Functional Family Therapy in Clinical Practice by Sexton, Thomas L. -- Read -- Imperial Library of Trantor

Index

Dedication Contents Foreword Preface

The FFT Story

I An Introduction to Functional Family Therapy: A Dynamic Evolution of Theory, Science, and Practice

1 The Evolution of Functional Family Therapy: From Traditional Theory to Evidence-Based Practice

The Dynamic Evolution of FFT

Origins Expansion Systematization

FFT as a Response to the Complexity of Adolescents With Behavior Problems

Range, Rate, and Prevalence of Behavior Problems

Risk and Protective Factors

The Search for Answers: The Rise of Evidence-Based Practice

The Gap Between Research and Practice

What Does It Take to Help? Lessons From the Research Functional Family Therapy

What Makes FFT Unique? The FFT Clinical Model in Practice Common Factors and Model-Specific Features The Art of FFT

Conclusions: Helping Troubled Youth

2 Core Principles of FFT: Clients, Clinical Problems, and Foundations of Effective Therapeutic Change

Core Theoretical Principles as the Lens of Clinical Practice Core Principles of Functional Family Therapy

A Functional Family Systems Approach

Model-Specific Mechanisms

Multisystemic Assessment and Intervention Strength-Based and Resiliency-Driven Acknowledging What Individuals Bring to the Table Central Role of the Family An Umbrella of Community and Culture Implications for Helping Youth and Their Families Clinical Problems Risk and Protective Factors Clinical Problems as Relational Problems Central Relational Patterns Relational Functions: The Glue

Clinical Change: Central Assumptions and Core Mechanisms Reflections on Theory and Practice

3 Clinical Change: Systematic Over Time, Relationally Focused, and Client-Centered

Systematic Clinical Change: Central Assumptions and Core Mechanisms

Therapeutic Change Is the Result of Alliance-Based Motivation Behavior Change Is Based on Meaning Change The Role of Cognition, Emotion, and Behavior Cognitive Restructuring Behavioral Change Goals Are Obtainable and Appropriate to the Family Intervention Strategies Match and Respect the Unique Characteristics of the Family Therapy Is Based on Purposeful Conversations That Address Immediate Needs

The Clinical Process of FFT

The FFT Change Model Assessment, Intervention, and the Family Scientific Foundations: Support for This Way of Working

Conclusions: Challenges and Opportunities of Systematic, Model-Based Practice

II The Practice of FFT

4 Engaging Individuals and Motivating Families

Early Change Goals: Building Engagement and Motivation

Involvement in the Therapy Process An Incentive to Try Something New A Family-Focused Problem Definition Perceiving a Credible Helper

Integrating Assessment and Intervention Into a Therapeutic Conversation in the Early Stages of FFT

What to Look For: Clinical Assessment Assessment of the Presenting Problem Understanding Individual Problem Definitions and Creating Family-Focused Themes Identifying the Problem Sequence Identifying Risk and Protective Factors Monitoring the Ongoing Progress of Therapy What to Do: Intervening to Build Engagement and Motivation Become a Credible Helper Bring an Attitude of Respect and Collaboration Engage the Family Reduce Negativity and Blame, Build Personal Responsibility Build Therapeutic Motivation Through Balanced Alliance

How to Do It: Interventions in Engagement and Motivation

Relational Reframing Acknowledgment Reattribution Assessing the Impact and Building an Organizing Theme Reframing … Again: Building on the Last Reframing Interrupting/Diverting to Structure Sessions Process Comments Building Organizing Themes

Outcomes of the Engagement/Motivation Phase

Changed Family Relationship Clients Ready for More Alliance-Based Therapeutic Relationship

Challenges of the Engagement/Motivation Phase Conclusions: The Early Stages

5 Behavior Change Phase: Enhancing the Relationships of Adolescents and Families Through the Development of Social and Behavioral Competencies

Middle Phase Change Goals: Building Within-Family Protective Factors

Find New Ways to Act Integrate New Behaviors Into Everyday Life Reach Obtainable Yet Lasting Change Address the Bigger Problems

Integrating Assessment and Intervention in the Behavior Change Phase

What to Look For: Clinical Assessment Identifying Relevant and Specific Risk and Protective Factors Further Assessment of the Problem Sequence Assessment of Relational Functions What to Do: Intervening to Build Protective Behavioral Skills Intervention Targets: Parenting Skills

Clear Expectations and Rules Active Monitoring and Supervision Consistent Enforcing of Behavioral Contingencies

Intervention Targets: Improving Communication Intervention Targets: Problem Solving Intervention Targets: Conflict Management Intervention Strategy: Matching the Change Target to the Family Reframing, Again and Again

Outcomes of the Behavior Change Phase Challenges of the Behavior Change Phase Conclusions and Reflections on the Middle Phase

6 Supporting, Generalizing, and Maintaining Family Change

Final Phase of FFT: Generalize, Maintain, and Support Family Change Integrating Assessment and Intervention in the Generalization Phase What to Look For: Clinical Assessment

Assessing Motivation Assessing Family Relational Patterns Assessing Relevant Outside Systems

What to Do: Intervening to Create Long-Term Empowerment

Create Continuity and Build on Success Reframe to Refocus Generalizing Therapy Gains Preventing Relapse Building Family Self-Efficacy Connecting to Community Referral to Other Professional Services

Outcomes of the Generalization Phase Challenges of the Generalization Phase Conclusions: Reflections on Ending Therapy

7 Therapist as Translator: Implementing FFT in the Therapy Room

The Role of the Therapist Case Example: Nigel

Engagement and Motivation Phase Developing Organizing Themes Cultural Differences Relational Patterns Relational Functions Behavior Change Phase Generalization Phase Outcome of Nigel’s Case

Lessons Learned

See Through the FFT Lens Plan Treatment Systematically Responding Contingently Act Purposefully Move Quickly Act on the Best Guess

Challenges of Implementing FFT in the Room Conclusions and Reflections

III Translating FFT Into Community Settings

8 Translating FFT Into Community Settings

Continuous Quality Improvement: Maintaining Model Fidelity While Meeting Family Needs Principles of Effective Community Implementation

Systematic, Ongoing Training Alliance-Based Implementation Long-Term Commitment Matching the Treatment Model With Agency and Service Delivery Characteristics

Examples of Moving FFT Into Community Settings

Family Project: Integrating Research, Training, and Community-Based Practice The Washington State Story: System-Wide Implementation of FFT The Miami FFT Project Amsterdam Project: FFT in a Forensic Psychiatric Treatment Setting

Conclusions

9 FFT as a Service Delivery System

FFT Within Service Delivery Systems Central Elements of an Effective FFT Service Delivery System

Developing and Maintaining Model Adherence and Therapist Competence Knowledge and Performance Model Adherence Therapist Competence Ongoing Monitoring and Feedback Data-Based Measures Session Planning Tools Model-Specific Adherence and Therapist Competency Measures Service Delivery Profiles Client Assessment and Outcomes Measures Feedback Reports

The FFT Clinical Supervision Model

Role of the FFT Site Supervisor Core Supervision Principles Systematic Supervision Protocol Supervisor Interventions Quality Assurance Measures of Adherence and Competence Data Supervision Planning and Staffing

Example of Coordinating Care in an FFT SDS

The Delaware FFT Service Delivery System Referral Management Case Assignment Intake Session FFT Therapy Enhanced Generalization The Role of the FFT Q-System

Conclusions

References Index

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