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

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 todays 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 worldfar beyond the academic settings where it had its beginningsto 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 FFTs 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.