Respect in therapy from the Functional Family Therapy model lens.

This is a blog for therapists, but is also a glimpse for patients into the work that goes into meeting with them with respect and compassion.

A fundamental principle of Functional Family Therapy (FFT) is respect. It’s why I’m on my 22nd year practicing and training this deeply human, richly clinical model of therapy.

Respect is a process in constant motion, but is often spoken of like a destination or desired “outcome.” This perspective, in my early years, limited my expression of respect in therapy to a few warm phrases, understanding nods, genuine empathy and a smile. It also included real concerted effort to not be judgmental. But, in those early days, I also thought that meant one must just BE non-judgmental versus one knowing their implicit biases, recognizing and challenging them actively and consistently. Back in the day, I just felt ashamed if judgment showed up and tried to run from it emotionally. That does not breed respect because I am not dealing with the issue. I was just pretending it does not exist and therefore, limited my ability to clearly observe and assess because I was almost working with one eye clenched shut. The fear of not being the perfect therapist, or even human, actually inhibited my ability to be present and truly respect the client fully. Luckily, one matures and works on the self and get better at it all!

Getting a little help from my friends. FFT group dynamic supports respect. In FFT, there is more onus on the therapist to DO the hard work, as it should be. Being in a supportive work-group, which FFT requires, gave me the space with trusted peers to see beyond my own understanding of things. In learning FFT, I learned what respect in therapy (as a verb) really can and needs to look like, along with how to get there. I am not saying I did not know how to respect people. My family raised me well! But, FFT work deepened my sense of it and how I embodied it in therapy. I also do alot of my own personal and professional growth around bias and showing up for people of all identities (and I recommend that for all). 

Respect in FFT: who are you really? Can I see and speak to the dignity in all you have experienced and how you survived? And then, when it comes time to do the work - can I make it fit you? Not the “you” that society wants or the “you” I might want based on my own values or biases. No, FFT is talking about respecting the “you” that is true (and, PS also good and worthy). This requires listening to understand, challenging your own biases, observing patterns, thinking outside the box, being willing to take clinical risks and most of all: being humble. If I think I have you figured out based on a few pieces of information or even a lot of information, I begin to close my explorative mind and move towards solutions. Solutions that may not fit or make sense for you. And that is NOT respectful. Solutions and change will come, but not before both the therapist and family reach a place of belief in the worthiness of this process, the worthiness of therapist and the worthiness of the family themselves. You cannot get there without respect at the forefront. The families we work with are often placed in the fringes of society and have been viewed through a narrow lens. A lens which tends to see them one-dimensionally. Real respect is a three-dimensional view of all, whether you like what they do or not.

So much of this is about what my heart and soul are doing. So, get comfortable with getting in touch with both. But, what about the head? How do we really “DO” respect as a verb in therapy/FFT. This is particularly challenging (and exciting) in family therapy where you have multiple generations with different perspectives on the same issues, loads of love and loads of hurt. How do we do it when we are challenged, when we are tired, when we are triggered, when we are… human? (As of today, AI has not yet replaced human therapists!)

 Knowledge, wisdom, techniques, skill and heart… you need it all to meet unique needs of families. Let us focus on technique for a moment. What comes first in FFT?

1.    Before we even meet a family, we review some information about them to begin the process of attempting to see the world from their context (“pre-staffing”). We imagine strengths that may exist for them, we consider how our own identity may clash with or complement theirs and we talk through this with a diverse group of therapists who make up our FFT team. So, first you imagine and think about another’s perspective with real consideration of their various identities (racial, ethnic, spiritual, gender etc). You will also though recognize that our initial impressions may be askew. Thus, we do not hold onto them tightly, but rather these impressions are explored in order to broaden our minds about who we are meeting. It is easy to think narrowly in a busy world; pre-staffing a case in a group setting can remedy that.

2.    We watch and listen. We get to our first meeting and we immediately begin noticing how they interact, where positivity occurs, what decorates and adorns their home that may tell us more about WHO they are rather than WHAT they may have done to get them referred to us. We see the people before we see the problem. The problem is just a moment in time. Who they actually are culturally, spiritually, stylistically and interpersonally tells us much more about them and what they need than presenting issues do. It’s not that risk and presenting problems are not important; it’s that they will never take precedence over seeing a family for all of who they are first and foremost. Observing behavioral patterns is a key element to this. But also, highlighting their strengths and hearing how they respond to that tells you much as well. FFT’s first three phases give you multiple techniques for accomplishing these tasks such as Pointing to Positive Interactions, Strength-based Relational Statements, Theme Hints and Function Assessment (just to name a few).

We work exceptionally hard to broaden the scope in which we see the family in front of us. We listen and engage, we help reveal more of their vulnerable and beautiful qualities by embodying non-judgment and respect and we create a space in which their deeper truths can exist all at once, all together. There is much more to what we do in FFT, but this is just a glimpse into the principles that guide us as clinicians.

For more information on FFT, please visit www.fftllc.com or to meet with one of our FFT-trained therapist, contact us at 610-390-6254 or fill out the form in the Contact Us section of the MTC website.