Systemic · 1973
Functional Family Therapy (FFT)
Change occurs when the family transforms the coercive functions of its interactions into patterns of support, responsibility and cooperation.
Functional Family Therapy (FFT) is a brief, active, manualised, evidence-based family treatment, developed initially by James F. Alexander and Bruce V. Parsons in the context of intervention with at-risk adolescents, conduct problems, juvenile delinquency, substance use and families with high relational negativity. The model conceptualises the problem behaviour as functional within a family system: however destructive it may be, it usually serves functions of protection, distance, contact, control, belonging or the management of tension within repeated sequences of attack, defence, withdrawal, punishment, escalation and hopelessness. The intervention organises change into phases: engagement, motivation, relational assessment, behaviour change and generalisation, maintaining a precise clinical logic: first blaming is reduced and a balanced alliance is built with every member; then the problem is reframed in relational and modifiable terms; next, concrete skills of communication, parenting, problem-solving, anger management and the reorganisation of contingencies are trained; finally the changes are consolidated in real life through coordination with school, the justice system, the community network and the extended family. Change is considered achieved when the family can sustain less coercive, more cooperative and more effective interactions without depending on the therapist, and when the adolescent reduces risk behaviours in the contexts where they were previously maintained. (Refs: Alexander & Parsons, 1973; Alexander & Parsons, 1982; Sexton & Alexander, 1999; Sexton, 2011; Alexander, Waldron, Robbins & Neeb, 2013).
Theory of change
The family changes when it reduces blaming, understands the relational function of the problem behaviour, practises new skills and consolidates those skills in the contexts where the risk was maintained.
Core ideas
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The problem behaviour serves a relational function
FFT starts from the premise that the adolescent's problem behaviour cannot be adequately understood if it is separated from the family system that maintains it. A behaviour may be aggressive, evasive or criminal and, at the same time, serve a relational function: seeking contact, creating distance, regaining control, protecting against humiliation, stabilising an alliance or expressing an unformulated need. The intervention does not justify the behaviour, but it does ask what function it serves so that it can be replaced with more effective and less destructive family responses. (Alexander & Parsons, 1982; Sexton, 2011).
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The first clinical change is to reduce blame and negativity
In high-conflict families, technique fails when it is introduced before the atmosphere of accusation, hopelessness and defence has been reduced. FFT devotes the initial phase to building alliance, hope and a relational explanation of the problem, because a family that feels judged usually drops out or complies superficially. Reducing negativity is not an added courtesy, but the condition that makes it possible to move on afterwards to behavioural coaching. (Sexton & Alexander, 1999; Alexander, Waldron, Robbins & Neeb, 2013).
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Reattribution turns a moral conflict into a modifiable problem
Functional reframing shifts expressions such as 'he's bad', 'she manipulates us', 'they're hopeless' or 'nobody wants to change' towards formulations that describe patterns, functions and consequences. This operation reduces defensiveness, maintains responsibility and opens the way to intervention: if the problem is a learned and reinforced pattern, the family can learn another. FFT's clinical power lies in transforming the interpretation of the problem without denying the gravity of its consequences. (Alexander & Parsons, 1982; Sexton, 2011).
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Relational assessment directs the plan for change
FFT does not apply skills generically. Before coaching communication, monitoring or discipline, the therapist identifies which sequences maintain the problem, which attributions trigger the escalation, what function the behaviour serves in each relationship and what resources already exist. This assessment makes it possible to match the change to the particular family: a technique that is useful in one family may be useless or even iatrogenic if it contradicts the relational function that sustains the current equilibrium. (Sexton & Alexander, 1999; Alexander et al., 2013).
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Change needs observable skills, not understanding alone
FFT integrates relational understanding with behavioural learning. A family may understand its coercive cycle and go on repeating it if it does not practise concrete ways of asking, listening, reinforcing, monitoring, negotiating and applying consequences. This is why the behaviour change phase requires rehearsal in session, tasks between sessions and review of outcomes: the new meaning is consolidated when it produces different experiences in real life. (Alexander & Parsons, 1982; Sexton, 2011).
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The alliance must be balanced across the members
The FFT therapist works with several clients at once: adolescent, mother, father, caregivers, siblings and sometimes external systems. If the therapist allies with one member against another, they reproduce the system's polarisation and lose the capacity to intervene. A balanced alliance does not mean passive neutrality, but differential validation, clear responsibility and language that allows every member to feel included in the change. (Sexton & Alexander, 1999; Alexander et al., 2013).
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The external context is part of the maintenance
FFT holds that adolescent behaviour is also maintained in school, judicial, community, peer and extended family contexts. Treatment is insufficient if it improves family conversation but leaves untouched the settings in which truancy, substance use, violence, offending or relapse appear. The generalisation phase intervenes precisely in order to connect supports, anticipate risks and transfer family skills to the systems where they need to work. (Sexton & Alexander, 1999; Sexton, 2011).
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Manualisation organises clinical judgement
FFT is manualised, but its manualisation is not equivalent to applying recipes. The phases provide a clinical compass: what to prioritise now, what risk to assess, which technique fits and when to move to the next phase. Fidelity to the model requires maintaining the logic of engagement, motivation, relational assessment, behaviour change and generalisation, adapting the intervention to the culture, risk, development, resources and relational function of each family. (Sexton & Alexander, 1999; Alexander, Waldron, Robbins & Neeb, 2013).
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Success is measured by family autonomy and maintenance
FFT's final goal is not for the family to function well in the therapist's presence, but for it to sustain new patterns when stress, conflict, risky peers, school demands or judicial pressure reappear. Ending is prepared by verifying maintenance, early identification of relapse signals, use of community resources and the family's capacity to solve problems without returning to the initial coercive cycle. (Sexton, 2011; Alexander et al., 2013).
Influences
- Strategic therapy (Haley)
- Social learning
- Behaviourism
- Cognitive psychology
- Systemic family therapy
- Research on juvenile delinquency and high-risk families
- Objectivist empiricism / Logical positivism
Key references
- Alexander, J. F., & Parsons, B. V. (1973). Short-term behavioral intervention with delinquent families: Impact on family process and recidivism. Journal of Abnormal Psychology, 81(3), 219–225.
- Alexander, J. F., & Parsons, B. V. (1982). Functional Family Therapy: Principles and Procedures. Brooks/Cole.
- Sexton, T. L., & Alexander, J. F. (1999). Functional Family Therapy: Principles of Clinical Intervention, Assessment, and Implementation.
- Sexton, T. L. (2011). Functional Family Therapy in Clinical Practice. Routledge.
- Alexander, J. F., Waldron, H. B., Robbins, M. S., & Neeb, A. A. (2013). Functional Family Therapy for Adolescent Behavior Problems. American Psychological Association.
- Sexton, T. L., & Turner, C. W. (2010). The effectiveness of Functional Family Therapy for youth with behavioral problems in a community practice setting. Journal of Family Psychology, 24(3), 339–348.