The Relapse Prevention Plan: a key component in the Generalization Phase of the Functional Family Therapy (FFT) through FFT LLC. Functional Family Therapy (FFT) is an evidence-based, community-based intervention that helps families reduce conflict, improve communication, and build healthier relationships. This final phase focuses on helping families maintain progress and prevent relapse into old patterns. When the FFT clinician and family have reached this phase, like a gymnast competing in the vault, they would’ve sprinted down the runway of Phase 1: Engagement, hurdled onto the springboard of Phase 2: Motivation, launched themselves onto the apparatus of Phase 3: Assessing Relational Functions, and performed their somersault in Phase 4: Behavior Change. Now it is time to stick the landing in Phase 5: Generalization.
What is the Generalization Phase in Functional Family Therapy?
In Generalization, through the strength-based and relational lens of FFT, the clinician is now tasked with supporting the family with:
- Generalizing the skills they’ve learned in Phase 4: Behavior Change to other domains outside of the home and/or other relationships with family members who were not involved in the FFT process
- Creating and implementing a plan to avoid relapses and maintain progress
- Linking families to community resources and/or extrafamilial supports for sustaining change
In short, the Generalization Phase is where families learn how to apply their new skills in everyday life and avoid falling back into old behaviors. This is also where relapse prevention planning becomes essential.
Why Does Relapse Prevention Matter?
Relapse prevention is an important aspect to helping families “stick the landing” of what they have achieved through the FFT process. Alexander et al, 2013 notes, “Risk for recidivism or a lapse back to former problem behaviors or interaction patterns can threaten the gains families have made.” In light of these risks, “Active planning for relapse prevention…is essential for a successful Generalization Phase.” (Alexander et al, 2013). The focus of this blog is about using creative strategies such as storytelling to support families with preventing relapses into negative and unpleasant situations.
The Power of Storytelling in Relapse Prevention with FFT
Storytelling is an impactful way to relay information. Vanessa Boris in her article on What Makes Storytelling So Effective For Learning? notes that “learning which stems from a well-told story is remembered more accurately, and for far longer, than learning derived from facts and figures.” In Functional Family Therapy, storytelling can help families connect to their experiences and remember important lessons about behavior change and relapse prevention. As a result, the focus is to help the family develop a plan that they can relate to, one that is memorable, and one that is doable. A plan framed in the form of a story can do just that.
Below is a story entitled “An Autobiography in 5 Short Chapters” by Portia Nelson. From this story I will share how it can relate to our families and layout the key elements for relapse prevention. It reads as follows:
Chapter 1: I walk down the street. There is a deep hole in the sidewalk. I fall in. I am lost. I am helpless. It isn't my fault. It takes forever to find a way out.
Chapter 2: I walk down the same street. There is a deep hole in the sidewalk. I still don't see it. I fall in again. I can't believe I am in the same place. It isn't my fault. It still takes a long time to get out.
Chapter 3: I walk down the same street. There is a deep hole in the sidewalk. I see it there, I still fall in. It's habit. It's my fault. I know where I am. I get out immediately.
Chapter 4: I walk down the same street. There is a deep hole in the sidewalk. I walk around it.
Chapter 5: I walk down a different street.
What is the Story's Journey Teaching Us?
In Functional Family Therapy (FFT), stories can mirror the real-life journey that families experience during treatment In this story, we find the main character who, like many of us and our families, is on a journey. In the process of traveling they fall into an unpleasant situation that causes despair and is full of blaming and negativity. Like many of us and those in our families, this character has found a way to survive but finds herself in a negative pattern that leads to continual failure and disappointment.
Finally, after many relapses, our lead character takes responsibility for their part in the process. The system hasn’t changed, but their view of the system and their part in it has. This process leads our character to another point of change. The journey is the same but now armed with new skills and an improved outlook, our character has learned to do something different: walk around the hole. This upgrade of thought and perspective then inspires our character to take a whole new path entirely.
In my experience in sharing this story with families, I’ve found that they get the point for themselves and others immediately. Even though they may understand the story, a concrete plan for preventing relapses still needs to be mapped out and constructed. Developing that plan in collaboration with the family allows the FFT clinician to connect the story’s lessons directly to real-life triggers, thoughts, and behaviors.
Matching the Story to Relapse Prevention Elements
Below is an example of how the principles of this story match many of the elements for creating a plan to prevent relapses. The principles and correlations are as follows:
- Element 1: Identify a negative situation [“the deep hole”]. It’s important to help the family identify negative situations they would like to avoid. Most likely this “deep hole” has already been identified in the Motivation phase. However, reviewing those unpleasant places is important when helping the family to develop prevention of falling back in.
- Element 2: List the thoughts, feelings, and behaviors that could lead the family to relapse [“the same street and sidewalk”]. Helping the family to think through and review their way of thinking which could lead to falling into negative spaces, enables the family to further their self-awareness. These may include cognitive distortions such as snowballing, mind reading, or jumping to conclusions. Encourage families to notice feelings like irritation, hurt, boredom, or anger—these often signal that relapse risks are increasing. Likewise, recognizing small behaviors (e.g., clenched fists, raised voices, avoidance) can help identify warning signs before escalation. Most of these warning signs are not new, for the family they’re the same street and the same sidewalk that our character walked down in her story.
- Element 3: The Potential relapse in 5 steps or warning signs [“the same street and sidewalk”]. Next is leading the family to understand their own narrative when it comes to relapses and having them right down or view them in writing, whatever approach matches better to them. The relational pattern understood in Motivation comes into play here for the family to review and discuss. Again, each thought, feeling, and behavior can lead them to fall into the “deep hole” which they are seeking to avoid.
- Element 4: List behaviors that you will do differently when the warning signs are happening [aka “walking around the hole or down another street”]. Here is where we guide family members in reviewing the skills they developed and practiced in Behavior Change to remind them that they have more improved abilities to do something different. The family may have discovered new things they can do to avoid those spaces and add them in to this new chapter in their pattern. The FFT clinician should remain aware of each family’s relational functions to ensure these strategies are realistic and tailored for success.
- Element 5: List behaviors that you will utilize to recover from a relapse if one were to occur. [“getting out of the hole]. The reality is that relapses do happen. In fact, relapses are a part of the process of growth and development. Helping the family to strategize ways to recover from the relapse is important. Those skills may include taking responsibility for their part, apologizing, making amends for errors, and the like. When families are equipped with these skills, it can make them more empowered to get up after a fall and continue maintenance their change.
The Impact of Matched Storytelling in FFT
Matching with families through storytelling to help them prevent and recover from relapses is an impactful way for them to remember and practice their plan. While storytelling may not fit every family’s style, it can be highly effective for those who connect with narrative learning. A memorable and relatable relapse prevention plan helps families sustain positive change long after therapy ends. In conjunction to generalizing skills and linking families to additional resources, having an effective plan for maintaining change is tantamount to “sticking the landing” in completion of Functional Family Therapy, setting families up for further success and empowering them to gracefully turn the page on to the next chapter of life.
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