Generalization Phase: maintenance, generalization, & support Thomas L. Sexton, Ph. D., ABPP Functional Family Therapy Associates

Goals Specific Focus on: Goals and focus of generalization phase Specifically…. Generalization and relapse prevention to empower families Case Study

Internal World Biological Substrate/Learning History/individual traits Clinical Symptoms/Behaviors Family Relational System Ecosystemic System Peer/school/community/extended family Ecosystemic System Peer/school/community/extended family ( Sexton, 2010 ) The Multisystemic Focus of Therapy The Multisystemic Focus of Functional Family Therapy Primary entry/ focus Point of immediate, relevant, and lasting change Functional Orientation - inside out conceptualization

Initial Presenting Problem Definition -attribution aspect -emotional valence -related behavioral patterns Comes from: Each individuals unique History/experience with problem, natural attempts to understand/ make sense, solve the problem Adolescent Initial Presenting Problem Definition - attribution aspect -emotional valence -related behavioral patterns Mother Initial Presenting Problem Definition -attribution aspect -emotional valence -related behavioral patterns Father Initial Presenting Problem Definition - attribution aspect -emotional valence -related behavioral patterns Each feels “misunderstood”, blames the other, Thinks the other is the problem, works toward a different solution Goal: Redefine each toward a “common family focused” definition That is - different from each individual definition -common to all -Where all have responsibility -No one has bla Not compromising mediating or negotiating Family Focused Problem definition The Outcome: Motivation, negativity reduction, Family to family alliance, Therapist to family alliance

Discussion focused on: - drug use -defiance Conflict Management 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 Targets of FFT Behavior Change Problem Solving

What is next in the change process families 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. To be successful the family needs to be consistent over time and learns to handle the emotional discouragement of “relapses.”

What it takes Families can be successful when they can: Keep it up Handle more and different problems Be consistent Adapt and adjust when things come up Address other bigger issues Be realistic

Logic of change These changes often don’t happen naturally Therapy can provide specific strategies for: generalizing new skills, maintaining change, and supporting those changes 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.

Shifting Focus for the Therapist focus of therapy moves from inside the family to the “interface” between the family and those systems that surround it. It requires a shift in direction for the therapist in regard to clinical assessment and intervention. respond to the “events” in the family with a primary goal of helping them become ultimately self-sufficient and empowered in their interaction with the surrounding context. Shift attention away from helping the family solve immediate problems to a discussion about the role of peer, school, and extended family and community interactions as they relate to the family’s ability to continue reducing the probability of future problems.

Ecosystemic System Peer/school/community/extended family Ecosystemic System Peer/school/community/extended family ( Sexton, 2010 ) The Multisystemic Focus of Functional Family Therapy Clinical Symptoms/Behaviors Family Relational System

Ecosystemic System Peer/school/community/extended family Ecosystemic System Peer/school/community/extended family ( Sexton, 2010 ) Court system involvement School Struggles Extended Family/commu nity Peer Group Pressure Involvement

Intervening to Create Long-Term Empowerment Tasks of the Generalization Phase

Focus of the Generalization Generalize change to other problems/issues Focus is on generalizing BC skill Maintain Change Individual & family risk factors and relapse prevention strategies Support Change Relevant and reliable support for changes So…they are empowered to handle the next problem themselves

Generalizing Change Fighting ( between Mother & Daughter) Going out With friends Homework Time with boyfriend Help family adopt the Behavior Change Plan in different areas of either conflict or risk’s Behavior change Plan Linked to a spot in the relational pattern Matched to functions & the theme Involves everyone This is not their only problem… More within family areas of struggle Risk areas….yet to be addressed

Generalizing & Maintaining Change Change process is a up and down experience Families faced with ongoing problems Often the down feels as if it is a failure The goal…. Keep it up Handle more and different problems Be consistent Adapt and adjust when things come up Address other bigger issues Be realistic In light of remaining challenges and difficulties

Generalization Goals Handle more and different problems… more likely when… when they confront a new problem….they can see it as solvable with skills they learned Know how to apply the approach/skill How to implement it in their family using the “organizing theme” They will be most successful if they can apply the small steps of behavior change to an increasingly wider range of issues in daily life.

Generalizing Change Keep it up. This most likely to occur if they know: Think about the problem as a family problem Know what to try Know it won’t be each Keep alliance focus How we can help: Reframing each new situation to be linked to the central theme of the family Build collaboration and alliance between them Maintain a family focus

Be consistent How we can help: Resist the temptation to add more skills…focus on keeping it up in a consistent way Adapt and adjust when things come up How we can help: Help them find their own style Focus on process not on outcomes Adjust

Be proactive and address other bigger issues Peers School & other community issues Legal requirements Extended family challenges How we can help: Reframing the discussion as protection Initiate discussion on existing risk areas

Be realistic If the belief includes knowing that things will happen again, that it won’t be fun, but, with effort, there is an alternative, which creates the motivation to initiate new behaviors and put effort into persisting at them. The belief needs to be realistic, not one that sets them up for failure by being too positive.

What about the future: Relapse Prevention Successful relapse prevention requires that the therapist take the initiative and direct a discussion that helps to: 1. Identify high-risk situations Areas known to occur within the family (within family risk areas These are things you have already seen and know Family may not now identify them External risk factors that you identify School Peers Extended family

Relapse Prevention 2. Learn alternate ways use the already established behavior change skills to these new situations : cope with the negative emotions that arise around these situations Using problems solving skills determining ways to deal with interpersonal conflict by applying conflict management principles discovering strategies to cope with social pressure that may result outside systems

3. Reduce unnecessary stressors 4. Develop a support system Friends, family and community links that provide: Instrumental support Emotional support (empathy and caring) Informational support

Medical Evaluation Psyc Intervention Community/School - direct and concrete communication Extended Family - monitoring and supervising Parent Adolescent Support Systems Types of support from each: Instrumental Emotional Informational

David, his mom Alice and his grandmother