Functional Family Therapy

What IS FFT?

Functional Family Therapy (FFT) is an evidence-based treatment model that helps families change their interactions to address youth and young adult behavioral or emotional issues.

It views these behaviors as ingrained within the family system rather than solely as an individual problem.

FFT views family dynamics through a relational lens, acknowledging that families develop unique interaction patterns and meanings. Rather than imposing a specific definition of a “healthy” family, FFT focuses on understanding how each family functions and tailors treatment to their unique needs and strengths.

FFT therapists work collaboratively with families to understand their unique interaction patterns and develop new, healthier ways of relating to each other.

It focuses on improving family dynamics and teaching positive coping skills through 12-14 sessions over 3-5 months. Sessions can occur in various settings, including homes, schools, and community agencies.

FFT’s strength lies in its adaptability and individualized approach, making it a suitable treatment option for various families and challenges.

The model’s emphasis on understanding each family’s unique functioning and tailoring treatment accordingly ensures that interventions are relevant, respectful, and effective.

Who can benefit from FFT?

Individuals, families, and communities can benefit from FFT. It is practiced in community and home settings, and has also been used in schools, child welfare facilities, and probation and parole setting.

FFT has been proven effective for youth aged 10-17 who exhibit a range of behavioral issues, including anti-social behavior, substance abuse, and mental health concerns.

Functional Family Therapy (FFT) can benefit a wide range of individuals and families facing challenges with youth and young adult behavioral problems. Here’s a breakdown:

• Families with Youth Engaged in the Justice System: FFT has proven effective in reducing recidivism rates and improving family functioning for justice-involved youth. This includes adolescents and young adults on probation, parole, or involved in diversion programs. FFT helps these families navigate the justice system, repair relationships strained by incarceration, and develop skills for long-term success.
• Families Involved in the Child Welfare System: FFT assists families in addressing issues leading to child welfare involvement, such as child maltreatment, neglect, or instability. FFT can help prevent out-of-home placements, support reunification efforts, and promote family stability.
• Families Impacted by Foster Care: FFT provides support and guidance to youth in foster care, their foster families, and their families of origin. FFT facilitates healthy relationships within foster homes, prepares youth and families for reunification, and promotes successful transitions to permanent placement.
• Families Seeking Behavioral Health Support: FFT effectively addresses a range of behavioral and mental health challenges in youth, including delinquency, substance use, ADHD, and internalizing symptoms. FFT helps families understand these challenges within the context of family dynamics and develop coping mechanisms and communication skills for improved well-being.

How Does FFT Work?

The foundation of FFT lies in its name: “functional.” This signifies that the model centers on understanding how each family functions – how their unique interaction patterns, meanings, and relational dynamics contribute to both the problems they face and their potential for change.

Instead of imposing a pre-defined notion of a “healthy” family, FFT therapists approach each family as a distinct system with its own strengths and challenges.

This perspective allows FFT to be highly effective across diverse communities and with a wide array of presenting problems.

FFT operates on three core principles that work together to guide therapists in their work with families:

1. The Lens: Systemic & Relational Thinking: FFT therapists view families through a systemic lens, recognizing that individual behaviors are interconnected and influenced by the broader family system. This lens emphasizes understanding the family’s unique patterns, meanings, and relational functions within their cultural and community contexts.
2. Treatment Phases: The FFT Clinical Model: FFT therapists utilize a strengths-based, non-blaming approach that focuses on building positive relationships within the family. The therapy process typically involves:
   • Engagement & Motivation: This initial phase focuses on building a strong therapeutic alliance with the family, fostering open communication, and understanding the problem from each member’s perspective. The therapist works to shift negative interaction patterns by reframing problems and highlighting the strengths and positive intentions within the family.
   • Behavior Change: Building on the foundation of a strong alliance and shared understanding, the therapist and family work together to develop and practice new behavioral skills to interrupt and change problematic interaction patterns.
   • Generalization: This phase focuses on helping families apply the skills learned in therapy to their daily lives and maintain positive changes over time. This may involve addressing potential barriers to generalization, developing relapse prevention strategies, and connecting families with ongoing support within their communities.
3. The Art: Matching to the Family and Context: While the clinical model provides structure, FFT also recognizes the crucial role of the therapist’s creativity and flexibility in tailoring interventions to match each family’s unique needs, strengths, and cultural background. This requires therapists to be highly attuned to the family’s responses, adjust their approach accordingly, and embrace the dynamic nature of the therapeutic process.

Treatment Phases

FFT ensures a systematic approach to addressing family challenges while allowing for flexibility and individualization in tailoring interventions to each family’s unique dynamics.

While the three-phase model provides a structured framework, successful FFT relies heavily on the therapist’s skill, creativity, and ability to tailor interventions to each family’s unique dynamics and cultural context.

This involves being present, attuned, and responsive to the family’s needs throughout the therapeutic process.

FFT stresses the importance of “matching” interventions to the specific relational patterns and functions present in each family. This means that what works for one family might not be effective for another, even if they present with similar problems.

For instance, a family characterized by high interdependence might benefit from interventions that emphasize emotional expression and direct communication, while a more independent family might thrive with strategies focused on clear boundaries and structured problem-solving.

Each of these phases involves both assessment and intervention components.

1. Engagement & Motivation (EM): Building a Foundation of Trust and Collaboration

Engagement involves ‘maximising factors which enhance the perception that positive change might occur (intervention credibility), and minimising factors (e.g., poor program image, difficult location, insensitive referral) that might signify insensitivity and/or inappropriate resources’ (Alexander, 1998; p. 15)

The EM phase focuses on establishing a strong therapeutic alliance and shifting negative interaction patterns within the family. It’s about creating a safe space where family members feel heard, understood, and empowered to engage in the change process.

Key Goals:

• Build a strong therapeutic alliance: The therapist works to establish trust and rapport with each family member, acknowledging their perspectives and experiences. This involves active outreach and demonstrating a genuine understanding of the family’s struggles.
• Reduce negativity and blame: Therapists help family members reframe problematic behaviors, shifting from blame and criticism to a focus on understanding underlying intentions and needs. This involves reframing negative interactions to highlight positive intentions.
• Develop a shared family focus: The therapist facilitates communication that helps family members see the problem as a shared challenge rather than attributing fault to individuals. This encourages a sense of collective responsibility for creating positive change.
• Enhance motivation for change: By fostering hope and a belief in their collective ability to change, therapists empower families to actively participate in the process.

Assessment in EM:

FFT therapists are trained to observe family interactions closely, looking for recurring patterns in how members communicate, handle conflict, and relate to one another. For example, a therapist might notice that a parent's attempts to assert control consistently trigger a defiant response from their adolescent, creating a cyclical pattern of conflict escalation

During this phase, therapists observe family interactions, focusing on identifying:

• Problem definitions: Understanding how each family member perceives and defines the problem involves recognizing that each member may have a different perspective on the issue and attributing blame to different individuals within the family.
• Core relational patterns: Recognizing recurring interactional sequences that maintain the problem requires identifying the typical ways in which family systems respond to events and how these repetitive patterns, whether positive or negative, contribute to family stability.
• Relational functions: Identifying the purpose or function that problematic behaviors serve within the family system means understanding that even seemingly maladaptive behaviors can represent individuals attempting to meet their relational needs based on their unique learning histories, capacities, and environments. For instance, a teenager’s seemingly rebellious behavior might be understood as a way of seeking autonomy and differentiation within the family system. 
• Risk and protective factors: Assessing potential challenges and strengths within the family and its social context involves examining elements within the family and its surrounding environment that might heighten the probability of problematic behavior, as well as factors that provide support and resilience.

Interventions in EM: relational reframing

Intervention is directed at accomplishing the goals of the relevant treatment phase. These interventions are used in a dynamic and responsive way, tailored to each family's unique needs and interactional patterns.

Relational reframing is the primary intervention strategy in the EM phase of FFT. It is a therapeutic process of creating alternative perspectives to redefine the meanings families attribute to events

Use reframing techniques to shift the focus from negativity to positivity in family communications.

Functional Family Therapy (FFT) practitioners use reframing as a core technique to shift family communication from negativity to positivity.

This process involves a collaborative and nuanced approach that moves beyond simply labeling behaviors as “good” or “bad” and instead seeks to understand the underlying needs and intentions driving those behaviors.

Reframing in FFT begins by acknowledging and validating the family members’ experiences, particularly the negative emotions and perspectives they bring to therapy. This doesn’t mean the therapist agrees with their interpretations but rather demonstrates that they hear and respect the family’s perspective.

For example, if a parent expresses frustration and anger about their teenager’s substance use, the therapist might say, “It sounds incredibly difficult to witness your child going through this and to feel like you’re losing them.”

By validating the family’s negative emotions, the therapist creates a safe space for them to be open and honest about their struggles. This is crucial because, as families often enter therapy feeling blamed, misunderstood, and hopeless.

Once the negative emotions are acknowledged, the therapist can begin to reframe the meaning of behaviors by exploring the underlying intent or motivation. This shifts the focus from judging actions as inherently “bad” to understanding them as often misguided attempts to meet needs or preserve the family system.

FFT emphasizes reframing negative behaviors by attributing a “noble intention” to the actor. For instance, a teenager’s defiance might be reframed as a way of trying to assert their independence and establish their identity, while a parent’s overprotective behavior might be reframed as an expression of their deep love and fear of losing their child.

Reframing often involves helping family members shift from external attributions (blaming others) to internal attributions (taking responsibility for their own feelings and needs). For example, instead of saying, “You make me angry when you do that,” the therapist might help a family member reframe this to, “I feel hurt and disrespected when you don’t listen to me.”

Reframing is not a one-way process in which the therapist imposes their interpretations on the family. Instead, it’s a collaborative effort where the therapist offers tentative reframes and actively seeks feedback from the family to see what resonates.

FFT therapists use phrases like “Does that fit for you?” or “What’s your experience of that?” to invite the family to reflect on the reframe and offer their own perspectives. This collaborative approach ensures that the reframes are meaningful and relevant to the family’s unique experiences and cultural context.

Based on the family’s feedback, the therapist continuously adjusts and refines the reframes until they resonate with the family’s experiences. This might involve changing the wording, emphasizing different aspects of the reframe, or incorporating new information that emerges during the conversation.

Develop reframing themes that describe problematic behaviours and provide alternative explanations of the problematic behaviours.

In addition to understanding relational dynamics, FFT therapists work collaboratively with families to develop an “organizing theme.” This theme is a shared narrative that helps to reframe the family’s struggles in a more hopeful and empowering light.

The organizing theme is not something imposed by the therapist but rather emerges organically from the therapeutic conversations. It reflects the family’s unique strengths, values, and cultural context.

This sense of being heard and understood can be especially powerful for adolescents who might feel misunderstood or blamed within their families.

The organizing theme helps families move away from blaming and toward a more nuanced understanding of how their problems have developed and how they might work together to create change.

For example, instead of viewing their teenager’s substance use solely as a personal failing, a family might come to see it as a symptom of their struggles to cope with a recent loss, fostering empathy and a sense of shared responsibility.

The organizing theme acts as a touchstone throughout the therapy process, helping the therapist and family stay focused on their goals and make sense of challenges. When new problems arise, the therapist can refer back to the organizing theme to reframe the situation and guide the development of new interventions.

When developing reframing themes, the therapist can work with the family to explore how past experiences might be contributing to current challenges. This might involve gathering information about the youth’s early childhood, any significant life transitions the family has faced, or any social or economic hardships they have endured.

For example:

• Theme of protection: If a family has experienced a significant loss or trauma, a central theme might revolve around the idea of protection. The therapist could reframe behaviors like anger, control, or withdrawal as ways family members have tried to protect themselves or one another from further hurt.
• Theme of resilience: For families who have faced significant adversity, a theme of resilience might be particularly empowering. The therapist could help the family identify and reframe past experiences where they demonstrated strength, resourcefulness, and the ability to overcome challenges. This can instill hope and confidence in their ability to create positive change in the present.

While engaging in the above interventions, the therapist simultaneously observes the family’s interactions to identify specific risk and protective factors. This assessment informs the interventions and goals of the subsequent Behavior Change phase.

Considerations for EM Interventions

• Active and directive therapist role: FFT therapists are not passive observers in the EM phase. Instead, they actively guide the conversation, redirect negativity, and create opportunities for reframing and positive interaction.
• Importance of timing and pacing: While FFT is a short-term model, rushing the EM phase can undermine its effectiveness. Therapists must balance the need to move the therapy forward with allowing sufficient time for families to build trust, reduce negativity, and develop a shared motivation for change.
• Integrating case management: Addressing practical needs (e.g., housing, school issues, access to resources) can be crucial for engaging and motivating families, especially in the EM phase. This might involve connecting families with community resources, coordinating with other service providers, and advocating for families within their systems.

By skillfully implementing these EM interventions, FFT therapists lay a strong foundation for the behavior change and generalization phases, setting the stage for lasting and meaningful change within families.

2. Behavior Change (BC): Developing New Skills and Interrupting Problematic Patterns

The behaviour change phase is aimed at developing ‘long term behaviour change patterns that are culturally appropriate, context sensitive, and individualised to the unique characteristics of each family member’ (Alexander, 1998, p. 15).

Building on the foundation established in the EM phase, the BC phase focuses on equipping families with the skills and strategies needed to change their interactions and address the presenting problems.

Key Goals:

• Identify and address specific behavioral patterns: Therapists and families collaboratively target behaviors that contribute to the problem, working together to develop alternative, more adaptive ways of interacting.
• Teach and practice new skills: This may include communication skills training (e.g., active listening, expressing needs assertively), problem-solving skills, conflict resolution, and parenting skills.
• Tailor interventions to fit the family: Therapists recognize that effective behavior change requires interventions that align with the family’s unique culture, values, and strengths.
• Promote a sense of mastery and empowerment: As families experience success in changing their interactions, they gain confidence in their ability to address challenges collaboratively.

Assessment in BC:

Family assessment focuses on the characteristics of the individual family members, family relational dynamics, and the multi-systemic context in which the family operates.

• Risk and protective factors: Therapists continue to assess these factors, with a focus on identifying specific behaviors that contribute to risk and protective factors that can be strengthened, recognizing that a single risk factor is not usually enough to cause problems, but instead problems arise over time due to the interplay of multiple risk and protective factors
• Skill deficits and strengths: Evaluating the family’s existing skills and identifying areas where new skills training would be most beneficial involves assessing for skills that might help family members interrupt problematic relational patterns and replace them with prosocial behaviors that match their unique relational functions.

Key Intervention Strategies:

Intervention is directed at accomplishing the goals of the relevant treatment phase. These interventions are used in a dynamic and responsive way, tailored to each family's unique needs and interactional patterns.

1. Tailoring Skills to family functioning.

FFT recognizes that “one size fits all” approaches are rarely effective in family therapy. Families are unique and dynamic systems, so interventions must be individualized to address specific needs and relational patterns rather than using a generic approach.

FFT therapists pay close attention to family interactions during coaching sessions, noting patterns and triggers, to provide real-time feedback and guide the family toward more adaptive ways of interacting.

This might involve redirecting negative interactions, prompting families to use newly learned skills, and highlighting successes, however small.

As in the EM phase, addressing practical needs and barriers can be crucial for supporting behavior change. The therapist might:

• Connect families with community resources (e.g., tutoring, job training, mental health services) to address underlying needs that might impede progress.
• Advocate for families within their systems (e.g., schools, child welfare, juvenile justice) to remove barriers and create a more supportive environment.

2. Identifying and teaching new skills.

Based on the assessment conducted in the EM phase, the therapist identifies specific skill deficits that contribute to the family’s struggles.

Teaching these skills is not merely about providing information. FFT therapists actively coach and guide families as they practice these skills in session, using real-life examples and role-playing to promote mastery.

These skills might include:

• Communication Skills: Active listening, expressing needs and feelings clearly, using “I” statements, avoiding blaming language.
• Problem-Solving Skills: Identifying problems, brainstorming solutions, evaluating options, creating a plan, and evaluating outcomes.
• Conflict Resolution Skills: Negotiating effectively, compromising, managing anger and frustration, using conflict as an opportunity for growth.
• Create Rules, Routines, Rewards & Rituals: Parents should work with their children to create clearly defined rules, routines, rewards and rituals for their family. Next, they should invite their children to a family meeting to discuss rules. Parents can share their list and explain how these values and behaviors help to create order and strong family relationships
• Parenting Skills: Setting clear limits and expectations, using positive reinforcement, implementing effective consequences, promoting age-appropriate autonomy.

3. Reframing for behavior change.

While reframing in the EM phase centers on changing the family’s perception of the problem (redefining its meaning), during the BC phase, reframing is used to encourage the use of new skills and behaviors. The therapist might reframe challenges as opportunities to practice these new skills.

The BC phase is often conceptualized as a “bridge into an action stage.” For example, instead of simply discussing the importance of communication, the therapist might reframe a conflict situation as a chance for the family to practice their new communication skills in that moment. This helps the family move from understanding the concept of the skill to actively using it.

In the BC phase, therapists often use reframing to link the new skills and behaviors back to this organizing theme (e.g., “working together”), ensuring that the family’s progress remains aligned with their initial goals.

Key principles guiding behavior change interventions:

• Collaboration and respect: The therapist works in partnership with the family, honoring their expertise and perspectives.
• Strengths-based approach: The therapist emphasizes the family’s existing strengths and resources, building on their successes to foster motivation and self-efficacy.
• Flexibility and responsiveness: The therapist remains adaptable, adjusting interventions as needed based on the family’s progress, challenges, and feedback.

Transitioning to Generalization:

As families begin to demonstrate mastery of new skills and show signs of positive change, the therapist initiates a gradual transition to the Generalization phase.

The therapist must ensure that families are equipped to maintain their progress, manage future challenges, and access support when needed.

3. Generalization: Maintaining Change and Building Long-Term Success

The final phase focuses on ensuring that the changes achieved in therapy extend beyond the therapy room (e.g., with schools, probation officers) and are maintained over time.

By successfully navigating the Generalization phase, FFT aims to equip families not just to resolve their presenting problems but to develop the skills, resilience, and support networks to thrive long after therapy ends.

Key Goals:

• Generalize skills to different contexts: Therapists help families apply the skills learned in therapy to a wider range of situations and settings, including home, school, and interactions with extended family and peers.
• Develop relapse prevention strategies: Recognizing that setbacks are a normal part of change, therapists work with families to anticipate challenges, develop coping mechanisms, and create plans for navigating potential relapses.
• Connect families with community resources: To support long-term success, therapists help families identify and access relevant community resources, such as support groups, after-school programs, or mental health services.
• Promote self-sufficiency and empowerment: The ultimate goal is for families to internalize the skills and perspectives gained in therapy, empowering them to address future challenges independently and confidently.

Assessment in Generalization:

Family assessment focuses on the characteristics of the individual family members, family relational dynamics, and the multi-systemic context in which the family operates.

• Barriers to generalization: Identifying potential obstacles that might hinder the family’s ability to maintain change outside therapy, such as a lack of support, a challenging community environment, the emergence of new stressors (like school transitions or mental health issues).
• Community resources: To support long-term change, FFT therapists help families identify and utilize community resources that can provide ongoing assistance, such as extended family members, supportive friends, school programs, community organizations, or additional professional services if needed

Interventions in Generalization:

Intervention is directed at accomplishing the goals of the relevant treatment phase. These interventions are used in a dynamic and responsive way, tailored to each family's unique needs and interactional patterns.

The Generalization phase of FFT focuses on equipping families to maintain the positive changes achieved in the Behavior Change (BC) phase, extending these changes to new situations, and developing strategies to manage future challenges.

This phase is not simply about ending therapy but represents a distinct stage of treatment with specific goals and interventions.

1. Reframing to maintain engagement:

As families approach the end of therapy, they may feel like they’ve accomplished their goals and may be less motivated to continue engaging in the process.

Therapists can use reframing to re-emphasize the importance of the generalization phase, reminding families that maintaining change requires ongoing effort and support.

The generalization phase prepares families for the reality that challenges and setbacks are normal, even after therapy.

Therapists can use reframing to help families view these challenges not as failures, but as opportunities for growth and learning.

Instead of becoming discouraged, families can learn to apply their newly acquired skills to navigate these obstacles.

For example, a therapist might reframe a conflict that arises as a chance for the family to practice their communication and problem-solving skills in a new situation, building their confidence in their ability to manage challenges independently.

Just as in the BC phase, reframing in the generalization phase should connect back to the overarching organizing theme established in the EM phase.

This theme provides a framework for understanding the family’s progress and helps them make sense of new challenges within the context of their therapeutic goals.

For example, if the organizing theme is “respectful communication,” the therapist might reframe an argument as an opportunity for the family to practice “respectful communication” when faced with a new disagreement.

Generalizing therapy gains: The therapist helps the family apply the skills learned in the BC phase to new situations and challenges:

Helping families recognize how seemingly new problems share underlying dynamics with previously addressed issues, allowing them to use their existing skills effectively.

Supporting families in using their communication, problem-solving, and conflict resolution skills not just within the family system but also in interactions with schools, peers, extended family, and community systems.

2. Relapse prevention planning.

A central focus of the Generalization phase is equipping families to manage the inevitable challenges and setbacks they will encounter:

• Anticipating challenges: Collaboratively identifying potential triggers, stressors, and high-risk situations that might lead to a resurgence of old patterns.
• Developing coping strategies: Creating concrete plans for managing these challenges, drawing on the skills and strengths developed throughout therapy.
• Reframing setbacks: Emphasizing that setbacks are a normal part of the change process and do not equate to failure. The therapist helps families view setbacks as opportunities to learn, adjust their strategies, and reinforce their commitment to change.

3. Building support networks.

Recognizing that families do not exist in isolation, the Generalization phase emphasizes connecting families with sources of ongoing support:

• Strengthening family and social connections: Helping families identify and mobilize supportive relationships within their extended family, friends, and community.
• Connecting with community resources: Linking families with relevant resources such as support groups, after-school programs, mental health services, or other community-based programs that can provide ongoing support and assistance.

4. Preparing for the end of therapy.

The therapist works with the family to process the ending of the therapeutic relationship and prepare for a future without regular sessions:

• Reviewing progress and celebrating successes: Highlighting the family’s accomplishments, reinforcing their strengths, and instilling a sense of hope for the future.
• Addressing concerns about ending therapy: Providing a safe space for families to express any anxieties or uncertainties they might have about ending therapy.
• Creating a plan for continued growth: Collaboratively developing a plan for continued growth and change, encouraging families to view therapy as a starting point for ongoing self-reflection and improvement. This might involve setting goals, identifying strategies for maintaining progress, and discussing when it might be helpful to seek additional support.

Considerations for the Generalization Phase:

• Timing and pacing: As with the transition from EM to BC, the shift to Generalization requires careful timing and pacing. It’s crucial to avoid ending therapy prematurely before families have solidified their gains and developed the confidence to manage challenges independently.
• Maintaining a collaborative stance: The therapist’s role in the Generalization phase is less about directing change and more about empowering families to take ownership of their progress. This requires a collaborative stance, honoring the family’s expertise, and fostering their self-efficacy.
• Tailoring interventions to the family’s unique needs: As in all phases of FFT, Generalization interventions should be individualized based on the family’s specific challenges, strengths, and cultural context.

Principles that inform the therapeutic approach

1. Understanding how families define “Problems”

The relational model of family functioning emphasizes that families don’t simply encounter problems -they actively construct their understanding of these problems. This model suggests that families often develop a shared definition of a “problem” that has several key components:

Attributing the problem to one member.

It’s common for families to single out one person as the source of the problem. This often manifests as blaming, with family members focusing on what the identified individual is doing “wrong” or how they are failing to meet expectations.

This tendency to blame is particularly prominent in families struggling with adolescent behavioral issues, where parents might see the adolescent as the primary problem, and the adolescent, in turn, might blame their parents.

For example, a family might define their problem as “Our son is constantly getting in trouble at school.” This definition places the problem squarely on the son’s shoulders, potentially overlooking other contributing factors within the family system or broader context.

Negative emotional component.

Family problem definitions are rarely emotionally neutral. They are often saturated with negative emotions such as anger, frustration, resentment, disappointment, or fear.

Returning to the example of the son’s school troubles, the family’s definition might be accompanied by intense emotions: the parents feeling angry and ashamed, the son feeling frustrated and misunderstood.

These emotions, if left unaddressed, can fuel conflict, hinder communication, and make it even harder to find solutions.

Blaming interactions as central to family patterns.

When families define problems in a way that assigns blame to one member, this blame can become deeply ingrained in their interactions.

These repetitive, negative interactional patterns as “family relational patterns.” These patterns are often stable and enduring, even if they are unhelpful or distressing.

Continuing with the example, the family’s interactions might revolve around a pattern of the parents criticizing the son’s behavior, the son withdrawing or responding defensively, and the cycle repeating itself.

This pattern, fueled by the initial blame, can become self-perpetuating, making it increasingly difficult for the family to communicate effectively or address the underlying issues contributing to the son’s school problems.

The importance of understanding family problem definitions in FFT

Recognizing and understanding how a family defines its “problem” is crucial for effective family therapy, particularly within the FFT model. Here’s why:

• Target for intervention: The family’s problem definition, with its inherent blame and negativity, becomes a primary target for intervention in FFT. By helping families shift to a more balanced, relationally-focused understanding of their struggles, FFT therapists aim to disrupt these negative patterns and create space for more constructive interactions.
• Reveals underlying dynamics: The way a family defines its problem can reveal important information about its communication patterns, power dynamics, and relational functions. By understanding these dynamics, therapists can tailor their interventions to better meet the family’s unique needs.
• Basis for reframing: As highlighted in our conversation history, reframing is a central intervention in FFT. By understanding the family’s problem definition, therapists can strategically use reframing to offer alternative perspectives, shift blame to a more systemic understanding, and promote a more hopeful and collaborative approach to problem-solving.

It’s important to note that the relational model of family functioning does not aim to excuse harmful behavior or suggest that individual responsibility is irrelevant.

Instead, it provides a framework for understanding how families get “stuck” in negative patterns and offers a pathway for shifting these patterns to promote healing, growth, and more adaptive functioning.

2. FFT is designed to empower, not to rescue or control families

Functional Family Therapy (FFT) is a model designed to empower families to address their challenges and achieve lasting change.

This emphasis on empowerment stands in contrast to approaches that might seek to “rescue” families by providing external solutions or to “control” families by imposing a predetermined set of rules or expectations.

In essence, FFT aims to walk alongside families, providing guidance, support, and practical tools to help them navigate their challenges and create a more positive and functional family system.

By fostering collaboration, building skills, and respecting family autonomy, FFT empowers families to become the architects of their own change.

Respect for family autonomy.

FFT recognizes that families are the experts on their own lives and that lasting change must be congruent with their values and goals. Therefore, FFT therapists:

• Avoid imposing values: FFT therapists strive to avoid imposing their own values or beliefs on families. Instead, they adopt a stance of curiosity and respect, seeking to understand and work within the family’s existing belief system.
• Empowering families to choose: FFT empowers families to make their own choices, even if those choices differ from what the therapist might recommend. The goal is not to force families into a pre-determined mold but to equip them with the skills and support they need to create the changes they desire.

Families as active participants.

FFT views families not as passive recipients of help but as active participants in the therapeutic process.

FFT therapists strive to create a collaborative and alliance-based therapeutic environment where families feel heard, respected, and empowered to make choices that align with their values and goals. This collaborative stance is evident in:

• Jointly defining problems: Rather than imposing an external definition of the problem, FFT therapists work with families to understand their unique perspectives and collaboratively construct a shared understanding of the challenges they face.
• Tailoring interventions: FFT emphasizes the importance of individualizing interventions to match each family’s specific needs, strengths, and cultural context. This approach ensures that the solutions developed in therapy are relevant, meaningful, and sustainable for the family.
• Promoting family agency: Throughout all phases of FFT, therapists actively work to foster the family’s sense of agency—their belief in their ability to create positive change.

3. FFT is based on respect for the diversity of family life and does not seek to impose a single model of family functioning

Functional Family Therapy (FFT) is grounded in a deep respect for the diversity of family life.

Unlike some therapeutic approaches that might promote a singular, idealized model of family functioning, FFT recognizes that what constitutes a “healthy” or “functional” family varies widely across cultures, communities, and individual family systems.

By embracing family diversity, prioritizing collaboration, and focusing on functionally-driven change, FFT offers a respectful and empowering approach to family therapy that honors the unique strengths and challenges of each family system.

FFT’s commitment to respecting family diversity.

Unlike other family therapy models that operate from the assumption that there’s a single “right” way for families to function, FFT views families as unique systems with their own strengths, challenges, and ways of interacting.

FFT does not seek to mold families into a predetermined template of “health.” Instead, FFT defines a “healthy” family as one that effectively meets the needs of its members within its specific cultural and contextual environment.

This approach recognizes that:

• Families have different strengths: What one family considers a strength (e.g., a high degree of emotional expressiveness), another family might view as less desirable. FFT therapists strive to identify and amplify each family’s unique strengths, using them as a foundation for change.
• Cultural norms shape family functioning: The powerful influence of culture on family dynamics. Factors such as ethnicity, religion, socioeconomic status, and community values shape how families define roles, communicate, and approach problem-solving. FFT therapists are trained to be culturally humble and to avoid imposing their own cultural biases on families.
• Family structures are diverse: The wide range of contemporary family structures moves beyond the traditional nuclear family model. FFT recognizes that single-parent families, blended families, multigenerational families, same-sex couples, and families with chosen kin all have the potential to be healthy and functional.

Focus on “functional” outcomes, not specific behaviors.

FFT emphasizes the importance of identifying and changing problematic behavioral patterns rather than focusing on changing the inherent personalities or relational functions of individual family members.

This means that FFT therapists:

• Work within the family’s existing relational system: Instead of trying to fundamentally alter the family’s preferred level of closeness or distance (as defined by FFT concepts of “relational hierarchy” and “relatedness”), FFT therapists strive to help families find more adaptive ways to manage their relational dynamics.
• Prioritize “Obtainable” Change: FFT recognizes that lasting change must be attainable and sustainable within the family’s unique circumstances. Imposing unrealistic expectations or overly ambitious goals can lead to frustration and therapeutic failure.

Emphasize collaboration and respect.

FFT therapists view themselves not as experts dictating solutions but as collaborators working alongside families to find solutions that fit their values and goals. This collaborative approach is evident in:

• Respectful communication: FFT therapists strive to create a therapeutic environment characterized by respect, empathy, and non-judgmental curiosity. They recognize that families often come to therapy feeling blamed, misunderstood, and disempowered, and they work actively to counter these dynamics.
• Jointly defining goals: FFT therapists work collaboratively with families to define therapeutic goals that are meaningful and relevant to their specific needs and aspirations. This ensures that the work of therapy aligns with what the family, not just the therapist, hopes to achieve.

4. FFT aims to develop family members’ inner strengths and sense of optimism

A core aim of Functional Family Therapy (FFT) is to cultivate family members’ inner strengths and a sense of optimism as a foundation for lasting change.

This emphasis on strengths and hope is woven throughout the FFT model, shaping both the therapist’s stance and the specific interventions employed.

By emphasizing strengths, fostering hope, equipping families with practical skills, and promoting positive relationships, FFT aims to cultivate a sense of empowerment and optimism that extends far beyond the therapy room, setting the stage for families to create a brighter future.

Here’s how FFT aims to develop family members’ inner strengths and optimism:

Shifting the focus from deficits to strengths: Unlike some therapeutic approaches that might primarily focus on identifying and correcting problems, FFT emphasizes the importance of recognizing and amplifying the existing strengths and resources within each family system.

This strengths-based lens helps to:

• Counter negativity and blame: Families often enter therapy feeling demoralized, stuck, and blaming of one another. By highlighting positive qualities and past successes, FFT therapists help to shift the family’s attention away from negativity and toward a more hopeful and empowered perspective.
• Build on existing resources: Every family, regardless of its challenges, possesses inherent strengths and resources. These might include strong family bonds, effective communication skills, cultural traditions, religious faith, community connections, or individual talents and resiliencies. FFT therapists work to identify and leverage these strengths, using them as building blocks for change.
• Create a more positive therapeutic alliance: When families feel genuinely seen and appreciated for their strengths, they are more likely to trust the therapist and to engage more fully in the therapeutic process. This positive alliance, in turn, creates a more fertile ground for growth and change.

• Promoting a belief in the possibility of change: Many families struggling with behavioral or relational challenges come to therapy feeling hopeless and resigned. FFT actively works to counter this sense of pessimism by:
  • Reframing challenges as opportunities for growth: FFT therapists help families to view their struggles not as insurmountable obstacles but as opportunities to learn new skills, strengthen relationships, and create a more positive future.
  • Highlighting even small successes: FFT therapists are trained to notice and celebrate even small signs of progress, recognizing that these small wins can fuel a family’s belief in their ability to make lasting change.
  • Instilling a sense of agency: Throughout all phases of FFT, therapists work to empower families to see themselves as active agents of change rather than passive recipients of help. This sense of agency, the belief that they have the power to shape their own lives, is essential for fostering optimism and sustaining motivation.
• Equipping families with practical skills and strategies: FFT recognizes that hope alone is not enough to create lasting change. Families also need to be equipped with the tangible skills and strategies necessary to navigate challenges, resolve conflicts, and create a more positive family environment. FFT achieves this through:
  • Skills training: The Behavior Change (BC) phase of FFT explicitly focuses on teaching families practical skills in communication, problem-solving, conflict resolution, emotion regulation, and relapse prevention.
  • Guided practice: FFT therapists don’t just teach skills in the abstract; they provide families with opportunities to practice these skills within the therapy session, offering support and feedback along the way.
  • Generalization: FFT emphasizes the importance of helping families generalize the skills learned in therapy to their everyday lives. This ensures that families are empowered to continue making positive changes long after therapy has ended.
• Fostering positive relationships and connections: Strong, supportive relationships are essential for well-being and resilience. FFT recognizes that families are embedded within a larger web of relationships and seeks to strengthen family bonds and connect families with community resources. These connections can support families, reduce isolation, and create a sense of belonging and hope.

5. FFT seeks to promote viable change in family function that is adaptive and productive, given the resources and value of the system in which it operates

Functional Family Therapy (FFT) strives to promote viable change in family function – change that is adaptive to each family’s unique circumstances and productive in helping them meet their goals.

FFT recognizes that families exist within complex social ecosystems and that effective change must be tailored to the resources and values of the system in which they operate.

By tailoring interventions to the resources and values of each family’s unique system, FFT strives to create meaningful change that is not only adaptive to their circumstances but also productive in helping them achieve their goals.

This focus on functionality, sustainability, and collaborative change distinguishes FFT as an approach that recognizes the complexities of family life and empowers families to create a more positive future.

1. Focus on Functionality Within the Family’s Context: FFT prioritizes helping families develop ways of interacting that are functional within their particular social environment, rather than imposing a universal standard of “health.” This means that:
   • Change is Relative: What constitutes “positive” change for one family might look very different from what’s considered “positive” for another. A family’s cultural background, socioeconomic status, community context, and access to resources all shape the potential for and parameters of change.
   • Contextual Factors Matter: FFT therapists are trained to consider the broader social ecosystem in which families are embedded, recognizing that factors such as poverty, discrimination, access to education, and community violence can all impact family functioning. Interventions are often tailored to address these contextual challenges, helping families navigate systemic barriers and advocate for their needs.
   • FFT Adapts to the Service Setting: FFT has been successfully implemented across a variety of service delivery contexts, including juvenile justice, child welfare, foster care, mental health, and schools. This adaptability speaks to the model’s flexibility in tailoring interventions to the unique demands of different systems. For example, FFT in a foster care setting might involve working with multiple families (biological and foster) to support reunification, while FFT in a mental health context might include psychoeducation about medication and crisis management.
2. Building Upon Existing Strengths and Resources: FFT emphasizes the importance of identifying and amplifying a family’s existing strengths, rather than focusing solely on their problems. This strengths-based approach recognizes that:
   • Families Have Inherent Resilience: Even families facing significant challenges possess internal strengths and resources that can be harnessed for change. These might include strong family bonds, effective communication patterns, cultural traditions, religious faith, or individual talents and coping mechanisms.
   • Strengths as a Foundation for Growth: By identifying and building upon existing strengths, FFT therapists help families develop a sense of agency and hope, which are essential for sustaining motivation and navigating the inevitable setbacks in the change process.
3. Promoting Sustainable, Long-Term Change: A hallmark of FFT is its emphasis on promoting lasting change that endures beyond the therapy room. FT achieves this through:
   • Teaching Practical Skills: The Behavior Change (BC) phase of FFT focuses on equipping families with specific skills in communication, problem-solving, conflict resolution, emotion regulation, and relapse prevention. By providing families with these tools, FFT aims to empower them to manage future challenges independently.
   • Generalizing Skills to Real-Life Contexts: FFT therapists work with families to ensure that the skills learned in therapy are applied to their everyday lives. This might involve role-playing challenging situations, developing action plans for managing conflict, or identifying supportive resources within the community.
   • Anticipating and Planning for Relapse: FFT acknowledges that setbacks are a normal part of the change process. The Generalization phase of FFT includes explicit strategies for helping families anticipate and manage potential triggers for relapse, promoting long-term stability.
4. Collaborating with Families as Partners in Change: FFT views therapists not as experts dictating solutions, but as collaborators working alongside families to identify goals and develop strategies for change. This emphasis on collaboration is evident in:
   • Shared Decision-Making: FFT therapists prioritize involving families in the treatment planning process, ensuring that goals are aligned with their values and priorities.
   • Ongoing Feedback and Adjustment: FFT utilizes real-time feedback from families to guide clinical decisions and adjust interventions as needed. This collaborative approach acknowledges that families are the experts on their own lives and that their input is essential for ensuring that therapy is relevant and effective.

Reading List

• Alexander, J., & Parsons, B. V. (1982). Functional family therapy. Brooks/Cole publishing company.
• Alexander, J., Pugh, C., Parsons, B., & Sexton, T. (1998). Blueprints for Violence Prevention: Functional Family Therapy. Vol. Book 3. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado.
• Alexander, J. F., & Robbins, M. (2019). Functional family therapy. Encyclopedia of couple and family therapy, 1232-1240.
• Barton, C., Alexander, J. F., Waldron, H., Turner, C. W., & Warburton, J. (1985). Generalizing treatment effects of functional family therapy: Three replications. The American Journal of Family Therapy, 13(3), 16-26.
• Collyer, H., Eisler, I., & Woolgar, M. (2021). Parent and youth perspectives and retention in functional family therapy. Family process, 60(2), 316-330.
• Hartnett, D., Carr, A., Hamilton, E., & O’Reilly, G. (2017). The effectiveness of functional family therapy for adolescent behavioral and substance misuse problems: A meta‐analysis. Family Process, 56(3), 607-619.
• Littell, J. H., Pigott, T. D., Nilsen, K. H., Roberts, J., & Labrum, T. K. (2023). Functional Family Therapy for families of youth (age 11–18) with behaviour problems: A systematic review and meta‐analysis. Campbell systematic reviews, 19(3), e1324.
• Olseth, A. R., Hagen, K. A., Keles, S., & Bjørnebekk, G. (2024). Functional family therapy for adolescent disruptive behavior in Norway: Results from a randomized controlled trial. Journal of family psychology.
• 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.
• Sexton, T. L., & Alexander, J. F. (2004). Functional Family Therapy clinical training manual. FFT, LLC.
• Sexton, T. L., & Alexander, J. F. (2004). Functional family therapy: A mature clinical model for working with at-risk adolescents and their families. In Handbook of family therapy (pp. 323-348). Routledge.
• Sexton, T. L. (2019). Functional family therapy: An evidence‐based, family‐ focused, and systemic approach for working with adolescents and their families, APA handbook of contemporary family psychology: Family therapy and training (pp. 171–188). Vol. 3 American Psychological Association In:.