FFT Model Effectiveness

Since 1971, the efficacy and effectiveness of FFT has been established in numerous research studies. The original studies were conducted by Alexander and colleagues at the University of Utah. Over time, independent replications and extensions of findings have been completed by other research teams. The positive effects of FFT have been observed for adolescent substance use and delinquency, and family functioning.

Below, we provide a list of studies documenting the impact of FFT on adolescent problem behaviors and family functioning. The list is divided into two sections. The first section includes highly controlled efficacy trials. The second includes effectiveness and quasi-experimental studies. In the second section, we also included a recent meta-analysis that compared effect sizes in FFT to other interventions for adolescent substance abusers.

Efficacy Trials (Citations)

  1. Alexander, J., & Parsons, B. (1973). Short-term behavioral intervention with delinquent families: Impact on family process and recidivism. Journal of Abnormal Psychology, 81(3), 219-225. doi:10.1037/h0034537.

  2. Parsons, B., & Alexander, J. (1973). Short-term family intervention: A therapy outcome study. Journal of Consulting and Clinical Psychology, 41(2), 195-201. doi:10.1037/h0035181.

  3. Alexander, J., Barton, C., Schiavo, R., & Parsons, B. (1976). Systems-behavioral intervention with families of delinquents: Therapist characteristics, family behavior, and outcome. Journal of Consulting and Clinical Psychology, 44(4), 656-664. doi:10.1037/0022-006X.44.4.656.

  4. Klein, N., Alexander, J., & Parsons, B. (1977). Impact of family systems intervention on recidivism and sibling delinquency: A model of primary prevention and program evaluation. Journal of Consulting and Clinical Psychology, 45(3), 469-474. doi:10.1037/0022-006X.45.3.469.

  5. Friedman, A. (1989). Family therapy vs. parent groups: Effects on adolescent drug abusers. American Journal of Family Therapy, 17(4), 335-347. doi:10.1080/01926188908250780.

  6. Waldron, H., Slesnick, N., Brody, J., Turners, C.W., & Peterson, T.R. (2001). Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments. Journal of Consulting and Clinical Psychology, 69(5), 802-813. doi:10.1037/0022-006X.69.5.802.

Effectiveness Studies/Quasi-Experimental Studies (Citations)

  1. Barton, C., Alexander, J. F., Waldron, H., Turner, C. W., & Warburton, J. (1985). Generalizing treatment effects of Functional Family Therapy: Three replications. American Journal of Family Therapy, 13(3), 16-26. doi:10.1080/01926188508251260.

  2. Gordon, D., & Arbuthnot, J. (1988). The use of paraprofessionals to deliver home-based family therapy to juvenile delinquents. Criminal Justice and Behavior, 15(3), 364-378. doi:10.1177/0093854888015003008.

  3. Gordon, D., Arbruthnot, J., Gustaffson, K.E., & McGreen, P. (1988). Home-based behavioral-systems family therapy with disadvantaged juvenile delinquents. The American Journal of Family Therapy, 16(3), 243-255.

  4. Gordon, D., Graves, K., & Arbuthnot, J. (1995). The effect of functional family therapy for delinquents on adult criminal behavior. Criminal Justice and Behavior, 22(1), 60-73. doi:10.1177/0093854895022001005.

  5. Waldron, H.B., & Turner, C.W. (2008). Evidence-based psychosocial treatments for adolescent abuser: A review and meta-analysis. Journal of Clinical Child and Adolescent Psychology [Special Issue: Evidence Based Psychosocial Interventions for Clinical Child and Adolescent Disorders], 37, 1-24.

The effectiveness of FFT has also been replicated by Kjell Hansson and colleagues in Sweden. In three separate studies, the effectiveness of FFT with juvenile offenders has been evaluated. These studies are available in Swedish only. The results of these evaluation were presented in Santa Fe, New Mexico in 1998. [Hansson, K. (1998). Functional family therapy replication in Sweden: Treatment outcomes with juvenile delinquents. Paper presented to the Eighth International Conference on Treating Addictive Behaviors. Santa Fe, NM, February.]

Dissemination and Training Materials

FFT has rigorous implementation and dissemination procedures and materials. Currently, the dissemination organization responsible for transporting the clinical model into community settings, FFT Inc., has trained more than 270 local, state, national and international organizations. Over 1100 FFT therapists have served over 12,000 families around the globe, with large scale multi-site implementations ongoing in California, Washington, Pennsylvania, New York, Florida, and the Netherlands. To address the key issue of enhancing treatment competence, FFT LLC recently developed and implemented a sophisticated web-based application designed to monitor highly structured FFT therapist progress notes, as well as supervisor and client ratings of therapist competence.

To support implementation, FFT has well developed treatment and training and supervision manuals. FFT also has extensive procedures for training sites during set-up and monitoring aspects of sites during implementation, including well developed systems for training on-site supervisors and booster trainings. A brief description of these training materials are provided below.

  1. Treatment Manual: FFT utilizes a training manual developed for one primary purpose: To prepare future Functional Family Therapy (FFT) trainees for Phase 1 of FFT training and certification. The current manual is a version of the original manual created for the Blueprint series through the Center for the Study and Prevention of Violence (University of Colorado at Boulder) in 1999. The manual includes information about all aspects of the FFT model (pretreatment activities and in-session activities for all three phases). In addition to the full manual, therapists are provided with a brief pre-training manual to provide an orientation to FFT prior to attending workshops. See attached FFT Treatment Manual and FFT Pre-Training Manual.

  2. Supervision Manual: FFT follows a prescribed format for conducting weekly group supervision with therapist teams. The procedures for supervision have been refined over the past decade of practice. Note: Revisions are currently being made to the existing Supervision Manual. The original manual is available upon request.

Change Mechanism Research

Finally, over the past three decades, intensive research on the clinical interior of treatment has been an essential component in the development of FFT. In fact, for over three decades, the articulation and understanding of mechanisms of action in FFT has evolved through a systematic program of research and clinical practice. This research complements the outcome studies reviewed above by providing information about the critical mechanisms of action of FFT that may account for positive outcomes with youth and families. Below, we provide references of exemplars of these process studies.

  1. Alexander, J. F. (1973). Defensive and supportive communications in normal and deviant families. Journal of Consulting and Clinical Psychology, 40(2), 223-231.

  2. Alexander, J. F., Barton, C., Schiavo, R. S., & Parsons, B. V. (1976). Behavioral intervention with families of delinquents: Therapist characteristics and outcome. Journal of Consulting and Clinical Psychology, 44(4), 656-664.

  3. Warburton, J. R., & Alexander, J. F. (1983). Treatment of female delinquency: Perspectives and techniques. In E. A. Blechman (Ed.), Behavior modification with women. New York: Guilford.

  4. Warburton, J. R., & Alexander, J. F. (1985). The family therapist: What does one do? In L. L'Abate (Ed.), The handbook of family psychology and therapy. Homewood, IL: The Dorsey Press.

  5. Barton, C., Alexander, J. F., & Turner, C. W. (1988). Defensive communications in normal and delinquent families--the impact of context and family role. Journal of Family Psychology, 1(4), 390-405.

  6. Alexander, J. F., Waldron, H. B., Barton, C., & Mas, C. H. (1989). Minimizing blaming attributions and behaviors in delinquent families. Special series on marital and family disorders. Journal of Consulting and Clinical Psychology, 57(1), 19-24.

  7. Morris, S. M., Alexander, J. F., & Turner, C. W. (1991). Do reattributions reduce blame? Journal of Family Psychology, 5(2), 192-203.

  8. Newberry, A. M., Alexander, J. F., & Turner, C. W. (1991). Gender as a process variable in family therapy. Journal of Family Psychology, 5(2), 158-175.

  9. Robbins, M.S., Alexander, J.F., Newell, R.M. & Turner, C.W. (1996). The immediate effect of reframing on client attitude in family therapy. Journal of Family Psychology, 10 (1), 28-34.

  10. Robbins, M. S., Alexander, J. F., & Turner, C. W. (2000). Disrupting defensive interactions in family therapy with delinquent adolescents. Journal of Family Psychology, 14, 688-701.

  11. Robbins, M.S., Turner, C.W., Alexander, J.F., & Perez, G.A. (2003). Alliance and dropout in family therapy with drug using adolescents: Individual and systemic effects. Journal of Family Psychology, 17(4), 534-544.

  12. Flicker, S.M., Waldron, H.B., Turner, C.W., Brody, J.L., & Hops, H. (2008). Ethnic matching and treatment outcome with Hispanic and Anglo substance-abusing adolescents in family therapy. Journal of Family Psychology, 22(3), 439-447.