To be successful with youth and their families FFT relies on…

1. Functional Family TherapyInternational Certification ProgramIntroduction to Behavior Change Phase(webinar 5)Thomas L. Sexton, Ph.D., ABPPFunctional Family Therapy Associates

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. Peer Groups Values/Norms Socioeconomic Status Risk and Protective Factors Cultural/Ethnic/Racial “Context” Family FFT…. “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” Behavior becomes of worry To parents/the system Community Adolescent Sibling(s) Parent(s) • Biological • Historical • Relational Individual Risk and Protective Factors • Values/customs/relational styles/ • Rules, rituals • Expectations/norms

5. Adolescent Dad/father figure Mom/mother figure Individual Behaviors • 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. 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. Peter: (comes home 5 hours late. Comes in the house and goes upstairs…on the stairs his mother comes out of her room… Anja: (to her husband)…”I can’t do anything with him…and you don’t help. I would at least like your support 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. Outcomes • Increase behavioral competency of all/family • Consistent performance of competency • in “real” problem situation Early Middle Late Functional Family TherapyClinical Model Engagement Behavior Change Generalization 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

9. 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 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 Reframing Opportunity Time Overtime…the outcome • Negativity decreases • Family focus increases • Motivation increases • Blaming decreases • Attributions change

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. 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 Problem Solving

15. Implementing BC Phase 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

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

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. 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 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 • How… • Within couple…as way to strengthen/change couple

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