Family Therapy Workshop PDF
Family Therapy Workshop PDF
Family Therapy Workshop PDF
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?
Personal History
Cultural context
Clinical Experience
Other & Agency Tradition Age
Intervention
models Expectations of
Referral agencies,
Gender
etc
Translated through the ..
FFT “Lens”
•See families in relational,
•strength based, non-judgmental ways
Clinical decisions
(what you choose to do at each moment)
Family “problems” are relational
The family’s experiences lead them to enter
therapy with a “definition” of what is the
problem
RELENTLESS EFFORT
TO UNDERSTAND AND RESPECT
THESE YOUTH AND FAMILIES ON THEIR OWN TERMS
Where do we start?
Why “FAMILY FIRST?”
.24
Self-Control Academic
Self-Efficacy .19
.70
.14
Social and
Community
Prevention (N=8,576)
(CSAP)
Ecosystem
School Influences Community
Clinically
Peer Extended
Groups Family
Significant
Behavior
Intra Individual
(Diathesis)
Factors & Processes
Clinically
Peer Extended
Groups Family
Significant
Behavior
Intra Individual
(Diathesis)
Factors & Processes
Family
First
Relational Functions
(inferred)
that serve to motivate and maintain stability
in family relational patterns
• 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
Peer Extended
Groups Family
Clinically
Intra Individual
(Diathesis) Significant
Factors & Behavior
Processes
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) FFT Behavior
Change &
that serve to motivate and maintain stability Generalization
in family relational patterns
35,0% •38%*
reduction in
30,0% felony crime
25,0% •50%*
reduction in
20,0% violent crime
15,0% •$10.67
return for each
10,0% $1 invested
* Statistically significant
outcome
Functional Family Therapy
Motivation
Implementing phases across sessions
When does FFT
begin? Before
the first clinical And before, between, and
contact after sessions,
Engagement/ PLAN, THINK, CONSULT
Motivation CSS & TEAM
Behavior Change
Generalization
1 2 3 4 5 6 7 8 9 10 11 12
Sessions
Engagement and Motivation
Phase
Engagement Our Goal
To engage and motivate families to
becoming part of and stay in therapy..
Assessment
by…
Building
Intervention “balanced” alliance - with everyone
ENGAGEMENT &
MOTIVATION
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
At first, negativity,
individual problem focus,
blaming, and negative
& hopelessness is high
&
THEME
+
REFRAME
Negativity Continues
THEME “HINT”
(56 - 70+%)
= NONBLAME SEQUENCE,
(MAKE IT RELATIONAL)
PROMPT
- FRAME
REFLECT Negativity begins
To shift (-> 35%)
What is Reframing?
Reframing is an Interpersonal Process in
which the interventionist usually takes the
lead …
Therapist Family
Tells
Listens for….
“what is the matter”
-attribution of cause (who, what)
-who, what, why
-position…values
-what it means, how I
-metaphors
Feel about it-what I attribute
Responds with….
the cause to be
Family/relationally
focused reattributing
Validate-reframe
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
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 connection
My “sense” of psychological with you seems to
& emotional well being seems to reflect both autonomy
not “centered” on you &
High Connection;
(Autonomy):
Autonomy & there seems to be a
Most of my “connection” is
High balance (or conflict) of
“invested” elsewhere
Interdepen- both
dency
My “sense” of psychological
& emotional well being
depends heavily on you :
Walling Off There is considerable intensity &
investment in you; I’m “centered”
Pulling In on you a great deal
Interpersonal Relatedness Functions:
When X relates to Y, the relational pattern (behavioral
sequences in the relationship ) of X’s behavior is
characterized by:
high
1 2 33 Mid-
Mid-
Autonomy:
distance
pointing
pointing
independence
separating, 4
Low levels of
psychological
intensity
(Fear of
Enmeshment?) 5
low
Parent Parent
up(+) down(+)
Parent
Symmetrical:
Parent up (Exchange = Parent down
Behaviors)
Relational factors: Hierarchy
Functions - Hierarchy:
PARENT VERY 1-UP (1
UP+)
Balance of influence very much “in favor” of parent
• “Bad” versions – Parent is perping kid & kid
can’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” of parent
• “Bad” 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
PARENT DOWN
Balance of influence “in favor” of
youth
• “Bad” versions – Youth is determining
parent’s behavior more than parent is
determining youth’s; Parent complains but
can’t influence youth to stop
• “Good” version – youth is a trusted
resource, provides positive structure,
anticipates and responds without guidance
from parent
Relational factors: Hierarchy
PARENT DOWN +
Intervention
Goal:
•develop and implement individual change plan that targets
presenting problem by reducing family risk and building family
protective factors…
Relational
Implementation
Target(s) •Match to…
to…
Assessment
•Communication •How to present/do
•Problems solving •Reframe to use as
•Sequence interruption context
Organizing
Theme(s)
Specific Session Intervention Plan
Get it started
Keep it on track
Follow-up
59
Behavior Change interventions….
How to implement:
• Apply…
– Behavior change technologies (interventions) and therapist
persuasion based on alliance, hope, and positivity
– In sessions
• Planned through teaching/using a client issue
• Opportunity…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)
• tape recordings, therapist handouts
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
Behavioral Active
Want Specificity/ Listening
Negotiation
alternatives (“you want…”)
Source
Directness
Responsibility + Brevity
(“you”)
(“I”)
Problem solving
1. Identify a problem….goals of the family in a specific
incident/area/with a specific problem
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
OR
OR
Assessment
Intervention
Intervention
• Maintain
Validate motivation when
the “felt need” is
gone using
Reframe reframing
• Redefine
challenge as
Assess acceptability/fit keeping going
despite the fact
feel better
Change/continue
• Link to
organizing
theme
Generalization Phase
Supporting Change
Relevant Community
Support
•Prosocial activities
•Monitoring/supervision
•Educational services
Generalization Phase •Matched to the family
Functional Family Therapy
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
• 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
2. Develop contacts
– have specific referral persons in
agencies (schools, mental health
agencies, YMCA, boys/girls clubs)
P H A S E G O A L S:
Create Therapeutic Individualized Maintain &Generalize
Alliance, Short & Long Term Positive Changes,
Positive Changes: Connect & Use
Reduce Negativity & Positive
Behavior, Attributions,
Hopelessness Emotional Reactions 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 Values, MULTIPLE SYSTEM-
Interpersonal Function Behaviors, COMMUNITY LINKS,
of Behaviors, Sequences, Extrafamilial Risk &
Emotions & Attributions Skills & Deficits Protective Factors
FFT Phases of Change (cont)
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
Direct,Teach,Model: “Family Case
Culturally Respectful
Communication Management”
& Appropriate bh’s,
Training, (Develop Commun-
Positive Reframing,
Parenting Skills ity Resources),
Nonblaming Themes,
Training, Relapse
Relational Focus,
Conflict Management, Prevention,
Divert Blaming,
Relationship Skills, Rehearse New
Sequencing
Problem Solving Skills For Future
•It isn’t just a set of skills”
•It isn’t just “an intervention”
•(e. g. the right reframe) •Process Focus
•It is a systematic system of: •what phase am I in?
•what are the goals of the phase?
•Understanding, deciding,
•what do I need to assess?
and….doing from within •how do I need to intervene
the model •to accomplish the goal
•how do I “match to…..”
•what do I need to know about…...
Therapist Reality
“process issues”
Change Process Expert
•Experienc
FamilyeReality
in the room
•how do I feel about….?
“alliance/outcome issues”
•how does this fit with
Life
what Expert
I think about…
•does this make sense to me?
•what does this mean I will
have to do?
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