FFT is a 5 Phase Model
The goal of this phase is to identify the patterns of interaction within the family to understand the relational "functions" or interpersonal payoffs for individual family members' behaviors. The therapist focuses on eliciting and analyzing information pertaining to relational processes, and assess each dyad in the family using perception and understanding of relational processes. The focus is directed to intrafamily and extrafamily context and capacities (e.g., values, attributions, functions, interaction patterns, sources of resistance, resources and limitations). Therapist activities involve observation, questioning, inferences regarding the functions of negative behaviors, and switching from an individual problem focus to a relational perspective. This sets the stage for planning in Behavior change and Generalization, where all interventions are matched to the families' relational functions.
What is the Relational Assessment?
“Andie…I notice that when mom started to talk about your grades, you placed your head on the table with a heavy sigh. I wonder if this is something that happens between the two of you a lot when this comes up?”
What is a point process?
Protection, survival, teamwork, anger implies hurt, resilience, fear of judgement
What are theme hints?
The first step of a BC session
What is the rationale?
10-18 years old
What is the age range for AMIKids Referrals?
The goal of this phase is to reduce or eliminate referral problems by improving family functioning and individual skill development. This phase often includes formal behavior change strategies that specifically address relevant family processes, individual skills or clinical domains (such as depression, truancy, substance use). Skills such as structuring, teaching, organizing and understanding behavioral assessment are required. Therapists focus on communication training, using technical aids, assigning tasks, and training in conflict resolution. Techniques and strategies often include evidence-based cognitive-behavioral strategies for addressing family functioning and referral problems. Phase activities are focused on modeling and prompting positive behavior, providing directives and information, developing creative programs to change behavior, all while remaining sensitive to family member abilities and interpersonal needs.
What is Behavior Change?
“Mom, this is obviously something that is really important to you; but, I want to bring it back around to how this seems like another example of you and Jon’s road to trust”
What is a diversion?
In session Mom begins blaming and yelling at her husband about the topic at hand. Therapist responds, “mom this is something you are very passionate about”
What is a relabel?
The minimum percentage a family should be practicing a skill in a BC session
What is 65/70 %?
Level 1 (High Risk OR High Needs), Level 2, Level 3, PRS; Diversion with State Approval
What are the eligible disposition levels AMIKids NCFS serve?
The goals of this phase involve enhancing family members' perceptions of therapist responsiveness and credibility. Therapists work hard to demonstrate a sincere desire to listen, help, respect and "match" to family members in a way that is sensitive and respectful of individual, family and cultural beliefs, perspectives and values. The therapist's focus is on immediate responsiveness to family needs and maintaining a strength-based relational focus. Activities include high availability, telephone outreach, appropriate language and dress, contact with as many family members as possible, "matching" and a respectful attitude.
What is Engagement?
Therapists stands up, waves hands in the air and loudly says, “Hey guys! WOW! You guys are really passionate about this, can we stop for a second. I want to come back around to…”
What is an interruption?
“Mom, when Tyler shuts down and goes in his room it really freaks you out. You are worried if he is okay and how you can help. Tyler I think you shut out and isolate when you are hurting to protect your mom. You have seen her go through so much of her own pain that you don’t want to burden her with your own. My concern is that it is hard for you all to heal your relationship, and heal together, through isolation.”
What is a reframe?
A family practices a new skill through role playing. Once they are finished, the therapist comments, “You guys did a really great job powering through this new experience, I could tell at times it got uncomfortable, but you stuck with it. What was this like for you all?”
What is coaching and feedback?
3 months (ideally 4 months)
What is the minimum time frame a youth needs to remain on probation to receive FFT?
The primary goals in this phase are to extend the improvements made during Behavior Change into multiple areas and to plan for future challenges. This often involves extending positive family functioning into new situations or systems, planning for relapse prevention, and incorporating community systems into the treatment process (such as teachers, Probation Officers). Skills include a multisystemic/systems understanding and the ability to establish links, maintain energy, and provide outreach into community systems. The primary focus is on relationships between family members and multiple community systems. This phase activities involve knowing the community, developing and maintain contacts, initiating clinical linkages, creating relapse prevention plans, and helping the family develop independence.
What is Generalization?
“When your family is faced with a threat, you all really bind together as one united front”
What is a strength based relational statement?
“Your family has been through a lot over the past years. I think sometimes a lot of your pain gets in the way of listening and you have all built protective shields around your hearts. In a way, this helps to keep you from experiencing more pain or disappointment. But, it can also really threaten the rebuilding the relationships you all want so badly.”
What is a relational theme?
Determining the risk and protective factors that will impact the families ability to maintain change (ie. what risk factors still need to decrease, what protective factors can be increased), assessing what steps are needed to assist the family in maintaining the change, and creating a session by session implementation
What is a Generalization Plan?
10-12 families
What is the average caseload of an FFT therapist?
The goals of this phase include creating a positive motivational context by decreasing family hostility, conflict and blame, increasing hope and building balanced alliances with family members. Therapists work to change the meaning of family relationships by emphasizing possible hopeful alternatives, maintaining a nonjudgmental approach and conveying acceptance and sensitivity to diversity. The therapist's focus is on the relationship process, separating blame from responsibility while remaining strength-based. Activities include the interruption of highly negative interaction patterns, changing meaning through a strength-based relational focus, pointing process, sequencing and reframing of the themes by validating negative impact of behavior while introducing possible benign/ noble (but misguided) motives for behavior. The introduction of themes and sequences that imply a positive future are important activities of this phase.
What is Motivation?
“Mom when Jaylen is gone for more than a few hours, you start to blow his phone up. I think sometimes the more you text, the more he ends up ghosting you. You do this because you are so worried about the past repeating itself.”
What is a sequence?
When an FFT therapist implements a change meaning technique, what is next step for the FFT therapist to assess once the change meaning has been stated?
What is the impact/family response?
Every intervention in Behavior Change and Generalization needs to match to what?
Relational functions and hierarchy
12-14 sessions (or 3-5 months)
What is the average length of FFT?