolution. Techniques and strategies often include evidence-based cognitive-behavioural strategies for addressing family functioning and referral problems. Phase activities are focused on modelling and prompting positive behaviour, providing directives and information, developing creative programs to change behaviour, all while remaining sensitive to family member abilities and interpersonal needs.

Generalization Phase

The primary goals in this phase are to extend the improvements made during Behaviour Change into multiple areas and to plan for future challenges. This often involves extending positive family functioning into new situations or systems, planning for relapse prevention, and incorporating community systems into the treatment process (such as teachers, Probation Officers). Skills include a multisystemic/systems understanding and the ability to establish links, maintain energy, and provide outreach into community systems. The primary focus is on relationships between family members and multiple community systems. Generalization activities involve knowing the community, developing and maintain contacts, initiating clinical linkages, creating relapse prevention plans, and helping the family develop independence.