Functional Family Therapy: What It Is, Cost, & What to Expect

What Is Functional Family Therapy?

Functional family therapy (FFT) is a treatment approach for families of teens between the ages of 11 and 18.^1,2 Functional family therapy is intended for teens displaying behavioral issues, such as drug and alcohol use, truancy, and school refusal. It is an evidence-based treatment, meaning that it has been well-studied and deemed to be effective at improving behavior problems in teens.

The goals of FFT are to increase positive behaviors and decrease negative behaviors in teens and improve family relationships. It accomplishes this by combining elements of cognitive behavioral therapy (CBT) and systemic therapy. Overall, FFT is effective at achieving its goals with families presenting from a range of cultures and backgrounds.

FFT is time-limited and brief. A course of FFT is typically 12 to 14 one hour-long sessions.² Therapists must undergo specialized training in order to qualify as functional family therapists. FFT can be provided in many different settings, including mental health clinics, home, and in schools.

Phases of Functional Family Therapy

There are three phases of FFT which include engagement/motivation, behavior change, and generalization.^2,3 During the engagement/motivation phase, a therapist works to engage families by providing outreach, listening, and conveying understanding and empathy. The goals of this phase include decreasing negativity and blame, focusing on the presenting problem, and building rapport.

The target of the behavior change phase is to decrease or eliminate negative behaviors and increase positive ones. This phase involves structure, teaching skills, modeling, and assigning tasks. Therapists may utilize techniques from CBT at this time.

Lastly, the generalization phase seeks to anticipate future challenges that may arise and encourage changes in other areas, like school and the community. The goals of this phase are to build connections to community resources, continue encouraging positive changes, and prevent relapse.

Functional Family Therapy Techniques

Functional family therapists use specific techniques to decrease and eliminate negative behaviors and improve positivity and cohesiveness among family members. Many of these techniques are active and involve providing information, guidance, and resources for families. The specific techniques used in FFT vary based on the phase of treatment.

Techniques used in functional family therapy include:³

• Creating alliances with family members
• Asking questions in ways that support individual family member’s strengths
• Validating family member’s feelings
• Interrupting negative behavior patterns
• Reframing blame, negativity, and anger by offering alternative perspectives
• Teaching communication, parenting, problem-solving, and conflict resolution skills
• Assigning homework when necessary
• Connecting families to community resources
• Anticipating future challenges that may arise
• Creating a relapse prevention plan

Functional Family Therapy Model

There are three key principles of the functional family therapy model.² These include motivation, a relational focus, and a strengths-based respect for people. Motivation is an important part of any change. Functional family therapy assumes that all people are motivated toward some sort of action, in some cases it may be negative action. In functional family therapy, therapeutic motivation is a process and is enhanced by creating a strong alliance and helping family members work together toward the same goals.

It is important for the therapist to have a strong alliance with both parents and teens. Functional family therapy also has a relational focus, meaning that the presenting problem, like a teen’s behavior issues, must be understood in the context of the family system. Functional family therapy is also a strengths-based approach that respects each person’s individuality and each family’s diversity. It’s important that therapists not only examine negative behaviors, but also identify positive behaviors and resources within a family.

Functional family therapy is both structured and flexible.² It follows three distinct phases of treatment, but also encourages therapists to be creative, intuitive, and open. The phases provide a map for therapists to follow to help them engage and motivate family members, change behavior, and strengthen connections within the community.

Assessment is also an ongoing part of functional family therapy and is integrated into each phase of treatment. In functional family therapy, assessment focuses on understanding how the family system relates to the presenting problem, identifying risk and protective factors, and considering many different dimensions and factors, such as the teen’s mental health, interactions between the teens and parents, and the social environment.

Functional Family Therapy vs. Other Types of Family Therapy

Functional family therapy differs from other types of family therapy in a number of different ways. First, it is brief and time-limited. A course of FFT takes place in approximately 12 to 14 sessions.² Many other forms of family therapy are open-ended in their timeframe.

Second, FFT is structured but flexible. Therapists follow a series of phases, each with its own goals and techniques, but are also encouraged to be creative and open. Third, FFT specifically focuses on helping families with teens who have behavior problems. There are some approaches to therapy that were also created for this specific purpose, such as multisystemic therapy for adolescents.

Other types of therapy, however, are available for families dealing with all different types of problems, not limited to teens with behavior issues. Lastly, assessment is an ongoing process in FFT, rather than a distinct stage in the beginning of treatment. In FFT, therapists continually assess how the teen’s behavior problems affect the family relationships and vice versa.

What Can Functional Family Therapy Help With?

Functional family therapy was developed specifically for families of teens with behavior problems. Functional family therapy can be offered as a prevention or intervention program.⁴ A prevention program for functional family therapy is offered before a teen’s behavior problems lead to serious outcomes. For example, a family may be referred to FFT after a teen is beginning to show a pattern of missing school, or after a teen is arrested for theft as a condition of their probation or as an alternative to incarceration.

The types of behavior problems that functional family therapy can address include:⁴

• Rule-breaking at home and school
• Disrespect of authority figures
• Curfew violations
• Drug and alcohol use
• Theft
• Violence
• Truancy

These behaviors can have serious consequences for the teen themselves and also negatively affect the community and their relationships with family and peers.² It also places a considerable financial burden on the government and community. One of the goals is to stop the teen’s school refusal before it has a significant impact on their school performance and leads to other problems.

Functional Family Therapy Examples

Functional family therapy is specifically intended for families of teens displaying behavioral problems, like drug and alcohol use, violence, and problems in school.² Therapists progress through the three phases of functional family therapy (engagement/motivation, behavior change, and generalization) to help teens display more positive behaviors and to help families improve their relationships with one another.

Case Example 1: Teen Alcohol Use

A teen is caught drinking alcohol on three different occasions. The parents have tried to talk to the teen about their behavior, punish them, and withhold privileges, but with little success. The parents contacted an functional family therapy program to help them address their teen’s drinking.

A functional family therapist would first work on building rapport with the teen and parents to help engage and motivate them for treatment. The therapist would discuss the negative consequences of the behavior, while also acknowledging the teen’s motives for drinking, such as a desire to connect with peers.

They would explore alternative ways that the teen could build connections with peers and teach the family skills to help improve communication. These skills may be modeled and roleplayed in session. The therapist would also offer referrals to community programs for the teen that would provide a positive social outlet. Toward the end of treatment, the therapist would help the family anticipate and plan for future challenges that might arise.

Case Example 2: Teen Shoplifter

A teen is caught shoplifting and is charged with a misdemeanor. The teen and family are mandated to attend FFT as a condition of the teen’s probation.A functional family therapist always begins by building an alliance with all family members. Once the family is engaged in treatment, the focus shifts to behavioral change.

The therapist would work with the family to understand the teen’s motives for shoplifting and work on ways to help the teen get their needs met in a less consequential way. The family would be taught necessary skills to help them deal with conflict. The final stage of treatment would involve taking steps to prevent future problems and connecting them with community resources. The teen’s probation officer would also be involved in treatment to help support these changes.

Case Example 3: Problems in School

A teen has been skipping school, not turning in assignments, and is in danger of failing. The school holds a meeting with the family and advised the family to participate in FFT to help address the teen’s school refusal.

The functional family therapist would initially focus on connecting with the teen and family and increasing their motivation to participate in treatment. This helps reduce negativity and resistance and enhances hope in functional family therapy as a helpful intervention. The next stage of functional family therapy would focus on addressing the teen’s lack of participation in school.

This might involve creating a plan to help the teen get back on track with school by turning in late assignments, speaking with teachers, and figuring out ways to engage the teen in school, such as by joining a club or sport. After a change plan is created, the therapist would help the family plan ways to intervene if the teen began displaying the same problems in school again in the future. They might also connect the teen with tutoring programs to help them maintain their progress in school.

Cost of Functional Family Therapy

Functional family therapy may cost between $50 and $250 per session. The exact cost will depend upon the type of provider, their level of experience, and where you seek therapy. Generally, masters-level therapists, like social workers and counselors, charge between $50 and $150 per session. Doctorate-level psychologists tend to charge around $100 to $250 per session. Some therapists offer sliding scales that may adjust the fee depending upon your income. Community clinics and training sites may also offer more affordable rates for therapy.

In many cases health insurance will cover the costs of family therapy. To use insurance for family therapy, one of the family members must be identified as the “patient” and given a diagnosis. If no one in the family meets criteria for a mental health diagnosis, then you cannot use insurance for family therapy. It is important to note that even if you are using insurance, you may still be responsible for meeting a deductible or paying a copay.

How to Find a Functional Family Therapist

Functional family therapists are specifically trained and certified to provide this type of therapy. In addition to their masters or doctorate degree in a counseling-related field, they also must go through a training process to learn the FFT model and how to apply it to families. To find a therapist, you can also search an online therapist directory of therapists. The directory allows you look for therapists with expertise in family issues. When you contact a therapist to set up an appointment, you can ask them if they are trained in FFT. There are currently over 200 certified functional family therapy sites in the United States and others located in Europe, Asia, South America, and Australia.⁵

What to Expect at Your First Appointment

Your first appointment may be at a therapist’s office, clinic, school, or even your home, since functional family therapy is offered in a variety of different settings. Prior to your first appointment, your therapist will likely have prepped you over the phone about what to expect from FFT, since connecting with families prior to therapy is a part of the engagement/motivation phase of treatment.

The focus of the first session will be on gathering information about the presenting problem and discussing treatment goals. The FFT therapist will gather information by not only asking questions, but also observing interactions between family members. By the end of the first appointment, you should have a better idea of what to expect from FFT and how it will help your family.

Is Functional Family Therapy Effective?

Functional family therapy is an evidence-based practice that has more than 40 decades of research backing it.¹Countless studies have looked at FFT as a treatment for teen behavior problems and has demonstrated that it is an effective form of therapy. These studies have found that FFT achieves its goals of decreasing teen behavior problems and improving family relationships. It has been shown to be effective across cultural groups and in a variety of settings.

Research on functional family therapy has shown the following benefits:^6,7,8,9,10

• Less involvement in violent and felony crimes
• Lower likelihood of adult criminal offenses
• Lower recidivism rates
• Less likelihood of teens being placed outside of the home
• Positive changes in family dynamics

In addition to being an effective treatment, FFT is also cost-effective.^3,4 FFT helps prevent future arrests and offenses that are costly, thereby saving the government and community money.

Final Thoughts on Functional Family Therapy

If your teen is struggling with behavior issues and it’s having an effect on your family, you are not alone. Functional family therapy was designed to help families overcome these challenges and function more smoothly. Consider reaching out to a therapist trained in FFT for help.