When SaintA therapist Lindsay Price started working with a family, the 14-year-old boy had stolen a car, was getting into fights at school, threatening his 8-year-old sister, and being disrespectful to his mother and grandmother.
By the end of five months working with Functional Family Therapy (FFT), things had dramatically improved. But getting there required a steady, step-by-step process — and a lot of patience.
FFT is a family-based intervention program for at-risk youth aged 11-18 that builds on family strengths to address a range of emotional and behavioral issues. This particular family had been referred to the FFT program by human services workers in Children’s Court because they knew this family needed support and didn’t have anything in place.
One of the first things Lindsay had to do was to try to build a relationship with everyone in the family, to open them to the concepts she would try to teach. When she looked deeper at the family dynamic, a few things became evident. There was a lot of negativity and blaming of the boy. For example, the mother said in an early meeting that the reason everyone was there was because the boy stole the car. She looked at him and said, “And now we all have to sit through all of this. You need to pay attention, because if you hadn’t done that, we wouldn’t be here.”
Lindsay steered the conversation in another direction, to focus on the family, not just the boy’s wrongdoing, and to get everyone to understand that was the goal. So, she went back to the mother’s statement and said, “How do you think that situation came about? How do you think things got to the point that he would want to do this?
“It’s not easy to answer that,” Lindsay said. “But it helps everyone see their part in the issue.”
Grandma offered that she was a bit too reward-focused, giving incentives and rewards for so many things that she often ending up rewarding negative behavior just to get things over with. The girl admitted she purposely annoyed her brother, which made the boy feel somewhat better that all of the blame was shifting off of him. She also said she was trying to get his attention because she wanted her brother to do things with her. Mom recognized that her son has a learning disability and that his acting out in school was a way for him to get attention and to detract from his disability.
Lindsay got the 8-year-old to realize that, with the age difference, she should not expect her brother to do things with her whenever she wanted him to. Grandma learned that incentives should be used appropriately. But the big breakthrough came when Mom realized she did not praise her son’s achievements enough.
“People gravitate to school-based versus personal achievements,” Lindsay said, “So if the child is not doing well in school, they think there is nothing to praise.”
With Lindsay’s help, mom recognized that her son is very handy, good with cars and tech savvy. She learned these were areas worthy of praise.
Lindsay also helped get an IEP for the boy, which gave his teachers a perspective on his behavior.
“He’s not a bad kid; he has learning and mental health issues and those may be reasons why he’s acting out.”
As part of FFT, Lindsay set up a behavior-change plan with all of the family, focusing on communication and problem-solving skills and self-regulation. The family learned about listening instead of interrupting each other, really hearing and understanding each other. Lindsay had them paraphrase what they had heard with talking to each other and clarifying, to ensure understanding.
She engaged in role playing, running through scenarios of real-life things that could happen, with the family acting out what they would say and do. She taught breathing exercises and mindfulness, and for the boy, finding an enjoyable outlet, such as journaling, typing on a computer or playing a game, as alternatives to becoming aggressive.
“They liked learning about mindfulness, especially the grandma, who was into yoga,” Lindsay said. “We give a lot of reasons before teaching a skill like that; we tell the family why it’s important and that in the past things escalated quickly because they didn’t regulate themselves.”
Lindsay stressed chores and setting up a routine that included real rewards and consequences, such as telling the teenager he could play video games after he finished a chore. This was different from the past, when, if the boy didn’t do what he was asked, yelling ensued.
Things did not always go perfectly smoothly, and there were bumps in the road, Lindsay said. At one point early in the process, Mom got so fed up with the boy that she sent him to a group home for a few weeks. The boy then had a choice, to continue with FFT or stay where he was. He said he wanted to continue with Lindsay.
“That was kind of shocking to me, and it made me feel good,” she said. “After that, I felt like I kind of had him hooked. It was like, ‘You told me that you liked me, so you’re stuck with me now!’” she said with a laugh. “When he got a choice, it led him to actually pay attention more.”
Toward the end of Lindsay’s time with the family, she transitioned the skills they had learned to other areas of their lives, and she helped link them with other resources in the community and school. She talked to the boy about how he had learned to regulate himself in school and how he needed to use those skills in the community and with peers and adults. She did relapse-prevention by bringing up scenarios the family potentially would encounter.
“We need to prepare them for things to go wrong, because they will. Families can’t stay perfect. But once you feel they have the skills to handle things well in new situations, you know they have succeeded. It’s about empowering them to trust themselves.”
Without FFT, Lindsay said families probably would continue with their patterns, or things would get worse. The young people who are served in FFT already are at high risk, and they probably would end up in jail. FFT is a benefit to the community as well as a family, she said, because the youth “are a high-risk population and some of them commit crimes, sometimes very serious crimes.
“The family is a big piece, but you’re not just helping one individual. It completely ripples to everyone they touch.”
In the end, the boy who was failing all his classes is not failing any and is doing well in school.
“The focus on self-esteem gave him the confidence he needed to do well in school and to do good things in general,” Lindsay said.
The family now says the boy is a lot more respectful, he helps out more at home and the family runs a lot more smoothly overall.
“At the start, I saw a kid who struggled a lot with emotional issues. I felt bad for him. Now I see a kid who will continue to struggle with his issues, but he has learned how to better manage them.”