Alexander Ch. 6- Motivation phase

Hey Guys, Sorry I feel really dumb. I wrote this before my client yesterday and then I came home and totally forgot to post it until this morning. 

Motivation represents the gateway for lasting change…therefore it = IMPORTANT!

From the first contact, therapist begin working towards specific goals:

• Establishing balanced therapeutic alliances with indivual family members
• Reducing negativity and blame
• Instilling a sense of hope (e.g., “I have something to gain by being a part of this process”); and
• Creating a family focus, rather than an indiviaul focus, for both problems and strengths

-Family members have developed rigid or defensive cognitive schemata through which all information is filtered. This is what fuels and sustains the negative interactions. Over time they become automatic.

•  Think about areas or rituals where you have automatic processing (driving, mundane tasks), you begin to do and respond to things automatically with very little conscious thought.

-Disrupting these automatic responses and interactions is a critical first step in the FFT treatment process.

The goal: intervene in the moment to create a different experience that disrupts the family’s automatic responses

• This can be difficult as the family strives towards being more controlled and deliberate, so its important for the therapist to have a lot of relational capital (therapeutic alliance).
• In the early stages, the intent may not be to change attitudes and attributions, or other cognition, but rather to disrupt rigid, negative patterns and create an opportunity for family members to experience that something new and more hopeful is possible.

THERAPIST CHARACTERISTICS: ADOPTING A STRENGTH-BASED AND RELATIONAL FOCUS

The emphasis early on in FFT is on creating a context in which family members begin to experience one another in new and more positive ways.

• Fundamentally, therapists must believe in and be committed to a relational and strength-based approach, even when positive strengths and goodwill in the family are not at all apparent.
• The intensity of the problems and behaviors can be a challenge for therapists and can push therapist’s personal buttons.

Traps that the therapist can fall into:

• taking sides
• Challenging a manipulative behavior to protect vulnerable family member
• using interventions that validate one family member but blame/distance another
• engage in a disproportional of supportive interventions towards family members whom they see as being the victim

-To stick to the relentless relational focus in a way that is sensitive to the diversity of individuals and issues presented in the context of treatment, Therapists must have courage and resilience.

“Fearless empathy”

The beginnings of empathy:

• send the message that the therapist is totally committed to understanding their inner world. Individuals need to feel acceptance from the therapist.
• therapist needs to be aware of potential biasing influence from his/her background
• Send the message that the therapist is not personally overwhelmed, shocked, or frightened, disgusted, or intimidated by the intensity or nature of the family members’ emotions and attributions. It is important that the therapist has non-avoidant ways of dealing with the conflict

To successfully play your role as a therapist, there must be creativity, a willingness to introduce new perspectives and frames, and the flexibility to approach conflict in the man different ways until the therapist gets something that sticks (e.g. creates hope).

SPECIFIC INTERVENTION STRATEGIES IN THE MOTIVATION PHASE

Change-Focus Techniques- Intended to disrupt unproductive family interactions

                Divert-Interrupt

• divert and interrupt escalating negativing and blaming behavior during session. This helps families de-escalate the family’s toxic negativity.

Pointing Process Technique

• Commenting on interactions or events that occur during therapy sessions.  Therapists can describe interactions from a strength-based approach. This serves to defuse or at least lessen the negativity by shifting the focus from the specific content being discussed to relational aspects that underlie it but are hidden from the family members at the current moment.

Systematically Attending to Positive Elements

• It is easy for the therapist to become trapped in focusing on problems and blame. Keep an intent to look for positive elements that exist midst the rapid processing of information. These interventions have 

There are more techniques but I, without thinking, went home after my session, spaced posting this blog entry, and also spaced that I had been using Austin's book at the clinic and don't have my own copy to add onto it. They were all pretty simple techniques, however, and should be easy to scan over in your book.

Functional Family Therapy ch. 7- Relational Assessment Phase

It addresses 2 family domains:

1. the degree of connection between family members
2. the hierarchical pattern involved in those connections

This treatment doesn't de-emphasize genetics, or trauma, or anything like that that affects families, but by the time you use this treatment it's hard to know cause from effect- these behaviors don't emerge overnight.

Goals and tasks of the relational assessment phase

• How do the two things above relate to the problems in the family?
• This assessment helps you to know specific interventions to target specific behaviors. 

FFT helps dysfunctional families become functional and better versions of themselves. This is done by working on relationship configurations to provide them with alternative, more adaptive ways to express these configurations.

Relational Functions as the Linchpin for Behavior Change 

• FFT therapists focus on the relational function of the problem behavior- like someone who is looking for comfort and stress reduction through drugs and unprotected sex. The FFT therapist doesn't try to take away the relational function (comfort and stress reduction) of the behavior but they try to change the cognitive, physiological, emotional, and behavioral strategies they use to meet the relational function. 

Assessment of Relational Functions

Relational Connection

• "midpointing" is optimal for teenager/parent functioning. Same level of closeness as autonomy. Teens can do things on their own but then feel close with the parents when together. 
• Each 3 of these states can be adaptive and they can all be maladaptive. "The problem is not what the relational function is, but how it is expressed and met."
• The important part of this is that FFT doesn't say what every family should look like. They respect individual and family wishes and accept diversity of families and what they want to do/what works for them. If they want an autonomous family, that's fine. If they want to be close, no worries. We just help them get there. 
• It is important to look at the strength of the interaction patterns, not necessarily the strength of emotion. (i.e. the difference between an abused woman fleeing with her child trying to create distance vs. indifference between family members creating just as much distance)

Relational Hierarchy

• Sorry, I don't know how to rotate the picture. 
• The balance of control and power is an important factor to consider in FFT
• IT's important for parents to exercise control through relational connection and relational quality. 
• FFT therapists work hard to create a situation where youth are influenced by parents because they love their parents instead of to avoid consequences. 
• We also want parents to provide guidance through caring, not just in order to control youth.

FFF Ch 4 - Matching and General Parameters of FFT

Matching

• "Matching in FFT means attempting to create an interpersonal relationship in which family members are in sync with the therapist and are consequently able to move through subsequent steps in the process with the fewest impediments.  Matching is related to but not the same as the construct of mirroring.
• Examples
• If a parent reaches out warmly to the therapist, a matching therapist response would be reflected in the same warm manner.  If a family member comes across as cold and distant, the therapist would respond with more interpersonally distant behaviors:  less smiling, more formal speech, fewer emotionally charged words.
• "To use more colloquial language, good FFT therapists are not simply ubiquitous "warm fuzzes."  Instead, they know when and how to behave with emotional distance, embracing warmth, overt control, and unassertive acceptance, depending, of course, on what the circumstances and family member presentations call for."
• "We start therapy very actively, rather than simply by asking lots of questions or allowing blame and sullenness to linger.  We also work very hard, at the outset, to give families the idea that we are looking for understand and solutions rather than adopting the stance of telling them what is wrong with them or proposing solutions without first getting to know them and developing trust and mutual respect."

Structured Parameters

• "By parameters, we mean how FFT is linked to other systems, who participates in treatment, where sessions are located, what the average number of sessions is in the typical course of treatment, anyhow booster sessions are used."  These are not rigid parameters!!!
• Who attends sessions?
• The decisions on who participates in FFT sessions is based on the understanding of which family members will be important in the therapy process to begin change or hinder the process of change from occurring with the referred youth.  It's a functional decision rather than simply grabbing everyone that lives in the home.
• Location
• Be flexible.  Go to their home, come to your office, a community center, wherever
• Number of Sessions by Phase
• Average length of treatment is 12 - 14 sessions over 3 - 4 months
• 5-9 sessions have the primary focus of behavior change.  3-4 sessions in which the primary focus is generalization
• Timing of sessions
• With high-risk families you probably need to have more than 1 session per week for the first 2 weeks.  The spacing of those sessions depends on the severity of the case.
• Booster Sessions
• These can happen over the phone or in person
• Flow of Treatment
• Just look at pages 74 - 76 to see their outline.  I just don't want to retype the entire thing. It's a very quick read.

11/1/14: FFT Ch 5 Engagement Phase

Engagement Phase

Engaging External Systems

• FFT therapists try to establish positive links with every referral source and respond immediately to each referral.  
• They provide as much info about themselves as possible to referral sources to foster a relationship of openness, collaboration, and willingness to help.
• As appropriate, they provide the referral systems with info about tx attendance, progress, need for ancillary care, or other info the systems might need for their own accountability.  
• Most FFT clients come after working with lots of different systems (medical, mental health, private groups, juvy, etc.) and those relationships have to be based on respectfulness, matching, and perspective taking.

Assessment: Pretreatment and During Engagement

• Referral info ("James--runaway", "James--Drug Dealer", etc.) can help to gain as much understanding as possible about the context therapy is about to occur in.
• Formal assessment is only used when specific questions can't be answered in direct clinical contact.  
• FFT emphasizes the identification of the interpersonal impact of the behavior on each family member

Engaging the Family System

• The goal of Engagement is to maximize family members' initial expectations of positive change.  This is accomplished through
• High availability
• Effective management of the intake process
• presentation of tx enhancing the therapist's credibility.
• Engage people who are the major players in the youth's referral and problem behaviors.  This might include people the referral source has left out (live-in boyfriends of mom, etc.)
• It helps to frame it like, "Would you be willing to attend one session so I can get a broader picture of what is going on?  I think your perspective will be very valuable."
• Whatever we can do to get parents and kids in their together from the outset is worth the effort for the increased retention rates and ability to move through the FFT stages more quickly. 
• See them anywhere--Jail, RTC, community shelter, school, etc.
• The first call requires some skills:
• matching
• nonjudgmental attitude
• strength-based focus
• respect
• persistence
• Schedule 1st session ASAP and offer to go to the home if necessary

"Engagement is not therapy--the only goal is to get them into the session so therapy can begin. "