Functional Family Therapy
Adolescents with disruptive behavior, typically identified as challenging to treat, juvenile delinquents, at-risk, violent, or offending youth (Alexander et al., 2013) Adolescents with disruptive behavior, often labeled as challenging to treat, can find relief through Functional Family Therapy (FFT), an evidence-based treatment (EBT) that has shown significant effectiveness. (Alexander & Parsons, 1973; Robbins et al., 2016). It is common for these youth to be diagnosed with disruptive behavior disorders or substance abuse disorders and could be engaged with the juvenile justice system. Often, they present with emotional disturbances, problematic behaviors, and distorted methods of thinking that do not affect only their family but the community also.
Family members have challenges accepting and rationalizing the adolescent disruptive behavior and become obsessed with the desire for them to change; however, the youth frequently is the most challenging and uncooperative as they are reluctant to self-refer and are undisturbed by their behavior (Alexander et al., 2013)Adolescents' motivation for treatment frequently originates from challenges associated with their direct social sphere, including their family and peers, or their social system, including justice and child welfare. Regardless of the referral source, these adolescents are generally uninterested in treatment.
FFT is a coherent theory utilized to comprehend family relational relationships and identify the relational function or "payoff" of the behaviors contained by the system (Robbins et al., 2016, p. 2). The foundational assumptions of FFT indicate it is a treatment modality that consists, on average, approximately twelve to fourteen hourly family therapy sessions each week (Robbins et al., 2016). In the early FFT phases, ideas are constructed involving behaviors and interactional patterns within the family, which will be the objective of the behavior change phase. Change objectives consist of family relational components, behavioral deficits, and assets that can be expanded.
There are five distinct phases engagement, motivation, relational assessment, behavior change, and (Robbins et al., 2016). During engagement, the emphasis is on expanding the family's initial prospects and perceptions to utilize their time best while attending their initial session (Robbins et al., 2016). During the second session, the clinician engages in motivation. The emphasis is on decreasing the family's discord, condemnation, and desperation, fostering a relational focus, and balancing the systemic alliance to develop a motivational context necessary for change.
The relational assessment phase of treatment is a critical element of FFT as it addresses two fundamental system relational domains, the degree to which connection amongst family members is present and the hierarchical pattern involved in the relationships (Alexander et al., 2013). The assessment component identifies how to confront variations within the family to oppose the minor conflict and construct the enduring impacts. Supportive and risk factors demonstrate multiple dimensions that contribute to adolescent problems. Identifying a single major event, such as job loss or a delinquent adolescent moving nearby, trauma, and neglect can further enhance maladaptive coping patterns that one has previously learned and substance abuse patterns that are firmly in place.
Identifying interactional and functional components of the system's behaviors, acknowledgments, and feelings concerning family members and significant supportive relationships, such as peers, is a primary focus of the assessment phase. Here, development and implementation for behavioral change phases involve training and the application of maintenance such as parent-child communication, behavioral contracting, emotional regulation, and expression (Robbins et al., 2016). Utilizing these skills training for issues such as problem-solving and other behavioral interventions included in the menu-driven process that individuals can use within each dyad of the system.
Strategies necessary to include in behavioral change plans include those developmentally appropriate for adolescents as they traverse the life cycle, cognitive skills, emotional development, social functionality changes, and independence grows. The parent-adolescent communication dynamic adjusts towards equilibrium. Change plans consider members' intellectual functioning, cognitive functionality, and individual sophistication, as the application of change plans fluctuates based on relative involvement concentrations. It can vacillate from straightforward tactics to elaborate or complex methods. Issues regarding what concessions are negotiated or how consequences are accomplished depend on the age and development of individuals in the system.
The overarching goal of FFT is changing maladaptive behaviors; thus, successful behavioral change depends on the system being motivated and ready for change and clinicians having a concise understanding of the relational functions within the system. In the context of FFT, 'system' refers to the family unit or the social environment in which the adolescent operates. (Alexander et al., 2013). FFT's progression through therapy is achieved as behavioral change strategies are implemented in methods congruent with the family's relational functions; however, the system's motivational readiness and positive trajectory are necessary for long-term change.
The behavioral change phase is explicitly focused on eliminating symptoms and conflicted or avoidant interactions, preventing maladaptive patterns from reemerging, and concurrently building a positive, nurturing relationship amongst members that is sustainable long-term. While an obvious target, the chief complaint may not be the maladaptive behavior creating the problems and the response to the behavior that motivates and encourages continuation.
The movement to the behavior change component is appropriate when the system demonstrates increased hope in the family and decreased negativity and blame (Robbins et al., 2016)Transitioning between behavior change and motivation can be fluid and is not necessarily repeated only once. Initial attempts at behavioral change may require several sources of the problem to be considered; the clinician may not have been clear with their directive or informed the system effectively to carry out their change plan. Additionally, a family's relational functions may have failed to satisfy the change plan, or repeating the motivation may be necessary to reduce negativity within the system to promote developmental readiness.
Replacing maladaptive behaviors to maintain relational functions is the focus of the change. Once achieved, the family transitions to generalization, shifting the focus to extending the novel skills and behavior the system has acquired and applying them to their home and external environments. Maintaining the status quo and extending treatment gains the system achieved independently from their sessions with the clinician is the goal of this phase. Termination criteria are dependent on individual cases and the treatment system. Typically, referral symptoms wish to be decreased, such as substance abuse. However, the extinction of risk factors such as parental neglect or failure to monitor problematic behaviors such as truancy needs to be addressed.
A significant indication that a system is ready to move toward termination is the spontaneous appearance of family member-initiated novel skills, techniques, and strategies utilized at home, tried between several sessions, and executed successfully. The system's successful generation and independence indicate their readiness for termination. However, termination depends on the system's ability to make significant progress through each phase of FFT and, most importantly, the attainment of the phase-correlated goals.
References
Alexander, J. F., & Parsons, B. v. (1973). Short-term behavioral intervention with delinquent families: Impact on family process and recidivism. Journal of Abnormal Psychology, 81(3), 219–225. https://doi.org/10.1037/h0034537
Alexander, J. F., Waldron, H. B., Robbins, M. S., & Neeb, A. A. (2013). Functional Family Therapy for Adolescent Behavior Problems. American Psychological Association. https://doi.org/10.1037/14139-000
Robbins, M. S., Alexander, J. F., Turner, C. W., & Hollimon, A. (2016). Evolution of Functional Family Therapy as an Evidence-Based Practice for Adolescents with Disruptive Behavior Problems. Family Process, 55(3), 543–557. https://doi.org/10.1111/famp.12230