On This Page:ToggleWhat IS FFT?Who can benefit from FFT?How Does FFT Work?Treatment PhasesTherapeutic Principles
On This Page:Toggle
On This Page:
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:
How Does FFT Work?
The foundation of FFT lies in its name: “functional.” This signifies that the model centers on understanding how each familyfunctions– 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:
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.
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:
Assessment in EM:
During this phase, therapists observe family interactions, focusing on identifying:
Interventions in EM: relational reframing
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
Functional Family Therapy (FFT) practitioners usereframingas 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.
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.
Reframing often involves helping family members shift fromexternalattributions (blaming others) tointernalattributions (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.
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.
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:
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 subsequentBehavior Change phase.
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.
Assessment in BC:
Key Intervention Strategies:
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:
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:
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 theuseof 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 skillsin 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.
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.
Assessment in Generalization:
Interventions in Generalization:
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.
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.
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.
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.
A central focus of the Generalization phase is equipping families to manage the inevitable challenges and setbacks they will encounter:
Recognizing that families do not exist in isolation, the Generalization phase emphasizes connecting families with sources of ongoing support:
The therapist works with the family to process the ending of the therapeutic relationship and prepare for a future without regular sessions:
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:
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.
Family problem definitions are rarely emotionally neutral. They are often saturated with negative emotions such as anger, frustration, resentment, disappointment, or fear.
These emotions, if left unaddressed, can fuel conflict, hinder communication, and make it even harder to find solutions.
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.
Recognizing and understanding how a family defines its “problem” is crucial for effective family therapy, particularly within the FFT model. Here’s why:
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.
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.
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:
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:
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.
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:
FFT emphasizes the importance of identifying and changing problematicbehavioral patternsrather than focusing on changing the inherent personalities or relational functions of individual family members.
This means that FFT therapists:
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:
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.
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:
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.
Reading List
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
