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.
In Generalization, through the strength-based and relational lens of FFT, the clinician is now tasked with supporting the family with:
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.
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.
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.
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.
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:
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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