Functional Family Therapy Brief Manual.
FFT LLC & James F Alexander, Ph.D., FFT LLC & University of
Utah, , April 2009
Brief History & overview of the Development of FFT as an Evidence Based
Intervention with High Risk Youth & Families

Phase 1: Developing the Evidence Based Model: (1971-1998)
 Integration of prior & current wisdom (theory, clinical, research, training
models); Clinical articulation and application in “accountability” contexts.
Major contributors: Alexander, Parsons, Barton, Waldron, Mas, Turner,
Schiavo, Warburton, Klein.
 Research (RCT’s, Effectiveness studies, Change Mechanisms research):
Alexander & colleagues (e.g., beginning with 1973 JCCP) & Independent
replicators (esp. Don Gordon, Kjell Hansson, Holly Waldron).
 FFT designated by the Center for The Study and Prevention of Violence
(CSPV; Delbert Elliott, P.I., 1997) as a “Blueprint Program” (one of only 12
such programs nationally) for the successful treatment of delinquency,
substance abuse, and violence for high-risk youth.
 Alexander, Pugh, & Parsons (1998). FFT: Volume 3 in the Elliott Blueprints
series.

Phase 2: Moving the EBT to large scale dissemination (1999-2007)
 FFT replications supported and guided by the Blueprints initiative (Elliott
& Mihalic, Center for the Study & Prevention of Violence - CSPV).
 FFT received designations as an “Exemplary Program,” “Best Practice,”
and “Evidence-Based Effective program” (Centers for Disease Control CDC; Office of Juvenile Justice & Delinquency Prevention - OJJDP,
American Youth Policy Forum, Surgeon General’s Report on Youth
Violence 2001).
 FFT LLC is established as the dissemination arm of FFT. Doug Kopp
becomes CEO and Director of FFT Dissemination strategies. Holly
DeMarranville becomes the FFT LLC Communication Director. Tom Sexton
provides creative leadership in the FFT dissemination system.
 Mike Robbins and Charles Turner emerge as the lead Change
Mechanisms FFT researchers with Jim Alexander.
 Functional Family Probation (FFP) emerges as case management model
for Juvenile Justice Systems statewide (UT, WA).
 Waldron develops the major NIDA & NIAAA funded FFT programs and
trials with Drug-involved Youth (with Brody, Ozechowski, Turner).

Phase 3: (2007- current):
 Further expanding the scope of FFT with respect to: Cultural, geographic,
funding stream, provider, treatment system, and “diagnostic”
designations & co-morbidity patterns.
 Strong emphasis on sustainability and extending the research and clinical
experience based principles to new populations and challenges. FFT
emerges within new treatment systems with unique system goals and
populations: FFT CW (Functional Families Through Child Welfare); FFT DI
(FFT Drug Intervention); FFT RS (FFT Reintegration / Reunification
Services), FFT JJS (FFT Juvenile Justice Services).

Major Components of FFT Direct Treatment
James F. Alexander Ph.D, FFT LLC & University of Utah
(This phasic model and primary components based on Alexander, Barton, Waldron, & Mas, 1985;
Alexander & Parsons, 1982; Alexander, Pugh & Parsons, 1998; and described in Alexander, Oct 2007)
The intervention program itself consists of five major components in addition to pretreatment
activities: Engagement in change; Motivation to change; Relational / Interpersonal Assessment and
change planning; Behavior Change (including more precise behavioral Assessment; and
Multisystemic Generalization across behavioral domains and multiple systems.
Engagement
In Change
Motivation
To Change
Assessment
(Interpersonal
and Behavioral)
Behavior
Change
Generalization Multi-Systems
Linking
PRETREATMENT
GOAL
ACTIVITIES
*Responsive and timely referrals, positive “mindset” of referring sources.
*Establish collaborative relationship with referring sources, be available,
appraise multidimensional (e.g., medical, educational, justice, child welfare,
mental health) systems already in place, review referral and other formal
assessment data available, and note safety issues of concern for monitoring,
anticipate & learn about possible cultural and additional factors.
GOAL
*Enhance perception of responsiveness and credibility, demonstrate desire to
listen, help, respect, establish cultural competence, have proximal services or
adequate transportation, contact as many family members as possible,
“matching” and respectful attitude.
ENGAGEMENT PHASE
MOTIVATION PHASE
GOAL
SKILLS REQUIRED
FOCUS
ACTIVITIES
*Create positive motivational context, minimize hopelessness and low self
efficacy, change meaning of family relationships to emphasize possible
hopeful experience, create positive change expectations.
*Relationship & interpersonal skills, nonjudgmental attitude and
demeanor, acceptance and sensitivity to diversity in all domains.
*Relationship process, separate blaming from responsibility, strength
based.
*Change Focus techniques (Divert and Interrupt highly negative
interaction patterns and blaming, Sequencing, Pointing Process, Strength
based relational focus), Change Meaning techniques (Relabel, Reframe,
Theme hints, Relational Themes (Behavioral and Relationship focused),
monitor safety issues if necessary
RELATIONAL ASSESSMENT
GOAL
SKILLS REQUIRED
FOCUS
ACTIVITIES
*Elicit and analyze information pertaining to relational patterns for
Behavior Change & Generalization
*Perceptiveness, understanding relational processes & functions of
behavior, understanding (and valuing) relational process
*Intrafamily & extrafamily context and capacities (e.g., values, attributions,
Relational Functions, interaction patterns, sources of resistance, resources,
and limitations)
*Observation, inference re the functions of negative behaviors, switch from
an individual problem focus to a relational perspective
Summary of the FFT Model “Attitude” during these early phases
- A Philosophy / Belief System about people which includes a core attitude of respectfulness (of
individual differences, culture, ethnicity, family forms, etc).
- A family focused intervention involving alliance and involvement with all family members
(Balanced Alliance) with therapists who do not “take sides” and who avoid being
judgmental.
- A phase based change model that is focused on risk and (especially) protective factors – “Strength
Based”
- With interventions that are specific & individualized for the unique challenges, diverse qualities,
and strengths (cultural, personal, experiential, family forms) of all families and family
members.
- And an overriding Relational (versus individual problem) INITIAL focus.
BEHAVIOR CHANGE PHASE
GOAL
SKILLS REQUIRED
FOCUS
ACTIVITIES
*Additional behavioral assessment, skill building, change habitual
problematic interactions and other coping patterns, enhance parent and
child well being and relational processes.
*Structuring, teaching, organization, understanding behavioral assessment
and a wide range of potential change techniques which can be matched to
each particular family and family member.
*Problem Sequences & Communication patterns, cognitions relevant to
dysfunctional behavior, use of technical aids & assigned tasks, assessing and
improving deficits in conflict resolution & problem solving, parenting skills,
compliance, self regulation.
*Undertake and complete more thorough behavioral assessment of withinfamily problem behaviors and the interaction patterns that elicit, support,
and reinforce them. Model & prompt positive behavior, provide directives
& information, develop creative programs to change behavior but remain
sensitive to family member abilities and interpersonal needs. Further
assess intra-individual & physiological / biological limitations.
GENERALIZATION PHASE
GOAL
*Extend and expand positive family and individual behavioral (including
emotional, cognitive, possibly spiritual if appropriate) functioning; relapse
prevention; incorporate positive community systems. Add pharmacological
interventions as necessary (if they are not already in place).
SKILLS REQUIRED
*Multisystemic / systems understanding and ability to establish links,
outreach.
FOCUS
*Relationships between family members and multiple community,
educational, support, legal, and medical systems.
ACTIVITIES
*Complete more thorough behavioral assessment of outside-the-family
problem behaviors (and emotional responses & cognitions) and the
interaction patterns that elicit, support, and even reinforce them. Know the
community, develop and maintain contacts, initiate clinical linkages, always
link and refer with each family members’ Relational Functions in mind,
undertake relapse prevention, help family develop appropriate levels of
independence. Monitor safety issues if necessary.
______________________________________________________________________________________
The Sequence of Functional Family Therapy (FFT) Intervention
From: Alexander. J.F. (2009) Functional Family Therapy Clinical Training Manual.
Functional Family Therapy (FFT LLC / FFT INC) Seattle, WA
Session 1 (Engagement, and Intake & Assessment if appropriate)

Further develop relationship with all family members that began during phone contacts, initiate
intake & assessment (if done by the FFT therapist). Otherwise, session 1 consists of establishing the
relationship with the family.

Initiate Motivation (therapy) Phase by using Change Focus and Change Meaning techniques, and …

Begin assessment of Relational Functions and observation of family interaction patterns.

End Session with assessment protocol & intake documentation, schedule next session within 2-4
days if necessary due to high risk factors.
Between Sessions 1 and 2

Review family members’ behaviors, feelings, & beliefs

Consider and “do your homework” about additional possible cultural match issues.

Identify unclear relationships within family and with extended family or other caregivers.

Identify resistance patterns of family members/caregivers.

Hypothesize Relational Functions for each family member.

Plan specific strategies to complete relational assessment.

Plan specific therapeutic interventions (e.g., strength based themes) based on the above.

Have additional conversations with all systems involved with the family i.e.: child welfare worker,
school officials/teachers, probation officers, and other treatment providers to develop
relationships and understanding of their perspective and expectations of case.
Sessions 2 & 3

Repeat techniques of Session 1 to continue to match and build relationships with family members.

Continue to use Change Focus and Change Meaning interventions.

Continue relational assessment.

Hopefully complete Motivation Phase goals.

Reschedule next session as needed; with high risk families usually within 3-4 days.
Between Session 3 & 4

Assess progress towards completing E & M Phase goals

Develop intermediate and long term change goals that will that will address family relational pattern
deficits, e.g., problem solving, communication, parenting skills, parent & youth well-being including
such specific issues such as PTSD & substance abuse.

Review and develop specific behavior change & educational techniques that lead to intermediate and
long term goals as new avenues to enhance all family members’ Relational Functions .
Middle (Behavior Change & Early Generalization) Sessions

Apply Behavior Change technology consistent with Relational Functions of the family members.

Resistance is feedback that one or more family member’s functions have not been met or Behaviro
Change strategies were not well-matched to family members

Develop increased family initiative in behavior change and continue to match relational functions.

Prompt, look for, and support appropriate family member competence
Later Phases

Differentiate subsystems and specific individual issues (e.g., vocational deficits).

Relapse prevention work.

Generalize specific behavior changes to other family situations.

Facilitate independence that is consistent with relational functions of all family members.

Maintain & create new links with extra-familial systems to generalize positive intra-family changes.

Evaluate quality of life issues and plan for future.
Termination

Problem cessation: verbal report and observed.

Spontaneous family process: new interaction styles and attributions for all family members.

Primary risk factors, including safety issues, reduced or eliminated; protective factors enhanced.
FUNCTIONAL FAMILY THERAPY
A Phase Based and Multi-Component Approach to Change
FFT is about youth and families who are in trouble; however FFT also is about therapists,
about treatment and other (educational, judicial, religious, cultural, political, economic,
marketing) systems, about critical research and evaluation and accountability, and about
values and goals. We hope to address these issues order to help readers understand what
FFT is all about and how to match the unique and special qualities each youth, family,
culture, treatment system, and research project brings to us.
Like essentially all coherent models of change, FFT is phasic and developmental. Every
system, ranging from human beings (and all animal life) to all created products (cars,
symphonies, clay figures, and so on), begin in quite a different form than they later become.
They go through phases which build upon each other and usually follow a specific pattern.
So too do families and therapists as they undertake and compete their journey together to
positive family change.
Clinical Model Overview:
The Phases of FFT Within Treatment and Community Systems
The Big Picture: Integrating FFT with Other Systems
Pretreatment
System Integration
Phase
Assessment
FFT Direct Treatment
Phases
Assessment
*
Posttreatment
System Integration
Phase
Assessment
- Engagement
Referral,
Preparation,
Pretreatment
Linking w/
Youth Mgt
Systems
- Motivation
- Relational > Behavioral
Assessment
- Behavior Change
- Generalization / Ecosystemic
Integration
Boosters,
Maintenance of
links w/ Youth
Mgt Systems,
Positive close
The Youth / Family Management System(s):
System(s):
Juvenile Justice, Drug Court, Welfare, Mental Health:
(PO’
PO’s, Case Managers, Trackers, Contingency Managers)
* Based on Alexander et al, 1983; Barton et al, 1985; Waldron et al, 2001
Major Components of FFT
The intervention program itself consists of five major components in addition to pretreatment
and post-treatment activities: Engagement in change; Motivation to change; Relational /
Interpersonal Assessment and change planning; Behavior change; and Generalization
across behavioral domains and multiple systems (Alexander et. al., 1983; Alexander et. al.,
1998; Barton et. al., 1985).
Pretreatment Preparation
Prior to actually seeing or even contacting the family, therapists engage in linking, studying,
and preparing. The therapist, upon receipt of a referral, first contacts the referral source(s)
quickly to acknowledge the referral and to solicit all information (including impressionistic as
well as formal assessments) available. In the case of formal legal involvement (e.g., Juvenile
Justice System) the therapist also clarifies system expectations and requirements, as well as
issues of confidentiality. In situations where the therapist might not have experience with
the culture or other characteristics of the referral, s/he will contact additional resources
within or outside of the treatment system to become better informed.
FFT Direct Treatment Phases
Analysis of Intervention Model*
Based on the “AIM Model” (Alexander, Barton, Waldron & Mas, 1983; Alexander, Pugh & Parsons, 1998)
BEHAVIOR
CHANGE
ENGAGEMENT
Assessment
Assessment
Assessment
GENERALIZATION,
Multi / Eco-systemic
Linking
MOTIVATION
PreTreatment
1
2
3
Sessions
5
6
7
>>>> End
PostTreatment
The First Phase: Engagement
The Engagement Phase actually begins prior to first contact, and very quickly blends into the
Motivation Phase. Engagement refers to any activity that can facilitate the family’s
willingness to show up for early sessions (or allow an interventionist into their home).
Engagement also involves creating an initial positive reaction to the therapist. These
activities can include “superficial” but important activities such as wearing clothes that
seem appropriate for family members and providing therapists that would appear to be
credible (e.g., gender and ethnic “matches” where this is relevant and possible). If a desired
“match” is not available, therapists must be as culturally competent and work to help family
members feel comfortable and respected. FFT therapists also make their own initial
appointments via telephone so therapists can listen for potential problems such as
transportation problems, distrust of and resistance to treatment, and confusion about
thereferral and/or treatment goals. Thus, the Engagement Phase is less characterized by a
formal set of therapeutic techniques than it is of an attitude on the part of FFT therapists that
families should be shown as much respect as possible and be made to feel as comfortable as
possible during the initiation of the process of intervention.
Pre-intervention Information and Assessment. Referral information is generally already
available for youth and families. Sometimes this information consists only of a name and a
reason for referral (e.g., runaway, found in possession of drugs at school; parent called
expressing concern that youth is becoming uncommunicative; social services receives
referral regarding possible neglect. At the other extreme are cases involving youth with
extensive diagnostic test information and perhaps even behavioral records in institutions,
and families with a history of many social service contacts. FFT interventionists review such
information, along with as much demographic information as is available, in order to
understand as much as possible about the context in which intervention is to occur: Is there
information available that might facilitate cultural sensitivity, be informative about
multisystem pressures (e.g., poverty) and resources, and that might suggest individual
constraints (e.g., learning disability, illiteracy) that must be considered?
The Second Phase – Motivation: Establishing a Strong Basis for Sustainable Change Through
Change Focus and Change Meaning Techniques
The Engagement phase consists primarily of transitory activities that are designed to get the
process of intervention “off on the right foot.” Then as direct contact is initiated in the first
session FFT therapists quickly move to more powerful motivational interventions. The
primary objective of the Motivation Phase of intervention is to create a motivational context
within which change can occur; the family members are helped to experience a reduction in
change-interfering negativity (anger, blaming, and hopelessness), coupled with an increase
in change-enhancing hopefulness. Decreasing negativity is essential in this early phase of
intervention, prior to initiating formal behavior change techniques, because family members’
intense negative emotions preclude them from making a realistic commitment to change.
Often family members have developed rigid defensive schema through which all information
is filtered, and their interactions are characterized by cycles of coercive and defensive
interchanges that reinforce their automatic negative processing patterns.
FFT addresses the early session (E&M) risk (for dropout) factors by engaging in two major
domains of activity: Changing Focus and Changing Meaning. Change Focus techniques
include: Interrupt & Divert; Point Process; Sequence, Selectively attend to positive elements
of patterns and reports – and always retain a strength based relational focus. Change
Meaning techniques include: Relabeling, Reframing, Creating Themes, and offering Theme
Hints.
Change Focus Techniques
Pointing Process. A major technique used by FFT therapists is pointing process. As
FFT therapists observe and attend to each family members’ perception of within-family and
extrafamily interactions, they can comment on the process of how family members relate to
each other. This is especially important with respect to those interactions that are
characterized by negativity and blaming but are identified in a non-blaming (and if possible
strength based manner).
Divert & Interrupt. Simply disrupting family members’ negative interactional
sequences through divert/interrupt represents a second major interpersonal maneuver
which helps families de-escalate their toxic negativity. Therapists divert family negativity
when they intercept a negative speech act made by a family member instead of allowing the
family member to whom it was directed to answer. Therapists interrupt family negativity
when they do not allow a family member who is making a negative or defensive speech act to
complete a blaming diatribe.
Sequencing. Sequencing behavior is a method used to assess what happens and
who does what within a family. Sequencing or circular questioning is usually done around
the specifics of a presenting problem. Because it is drawn out in a circular fashion it is
visually easier to see the context in which behavior occurs. This information is rich in
knowledge about all the participants, the action each took, and the meaning of each
participant’s behavior. When a sequence is completed to include what occurs before,
during, and after an event, there is often an identifiable outcome that can be tied to a theme
or function of the participants (see Reframes and Themes below). When used in a
relationally focused and non-blaming way, the focus of sequencing is not on the presenting
or other problems but on a family interactions. This can help create an atmosphere in which
family members can see their own patterns when sequencing is accompanied with nonblaming, contextual narrative. Another variation is to sequence a positive behavioral
outcome so that family members can begin to see what they do “through different eyes.”
Strength-based relational statements represent statements of positivity or even
nobility about one person’s efforts towards another person. This also includes seeing the
positive side of apparently negative relational patterns: For example (to parent and child who
are beginning to argue loudly with each other): “OK – I’m going to jump in here for a second.
You both are angry right now, and pretty much yelling. I’m sure that at times you or someone
else wants you to stop yelling. But for now, I want to note that you seem to be at least on the
same page … no one seems to be holding back much, and both of you are honest in
expressing your anger. Lots of families tend to go underground with their anger … but with
you two I can trust that you will bring it out and deal with it directly. That gives me something
to work with that often I don’t have. Now, I wonder ….”
Change Meaning Techniques
Relabeling. Relabels are close to being synonyms for a behavior, but are used to
switch some of the negative intensity in the meaning of that behavior. Consider a teenage
son’s complaint about his mother arising in an early (Engagement & Motivation Phase)
session: “As soon as I walked in the door she just went off on me!” and the therapist’s
response of: “So she let you know right off the bat that she had an issue with you.” While
these statements may seem quite similar, in most situations “ went off” tends to conjure up a
more intense image than “ …let you know right off that she had an issue with you.” This
relabel of “went off” also added a “softer” relational component (“she .. with you.”) rather
than the more “attacker – victim” tone of “she … on me.” Relabels set a tone which is less
intensely negative and provide the therapist more positive avenues to pursue.
Reframing. Reframing is generally described as a “technique,” and although its
elements may differ across therapy models, the process of reframing seems to transcend
most family based intervention models. This helps us develop consistency across many
agencies, therapists, and treatment populations. We also have realized that reframing is not
only a technique; it also is an attitude, a perspective, and a belief system that helps FFT
therapists facilitate positive change even when all of the technical elements of a reframe
cannot be presented.
Reframes, as we undertake them in FFT, add two components to the change meaning
process: 1) Clear acknowledgment of the negative, and 2) proposal of a possible alternative
(and perhaps even benign) motive. These components add significantly to the therapist’s
ability to impact negativity while maintaining an overall nonblaming relationship with all
family members. The most powerful, although also the most difficult to create, reframes
include the acknowledgement of the negative behavior, but rather than offering an
alternative neutral or benign motive for the behavior (e.g., mom’s frustration), the
hypothesized motive is now more “noble” in its intent. Usually the noble intentions are seen
as “misguided” but they are nonetheless well intended.
Creating Themes. To generate behavioral themes, therapists identify sequences of several
problem family member interactions in which all of the negative elements are identified but
reframed (or at least relabeled). This focus has the advantage of helping create a family
(versus individual) focus, and because all members are reframed the therapist can identify
quite negative interactions and yet “come across” as seeing the possible benign intent of
each member. In this way the therapist avoids taking sides and goes a long way to
preventing the defensiveness that occurs when only an individual’s negative behavior is the
focus. Relational themes switch the focus to relationships rather than behaviors. Relational
patterns, and how they have been experienced, become the major focus. And while
Relational Themes still maintain the basic elements of reframes (acknowledge negative,
reframe intent or meaning in more benign if not noble terms), they often seem more like
“stories” and even “myths” than specific sequences of negative behaviors. Coupled with our
core generic principles of matching and respectfulness, our powerful change meaning
techniques help families move quickly to being open and responsive to techniques to change
behavior (in both the short and long term).
Note regarding FFT “front loading:” The spacing (number of days) between the first,
second, and third FFT sessions depends primarily on:
1 - the severity of risk factors,
2 - the immediate availability of protective factors, and
3 - your over all judgment of how long the family can go without a major disruption.
- With high risk families we would expect 3 sessions in the first 10 days of FFT.
Assessment in Early Phases (Engagement and Motivation): Relational Functions
By the time FFT receives referrals for dysfunctional behavior patterns, the relational
functions they express in important relationships usually are established and easy to
recognize; rarely do adolescent disruptive behaviors (nor parenting “styles” and
“challenges”) emerge “all of a sudden.” As a result FFT looks for stable patterns, first
assessing the relational functions. These “relational functions” represent inferred internal
motivations based on overtly expressed (behaviorally, verbally, emotionally, even
physiologically) patterns within the family.
After at first focusing on within-family interactions, FFT repeats the assessment process for
relationships and problem behavior patterns outside the family (especially with peers). FFT
does not attempt to change the relational function itself, but we do change the cognitive,
physiological, emotional, and behavioral strategies in which the youth or parent engages to
meet relational functions. If a child acts out to “get attention” FFT does not work hard to
eliminate children’s need for attention! Instead we change the means though which this
attention is elicited. This of course usually requires dealing with the rest of the system(s)
involved with the youth
Relational Connection: Contact/Closeness/ versus Distance / Autonomy/ Independence.
The most salient category for FFT represents the degree of interpersonal connectivity
seemingly involved when a person expresses a stable behavior pattern that directly or
indirectly impacts another person (or persons). The degree of connection can range from
“close” and highly interconnected to “distant” and quite independent or autonomous. These
dimensional anchors do not represent fixed and invariant points on a dimension; they are
instead the seeming central tendency (or apparent “default mode,” or “average “) behavioral
pattern that best characterizes the ongoing relationship. Whatever the behavioral pattern is
over time, FFT’s intervention philosophy the respectful acceptance of the diversity that all
family members bring us in terms of what we call Relational Functions. All three of those
relational states can be adaptive, and all three can be maladaptive. The problem is not what
the relational function is, but how it is expressed and met.
Within Family Relational Functions:
Degree of Connection / Attachment As Reflected In
Typical Behavioral Patterns
:
high
1
Autonomy:
independence
separating,
(Fear of
Enmeshment?)
2
Autonomy
3
Mid
ting
n
i
o
p
Contact/4
closeness
5
low
low
Contact: closeness, connection:
enmeshment, (Fear of abandonment?)
high
The Second Dimension: Relational (“Relative Power”) Hierarchy. Relational Hierarchy
reflects the pattern of relative influence parent & youth have over each other in terms of
“controlling” each others’ behavior. With Adolescent Disruptive Behavior Disorders (DBD’s)
it is common to use such phrases as “S/he’s out of (parental) control.” However, FFT
examines not just the behavior patterns of one individual. Instead we examine the relative
balance of control and power rather than simply isolating our focus on whether or not the
parent can “control” the youth. When we broaden our focus to look at the relative balance of
power, it is not at all uncommon for us to find that a youth is able to exert less or more
“control” over a parent’s behavior than vice – versa. Interventions that fail to examine the
relative balance of the interpersonal “control” in these relationships often fail repeatedly if
all they attempt to do is to increase the “control” the parent has “over” the youth.
In many ways parents experience the “power” issue as the most salient in raising
adolescents, however FFT asserts that primarily what parents want is a sense of being able
to control (if not help) their youth. As a result, when FFT provides alternative ways to
influence youth relationally, hierarchy itself becomes less salient. In fact, many parents are
quite pleased when their kids begin to “obey” because the relationship with the youth has
been “repaired” and the youth now wants to maintain a positive and less blaming relational
pattern with the parent(s). Power and consequences are important, but difficult to achieve
in many cases, and certainly less positive than relational changes that motivate youth to
comply and develop positive behaviors without the constant use of power and
consequences.
The Second Relational Dimension:
Hierarchy
Hierarchy refers to the pattern, over time, of
relative influence based on power,
power, position,
position, and
resources (as opposed to Relational Connection”
Connection”)
Parent 11- up
Parent
Symmetrical:
(Exchange =
Behaviors)
Parent 11- down
Unlike the concept of personality which presumes a core underlying motivational structure,
FFT assessment of functions often identifies important differences within one person. The
FFT interventionist understands for example that the motivational needs of the parent with
different children can be markedly different. As a result, behaviors that would be
comfortable for the parent with respect to the “close” child could be quite unacceptable with
respect to the distanced child. Thus prescriptions for good parenting cannot be simply
homogeneous since the behaviors through which effective parenting is carried out will differ
depending on the child in question.
Finally, the assessment of relational functions is essential if therapists want to insure rapid
compliance with change interventions. Prescribing tasks or change strategies for one family
member with respect to another member will elicit considerable resistance if the
prescriptions are implicitly or explicitly inconsistent with the family members’ functions.
Simply put, the more divergent the techniques are from the relational functions, the more
resistance (e.g., poor participation and dropout) the therapist will face, and the more
external forces need to be brought to bear to facilitate (force?) and maintain change. As an
empowerment model FFT offers a more relational and less opposition based belief system
and intervention philosophy.
Transitioning between Engagement & Motivation into Behavior Change
Over the years FFT has utilized two broad classes of “techniques” for Behavior Change. The
first class is represented by general skill-building processes such as communication
training, problem solving, and conflict management techniques. We use these techniques in
almost all families, and they represent skill development which is useful to family members
when they interact, but they also generalize nicely to other extrafamily systems (school,
work, friendships). The second class of techniques represents problem specific techniques
which may apply to some people and families but not others. These include “internal” coping
techniques involving anger, impulse problems, and cravings; challenges unique to some
families such as a single parent with physical disability which preclude many parenting
strategies, or youth referred with specific developmental disorders. Special techniques or
unique configurations of behavior change approaches also may be utilized, for example,
when severe trauma / PTSD has been experienced by the youth (or parent, or both), and
when youth spend time with two active parent figures who live separately and who may have
their own new family relationships developing.
Behavior Change (BC)
* Develop individualized change plans that fit “match”) the family
(values, Relational Functions, abilities) and which increase
resources and competence in adaptive positive behaviors
* Eliminate dysfunctional behaviors (drug abuse, delinquency,
violence, maladaptive expectations & beliefs, etc) by changing
the processes (intra-individual, family relational, multisystemic)
that support them;
BEHAVIOR CHANGE
*Change the problem and related behavior(s) by using the
therapist skills of Teaching, Modeling, Coaching, providing
Technical Aids, and giving Directives & Homework that helps
families improve their ability in: Parenting, Youth Compliance,
Communication, Problem solving, Conflict management,
Managing anxiety, “urges,” PTSD, etc.
Behavior Change: Specific Elements
The FFT therapists’ style shifts during Behavior Change, becoming much more structured,
direct, and in some ways hierarchical than during Engagement and Motivation. In addition,
FFT interventionists prescribe specific interpersonal tasks often involving the technical aids.
Communication Training. Communication training is commonly used in FFT. In some
families the training represents a focus on a true skill deficit; the family members truly do
not know the basics of interpersonal communication. In many other families, however,
family members know how to communicate quite well (e.g., some have been effective
teachers, professors, clergy, girl scout leaders, etc.). However, in the current
individual/family/community context they are unwilling or unable to communicate in the
effective ways they can demonstrate in other contexts. With family members who truly
are characterized by skill deficits, emphasis is on explaining and practicing the positive
elements of communication listed below. When instead the problem is one of
performance rather than ability, emphasis is placed on the reattribution (e.g., reframing)
interventions described earlier, and providing constant reminders of the rationale behind
positive and effective communication.
Elements of Positive Communication

Source Responsibility. Needs and reactions are expressed in “I” statements

Source Directness. Directness if the complement of source responsibility

Brevity. Communications must be short to avoid overloading and facilitate
which facilitate the centering of responsibility on the speaker Keeping statements
at a personal level reduces blaming and defensive communications.
involving the specific identification of “you” in expressions. This helps avoid
third-person comments, innuendo, and inappropriate generalizations.
listening. Family members are often literally asked to state their needs or
reactions in ten words or fewer. By requiring member to do this, it reduces
unnecessary statements and the opportunity to blame others or make
provocative accusations

Concreteness and Behavioral Specificity. Abstractions such as “being

Congruence. Family members are helped to present messages that are

Presenting Alternatives. By presenting alternatives, family members move the

Active Listening. The art of active listening as developed by Rogers and others

Impact Statements. In response to someone else’s communication, impact
responsible” must be translated into specific behaviors to be performed at
specific times. When trust is only emerging, or still not present, an ambiguous
situation provides too many opportunities for failure. Helping family members
translate their feelings and demands into specifics facilitates negotiation,
contracting, and presenting alternatives.
congruent, or consistent, at the verbal, non-verbal, behavioral, and contextual
levels. Family members are assisted by the therapist to provide congruent verbal
and non-verbal cues, then helped to learn how to help each other to do this in the
absence of the therapist.
atmosphere away from non-negotiable demands, and helps all family members
see the benefit of flexibility in their problem-solving attempts. They allow the
presenter to retain a sense of control, yet also provide the recipient with a sense
of having options.
involves the presentation of cues, by the listener, both during and after the time
someone else communicates. These cues reflect accurate listening and include
eye contact, nodding, leaning forward, and restating or rephrasing what was
communicated, in content as well as in the feelings expressed
statements provide feedback in terms of personal reaction that require no
justification from either party. Their expression helps family members break up
what often seems to be wired in relationships between feelings and behavior.
Examples of impact statements include: “When you do ______, the effect on me is
_______”; “The impact on me when ______, is that I feel _______.”
Basic Parenting Principles/Techniques. Positive reinforcement/praise, negative
reinforcement, ignoring, distracting, clear limit-setting with consistent follow-through
and a reasonable number of limits, parent-child special time, and parental monitoring of
activities are applied when deemed appropriate during the Behavior Change Phase of
FFT. On their own, parent management techniques appear to be more effective with
younger rather than older adolescents. Because FFT is a systemic model and all family
members are included in therapy, choosing and relaying these techniques to family
members must be done in a sensitive and flexible way. In general, the use of these basic
parenting principles is encouraged in FFT through incorporation into the more systemic
and collaborative techniques of response-cost and contracting. Therapists should keep
these principles in mind, but their application is more commonly conducted through
more systemic means than classic parent-training.
Contracting. Contracting involves having family members identify specific things they
would like other family members to do in exchange for interactions/behaviors or tangible
rewards. This procedure is especially important with adolescents (as opposed to your
children). In fact, other than basic communication training, contracting is the parentyouth interaction/ influence technique that is most commonly used by FFT therapists
because it is systemic (e.g., involves considering the idea of reinforcement / reward for
all members of a system or subsystem).
Therapists also need to monitor contracts to make certain they are attainable based on
the functional relationship needs of each participant. Finally, therapists need to monitor
the in-session contracting process to maintain the decreased negativity attained during
the Motivation Phase. To this end, therapists often refer back to specific reframes and
themes from the Motivation Phase that were particularly helpful in creating positive
attributions in family members. If communication training was conducted earlier in the
Behavior Change Phase, the therapist will also model and remind the family to use
communication techniques during their in-session contracting discussions.
Response Cost Techniques. Especially effective with children and preadolescents, the
specific approach to reward and punishment identified by Webster-Stratton and Herbert
as Response-Cost Techniques provide a wonderful framework that helps a parent or
parents learn how to set clear penalties (typically loss of privileges/current rewards) for
inappropriate child behaviors or failures to perform. Expected behaviors and penalties
should be fair and clearly stated, and augmented by visual aids whenever possible
Additional Intervention Strategies. In addition to providing communication and additional
skill training, FFT interventionists prescribe specific activities and behaviors that will
enhance the family’s experience of positive change. In particular, interventionists utilize
as many technical aids as possible. These technical aids include such simple items as
sticky-type notes that can be put on mirrors to remind family members about a particular
behavior, audiotape recordings of communication practice session that can be taken
home for review, commercially available manuals on parenting, a wide range of similar
free information provided by social service agencies, training in the use of answering
machines and cell phones to leave messages for family members, a schedule of reminder
telephone calls made by a volunteer to families who need additional structure to change
old behavior patterns, and so on
Interventionists also are reminded to be very creative and energetic with respect to
providing specific and concrete resources for families as they enter the change process.
We don’t want to send families (many of whom have only limited resources and few good
work habits) out of sessions with little more than suggestions about how to change
behavior. Instead we are much more direct and in some ways “controlling” (or
“educational”) during Behavior Change.
Using Technical Aids (examples)
 tape recordings, therapist handouts for family to take home & review
 reminder cards / post-it notes /charts, notes, message centers on
refrigerators
 school-home feedback systems
 answering machines, beepers, 2-way radios, cell phones
 pictures, “corny sayings,” symbols
 relaxation techniques
Conflict Management
 Avoid conflict situations as much as possible
 Change reaction to early steps in the process
 Contain it…
 Present orientation (no “gunnysacking”)
 Issue focused (no “character” attacks)
 Time - out for transitions
Problem Solving
1 Identify a problem in a specific incident/area/with a specific problem
2 Use principles of positive communication
3. Clarify desired outcomes for all participants
4. Agree / negotiate regarding what it takes to accomplish the task
5. Try to anticipate all the ways it can go wrong
6. Review plan, develop relapse prevention plan
The above examples represent the more common techniques used by FFT therapists.
However, just about any structured activity can represent a useful technique in FFT
Behavior Change, as long as the behaviors they create and maintain are consistent with
Relational Functions. Over the years FFT therapists have utilized a very wide range of
cognitive-behavioral techniques, trauma and experiential techniques developed in other
contexts, and already established cultural practices (preparing meals together, etc) as
contexts for FFT Behavior Change. Once they become comfortable with the core
construct of “matching,” FFT therapists have found almost limitless techniques available
during this phase of FFT intervention.
The Generalization Phase of FFT
The FFT Therapist as “Family Case Manger.” Unlike generic treatment planning which
sometimes wraps services around families and family members with little consideration
of family dynamics, FFT focuses on each individual family’s interpersonal and systemic
needs when considering adjunctive support services. In addition, before ideas with good
face validity are implemented to advance a treatment plan, it is necessary for a
therapeutic alliance to exist for the family to view these ideas as valid, and the idea must
be based on an understanding of the functional aspect of family behavior. FFT believes
that extrafamily (ecosystemic, multisystemic) links must incorporate developmental, and
synergistic intervetions, and they must be consistent with each another as well as the
family’s culture.
FFT extends or exports family functioning into a variety of community systems, which
helps the family as well as the community. It is our belief that adjunctive services often
(or usually) must be developed in order for the treatment effect to generalize. In doing
so, the FFT Family manager helps anchor the family and the family members to a larger
supportive community.
Because of this, successful intervention cannot begin with this phase of intervention. To
simply wrap services around a family or family member without considering the impact
on family functioning is to risk destabilizing the already precarious family process. Thus,
the accomplishments of the Generalization Phase are predicted on successful handling
of therapist-family core therapy processes.
FFT Direct Treatment Phases
Analysis of Intervention Model*
Based on the “AIM Model” (Alexander, Barton, Waldron & Mas, 1983; Alexander, Pugh & Parsons, 1998)
BEHAVIOR
CHANGE
ENGAGEMENT
Assessment
Assessment
Assessment
GENERALIZATION,
Multi / Eco-systemic
Linking
MOTIVATION
PreTreatment
1
2
3
Sessions
5
6
7
>>>> End
PostTreatment
Summary of the FFT Model & Core Elements
In sum: FFT is a relational, family based, ecosystemic, communication theory, and
cognitive-behavioral based model, with consideration of intrapsychic (or at least intraindividual) factors and biogenic influences. FFT produces change through a phase
based process (Engagement, Motivation, Relational Assessment, Behavior Change,
Generalization / Ecosystemic focus). These phases are wrapped in, and informed by
core concepts of matching, non-blaming relational focus, balanced alliance and
respectfulness with all family members involved.
It should be noted that while various conceptual systems, each of whom involve specific
assessment and intervention components, have informed the development of FFT, the
elements are not conceptualized and treated in an eclectic or haphazard manner within
FFT. Nor is any one historical perspective adopted in its entirety. FFT recognizes that
each perspective, and the processes they assume to be relevant, may be more or less
influential or appropriate in any given family or even any particular aspect of a family. As
in Bandura’s (19xx) notion of “reciprocal determinism, some families face biological
challenges that others do not; some families and family members have experienced
pervasive levels of “trauma” in the past, and some have not; some families are trying to
exist in very negative community contexts, others are not. As a result FFT is an
“integrative” model which allows us to conceptualize families and problem behaviors, as
well as family strengths, from various perspectives depending on a number of contextual
variables. However, these perspectives must not be mutually exclusive nor represent
paradigm shifts or clashes with respect to FFT core principles .
In all this FFT is clear about the overall principles and perspective that guides the
integrative process. Our “default mode” is relational and respectful, but it is
accommodating enough to utilize other perspectives as long as they are consistent with
the core FFT model and they help the therapist understand and intervene with this
particular family, effectively, at this particular time .
And finally, FFT represents a motivational and a systems model; that is, the behaviors we
address clinically are assumed to be motivated “internally” on the part of the people
evincing them, yet the behaviors also “co-influenced” by others in the environment.
Others influence, if not determine, what individual behavioral expressions are
acceptable, and they influence (if not determine) how behaviors “function” in the context
of those other important people. As such FFT is both an individual and a relational
model. We assess the intersection of these forces and how they emerge in terms of the
Relational Functions that represent that intersection.