Functional Family Therapy

About the programme

What happens during the delivery?

How is it delivered?

• Functional Family Therapy (FFT) is delivered in 8–16 sessions (with an average of 12–14 sessions for most cases). Challenging cases may receive 26–30 sessions.
• Each session is 45–60 minutes duration.
• These sessions are delivered over 3–6 months.
• FFT is delivered by 1 therapist (QCF-7/8), to families.

What happens during the intervention?

• FFT is applied in five distinct phases: Engagement, Motivation, Relational Assessment, Behaviour Change, and Generalisation. Each phase has associated specific goals, techniques, and important therapist relationship and structuring skills.
• In the first phase, the focus is on enhancing therapist credibility and expectations.
• In the second phase, the focus is on building motivation for change by reducing negativity and blame, creating hope and a relational focus, and developing balanced alliances with family members.
  • Relational assessment involves identifying the interactional and functional aspects of specific behaviors, attributions, and feelings of family members and extrafamilial significant others (e.g. close relatives, peers).
  • This assessment sets the stage for designing and implementing the behaviour change phase.
  • Motivation to participate in the change process is enhanced by effecting changes in the attitudes and feelings of family members about each other and problematic behaviors.
• The behaviour change phase involves training and applying maintenance technology (e.g. parent-child communication training, behavioural contracting). Skills training interventions such as problem-solving and other behavioural intervention strategies are included using a menu-driven process from the behaviour therapy literature (e.g. listening skills, anger management, parent-directed behavioral consequences, improved parental supervision).
• A unique feature of FFT is the specific focus on skills in the context of assessed relational functions of behaviour (e.g. separation, contact) within each dyad of the family system. The focus of change is on replacing maladaptive behaviours used to maintain relationship functions.
• Readiness for therapy is based on the family demonstrating the generalisation of new skills and behaviours to the home and environment outside the therapy session, the maintenance of treatment gains, and the ability to function independently from the therapist.

What are the implementation requirements?

Who can deliver it?

• The practitioner who delivers this programme is a therapist with NFQ-9/10 level qualifications.
  

What are the training requirements?

• The therapist undergoes 24 hours of face-to-face training prior to the first meeting with the client. An additional 48 hours of face-to-face training is required during the course of the first year.
• Booster training of practitioners is recommended.

How are the practitioners supervised?

Practitioner supervision is provided through the following processes: 

• FFT LLC trained consultants provide the clinical supervision to the FFT therapists on a team in phase 1 (year 1). During this time (phase 1), the on-site person who will become the clinical supervisor in phase 2 (year 2) goes through an off-site externship process (seeing clients behind a mirror with clinical oversight) and then they also attend off-site supervisor training. 
  
• Once they have done all of this, they take over the clinical supervision of the FFT therapists at their agency. The FFT consultant then provides supervision only to the on-site clinical supervisor. 
  
• This supervision of the supervisor continues throughout the time a site is providing FFT services.
  

What are the systems for maintaining fidelity?

Programme fidelity is maintained through the following processes:

• training manual
• other printed material
• face-to-face training
• fidelity monitoring.

Is there a licensing requirement?

There is no licence required to run this programme.

How does it work? (Theory of Change)

How does it work?

• FFT is based on the assumption that every family member’s behaviour serves a function within the family system.
• Once family members understand the function of their behaviours, they are in a better position to improve and/or change them.
• FFT therapists help family members identify positive and negative functions of family behaviours (including the young person’s antisocial behaviour) and develop strategies for changing them within the family system.
• In the short term, family members will experience less conflict and improved communication and the young person will be better able to manage his emotions and behaviour.
• In the longer term, the young person will be less likely to reoffend and misuse substances and be more likely to remain with his family and attend school.

Intended outcomes

Contact details

Holly DeMaranville
Communications Director, Functional Family Therapy
holly@fftllc.com

www.fftllc.com

About the evidence

Functional Family Therapy (FFT) has evidence from at least one rigorously conducted RCT (Waldron et al. 2001) along with evidence from an additional comparison group study (Alexander & Parsons, 1973). These studies identified statistically significant positive impact on a number of child outcomes.

This programme does not receive a rating of 4 as it has not yet replicated its results in another high-quality study (where at least one of the high-quality studies suggests long-term impact, and at least one of these studies uses assessment measures independent of study participants).