Bright Idea: Functional Family Therapy Helps Young People and Their Kin to Cope and Change

An Asian American family.

In his work with troubled youth, Functional Family Therapy co-founder James Alexander found that his efforts that didn’t include a child’s family often weren’t successful. And work with parents that didn’t include the child met the same fate.

So Alexander developed Functional Family Therapy, or FFT, to help the individual by including the entire family. More than 40 years later, organizations around the world are using the therapy. One such group is The New York Foundling, a nonprofit that offers an array of services to address 6,000 children and families in crisis in New York and Puerto Rico.

“The two key things that stood out to us about the FFT model were the capacity to engage with families and the capacity to fundamentally change the conversation taking place in the home,” says Bill Baccaglini, president and CEO of The New York Foundling.

“FFT works relationally, meaning with the whole family, rather than just the individual child or parent,” Baccaglini says. The aim, he says, is to empower them to address the issues that present a risk and ultimately motivate family members to work together to create a healthier future.

There are some instances when FFT isn’t an appropriate option, says Pam Hawkins, senior associate at the California Institute for Mental Health.

If the youth is in immediate crisis –- suicidal or homicidal –- FFT is not appropriate, she says. But even in such cases, once the crisis is resolved FFT can be helpful to prevent future crises in the family, Hawkins says.

Phases of Change

Often, families aren’t initially excited about participating in the therapy, says Doug Kopp, CEO of FFT, LLC, which provides FFT training to organizations around the world.

“Sometimes families come in defensive or overwhelmed, not knowing what to do,” he said. “They feel like they’ve done something wrong.”

Therapists guide the family through five phases, usually in 12 sessions.

  1. Engagement phase: Therapists work with families to ensure they’ll stick around for all of the sessions and show their desire to listen, help and respect everyone involved.
  2. Motivation phase: Therapists work to minimize hopelessness and low self-efficacy, creating a positive motivational context. They work to stop negative interactions and blaming.
  3. Relational assessment: With the family, therapists use the skills of observation, questioning and analysis to move from an individual problem focus to a relational perspective. They also develop plans for behavior change and progress post-therapy in preparation for the final two phases of the therapy.
  4. Behavior change phase: The goals of this phase are skill building and changing problematic behavior and coping patterns. Therapists work with families to model and promote positive behavior and develop creative ways to change behavior.
  5. Generalization phase: This phase involves planning to prevent relapse and encourage the use of community systems.

Throughout the process, family members are encouraged to talk about their issues. Therapists work to create an open environement where everyone can talk honestly and feel heard, understood and respected, says Kopp.

Organizational Shift

Baccaglini notes that it’s not just the participating families that have to be ready for change in order for FFT to be successful.

“FFT gives caseworkers tools to work in very prescribed, methodical ways,” Baccaglini said. “But the culture of your agency must be ready to accept and support this type of shift.”

Hawkins acknowledges that a lack of flexibility can change the way a practitioner does their work, but complications can be avoided if the organization takes into account the requirements of the therapy and allows practitioners the time and resources they need.

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