Functional Family Therapy

*PROGRESS NOTE
Motivation/Engagement Phase
(Early Sessions)
~ *SAMPLE PROGRESS NOTE ONLY ~
Client Name / Case Number: Youth Session
Doe / 11111-1111 Date: 00/00/00
Therapist #: Session Number: 1

This Session: Engagement/Motivation Phase

Goals of the session and progress made toward those goals in this session

Present: Mom, youth and youth’s younger sister (9 years

old). The family presented as friendly and good-natured.
They laughed with each other, and this therapist, frequently.
Youth's mother was talkative and immediately discussed the
number of stressors in her life (can't make mortgage
payments, single-parent, bills overdue, mental health and
medical issues). She also discussed the kids' fighting as
Initial Family
another stressor. Youth was friendly, but not talkative. His
Presentations
mother often interrupted when he spoke (not in a negative or
blaming way, just added to what he was saying). His sister
was quiet and told her mom she would not speak and did not
want counseling. She eventually became a bit more talkative
and pleasant with this therapist.
The kids identified a partial problem in mom's mood
changes (when "manic" she is "annoying").

SESSION INTERVENTIONS
Youth had a football sports jersey on, which prompted a
brief Super Bowl discussion. He smiled and relaxed upon
Relationship Building
starting with this conversation. See "Matching" for further
relationship building.
Initial Family Presentations Addressed Through:

In pre-engagement, learned that sister was unhappy about

Matching starting services. She stated to her mother that she would
not speak. This therapist did not press her to talk, but
 commented on her strengths to her mother. This way,
addressed her strengths without putting her off.
Youth's mother immediately jumped into listing the
number of stressors in her life. It was evident she was a bit
anxious about this and how she would be perceived. This
therapist acknowledged the level of stress that she is under,
which in turn becomes a stressor for the whole family
because she is a key part (responding to her being a strong,
single mother). The entire family is funny, so used humor
to approach topics that they were OK with (like mom and
dad's relationship). Remained serious and more
"professional" when discussing the things that mom
became more serious about (her mental health history,
previous abusive relationship). The family has a history of
a variety of services, so the use of professional language
mixed with a genuine humor seemed to work for them, as
it both solidified my expertise, but also made me
approachable.
Youth's mom was not negative, but was more problem
focused (the list of stressors, acting out of kids). She tends
to be excessive in her speech and this therapist could see
the children rolling their eyes or zoning out. Interrupted
her with a relational statement about "stress." Turned to a
discussion about the family's tight-knit relationships which
Interrupting/Diverting
is a huge strength and how when stressors become
unbearable, the family begins to lose patience with each
other. Turning to this theme of "stress and being intune to
each other" helped to quell mom's discussion of each
individual stressor, and rather led to a discussion about the
impact stress has upon them all.
Mom relayed what happens when she and her daughter are
bickering (which they are fine with but bothers Youth -
they all readily agreed with that). Sequenced it back to
them as: So, during times of light stress - everyone's
feeling pretty good - you and your daughter bickering may
be an annoyance to Youth, but you can all laugh it off.
Sequencing However, during times of high stress, maybe a bad day at
work/school, the bickering is more intense and Youth's
response is more intense. Youth, rather than escalate the
fight, goes to his room and cries in order to get out his
frustration. Mom picked up saying this inverted "acting
out" he does scares her. She is used to herself who is more
outward in the "freaking out."
Point Processing None in this session.
 Reframing None this session.
See "Interrupting/Diverting."

SBRS to mom about her being in-tune to the kids and

Strength-based respectful of their stressors as well. Discussed the rarity of
Relational Statements finding a parent who will acknowledge and be sympathetic
to the stressors of childhood and adolescence. This impact
was great in that she became even more relational in her
discussion of stress.
Theme Hints Stress, being in-tune w/each other

Relational Themes See "sequencing."

ASSESSMENT
Risk and Protective Factors

Therapist
Family Perspective
Which family member sees Perspective
factor as a problem? How important do you
see these factors?

Father Mother Adol Sib1 Sib2 Importance

Parenting Very

Communication Very

Problem Solving Little

Family Negativity Not

Adolescent Substance Not

Use

Parent Substance Use Not

School Attendance Not

Delinquency Behavior Not

Running Away Not

Peer Group Influence Not

Family Relationships Very

Marital Discord Not

Additional Protective and

Risk Factors

Relational Assessment

Behavioral Pattern
Youth's sister will go in his room - he asks her to leave because he wants privacy -
she will refuse - he'll ask again - she will refuse, and go further into his room - he
will, with clenched teeth tell her to leave...

Mom and daughter often go out. Youth will not go with them - he does not enjoy it.
They don't seem to take offense at all. When he has to accompany them, he is often
angry at them because they are loud and bring attention to themselves (they don't
notice - he does).
Relatedness Functions
Relationshp dyad How sure are you?

Mother figure...adolescent 2 Somew hat sure

Adolescent......mother figure 2 Somew hat sure

Father figure...adolescent
Adolescent......father figure
Husband.........wife
Wife............husband
Hierarchy Functions
How sure are you
Relationshp dyad
of this assessment?
Mother figure...adolescent 3, Symmetrical Very sure

Father figure...adolescent
Wife............husband

SESSION OUTCOME

Progress Progress
made toward this goal (this session) made toward this goal (overall)
 Balanced Alliance good good

Build Hope significant significant

Reduce Blame progress progress

Reduce Negativity significant significant

Building Relational Focus progress progress

NEXT SESSION PLAN

Phase Engagement/Motivation

Need to get more information about the family pattern -

Assessment Focused
would like to know how issue of his sister being in his room
Questions
gets resolved. Does mom step in?
Goal Focused Questions
Who to engage? (check all that apply)
Dad Sibling Adolescent Mom
This is a family where mental health issues have impacted
Specific Session Plan
Describe your targets and goals for your them for such a long time that they are on edge all of the
next session. Consider what is necessary to time. It seems that this edginess impacts their ability to talk
engage different family members, to create
a more relational focus, to motivate family about things when there is any additional stress. They all
members, and to assess relational functions
tend to shut down or shut each other down in different ways.
Between Session We set up a tentative session date but need to call mom on
Intervention Plans: Monday when she gets her work schedule for the week to
Describe what interventions (phone calls,
learning about family/community resources, make sure it’s okay.
etc) you plan before next session.

Review of assessments in session: no indication of

Agency Related suicide/homicide in assessments for all participants and
Information observed no evidence of this either (no hopelessness or
excessive sadness, etc).

Sample progress note provided by May Ambrogi. Names and

identifying information were changed in order to ensure
confidentiality of family.