Core Principles, Goals, and Techniques

Functional Family Therapy is so named to identify the primary focus of intervention (the family) and reflect an understanding that positive and negative behaviors both influence and are influenced by multiple relational systems (i.e., are functional). FFT is a multisystemic prevention program, meaning that it focuses on the multiple domains and systems within which adolescents and their families live. FFT is also multisystemic and multilevel as an intervention in that it focuses on the treatment system, family and individual functioning, and the therapist as major components. Within this context, FFT works first to develop family members’ inner strengths and sense of being able to improve their situations—even if modestly at first. These characteristics provide the family with a platform for change and future functioning that extends beyond the direct support of the therapist and other social systems. In the long run, the FFT philosophy leads to greater self-sufficiency, fewer total treatment needs, and considerably lower costs.

At the level of clinical practice, FFT includes a systematic and multiphase intervention map—Phase Task Analysis—that forms the basis for responsive clinical decisions. This map gives FFT a flexible structure by identifying treatment strategies with a high probability of success and facilitating therapists’ clinical options. FFT’s flexibility extends to all family members and thereby results in effective moment-by-moment decisions in the intervention setting. Thus, FFT practice is both systematic and individualized.

The following sections describe the intervention phases and the model of FFT clinical assessment. As the clinical map presented in the table reflects, FFT is a multiphase, goal-directed, and systematic program.

Intervention Phases

FFT’s three specific intervention phases—engagement and motivation, behavior change, and generalization—are interdependent and sequentially linked. Each has distinct goals and assessment objectives, each addresses different risk and protective factors, and each calls for particular skills from the interventionist or therapist providing treatment. The interventions in each phase are organized coherently, which allows clinicians to maintain focus in contexts that often involve considerable family and individual disruption. The three intervention phases are described in the sections that follow.

Phase 1: Engagement and Motivation. This phase places primary emphasis on maximizing factors that enhance intervention credibility (i.e., the perception that positive change might occur) and minimizing factors likely to decrease that perception (e.g., poor program image, difficult location, insensitive referrals, personal and/or cultural insensitivity, and inadequate resources). In particular, therapists apply reattribution (e.g., reframing, developing positive themes) and related techniques to address maladaptive perceptions, beliefs, and emotions. Use of such techniques establishes a family-focused perception of the presenting problem that serves to increase families’ hope and expectation of change, decrease resistance, improve alliance and trust between family and therapist, reduce oppressive negativity within families and between families and the community, and help build respect for individual differences and values.

Phase 2: Behavior Change. During this phase, FFT clinicians develop and implement intermediate and, ultimately, long-term behavior change plans that are culturally appropriate, context sensitive, and tailored to the unique characteristics of each family member. The assessment focus in this phase includes cognitive (e.g., attributional processes and coping strategies), interactive (e.g., reciprocity of positive rather than negative behaviors, competent parenting, and understanding of behavior sequences involved in delinquency), and emotional components (e.g., blaming and negativity). Clinicians provide concrete behavioral intervention to guide and model specific behavior changes (e.g., parenting, communication, and conflict management). Particular emphasis is placed on using individualized and developmentally appropriate techniques that fit the family relational system.

Phase 3: Generalization. This FFT phase is guided by the need to apply (i.e., generalize) positive family change to other problem areas and/or situations. FFT clinicians help families maintain change and prevent relapses. To ensure long-term support of changes, FFT links families with available community resources. The primary goal of the generalization phase is to improve a family’s ability to affect the multiple systems in which it is embedded (e.g., school, juvenile justice system, community), thereby allowing the family to mobilize community support systems and modify deteriorated family-system relationships. If necessary, FFT clinicians intervene directly with the systems in which a family is embedded until the family develops the ability to do so itself.

Assessment

In general, assessment in FFT is based on the following principles:

• FFT assessment should focus on the ways that family relational systems are related to the presenting behavior problems—in both adaptive and maladaptive ways.

• FFT should identify risk and protective factors through clinical and formal assessment. In doing so, FFT helps identify family, individual, and contextual issues that might become the targets of treatment.

• Assessment should be multilevel, multidimensional, and multimethod. Individual factors include the adolescent’s cognitive and developmental level and any psychological conditions that he or she may have (e.g., depression/anxiety, thought disorders). Assessment should also consider the adolescent’s family because the family is the psychosocial context in which the adolescent lives. Family factors considered in an FFT assessment include what goes on during daily family life (e.g., parenting, teaching, supporting, providing, and relating). Behavioral and contextual factors include external and social factors that influence the adolescent (e.g., the presence or absence of risk and protective factors and the availability of community resources).

• Assessment of family functioning—rather than completion of a diagnostic assessment—is the most helpful way to identify appropriate treatment options and approaches. The goal of assessment is to plan the most appropriate treatment.

• Clinical, outcome, and adherence assessment are critical to successful implementation of the FFT model.

FFT has identified formal and clinical tools for model, adherence, and outcome assessment. These tools are incorporated into the Functional Family Assessment Protocol—a systematic approach to understanding families—and the Clinical Services System (CSS)—an implementation tool that allows therapists to track the activities (i.e., session process goals, comprehensive client assessments, and clinical outcomes) essential to successful implementation.

CSS seeks to improve therapists’ competence and skill by keeping them focused on the goals, skills, and interventions needed for each phase of FFT. CSS’s computer-based format gives therapists easy access to a variety of process and assessment information which, in turn, allows them to make good clinical decisions and provides them with the complete outcome information needed to evaluate case success.

Functional Family Therapy	Juvenile Justice Bulletin • December 2000