Family Voice

by Tom Sexton

Family Voice…the evidence needed to “hit the target

Family Voice -  the essential feedback that lays the groundwork for clinicians working with families - can feel a little like trying to hit a moving target.  Regardless of what approach you use….what you assessed in one session; it appears to change in the next one. The goals and issues that seemed important at the outset of treatment begin to change over time. 

You think things are going well…only to have the family drop out.  

With families, “hitting the target” means you can assess how they are doing, if they are with you, and if the discussion feels relevant.  Hitting the target means your choice of how to help, fits to the family.  The challenges of hitting the target or fitting to the family are complicated.  If you happen to hit the center of the target the first time, it is a success…but, in actuality, you are probably just lucky.  More often, hitting the target requires missing on the first try—getting feedback about how far left or right you missed—adjusting and trying again.  It is the feedback and ongoing adjustment that makes hitting the target more likely. 

This analogy fits the challenges faced by FFT therapists in the work they do with families.  Functional Family Therapy (Sexton, 2010, Alexander & Sexton 2006; Sexton & Alexander 2004; Alexander et al. 2013) is one of the few family-based interventions with defined and evidence-based change mechanisms that have been translated into phase goals and specific therapeutic interventions to reach those goals.  When done well, the model typically produces outcomes better than those of other non-specific models of practice.  Despite FFT's evidence-based specificity, it is still tough to know how to "hit the target" within family relationships' complexity.

In FFT, "hitting the target" is all about individualizing how the goals of each FFT phase are translated by the therapist to the family.  Translating means that you find a way to help the family change - from within the family's values, culture, experiences, background, and needs. FFT is the only evidence-based intervention program to systematically solicit, analyze, and present “family voice” to therapists session by session.  Progress, alliance and impact are the three core indicators of the voice of the family. 

The family's voices are used session by session by therapists to individualize treatment that fits to the family.  After each session of FFT, every member of the family is asked to comment on their progress, the alliance they experience with the therapist, and the impact the treatment is having on them.  FFT-Care4 is the tool we use to solicit information from the family and turn it into easily digestible feedback for therapists to plan the next session.  In this way, family feedback on progress, alliance, and impact are the critical elements in planning, adjusting, and adapting treatment session by session. 

From our perspective, families are more than our clients.  You can't individualize, translate or "hit the target" without the active participation of every family member in every session.  Conceptually, FFT considers the family to be the expert in their life.  FFT sees the therapist as the expert in translating FFT's valuable change mechanisms to the family.  In practice, we believe the family voice is even more important.  Family voice in each session is one of the essential features in successful outcomes, successful family engagement, and in designing treatments that fit families. Family voice is the session by session evidence indicating whether a therapist doing FFT has hit the target that is the uniqueness of the family. 

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