Conflict of Interest

Functional Family Therapy

International Certification Program

Clinical Training 1

Thomas L. Sexton, Ph.D., ABPPIndiana University

Conflict of Interest• The presenter of this information is

required by Indiana University to reveal a potential conflict of interest. He is an owner of a training program that receives income from that activity, his primary writing and scholarly work is in this area, and he promotes this particular model of therapy.

FFT is unique in the EBP World

and evidence based treatment that is:• Purposefully Creativity

• Flexibly Structured• Model focused and Client Centered

• Change that is guided by the model….driven by the Family…with respect for how the family

“functions”• “inside out” approach

• Requiring a creative therapist• Aided by….

The FFT Story• Evolution in Theory• Evolution Through Practice

• Diverse cultures/communities (African American, Hispanic, Vietnamese, Chinese, Haitian, Dutch)

• Diverse clients and therapists• Multiple Languages (8 different languages:

English, Spanish, Mandarin, Creole, Dutch, Moroccan, Turkish, Sudanese, Russian)

• Urban/Rural• Evolution through Science

• Clinical outcome studies—does it work?• Process studies—what works? How does it

work?

Common Factors FFT

Principles of Good Practice“Common Factors”-therapeutic relationship

-hope/expectation-ritual of practice

Unique Features-Clinical Protocol

-relationally focused process-specific change mechanisms

-for specific problems

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

1. Guiding Theoretical Principles• Conceptual, philosophical, and emotional center of

the model• Parameters within which FFT occurs

2. A Clinical “Map”• Systematic process of therapeutic change• Specific goals, objectives, and therapist activities• Mechanisms of change

3. System SupportSystematic, model based clinical supervisionAccountability Quality assurance methods

• Management/treatment responsibility/supervision/clinical decisions FFT based (FFT/CFS)

How we do training• In ways that match adult learning

theory research• Diverse methods• Sequenced over time• Repeated within increasing specificity

• Goal: adherence & competency in FFT

• Thinking through the lens• Following the map• Creativity within the structure

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

6 month 12 months 18 monthsAdherent 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

Clinical Outcomes & Model Adherence

Washington State Project

* Statistically significant outcome

“Adherence to the Model as a vehicle to

Meet the needs of the client”

Training Process• Phase I: Learning the Clinical Model

• Clinical Training• Ongoing Consultation/Supervision• Continuous Quality Improvement (Q-

System use)• “practical” training/observation

• Phase II: Site Clinical Supervisor Training

• Site supervisor• Training to prevent model drift• Continuous Quality Improvement (Q-

System use)

Functional Family Therapy is unique

The “LENS” of FFT

• Systemic foundation

• Pragmatic focus on how the family “functions”

• Our…”inside out” approach

Lens are…..

• Explicit or implicit, Principles/theory that explain

• clients, therapy, and change, and a systematic

• how clients function, • how psychological problems develop,• how to help people change, • and the interrelationship among these

factors

• FFT tries to make these principles explicit, practical, and relevant to clinical change

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

Change the probably of future behavior problems

Primary entry/focus

Point of immediate,

relevant, and lasting change

Functional Orientation-inside out

conceptualization

Systemic Foundation

Basic Unit of Analysis

Family

Child

Mother/Figure

Child

Father/Figure

Finding the “function” of the symptom in the

relational system• Relational patterns• Coalitions/alliance

within patterns• Relational “information”

and its movement through the system

What is the “root cause”

• Physical (genetics/brain function)

• History (trauma/background)• Learning History

• Etc.

A matter of “figure & ground”

Systemic Foundation

Relational Patterns

Mom

Son

Mom

Dad• Relational Patterns are common ways of working

in families that involve everyone

• Problem sequences….are are common across

“content”• Maintain and support the

“problem behavior”• Point of intervention and

change

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

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

Anja: “there is no going out for you….it just ins’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 wans’t raised right…”

Mom/mother figure

Dad/father figureAdolescent

Problem Behavior

Problem “definition-what/who the problem is

Emotional Reactions (negativity)-why its an important problem

Behaviors-what should be done about it







Relational Functions• Functional outcomes of these patterns

• Relational “glue” • Stable and consistent

Mom/mother figure


Clinical Symptoms

Match to…

The goal….Reduce the future

Probability ofthe “problem behavior”

Targets of Change-underlying patternsof FAMILY behavior

Relational “Functions”

Goal..understand and use…Attempting to change these basic motivational

components of human behavior in just a few sessionsis clinically impossible and ethically inappropriate

“When X relates to Y, the typical relational pattern (behavioral sequence within the

relationship ) is characterized by degrees of:Relatedness….contact vs. distance

(psychological interdependence)Hierarchy….relational control/influence

When X relates to Y, the relational pattern (behavioral sequences in the relationship ) of X’s behavior

is characterized by:

RelationalIndepende

nceAutonomy:

distance,Independenc

e,disengageme

nt(Fear of

Enmeshment?)

high

low

Interdependency: closeness, dependency, enmeshment (Fear of abandonment?)

low high

12

4

5

3 Mid-pointing

Its not the specific behavior…..but the functional-relational pattern it

represents….behaviors and their possible interpersonal (relatedness) functions

RelationalIndependenceAutonomy:distance,Independence,disengagement

high

low

low high

Withdrawing passively

Being cold, sarcastic,rejecting

Substance Abuse

Having childhood phobias,Being insecure

Being depressedDouble dating

Being hysterical

Teenage runaway

Teenage runaway

Contact: closeness, dependency, enmeshment, (Fear of abandonment?)

Visible self mutilation “ideal” balanced adult

Having many jobs and outside activities

Giving considerable Nurturance, warm & loving

Focused/successful professional

“Positive” Behaviors

“Negative” Behaviors

P

A

PA

P AP

A

One-up One-up

Symmetrical

Relational Hierarchy pattern of relationship determination over time

When X relates to Y, the relational pattern (behavioral sequences in the relationship ) of X’s behavior is characterized

by:

Degree to which on personDetermines the relationship

Degree to which on person determines the relationship

Symmetrical:Exchange = Behaviors

1-up +

1-up P

A

Relational factors…...What to do about relatedness

functions• Goal: identify relational functions….use

these as “Pathways” to change…ways to implement behavior changes

• Match to….relational functions• To do so…

– discrepant functions are accommodated– all functions are accepted as legitimate– generally don’t change functions…..– …..change the behavior, affect, and

cognitive/attributions related to the expression of the function

– goal is to provide alternative ways of expression– Use to match to behavior change intervention…

outcome sample

Use of Relational Functions• Matching to the family in

– Reframing– Organizing themes– Behavior change implementation– How to generalize, maintain, & support

changes

Mom/mother figure

Dad/father figure

Adolescent

• Current behavior makes sense in light of …• What people “bring” with them

•Where people come from (relational context)– Types of relationships…with parents/family

•What people are made of….(biological context)

•The environment in which they live (ecosystemic context)– Peers/schools/mental health system/community

• Interactional Relationships• Core family/dyad stable relational patterns

Relational sequences/problem sequences

What people bring to relational systems

When you know what families bring…

• You can:– Better understand what is important – Understand family reactions to events– Acknowledge and reframe– Organizing themes that “match” to

them– Find a way to make therapy relevant

When you think relationally• Clinical problems are NOT because of:

– the family/youth’s anger– the family/youth’s lack of “motivation”

• We expect them to be discouraged, lack motivation, angry, unhappy with the systems

– history or biology– peers– bad choices– inability to “just say no”– “mental health” issues– Drug abuse

• Based on the individuals “problem definition”

Comes from……• Family has been functioning for

some time….encountered problem that has become “part” of the family….now “functions” as a central part of how they relate

– Not what they “want”– Not what they “need”– They way in which they have come to

“be” in response to the “problem”

Clinical Problems

Family “problems” are relational problems

In their attempt to solve/deal with the problems….• Family come to therapy with a

“definition” of what is the problem– Result of each family members experience and

thinking/working to understand their life/problems– Natural part of finding a solution

• This definition is usually:– focused on “a person” (attributional component)– has negativity attached (emotional component)– is accompanied by blaming interactions that have

become central to the relational patterns of the family (behavioral component)

•

What therapy changes

Individual

Mom/mother figure

Dad/father figure

Adolescent

1. Most critical issuesolved…and

2. Prepared for the next “problem”

-cope/deal with in a new way-empowered with a “way”

To solve future

The “MAP”• The Clinical Protocol

• Goals, Directions• Pathway of change• Relational & process focus

Clinical Model

Motivation

Intervention

Assessment

Engagement Behavior Change

Behavior Change

Generalization

Generalization

Early Middle Late

Goals• Alliance between family

with therapist• Family/relationally

based problem problem focus• Reduced family member

negativity/blame• Increased motivation

Goals• Increase behavioral competency of all/family

• Consistent performance of competency in “real” problem situation

Goals• 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

Engagement & Motivation Phase

Motivation

Goals:1. lower within family

blame and negativity2. Increase within family

alliance3. family focus to the

presenting problem

Intervention

Assessment

Engagement

Early

OutcomesWhen they Interact and solve problems it is with:

• Alliance • Family/relationally based problem problem focus

• Reduced negativity/blame• Shared responsibility and ownership

Engagement/Motivation Phase

Engagement For positive participation a discussion that is relevant

(about what is important) that involves trust, respect and alliance

(e.g., core relational skills, acknowledgement)

MotivationNot only to participate in therapy, but to undertake the

specific behavior change steps designated by therapist(e.g., Reframing, Theme Developing Skills)

Engagement/Motivation Sessions

Goals• reduce within family

blame• reduce within family

negativity• build therapeutic

alliance• redefine problem as

family focused• increase

hope/expectation for change

Assessment• problem definitions• Problem sequence• How they “function”

or work together

Interventions

• reframing • Develop an

organizing theme that is family

focused• diverting and

interrupting• structuring session

to discuss relevant topics

Implementing Engagement/Motivation Phase

E/M PhaseFunctional Family Therapy

Goal…Engagement in therapy

Motivation to try something new/engage in change

Family focused experience/understanding of the problem

New ProblemSituation



Help the family develop a “climate” of working together to solve problem

-Individual responsibility for somePart of/role in the problem

-new “definition”/understanding of the problem”

-reduction in negative feelingsblaming










What to hear

• FFT therapists try to hear something different: 1. Hear attribution, emotion, and

behavioral pattern as central element underlying the “presenting” problem

2. Hear risk and protective factors embedded in this pattern that increase the likelihood of “clinical problems”

3. Think….”family relational pattern”• Common/central pattern that is at the foundation

of the many different “presenting” problems

Engagement/Motivation Goals…Developing motivation and

alliance • Creating a “family focus” to the

presenting problem– Redefine the problem (away from presenting one)

• Family enters with “problem definition” that is part of what has them stuck

• New problem definition that is less blaming, negative, and individually focused

• Create a relational focus--a family focus for the problem…

• Each family member has a “part” (responsibility without blame)…everyone involved in some way

• Each “part” linked to the challenge that the family currently faces (family focused)

• Sets the stage for different solutions (behavior change)

……thus, minimize hopelessness, ready family to take responsibility for trying new skills and making behavioral changes

Initial Presenting Problem Definition-attributional 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-attributional aspect-emotional valence


MotherInitial Presenting Problem Definition

-attributional aspect-emotional valence


FatherInitial Presenting Problem Definition-attributional aspect-emotional valence


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 blame

Not compromisingmediating

or negotiating

Family FocusedProblem definition

AccomplishedThrough relentless relational

Reframing

The Outcome:Motivation, negativity reduction,

Family to family alliance, Therapist to family alliance


Reframing


Reframing

Two direction ways to reduce negativity and blame

• Change the meaning of the behavior of the other

• Build Responsibility in the “speaker”/”blamer”

Engagement/Motivation Phasepurposeful, therapeutic

conversations

Individual ResponsibilityTime…..

Family Therapist

Between family member negativity/blame

Personal conversation…that is direct…

about the most important issues to the family

Therapist

RelationalProcess of Reframing

Acknowledge

Reframe

ImpactAssess acceptability/fit

Change/continueMaking it fit the client

RelationalProcess of ReframingAcknowledgment of:

-exhibited emotion-participation, effort

Description of:-current behavior/event

taking place between people/with one personin the session

--reported event/behavioreither between family

or of one person

Identification of:-important values,

beliefs, desires

Themes:1. Hurt behind the anger2. Protection3. Anger is loss4. Speaking out represents Independence

….as beginning points

tounderstanding of Persons, situations, etc.

1. Meaning-attribution-event-emotion(reduces negativity/blame)

2. Find the Noble Intent

3. Link family members togethermembers togetherIn struggle/problem(builds family focus/Interdependence)Listen…listen…listen

Acknowledge

Reframe

Impact

“Build on”/continueBuilding theme that fits

Theme hint(best guess/hypothesis)Description, statement, questionSuggesting alternative theme

ThemeA “new” explanation based on…1. Changed Meaning

2. Reduced negativity/blamepossibilities for change

3. Linked together in Problem and futuresolutionas all having someresponsibility/ownershipfor the problem and solution

Why Reframes & Themes Work“Respect based” Reframing

• Acknowledge (“yes….)• What they just said is important..frames

the situation/problem/event that is the “target”– Specifically/directly what happened (“…yes

that is what is happened here…)– Identifies a specific event, emotion…behavior

that has happened in the room of what has been reported

• What you “guess” to be important to them– What you guess to be the most important

value/aspect of what happened– Determined from “what they bring to the table”– Comes from what you heard…assumed…

guessed about the reason this is so important to them

Why Reframes & Themes Work“Respect based” Reframing

• Reframe (“and….)…what you “add to” the session

• Alternative meaning for what was acknowledged

• what might be “behind” or “the reason”• Focus…

– Person focused (their part)– Family focused (all of the parts) (“…yes that is what is important here…)

• Non-blaming…just an alternative description

• Non-interpretative– Doesn’t explain away…or excuse….DESCRIBES

• “theme hint”…just a guess– Based on what you have heard, what you know about them, what is common to adolescents

• Over time…. Built a “theme” about the family that is more inclusive than this one event/situation

Some examples• Hurt behind the anger• Anger is hurt• Control is protection• Etc.

How would you say it…..(acknowledge & reframe)

• “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”

Some examples• A boys is very angry• A girl is ….• A mother is hopeless….• The youth is quiet….• The family is in chaos…..

• Acknowledge & Reframe

Mom/mother figure


Clinical Symptoms

Problem “definition-what the problem is, why its an important problem

-what should be done about itBehaviors

-role in the problem sequence, the part they “play”-their responsibility







Mother Therapist

-Frame “this is important….”

-Acknowledge“this is what is important

to you…?”-Reframe

(“and it means…(theme hint) -change the meaning of

what was framed-individual responsibility

-linked to the pattern-different intention/

Meaning behind

Tells what is important-about what you said

-about what you didn’t Say

-About the problem definition

Adolescent Therapist




(“and it means…(theme hint) -change the meaning of

what was framed-individual responsibility

-linked to the pattern-different intention/

Meaning behind




Father Therapist







Organizing Theme• Frame…

• “you are…”• “this is a family….”• Specific behavior/pattern… Problem sequence

• Reframe– Explanation…gives different meaning of “how they

work” and “what is going on between them”• reframes “put together”• New story about what is going on in the family

(describes different reason for problem sequence) – each person….the family…how linked together– “your part….what it means….how it linked with othe rfamily

members• Complete, includes what is most important to family,

personal, specific in way that is individual

Engagement/Motivation Interventions…reframing

• Reframing…a response to a CLIENT statement– Acknowledge (acceptance/support of the intent, the position, the

values) of the client…..• not agreement…not empathy….• Personal not general

– Reattribution of that statement (change in meaning)

• Building Themes…..reframing a CLIENT statement to:– Your hypotheses of a theme (theme “hint”)– An existing theme in the conversation

• Organizing Theme…..a theme that describes:– Each persons motivate in non negative ways– Links everyone in the family together….to a common problem,

challenge, of situation

What makes reframing work

1. “feel” the reframe• Therapist able to “be the client” and know what is

important…the nobel intention behind the behavior

2. “believe” the reframe• It “is” how you understand them

3. “linked” to everyone else4. Presented in a way that is…

• With acknolwedgement• Respectful

Outcome• Themes….1. identify the noble intention2. Set the goals of therapy3. Help you stay our of the “weeds” (details)4. Break negative relational patters5. Provide positive attribution6. Build a family focus “(it is all of us”)

Behavior Change Phase

Behavior Change

Phase based Treatment Goals:

1.Build behavioral competencies that

fit the family 2. Target the most

relevant, obtainable, and maintainable competencies

3. Match competencies to

relational functions

Intervention

Assessment

Behavior Change

Middle

Outcomes• Increase behavioral competency of all/family


Behavior Change Phase

Behavior change sessions

Goals• Specify the

behavior change “individualized

plan” • 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

Problem Solving

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

Conflict Management

Implementing BC Phase

BC Session




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



that come up



that come up


Behavior Change Targets1. Is it Relevant?

– What would feel to the family like success– What make a “difference”

2. Is it Obtainable?– Can they do it– Will it derail therapy because it is to hard

3. Does it “fit” them– Relational functions– Organizing them

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

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

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

• Single, individualized “behavior change plan”• Combination of individual skills

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



curfew-specific spot in the

sequence

Conflict Management

Communication-direct and concrete

communication

Parenting-monitoring and supervising

Where they use:Negotiating/

Problem Solving

as a family based resource

Parent Adolescent

With components of….to individualize to the family

Targets of FFT Behavior Change

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”…a way to “prevent” in the future

Generalization Phase

Generalization

Phase Based Treatment Goals:

1.Reduce within family risk factors

2. Lower within family blame and negativity

3. Increase within family alliance &

family focus

Intervention

Assessment

Generalization

Late

Outcomes• Increase behavioral competency of all/family


Generalization Phase

Generalization Sessions

Goals• Generalize the BC target skills to

other areas• Maintain change

through relapse prevention

• Access external resources to

support change

Interventions• Relapse prevention

(if the family is falling back into

problem behaviors)

• Linking new problem situation

to BC skill• Linking family to

relevant outside resources

Assessment• Identify external family systems to

apply BC skills• Identify contextual

barriers to maintaining the BC

target• Find areas to

generalize• Identify relapse

points

Generalization Phase…shifting focus

In generalization two points of attention• Within the family:

• Relapse prevention • Generalization of competencies• Maintenance of alliance

• Outside the family:• family--environment interaction(interface)…where

the family interacts with the community/environment

• Relationships between family (individual and whole) and the community

• Use of behavioral competencies in these relationships

• In order to use relevant available resources to support changes

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

Why the Generalization phasefamilies 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.

• In this step, the successful family becomes consistent over time and learns to handle the emotional discouragement of “relapses.”

Logic of Generalization• Small changes can have a multisystemic

effect • These changes often don’t happen

naturally • Specific strategies for:

• generalizing new skills, • maintaining change, • and supporting those changes with the aid of

informal and formal community support systems helps create the necessary system change for long term success.

• 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.

Generalizing Change

Primary Target

Area/content focused on:


etc.

New area

New area

New area

Behavior ChangeBuilt a “competency”

to reduce a risk pattern

-communication/problem solving/ etc.Move competency to a

new “content” area

Move competency to a new “content” area

Going outWith friends

Homework

RelationshipWith sibling

Time withboyfriend


How to maintain, support, and

generalize new climate, alliance, behavior changes

Medical Evaluation

Psyc Intervention

Community/School-direct and concrete communication

Extended Family-monitoring and supervising

Parent Adolescent

Area to support changes, add to

changes, and places to generalize and

extend change

Supporting Change

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

Clinical “Art”• Creativity within the

structure• Therapists as translators• Family based change

through reliable change processes

Bringing Creativity to the Structure

• Client Centered– Responsive to clients– Responsive to client needs– “fit” to a client

• Artfully applied– Require clinical creativity and

expertise

Contingent nature of phases...

Contingent nature of phases...

Matching to….• Match to…….guides therapist clinical

interventions behavior– Model sets the process goal….match to

helps us individualize how we get to that goal to the unique family in front of us

– Match therapy to family….How those goals are accomplished

• Unique solutions within a structure model

What does it take? A therapist that……

• Looks through a “lens”• Follows a Model……follow the “map”• Creates and implements a “unique case

plan” for each family• Use “in the room” experiences to promote

change (change mechanisms)• Creatively Adapt.....

• Matching to the client• adapting next response to”

• match client/context• add what was not understood/missed

• Access change....did it work?

“Matching?”• Matching means…

– Matching interventions to family presentations • Change meaning in ways consistent and respectful of all

family members• Themes to generate hope

– Working within families’ existing structures• Relational function matching• Changing patterns but not relational functions during

Behavior Change• Making sure family links to external resources maintain

relational functions

– Ensuring all of this done in a manner that fits the developmental, cognitive, and physical abilities of all family members

Creativity within the Structure

Continuous Quality

ImprovementProgress notes, Session Plans

& Process/Outcome Measures

FFT/CFS & model specific Feedback

FFT/CFSquality improvement system for Functional Family Therapy

• Clinical Feedback tool….– Bring information to you…at a glance to

help plan sessions– Allows client a “voice” in the progress– Lets you know how to match to the family

• Domains:

– Service delivery (the profile of how units of service are delivered in FFT)

– Treatment planning (case conceptualization and session planning)

– Model Specific Adherence (treatment fidelity)

– FFT treatment progress & Process (impact of treatment on client

– Outcomes (Client reported outcomes of the FFT treatment episode)

FFT/CFScontinuous quality improvement system for Functional Family

Therapy

Clinical Decisions& Adaptationsthat match to

• immediate client needs• Promote the most efficient delivery of FFT

FFT/CFS Clinical Markers

Real Time Feedback

Treatment Planning (Progress

Notes)

Session Planning (Session Planning Guide)

Client

Session Impact

(immediate

family changes

)

Caregiver Strain

Questionnaire-Short

Form (CGSQ-SF)

Therapeutic

Alliance(TA)

Youth Symptom

and Functionin

g(SFSS)

Session

BaselineFamily

Functioning

(Com-R)

Post Treatment Family Functioni

ng Measure (Com-R)

Model Specific Adherence (CQP)

Motivation

Engagement Behavior Change

Behavior Change

Generalization

Generalization

Session

Documents

Conflict of Interest