2 Training GoalsDiscuss the role of case conceptualization as a foundation for FFT treatmentIdentify the critical elements of case planningPlanning for the casePlanning for the phasePlanning for the sessionReview the role of the Progress Notes & Case Planning guides in case conceptualization and planningPlanning measures/toolsContinuous quality improvement
4 To be successful with youth and their families FFT relies on… Guiding Theoretical PrinciplesConceptual, philosophical, and emotional center of the modelParameters within which FFT occursA Clinical “Map”Systematic process of therapeutic changeSpecific goals, objectives, and therapist activitiesMechanisms of change3. Session Planning4. “In the room” clinical decision makingResponding to “events” in ways that are phase specific and client centered5. Ongoing monitoring/assessment/adaptationuse of the Q for session planningFFT has good outcomes…but, they all depend on how it is deliveredWe do know the components that make it successful
5 Doing FFT Thinking FFT Planning what you do in the room What you do outside the roomCase conceptualizationPut client story into core principlesThinking through the lensDoing FFTwhat you do in the room-reframing problems/blame/negativity-interrupting negative behavioral patterns-promoting the use of newbehavioral competencies-generalizing changePlanningWhat you do outside the roomCase planningSession planningGoal (which one is most important)Progress (progress in achieving the goal)In essence it really takes three things to give FFT a chance to work
6 Keys to success in FFT Model specific Case conceptualization Model driven planningIn a way that….Matches the family processMatches the families way of functioningThat is relevant and important to themThat helps reduce risk factorsReduces the likelihood of future behavior problemsEmpowers the family to keep changes going
7 Functional Family Therapy Clinical Model Behavior ChangeMotivationEngagementGeneralizationBuild within familyprotective factors-behavior competencies-interaction change-that increase probability of- behaviorReduce within familyrisk factors-negativity/blame-hopelessness-build engagement/reduce dropoutBuild family to contextprotective /reduce riskfactors-peers/school/communityAssessmentEarlyMiddleLateInterventionEarlyMiddleLate
8 Functional Family Therapy Clinical Model Goal-phase/intermediate objectivesSkills-therapist actions that have high probabilityof reaching those goalsGoal-phase/intermediate objectivesSkills-therapist actions that have high probabilityof reaching those goalsGoal-phase/intermediate objectivesSkills-therapist actions that have high probabilityof reaching those goalsFunctional Family Therapy Clinical ModelEngagementBehavior ChangeGeneralizationAssessmentInterventionMotivationBehavior ChangeGeneralizationEarlyMiddleLate
9 Engagement/Motivation Sessions Assessmentproblem definitionsProblem sequenceHow they “function” or work togetherGoalsreduce within family blamereduce within family negativitybuild therapeutic allianceredefine problem as family focusedincrease hope/expectation for changeInterventionsreframingDevelop an organizing theme that is family focuseddiverting and interruptingstructuring session to discuss relevant topics
10 Engagement/Motivation Goals… Developing motivation and alliance Creating a “family focus” to the presenting problemRedefine the problem (away from presenting one)Family enters with “problem definition” that is part of what has them stuckNew problem definition that is less blaming, negative, and individually focusedCreate a relational focus--a family focus for the problem…Each family member has a “part” (responsibility without blame)…everyone involved in some wayEach “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
11 Behavior change sessions AssessmentIdentifying prosocial family based skill that fits youth/family problem sequenceFind barriers to adoption of BC skillDetermine if the target is being performed (compliance)GoalsSpecify the behavior change “individualized plan”Link BC targets to the organizing theme to build relevance and motivationBuild compliancematch to the clientcheck if the BC target works to solve conflictInterventionsreframingModelingTeachingOvercome barriers/adapt
12 Not a “curriculum approach” Targets of FFT Behavior ChangeDiscussionfocused on:-homework, going out with peers, curfew-specific spot in the sequenceParenting-monitoring and supervisingCommunication-direct and concretecommunicationWith components of….to individualize to the familyParentAdolescentProblem SolvingWhere they use:Work out problems…our focus is on their process of doing soNot a “curriculum approach”Set of principles (in each area) that serve as the basis of assessment of and and target developmentPrinciples used by the therapist to “construct” a set of targets that match the unique familyImplemented within session in ways that match:Relational functionsSituationThemeConflictManagement
13 Generalization Sessions AssessmentIdentify external family systems to apply BC skillsIdentify contextual barriers to maintaining the BC targetFind areas to generalizeIdentify relapse pointsGoalsGeneralize the BC target skills to other areasMaintain change through relapse preventionAccess external resources to support changeInterventionsRelapse prevention (if the family is falling back into problem behaviors)Linking new problem situation to BC skillLinking family to relevant outside resources
14 Generalization Phase… shifting focus In generalization two points of attentionWithin the family:Relapse preventionGeneralization of competenciesMaintenance of allianceOutside the family:family--environment interaction(interface)…where the family interacts with the community/environmentRelationships between family (individual and whole) and the communityUse of behavioral competencies in these relationshipsIn order to use relevant available resources to support changes62
15 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 familyUse “in the room” experiences to promote change (change mechanisms)Creatively Adapt.....Matching to the clientadapting next response to”match client/contextadd what was not understood/missedAccess change....did it work?
16 Functional Family Therapy Case Conceptualization What lets you make model specific and client center actions that helpLets look at understanding cases….
17 Case Conceptualization Understanding the Family through the FFT “lens”Presenting ProblemHow the family functionsRelational patternsRelational functionsThe multisystemic context….Of the problemOf the family
18 Example Regina (14 years old) Referred to mental health center from juvenile courtHistory of difficultiesEarly school problemsHospitalizationMost recently….Drug use (mj)Drug rehab residential treatmentOther problems in the familyThe best way to illustrate the core principles of FFT is through a clinical example.Consider the following case of Regina, a 14-year-old girl who was referred to mental health treatment through the juvenile court in her area. Regina was referred to the FFT therapist by her juvenile probation officer and case manager. Regina has been on probation for the last 2 years.By all reports, her problems first begin at the transition from elementary school.She at first showed some reluctance to attend school, increasing incidence of teacher-reported behavior problems at school, trouble with fights and arguments with peers, and increasing conflict with her mother at home.Her mother indicated that Regina had always had trouble reading and was never very good academically in school. One year earlier Regina had broken up with her boyfriend and become emotionally distraught.By reports from her older sister and her mother, Regina seemed to “pull away” at home, becoming increasingly isolated and unresponsive.Over the course of a few months of this pattern Regina revealed to her mother that she was depressed and that she had thoughts of harming herself. Regina’s mother told the probation officer and case manager who referred her for admission to a local psychiatric facility. Regina spent 3 months in the facility and returned home.Immediately her troubles began again. This time she was caught smoking marijuana. She was again referred to a different juvenile psychiatric inpatient facility, this time one specializing in drug rehabilitation.The referral came to an FFT therapist who worked a large community multiservice mental health center. The center provided family therapy services (FFT), as well as psychiatric care, individual therapy, and group and substance abuse treatment interventions. The FFT therapists worked within an FFT treatment team that met frequently to discuss cases.The therapist also received a call from the probation case manager. The case manager thought it was important that the therapist know that the mother’s former husband had abused her and the children both physically and emotionally. It seems that the girls witnessed much of the physical conflict between mother and her former husband. The probation officer thought it might be useful for Regina to receive individual therapy because she seemed to have trouble but got along with her mother very well.
19 Initial QuestionsIs this an FFT case?How and what “lens” to use in understanding ReginaWhere to start (in FFT)How will therapy proceed?What is a possible outcome?(much of this you know….without any more information!)The model provides the first structure to conceptualizing the caseWithout more information:-multisystemic (individual, within family, in community/cultural context)-start with “what is the problem”-proceed through phases--possible goals (stay home…family handle it)But….clearly there is more to know…the specific things about the familyIn traditional treatment the information for understanding the case, the goals, the process would be obtained through assessment or goal setting (what do you want)Not in FFT
20 Client Story (details of the case….history….purpose for the referral) Mom/mother figureDad/father figureAdolescentFFT case conceptualization begins with the “clients” story of what is going on….Based on the notion that meaning is created in the relational context in which it occursTherefore….the specific behaviors (hospitalization, drug use, abuse) have no meaning….Until we see how it functions/works or makes sense to themCompare this to other types of treatment….The very existence of these problems (abuse, drug use etc) would be framed by the therapist experience and understandingIn that way it would be “put on the client” (outside in…..approach)As you can see….FFT is an “inside out approach”Story functions to create pattern…which is where the meaning of the events can be foundSo the focus of case conceptualization lies in understanding the “story” from the inside outThe “how” events are acted on nowWhere all that they “bring as individuals” is activeCore family/dyad stable relational patternsRelational sequences/problem sequences
21 Ecosystemic System Internal World Ecosystemic System Peer/school/community/extended familyInternal WorldBiological Substrate/Learning History/individual traitsClinical Symptoms/BehaviorsEcosystemic SystemPeer/school/community/extended familyFamily Relational SystemThe problem is…however embedded in a UNIQUI multisystemic contextIt is abundantly clear that parents and youth alike make individual contributions to the multisystemic system (Liddle, 1995; Szapocznik et al., 1997).Every individuals based on a combination of predisposition (e.g., level of intelligence, emotionality, physical ability), which interact with experience (learning histories, culture, “role models”)as well as various environmentally generated physiological and neurological processes, in an emergent process involving cognitive, emotional, and behavioral domains (Sexton & Alexander, 2004).By adolescence, these domains are the cognitive and emotional basis of appraisal and reaction, which are coupled with behavioral response within relational patterns. In turn, these tendencies interact with the environment (parents, other members of the youth’s microsystem) on a moment-by-moment basis in which each participant influences (constrains, reinforces, punishes, etc.) the other..Diagram you will be familiar with from Book/and trainingConsider a broader, multisystemic view of Regina.While she shares some common adolescent “behavior problems” (truancy, drug use, conflict, school problems, and depression), those elements are embedded in a relational and social context that is unique.She is also resilient—having survived abuse, peer troubles, drug use, and depression.Her mother, with her own difficult past, has at the same time successfully provided for her daughter and continued to carry out a productive life herself.Each brings a complex history of events “to the table,” and for both their relationship is the place where these individual contributions come to life and impact each other and their solutions to problems(Sexton & Alexander, 2004)
22 What does the client “story mean” Where people come from (relational context)Types of relationships…with parents/familyWhat people are made of….(biological context)The environment in which they live (ecosystemic context)Peers/schools/mental health system/communityAcknowledging what individuals “bring to the table.”Just because FFT is a multisystemic family-based approach, it doesn’t mean that individuals don’t have a part in the emotional climate, the behavioral patterns, and the cognitive attributions that surround family functioning.Parents, youth, and siblings (as well as extended family and others involved) bring a rich array of factors “to the table” of the family. Some of these factors are biological and form a “biological foundation.”For example, the biological pressures and predispositions of attention deficit disorder are real and become part of whatever relational system that exists in the family.Each family member also brings experience of other relationships. Parents, for example, come to their current family with experiences of growing up in their families of origin.This “relational history” has formed certain expectations and beliefs about what a family “should” be, how parents “should” act, and how children “should” behave.Some knowledge of these individual histories or expectations (short of a detailed family history) can help us understand the meaning that the parents attribute to events in their current families.But while these experiences are critically important, to be understood successfully, they must be seen as indirect influences mediated by the current family relational systems. The therapist must be aware that parents and kids react in their unique ways to events and the behavior of others in part because of what is important to them from the past.The role of individual contributions goes beyond just historical data. The more direct impact of individual histories, biology, and expectations is on the ways in which family relational patterns develop and are maintained.One of the biggest surprises for me as a family therapist is how an event, such as drug use by an adolescent, can have such different meanings in different families.In one family, drug use by their son or daughter is a behavior that represents a major crisis requiring immediate, massive, and intrusive help. The youth immediately finds himself or herself being assessed by a mental health professional, maybe in a hospital, and often in extensive treatment through individual, group and family therapy.What is curious is that the very same event, drug use by an adolescent, can also result in an entirely different reaction in another family. Here the parents worry, talk with their child, and increase their level of monitoring and supervision. In both situations, both sets of parents acted to help their child. The difference in the scale of the parental actions is clear. The curious question is why they are so different.We would suggest that despite the same behavior on the part of the youth, both sets of parents react to something different—something that has more to do with their own values, beliefs and standards than the behavior of the youth alone. These values, beliefs and standards, and the actions taken, result from what the parents “bring to the table.”In the first family, it may be that alcohol abuse was a problem that existed in the father’s life—an experience that left him particularly sensitive to and attentive to such issues.The point here is that even in a family relational and systemic intervention like FFT, the individual history, biology, and environments of the individual parts of the system (e. g. parents and youth) are critical in understanding why certain things are important and others are not in the current relational functioning of the family.Client StoryThe “why” things are so important, meaningful, etc.
23 Culture Peer Group School Community Ecosystemic system How does the family Function/what role does the problem play Environmental ContextEcosystemic systemRiskFactorProtectiveFactorCulturePeer GroupSchoolCommunityAn Umbrella of Community and Culture.The family is embedded in the contexts provided by culture and community.Culture includes the important ceremonies, customs and folk ways, beliefs and behavior patterns that generate the values, emotions, and beliefs that manifest inside the family.For example, every culture has its rituals for important family events (e. g. birth, birthdays, marriage, and family life). The rituals of culture come with shared cultural meaning, expectations, and proscribed behaviors. The religious, ethnic, and location-specific values, norms and behaviors that characterize the culture come to promote certain behaviors, form the basis for telling “right” from “wrong” behaviors, and indirectly influence the way that individuals and families function. Communities are surely influenced by culture or cultures that compose them, but also have a unique role. Communities have a location-specific culture and a social climate of their own that have an impact on youth and family functioning.Cultural expectations contribute to patterns of interaction within the family, the ways it expresses emotion and organizes around roles, how the roles generally look and feel, and parenting style. (Falicov, 1995).cultural values and practices of the community may have an impact on participation, engagement, and specific ways of matching to the client. For example, the socioeconomic composition of the community affects the kind and quality of school, community activities, and community resources to which the family has access.Furthermore, the values of different community cultures foster a climate that may be prone to violence, collaboration, cooperation or individuality, for example. The values of peer groups in particular play an important role in the functioning of the adolescents that we deal with in FFT.This variety of influences suggests that it is important to respect and understand the potential impact of these different cultures on the “clinical problems” which are often more in the foreground.When youths are involved in the mental health and juvenile justice system, culture plays a sobering role. In juvenile justice settings, the disproportionateBest expressed as risk and protective factorsMom/mother figureDad/father figureAdolescent
24 Core family relational patterns What People “bring to the table”Where people “come from…..”-History of relationships (parents/significant others/peers) that become the meaning individuals make of relationshipsWhat people are “made of”-Biological “foundation”)-predispositions for individual behavioral reactionsCommunityCultureCurrent environmental contextSchoolSocial/peerClinical Symptoms(individual behaviors that are the focus of treatment)Withing this context of the past of the individual and the current problem is the Central Role of the Family.FFT is a family-centered therapeutic approach.Families play a role in how the child develops but, even more importantly, in the direct functioning of the family and the child every day.Families are the earliest and possibly the dominant context for childhood learning, especially for what relationships mean and how to develop and maintain them.Relational patterns that are initially developed in the family context carry over into new contexts such as schools and the peer groups, and often even into adulthood.Unfortunately for many of the adolescents referred to FFT, the only interpersonal strategies supported by the systems they belong to (especially the family) are dysfunctional.Some families model and reinforce the use of drugs or violence to feel in control; others permit children and adolescents to get attention only by coercion. Some adolescents have to join a gang to get a sense of belonging. Dysfunctional patterns carried out of the home into the world end up in “problem behaviors” which the mental health and juvenile justice systems label according to various clinical syndromes (e. g. oppositional defiant disorder, conduct disorder, drug/use and abuse).The relational patterns, roles, expectancies, and sometimes-invisible rules that make up a family system are very powerful factors.Minunchin (1967) described family relationship in a structural way—as subsystems with boundaries and a hierarchical relationship among them. The early internationalists (Walzlawick, et al., 1974) suggested that the patterns of relational interaction become stable and enduring and even come to define the relationship between people.The FFT “lens” is one that views family patterns as stable, enduring and functional.Relational patterns are the “stage” where the biological and individual contributions of the individuals mix with the more indirect expectations of culture and community. These patterns are where the history, biology, and contextual stressors are “felt” and “noticed,” And as such they provide a point of entry for gaining a better understanding of how the family works and where in the family system to intervene.Family relational patterns are difficult to grasp.When any of us look at a family, what we see are behaviors.It may be that we get a sense of the emotional context of the behaviors and a glimpse of the cognitions and beliefs that surround both the emotions and the behaviors.What we tend not to see are the unspoken connections that limit, promote, support, and encourage the behaviors and emotions we notice in our observation.The patterns are a bit like a spider web. Any single element in the web is connected by innumerable smaller, subtle strands to other elements. Pushing on the web means that every part connected through these strands moves, adapts and adjusts.Small and invisible as they might be, the connecting strands are strong, sticky, and serve to make a unified whole out of the individual parts. Families are much the same.While hard to see, multiple strands of connection link each member to the others in the immediate and extended family. These strands define the relationship, in a sense are the relationship, and certain strands, like those of the spider web, hold the relationships together.The implication is that moving any one part moves all the others, that in trying to pull one part out, there is resistance and “pull back” from the other parts, and that to understand any part, the whole relationship must be considered.Mother FigureFather FigureAdolescentCore family relational patterns
25 Regina: “Whatever….later, I am going out…., I’ll be home…..” Anja: “ Regina have you done…””you know you are getting behind”….”you need to take some responsibility” (escalating the longer she doesn’t answer)Regina: “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….Anja: “I just worry about you” (she feels comforted that he understands)Regina: “Whatever….later, I am going out…., I’ll be home…..”Regina: “I am sorry Mom…but, I can handle it”Anja: “there is no going out for you….it just isn’t good for you…..you know you can’t say no to those friends of yours…”Anja: “What are we going to do..I can’t take this any more…”Regina: “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 supportRegina: (comes home 5 hours late. Comes in the house and goes upstairs…on the stairs his mother comes out of her room…Captured in some thing more complex than simple diagram…here is an example from reginaStepfather: …continues watching the football game…worries about his wife…gets angry with Peter…..”Stepfather: …When she talks, he continues to watch to TV…..he listens quietly and say…”what do you want me to do…he wasn’t raised right…”Stepfather: …”I am tired of this…what is the matter with you…don’t you know how this hurts your mother?”Anja: is hurt by his comment…goes to her room…watches TV…worries and “feels” bad about her situation……Peter: “Fuck off..” the typical argument ensues until Peter goes to his room
26 “Problems” are embedded in the context What is the Problem?“Problems” are embedded in the contextThey are relationally basedFamily has been functioning for some time….encountered problem that has become “part” of the family….now “functions” as a central part of how they relateNot what they “want”Not what they “need”They way in which they have come to “be” in response to the “problem”So…if it is multisystem and it is relational and all about patterns…..What is the problem?What principle one says…is that problems are in the whole system of the family…..relationally based.
27 Core of FFT 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 problemResult of each family members experience and thinking/working to understand their life/problemsNatural part of finding a solutionThis 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)
28 Story takes the form of problem definitions -what the problem is-why its an important problem-what should be done about itProblem “definition-what the problem is-why its an important problem-what should be done about itReferral BehaviorMom/mother figureDad/father figureAdolescentTherfore it is captured best in the problem definitions they bring to therapyFirst…because it is what you first see are problem definitionsDuring the engagement and motivation phase, while a family member talks about problem situations and/or why they believe they are in therapy, the therapist knows to listen to the “content” of the problem and translate it into the goals of the phase.All of this information for case conceptualization is captured in the “problem definitions” that the family brings..or what they think is the problemProblem “definition-what the problem is-why its an important problem-what should be done about it
29 What to ask yourself ….“What does this tell me about what is important to this person?”The answer to this question helps the therapist know what to acknowledge in reframing.“What does this tell me about their relational patterns and how they link the family members together?”This assessment helps the therapist develop a family-focused way of understanding how the presenting problem functions.“What does this tell me about the biological, historical, and relational things that family members bring to any interaction that will help me understand why they are reacting this way?”This assessment helps the therapist determine where the energy and emotion might come from and also helps identify what to acknowledge in the reframing process.“To what cause are they attributing the problem? What is the problem definition?”This assessment helps the therapist identify the target for blame and form a target for reframing.How do you get to this multisystemic view without getting caught in details?
30 Case conceptualization in the “real world” Given all you have to do…..thinking in this complex way is very difficultIn the “real world”…What you do out of the roomAided by the FFT progress notesWalk you step by step through case conceptualizationMake sure you don’t get lostHelp you overcome your own values and biasesHappens over time….Not as a stage….but as treatment is going onBuilding a “picture of the family” in which you add more and more
31 Functional Family Therapy Case Planning What to do in the next session, session, phase etc.Biggest difficult about case planning….is that you don’t really have time to just sit and make a planIn the Real world you must…Act before you know everythingStart FFT right away…without a formal assessment processStart before complete conceptualization and understandingThat can be done because:All cases proceed in the same “map” or path wayWhat change is what you emphasize, how you accomplish the goals etc.Goals and plan of treatment has, in FFT a Process focusTreatment Plan is the modelSo for us case planning is not determining what to do when and next…but, determining how to apply that map to this individual fmaily who present in the way in which they doAbout adaptation….fitting, and “matching to the family”
32 Treatment Planning Understanding the Change process…the map of change Phases (what is first, second, third….)Mechanisms to use in achieving the phase goalsFamily focused/driven outcomes that are obtainable and relevantplanning is the way to bring the content and the process of therapy togetherUnderstanidn how change happensNeither treatment or session planning is done “in the room” while interacting with the family.It is a process that takes place in the treatment planning time allocated to or by the therapist to prepare for the next session. It is also true that FFT therapists do approach sessions with a specific plan.The therapist knows the goal and has ideas about how to achieve them.As noted earlier, the FFT therapist is also contingent in her application of those goals.This means that FFT therapists pursue model-specific goals, in ways that match the way the family functions, and at the same time stay open to “contingent” application of those goals.
33 Case Planning Systematic process that includes Next session planning Goals of the phase“What needs to be done next?”Long term goals…..Obtainable changeWhat matches the familyThe smallest change that will make a differences. Plan Treatment Systematically Session planning requires assessing the goals of the previous session and the change in progress toward those goals, and coming up with new ideas about ways to accomplish those goals in the next session.Session planning is based on two elements:matching to the model (for goals) andmatching to the client (for how to implement those goals).The plan takes short-term process goals from the model, and then the therapist specifies how those look and can be accomplished with this unique family, and gathers more information about the family and how they work.FFT therapists are constantly thinking (about how they work, how problems function, core patterns, relational behavior change targets, obtainable outcomes).As a result of session planning, the therapist asks herself questions to bring to each session, such as:“What does alliance look like with this family?How can I be credible with this family?What is the father’s problem definition?What is important to the person identified as the cause, so I can include it in the acknowledgement part of reframing?What competencies will help in monitoring and supervising adolescents?What school resources are available for her reading difficulty?”These and similar questions help fill in the ongoing assessment of the family, individual, and context.Long-term planning involves creating what Bruce Parson’s labeled as an “outcome sample” (Alexander & Parsons, 1981).And outcome sample is a qualitative “picture” of how the family might “look” or act if, for example, they reduced the blame and negativity between them, if they had family-based alliance, or a reduction in hostility.As therapy moves along, the outcome sample might include a “picture” of how family might operate differently if they used negotiation as a parenting technique to help them better monitor their adolescent.Near the end of the therapy, the “outcome sample” might include how the family and the school might work together and what it would take from both the parents and school to start and maintain that outcome. This isn’t an objective assessment of the client. Instead it is a clinically based representation of how the family will work, look, act, with changes.The qualitative “picture” that emerges is a guide for therapists as they try to move the family. In addition, the picture grows in detail and clarity with each encounter.
34 Long Term Outcome Goals The behavioral outcome goals of therapy are those that are obtainable and lastingnot healthy families but……..obtainable behavioral changes...are those that are:obtainable behavioral changes …for these people …with these resources …and these value systems …in this context(4) The outcome goals of therapy are those that are obtainablenot healthy families but……..obtainable behavioral changes(5) Therapist plays an active role in the change processfocus on….doing (pragmatic)thinking (conceptualizing)relating/(personal)active and changing role (phase dependent)relational stance10
35 What therapy changes 1. Most critical issue solved…and 2. Prepared for thenext “problem”-cope/deal with in a new way-empowered with a “way”To solve futureIndividualMom/mother figureDad/father figureAdolescentTo Plan you need to know how the change process of the model works
36 Case Plan Based on: FFT’s Systematic Change Model the model matching to the clientCase conceptualization--understanding clients relationally--understand problems relationallyFFT’s Systematic Change ModelA model focused yet client/clinically responsive process….Systematic and flexible…The therapist “anchor” and “lens”….The source of therapist creativityGiven these first two principles….what do you do and what is change…This is an important foundation of the FFT model….
37 Engagement/Motivation Sessions Assessmentproblem definitionsProblem sequenceHow they “function” or work togetherGoalsreduce within family blamereduce within family negativitybuild therapeutic allianceredefine problem as family focusedincrease hope/expectation for changeInterventionsreframingDevelop an organizing theme that is family focuseddiverting and interruptingstructuring session to discuss relevant topicsexample
38 Example Regina Early goals: Intermediate goals: Long Term goals Alliance-common problem definition, goals & bondShared family focused problem definitionReduction in blame/negativityIntermediate goals:Problem solvingConflict managementLong Term goalsFamily can manage supervision, work out problems
39 Using the FFT Progress Notes Again the Q is you guide to keeping model focused
41 Using the FFT Session Planning Guides Again the Q is you guide to keeping model focused
42 To be successful with youth and their families FFT relies on… Guiding Theoretical PrinciplesConceptual, philosophical, and emotional center of the modelParameters within which FFT occursA Clinical “Map”Systematic process of therapeutic changeSpecific goals, objectives, and therapist activitiesMechanisms of change3. Session Planning4. “In the room” clinical decision makingResponding to “events” in ways that are phase specific and client centered5. Ongoing monitoring/assessment/adaptationuse of the Q for session planningFFT has good outcomes…but, they all depend on how it is deliveredWe do know the components that make it successful
43 Keys to success in FFT Model specific Case conceptualization Model driven planningIn a way that….Matches the family processMatches the families way of functioningThat is relevant and important to themThat helps reduce risk factorsReduces the likelihood of future behavior problemsEmpowers the family to keep changes going
44 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 familyUse “in the room” experiences to promote change (change mechanisms)Creatively Adapt.....Matching to the clientadapting next response to”match client/contextadd what was not understood/missedAccess change....did it work?