Parent and Youth Perspectives and Retention in Functional Family Therapy

Abstract

This qualitative study aimed to understand factors relating to dropout in Functional Family Therapy (FFT) through exploring the experience of families who have completed FFT and those who have dropped out from therapy. Individual interviews were undertaken with parents and adolescents from 12 families who had completed FFT therapy in England and eight families who had dropped out from therapy. Using thematic analysis, six themes were established, clustered within three domains. The patterns of responses across the accounts of families who did and did not complete FFT suggest processes that may facilitate retention in FFT. These include relational processes specific to family therapy including having a shared problem definition and a balanced therapeutic alliance. In addition, processes commonly observed across both individual-and family-based interventions were found. These include the credibility and relevance of the therapeutic work, openness in therapy, and practical barriers. Findings also suggest that establishing motivation to participate in therapy may be more important for retention in therapy than overcoming practical barriers. Barriers to retention in therapy also differ for parents and young people. These differences highlight the importance of the therapist maintaining credibility and support for parents while concurrently reducing blame toward the young person to encourage youth openness. Findings have implications for therapist actions to retain families when using the FFT model.

The Implementation of the Functional Family Therapy in China

“…The researchers noticed a possibility that not all therapists in FFT were skilled and adherent to the FFT model enough. Another outstanding defect could be that only 60% of participants completed the whole FFT sessions in that study, compared to completion rates of 77 to 89% in the US (Collyer et al, 2021). Secondly, the design of the FFT group receiving both FFT and MAU during the treatment may also cast some influences on the outcomes.…”

Systemic and family therapy with socially disadvantaged children and young people with complex trauma

“… The significant attachment difficulties of young people with CT make family therapies such as FFT and MST, where the therapist has to attend to the needs of multiple family members, too difficult for them to cope with initially. This hypothesis is supported by research on improving engagement with FFT which demonstrates that unequal alliances between therapist and family members is a predictor of dropout (Collyer et al 2020; Robbins et al, 2003). Young people with CT may therefore benefit from an individual therapy component to support their attachment difficulties and allow for the development of a trusting relationship with the therapist; The significant dropout rates for TF‐CBT, which reflect dropout rates generally for child trauma‐focused therapies (Wamser‐Nanney & Steinzor, 2017), are likely related to the emotional difficulty of processing trauma, particularly for young people.…”