1. Functional Family Therapy International Certification Program Introduction to Behavior Change Phase (webinar 5) Thomas L. Sexton, Ph.D., ABPP Functional Family Therapy Associates
©Functional Family Therapy Assoc.

2. To be successful with youth and their families FFT relies on…
Viewed through the Lens
After Engagement & Motivation
Take advantage of the successes of that phase
Before Generalization
Need to set the stage
Done in ways that “matches to the family”

3. Thinking Through the Lens
Therapeutic change process

4. Family Cultural/Ethnic/Racial “Context” Community FFT…. Peer Groups
Values/Norms
Socioeconomic Status
Risk and Protective Factors
“The Current Problem”
-Cognitive aspect
(Understanding/attributions
of the “problem”--definition)
-Emotional response
-Behavioral response to the perceived problem
aimed at
solve problem it
Unique “whole”
Central Family relational patterns
problem “fit”/”functions” within
Relational “outcomes”
Cultural/Ethnic/Racial “Context”
Behavior becomes of worry
To parents/the system
Family
Community
Adolescent
Sibling(s)
Parent(s)
Lets get the big picture of how to think about a family to see how problems are relational
We all know it is a system…but in what way
People (with biology etc./cognitive part of the problem0
Community
Culture
Family…unique to all…and the primary focus of fft
This is what we mean by the system
Our FOCUS….on the family as a way to get to these other areas…this is unique and the essence of FFT….
Big picture slides…..this is discuses/each thing is discussed into eh slides that follow
Biological
Historical
Relational
Individual Risk and Protective Factors
FFT….
Values/customs/relational styles/
Rules, rituals
Expectations/norms

5. Individual Behaviors Mom/mother figure Dad/father figure Adolescent
RELTIONAL PATTERNS
Core family/dyad stable relational patterns
Relational sequences/problem sequences
Relationship defining
Maintains the problem behavior
Promotes certain protective/risk behaviors
“personality” of the family
Central Focus of FFT

6. Relational Patterns

7. Peter: “Whatever….later, I am going out…., I’ll be home…..”
Anja: “ Peter have you done…””you know you are getting behind”….”you need to take some responsibility” (esclating the longer he doesn’t answer)
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….
Anja: “I just worry about you” (she feels comforted that he understands)
Peter: “Whatever….later, I am going out…., I’ll be home…..”
Peter: “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…”
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
Peter: (comes home 5 hours late. Comes in the house and goes upstairs…on the stairs his mother comes out of her room…
They are studk
Stepfather: …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……
Figure 7.1
Peter: “Fuck off..” the typical argument ensues until Peter goes to his room

8. Functional Family Therapy Clinical Model
Outcomes
Increase behavioral competency of all/family
Consistent performance of competency
in “real” problem situation
Functional Family Therapy Clinical Model
Engagement
Behavior Change
Generalization
To accomplish the changes you have outcomes….outcomes that help you change the symptom
A relational process with comprised of….
Purposeful interactions promote model process goals…
therapist is goal directed (specific process outcomes)
In a relational interchange between two experts…..
Client…..-life/experience expert
Therapist….change process expert
Assessment
Intervention
Outcomes
Alliance between family
with therapist
Family/relationally
based problem problem focus
Reduced family member
negativity/blame
Increased motivation
Outcomes
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
Motivation
Behavior Change
Generalization
Early
Middle
Late

9. …developing a relational thread
A family Focus
…developing a relational thread
Presenting Problem
He is manipulative…he just says/gives you the lines you want to hear when we are here…what he really needs is “crack you head open therapy”…responsibility needs to be put with him…I am just tired, I don’t want to be a parent anymore
Reframing
Redefined “problem”
He is having a very difficult time learning how to be a man (have values and know what is right), I can’t find a way to get him to do what he needs to do..., I am just really hurt by it all

10. Themes Themes Reframing Opportunity Reframing Opportunity New problem
Add to..Elaborate..
Link individuals to
family
Themes
Reframing
Opportunity
Validation --Reframe
Listen--change-incorporate
Continue
Reframing
Opportunity
Validation --Reframe
Listen--change-incorporate
Continue
New problem
definition
-explains problem in
family focused way
Reframing
Opportunity
Reframing
Opportunity
Organizing Theme
Individuals linked to family
“Braided” reframes
Overtime…the outcome
Negativity decreases
Family focus increases
Motivation increases
Blaming decreases
Attributions change
Reframing
Opportunity
Time

11. Outcome: Motivation through family focused relational themes
Themes….that identify the noble intention
“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”
Themes function to:
Stay out of the details….break relational patterns
Reduce negativity & blame
Increase a family focus
Empower the family: Focus on the “Nobel intention”

12. Behavior Change Phase
Assessment
Intervention
Early
Middle
Late

13. Behavior change sessions
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)
Goals
Specify the behavior change targets as family prosocial skills:
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
Interventions
reframing
Modeling
Teaching
Overcome barriers/adapt

14. Not a “curriculum approach”
Targets of FFT Behavior Change:
How they go about working together
Discussion
focused on:
-homework, going out with peers, curfew
-specific spot in the sequence
Parenting
-monitoring and supervising
Communication
-direct and concrete
communication
With components of….
to individualize to the family
Parent
Adolescent
Conflict
Management
Where they use:
Work out problems…our focus is on their process of doing so
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
Problem Solving

15. Implementing BC Phase BC Phase Functional Family Therapy New Problem
Target a new skill
that fits the specific problem that
brought them to therapy
Changes the Problem sequence
central to way family functions
Uses new “skills” in problems
that come up
New Problem
Situation
New Problem
Situation
BC Phase
Functional Family Therapy
New Problem
Situation
New Problem
Situation
Target a new skill
that fits the specific problem that
brought them to therapy
Changes the Problem sequence
central to way family functions
Uses new “skills” in problems
that come up
Target a new skill
that fits the specific problem that
brought them to therapy
Changes the Problem sequence
central to way family functions
Uses new “skills” in problems
that come up

16. 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
Challenge that promotes motivation
Building family competencies…so that the risk patterns central to family change….
Communication
Problem solving/negotiation
Conflict management
Parenting (monitoring supervising)

17. 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
Individualized change plan

18. Behavior Change… Interventions technologies/targets
Communication skills training: principles 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 58

19. Behavior Change… Interventions technologies
Problem Solving…method for adolescent and parents to work together to jointly solve” problems
1. Identify a problem….goals of the family in a specific incident/area/with a specific problem
2. Identify the outcome desired
3. Agree on what it takes to “do” it
Sub goals….who has what part
Contracts/negotiations etc.
4. Identify all the ways it can go wrong
5. Come back and see if goals are met
accountability
(Gordon Tape…demonstrating problem solving)

20. Behavior Change… Interventions technologies
Conflict management….for those “problems” that can’t be solved in other ways
Avoid it…..change reaction to early triggers
Principles to use in trying to contain it…
Present orientation
Issue focused
Adopt a conciliatory set
1. Exactly what is the issue
2. Exactly what would satisfy me?
3. Is the goal important?
4. Have I tried to get what I want through problem solving?
5. How much conflict am I willing to risk to get what I desire?
Time-out for transitions

21. Not a “curriculum approach”
Individualized Change Plan…..
Discussion
focused on:
-what is most relevant to this family….most important topic
Parenting
-monitoring and supervising
Communication
-direct and concrete
communication
With components of….
to individualize to the family
Parent
Adolescent
Conflict
Management
Where they use:
Goal: Work out problems…our focus is on their process of doing so
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
Problem Solving

22. Case Example……Siemone.

23. Behavior change interventions require therapist…
To have a well thought out change plan
Structuring the session to accomplish it
Contingently responding to what happens in the session…hearing/seeing feedback
Ignoring…some things
Finding ways to use other things to fit behavior change goals
Staying with it…while responding interpersonally
Monitoring of motivation through out implementation
Backing up to engagement/motivation when needed….
Follow through
Match to….the family relational functions

24. 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”…Specific task that is accomplishable..one issue
Clearly presented/understood
High expectation of success….define success as doing it
Within couple…as way to strengthen/change couple

25. Case Example…….what happened with Siemone?