Functional Family Therapy in Clinical Practice: An Evidence-Based Treatment Model for Working With Troubled Adolescents

387 Pages·2010·2.64 MB·English

by  Thomas L. Sexton

Functional Family Therapy in Clinical
Practice
Functional Family Therapy in Clinical
Practice
An Evidence-Based Treatment Model for Working With
Troubled Adolescents
Thomas L. Sexton
New York London
Routledge
Taylor & Francis Group
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Library of Congress Cataloging-in-Publication Data
Sexton, Thomas L., 1953-
Functional family therapy in clinical practice : an evidence-based treatment
model for working with troubled adolescents / by Thomas Sexton.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-415-99691-4 (hardback : alk. paper) -- ISBN 978-0-415-99692-1
(pbk. : alk. paper)
1. Functional Family Therapy (Program) 2. Behavior therapy for
teenagers--United States. 3. Family psychotherapy--United States. I. Title.
RJ505.B4S49 2010
618.92’89142--dc22 2010007097
Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com
and the Routledge Web site at http://www.routledgementalhealth.com
Dedication
To the families that seek help from FFT and the community organizations that
implement FFT. I am humbled by the strength, resilience, and tenacity with
which you face sometimes overwhelming odds. Each day I learn from you how
FFT works in the real world.
To my colleagues (N.O., J.B.), who joined me on the journey that made this
contribution to the FFT model possible.
To J.F.A. for the mentorship, collegiality, and opportunity to be part of the FFT
history.
To Matt and Astrid. You teach, inspire, support, and show me the meaning of
family every day.
Thomas Sexton
Bloomington, Indiana
Contents

Foreword ix
Preface xi

SECTION 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 1-1
2 Core Principles of FFT: Clients, Clinical Problems, and Foundations of
Effective Therapeutic Change 2-1
3 Clinical Change: Systematic Over Time, Relationally Focused, and Client-
Centered 3-1

SECTION II The Practice of FFT

4 Engaging Individuals and Motivating Families 4-1
5 Behavior Change Phase: Enhancing the Relationships of Adolescents and
Families Through the Development of Social and Behavioral Competencies 5-
1
6 Supporting, Generalizing, and Maintaining Family Change 6-1
7 Therapist as Translator: Implementing FFT in the Therapy Room 7-1

SECTION III Translating FFT Into Community Settings

8 Translating FFT Into Community Settings 8-1
9 FFT as a Service Delivery System 9-1

References References-1
Index Index-1
Foreword
Twenty-five to thirty years ago, there were no methods of family or couple
therapy that had accumulated enough research evidence to qualify as
“empirically supported” by today’s standards. Currently, there are a substantial
and impressive number of approaches to family and couple therapy that have
deservingly earned the reputation of being “empirically supported.” Some of
these, especially in the couples’ domain, are “broad-spectrum” in that they are
provided for dealing with a very wide array of important relationship difficulties.
Others, especially in the family domain, have been developed for more targeted
clinical problems of great mental health significance. Within this select latter
group, none has earned as lofty a position in the history of family therapy as
Functional Family Therapy (FFT).
Many family therapies have come and gone, often fading when their creators
leave us. But FFT has come and grown over the last 35 years. Undoubtedly the
only major school of family therapy that has been grounded in an unending
reciprocal relationship between research and practice, FFT has been dedicated
not merely to its clinical principles, but also to scientifically demonstrating its
effectiveness and efficacy long before it was stylish to have such concerns. And,
unlike some empirically supported psychotherapies, whether focused on
families, couples or individuals, the practice of FFT has always been grounded
in the “real world” of people struggling with problems of genuine clinical
significance. And more recently, FFT has gone where few other therapies have
dared to go: into the “outerspace” clinics of the world—far beyond the academic
settings where it had its beginnings—to demonstrate convincingly its cross-
cultural potency. Given its longevity and its repeated and varied demonstrations
of efficacy, it is not an exaggeration to say that FFT is truly unique in the world
of family therapy.
What is it that has allowed FFT to grow, prosper, and become such a
compelling approach to working with families faced with very challenging and
disheartening adolescent behavior disorders?
FFT is a very sophisticated approach to working with families, at once both
refined and complex. So, others might well identify different attributes of FFT
that explain its increasing visibility and influence in the field. For me, there is an
awesome trifecta of attributes of FFT that warrant its special place in the world
of family therapy; indeed, in the wider world of all psychotherapies: FFT is
grounded in solid psychological science, it is eminently teachable, and it requires
therapist creativity.
FFT systematically incorporates into its evolving clinical theorizing and
practice development advances in the psychological sciences of systems theory,
epidemiology, developmental psychopathology, and clinical intervention
research focused on both outcome and process. As a result, FFT focuses its
understanding of core family processes and its use of particular therapeutic
strategies and interventions on the most telling protective and risk factors
involved in adolescent behavioral disturbances.
Given the clarity of its conceptual model of how adolescent behavior
disorders develop, and what is called for to improve the family interactions that
maintain such problems, it is not surprising that FFT is unusually teachable. But
FFT is not merely teachable in the important sense that, unlike most family
therapies, it defines both the necessary phases of therapeutic engagement and the
necessary subtasks within these phases. FFT spells out with decided precision
and coherence not only how to practice as a therapist, but also how to effectively
supervise the practice of FFT, and how to assure the institutional quality of its
practice. There is no other method of family therapy that can boast that.
But, lest you think that FFT’s teachability may be the kind that renders the
FFT therapist a manual-driven robot, not to worry. The central concept of
“relational functions” in family relationships absolutely requires two things.
First, in FFT, the therapist must always be not merely respectful of, but even
deeply in tuned with, the unique psychological “culture” of each individual
family and each of its members. In this profoundly clear way, FFT is inherently
sensitive to differences of race, religion, ethnic identity, social class and the like.
Second, this functional emphasis also absolutely requires that the therapist be
strategically flexible, open, and, indeed, downright creative in helping family
members find, or develop, new and more collaborative ways to maintain their
individual relational goals and preferences, while enhancing the overall
functioning of the family as a whole.
Although FFT’s effectiveness is well researched and its technical aspects well
articulated, this is not a “therapy by the numbers.” FFT is an exquisite
synergistic blend of clinical science and clinical attunement, and Functional
Family Therapy in Clinical Practice is a most welcome, long-overdue
contribution.
Alan S. Gurman, Ph.D.
Emeritus Professor of Psychiatry
University of Wisconsin School of Medicine and Public Health
Preface
Functional Family Therapy (FFT) has been a major family therapy approach for
working with externalizing adolescents for more than 30 years. The first (and
only) book on FFT, by Alexander and Parsons, appeared in 1982. Since that
time, chapters on the FFT model have appeared in the most prestigious
publications in the field, including Gurman and Kniskern’s Handbook of Family
Therapy (Barton & Alexander, 1981), Comprehensive Handbook of
Psychotherapy (Alexander & Sexton, 2002; Sexton & Alexander, 2002), Sexton,
Weeks, and Robbins’s Handbook of Family Therapy (Sexton & Alexander,
2003), The Handbook of Clinical Family Therapy (Sexton & Alexander, 2006),
and the Handbook of Family Psychology (Sexton, 2009). These publications
demonstrate FFT’s importance as a major theoretical and conceptual model in
the field of family psychology. FFT has been designated by the Center for the
Study and Prevention of Violence as a Blueprint Program for the successful
treatment of delinquency, violence, and co-occurring problems for high-risk
youth (Alexander, Pugh, Parsons, & Sexton, 2000).
The clinically rich, theoretically integrative, and systematic nature of the FFT
clinical model along with its repeated demonstrations of successful outcomes
with at-risk adolescents and their families has led to widespread community-
based application in many settings with a wide range of clients (Alexander,
Holzworth-Munroe, & Jameson, 1994; Sexton & Alexander, 2002; Sexton,
Alexander, & Mease, 2004). Functional Family Therapy is now being
extensively used in mental health and social service treatment systems in the
United States and internationally to treat one of the most difficult clinical
problems: externalizing behavior disorders of adolescents. At-risk adolescents
are often viewed as treatment-resistant and unmotivated, with few effective
treatment options available. These youths represent the most common clinical
referrals in mental health systems, and youths who enter the juvenile justice
system require significant resources and attention.
Because of its systematic clinical model, scientific research, supervision and
training protocols, dissemination and implementation process, and quality
improvement system, FFT appeals to practitioners, service providers, and
communities seeking ways to help at-risk youth. In addition, its cultural
sensitivity and ability to address the problems of diverse clients make it
particularly valuable. In mental health systems FFT is a primary treatment
program for a wide range of problem youth (from early-entry first offenders to
serious offenders and high-end youth) and their families in various contexts
(Alexander, Sexton, & Robbins, 2002; Alexander & Sexton, 2002). In juvenile
justice settings FFT is often a prevention program, where it is effective in
diverting the trajectory of at-risk adolescents away from the mental health and
justice systems (Alexander, Robbins, & Sexton, 2000). Across settings a wide
range of interventionists including social workers, psychologists, counselors, and
marriage and family therapists use FFT. In each of these settings FFT illustrates
the successful integration of science and practice in a way that has important
social consequences and very personal human impact. Because of its widespread
application, it also represents a unique movement in the history of psychological
interventions in which the strong theory and science of a powerful intervention
model are being systematically moved into the world of clinical practice.