Grupos multifamiliares: história e conceitos

This paper, which has been produced from the experience that we have developed since 1995 with multi-family groups, intends to highlight the multifamily therapy in the field of psychotherapy, group therapy and family therapy. Family therapists have been faced with several families who live in contexts of extreme vulnerability. These families are marked by intense suffering and helplessness engendered more by socio-cultural issues than by psychiatric “deviations”. This fact has made rethink the psychotherapy practice, based on the tradition of individualistic psi practices with the necessity of recovering the historical and social dimension of subjectivity production and psychological distress, to rescue the collective strength, both in the disease production and in the invention of health. Believing in healthy resources of families and communities, the redemption of subjectivity and citizenship of these suffering individuals as protagonists of their stories can be through the sharing of their pains and hopes. Thus, the aim is to present the creative and “subversive” alternative of multi-family groups – subversive of some ideological postures that operate in favor of the dichotomy between public and private, alleging that mental suffering, often perceived as a private matter, is actually produced in collective, therefore, social and political, rather than intrapsychic or familiar. Initially, we describe the emergence of group therapy in its historical, theoretical and epistemiological aspects, as well as the incorporation of multifamily and networks paradigm in the family therapy field. Some concepts about group therapy and multifamily group therapy, as well as some advantages and disadvantages of these approaches are presented. Key words: multifamily groups, group therapy, psychotherapy.

IntroductionThe American Psychiatric Association and NICE’s Guidelines for schizophrenia recommend psychosocial interventions as adjuvants to pharmacological treatment, highlighting the role of cognitive behavioral therapy for psychosis, psychoeducation, family intervention, cognitive remediation, autonomy training, social skills training, and supported employment. Although highly recommended in their individual forms current guidelines make no definitive statement about their group applicability.ObjectivesThe goal of this work was to critically review the evidence of group interventions in schizophreniaMethodsNon-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “schizophrenia”, “group therapy”.ResultsGroup therapy has shown important benefits in different conditions over the years, likely through mechanisms such as peer motivation, controlled confrontation, increased insight and even a tendency to homogenous results between group participants through peer influence. These results have been reproduced in schizophrenia though the benefits of applying group concepts to structured psychosocial interventions is still under study.ConclusionsRecent evidence suggests some evidence-based interventions can be applicable in group form, namely social skills training, cognitive remediation, psychoeducation, and multifamily groups, synergizing the already known benefits with newer therapy models and decreasing costs for patients and healthcare systems. Adequate controlled studies between individual and group therapy will shed further light on this matter.DisclosureNo significant relationships.

The paper discusses varieties of group therapies with refugees and torture survivors and the logic behind enhancing traditional group therapies to fit the unique experiences of refugees and torture survivors. It discusses some lessons learned from practice and from empirical research and some recommended adaptations. Finally, it discusses the Center for Torture and Trauma Survivors’ therapy group model for torture survivors and describes two of its variants: The Bashal group for African and Somali women and the Bhutanese multi-family therapy group. Group therapies, in this model, extend to community healing. One of the essential and innovative features of the model is that it focuses not only on treating individual psychopathology but also extends to community healing by promoting the development of social clubs and organizations that promote the values and culture of the graduates of the therapy group and the continuation of social support. New graduates from the group join the club and become part of the social advocacy process and of group and community support and healing. This model adds an ecological dimension to the traditional group therapy.

In 1970, Nathan Ackerman challenged the field of marriage and family therapy to actively involve young children in the family therapy process. How has the field of marriage and family therapy responded to his challenge? Using a systematic research synthesis to review and critique the non-empirical and empirical literature in the area of children in family therapy, the author discovered that the field of marriage and family therapy has not responded to Ackerman's challenge in the way he may have hoped for nearly three decades ago. A summary of the literature's findings is provided and recommendations for future research, as well as implications, for the field of marriage and family therapy are discussed.

The Oklahoma City Veterans Affairs (VA) Medical Center modified an evidence-based model offamily psychoeducation (the multifamily group model; McFarlane, 2002) and implemented it for thefirst time in a VA setting and with veterans living with posttraumatic stress disorder (PTSD). Namedthe REACH Program (Reaching out to Educate and Assist Caring, Healthy Families), the 3-phaseprogram begins with 4 weekly “joining sessions” with the individual veteran and his/her familyfocused on rapport building, assessment, and goal setting. Phase II consists of 6 weekly diagnosis-specific educational/support sessions for cohorts of 4 to 6 veterans and their families. In Phase III,veterans/families attend 6 monthly multifamily groups to support the maintenance of gains. Thisarticle describes the rationale for modifying the original Multifamily Group Program (MFG) for aunique setting (the VA) and the needs of families of veterans in a new diagnostic group (PTSD). Thechanges to the MFG curriculum are specifically described, and details of the new REACHintervention are explained. Attendance, retention, and satisfaction data for 2 diagnostic cohorts,PTSD and affective disorders, are also presented.Keywords: family psychoeducation, PTSD, affective disorders, family therapy, multifamily group

Eating disorders are complex psychiatric disorders characterized by compensatory and restrictive behavior and a preoccupation with one's body. Eating and purging behaviors are considered dysfunctional emotional regulation strategies. Therefore, psychological treatment is essential. The most common psychological interventions are dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), family therapy (FBT), multi-family group therapy (MFTG) and mentalization-based treatment (MBT). The aim of this study was to summarize the current evidence on the impact of psychological treatments on emotional regulation difficulties and psychological symptoms in patients with eating disorders, especially anorexia nervosa. A search was conducted on PubMed and Web of Science using the terms "anorexia nervosa" and "emotion dysregulation". Of the 278 initial articles, we included 15 publications. The results indicate that the acquisition of coping strategies, through DBT, leads to an improvement in anxiety and alexithymia. DBT, CBT and MBT lead to a reduction in the use of dysfunctional emotional regulation strategies too. Eating disorders involve both physical and mental health; therefore, it is desirable for future research to focus on the mutual synergy between the mental and physical components by evaluating various factors, such as biomarkers and the most appropriate therapeutic approach, with respect to the treatment setting.

Introduction There are two groups of psychotherapies. The one that is informed by ‘academic psychology’ emphasises techniques that have been empirically validated by experimental procedures. The second group is that which develops using clinical thinking. The former group of therapies are mainly represented by the behavioural and cognitive psychotherapies and by combinations of the two. The second group are represented in this chapter, by reference to psychoanalytic psychotherapy and family systems thinking, although there are actually vast numbers of other therapies, humanistic, gestalt, existential and so on, which fall within this set. The first group of psychotherapies can be thought of as relying on quantitative methodology and the second upon qualitative research, although any attempt to make exclusive definitions founders. Clinical intuition cannot be precluded from any therapy and all therapies can, in principle, be validated using empirical techniques. Clinical method depends upon the use of continuous observation of patient response to inform the development of therapy in general, and with a particular patient. This is a form of empirical validation. This chapter is about the second group of therapies: those deriving from the psychodynamic tradition in combination with family systems thinking. The additional integration of thinking from the field of child psychotherapy and family therapy, into the practice of psychotherapy, contributes resources both to the conceptual schemes and practice. Child psychotherapy demonstrates that communication does not require verbalisation. Dance therapy, music therapy and drama therapy (not to say psychodrama) are psychotherapeutic tools available for adults who, for whatever reason, cannot produce an account of their experience in words, to engage in expressive therapy. Family therapy has shown the therapeutic power of utilising the intimate social network, within which most of our patients live. This chapter recommends that those who wish to practice psychotherapy look to an expansive spectrum of practice to seek effective techniques. The author's own work, in the field of eating disorders, has shown disparate reactions to different treatments depending both on illness characteristics and such factors as age of onset and duration of illness (Dare and Crowther, I994 a,b ; Dare and Eilser, 1994, 1995). The difference in response to treatment in different age groups of patients can be understood as a function of interactional aspects of development that constitute the family life cycle rather than as simply an age-related function.

Qualitative research is becoming accepted by the scientific community as a viable way to explore and understand socialscience phenomena. The purpose of this paper is to describe the essential features of the qualitative research paradigm and to encourage further development of that paradigm in the field of family therapy. First, typical characteristics of qualitative research designs are delineated; these characteristics are illustrated with two extended examples from the qualitative research literature in the field of education. Next, possible applications of the qualitative paradigm to research issues in the field of family therapy are discussed. Finally, potential pitfalls that could inhibit the development of qualitative family therapy research are examined. It is hoped that this paper will serve as a stimulus for the development of qualititative research in the field of family therapy.

Acquired brain injuries (ABI) can have a major impact on social participation, causing increased social isolation and emotional distress for people with the injury and their family members. Multifamily Group Therapy (MFGT) provides information, resources, problem-solving strategies and opportunities for social networking for families where one member has an illness. By qualitatively examining the experience of group participation from the perspectives of both individuals with ABI and their family members, the present study aimed to elucidate the processes underlying and factors influencing success of facilitated MFG programmes with families impacted by ABI. Following participation in the 12-week MFGT, 29 individuals with brain injury and 30 caregivers participated in 90-minute, semi-structured focus groups. The overarching theme emerging from the transcripts was that of “Finding One's Place”, with sub-themes of Connectedness, Identity, and Knowledge and Understanding. The MFGT experience made a contribution to participants' efforts to find their place in the world after an ABI. This was enhanced by connection with others within the group, sharing experiences, the development of self and family identity, and the gaining of knowledge and understanding. These findings consolidate a growing literature, which points to the importance of “Reconstruction of a place in the world” and “Reconstruction of personhood” in ABI recovery.

This article reviews and evaluates available research on multicultural training within the field of marriage and family therapy. Four top-tier journals in the field of marriage and family therapy (Journal of Marital and Family Therapy, American Journal of Family Therapy, Contemporary Family Therapy, and Family Process) were used to identify studies on multicultural training. A total of 15 studies met inclusion criteria for review. Following an account of existing trends within the marriage and family therapy multicultural training literature, we provide a critique of the research reviewed and make numerous recommendations for future research in this area.

This paper presents a review of the current literature on cotherapy with special reference to therapeutic outcome. The review covers the fields of sex therapy, group therapy, and family and marital therapy. It considers both patient variables and cotherapist variables. There are few "research" studies of cotherapy. Most data derive from case illustrations, which, however well detailed, are anecdotal in nature. The most widely addressed effect of cotherapy upon patients is presented in terms of treatment process and not treatment outcome.

Target Complaints as Criteria of Improvement

To set the stage for this chapter, background information is presented on family systems theory. This is followed by a section on the characteristics of individual families, which emphasizes family development; family structures/types; family normalcy/health and dysfunction; and meaning, beliefs, and rituals. Attention is then turned to a discussion of the major theoretical models that serve as the basis for family therapy as it is practiced today. The family therapy models that are examined include: psychodynamically oriented, experiential/humanistic, communication, strategic, structural, behavioral and cognitive‐behavioral, transgenerational, psychoeducational, and systemic/Milan. This is followed by a brief review of more current and evolving approaches such as solution‐focused, solution‐oriented, reflecting team, externalization and reauthoring lives and relationships, therapeutic conversations, and integrative. Information is also presented on culturally competent family therapy and gender‐sensitive approaches to family therapy. Specific applications of family therapy are delineated related to medical problems, substance abuse, and family violence. After a presentation of the major empirical findings related to the efficacy and effectiveness of family intervention approaches, future directions for practice and research within the field of family therapy are provided.

Therapeutic modalities centered in interpersonal processes, in structural phenomena, and in reality constructions--the three care orientations in the field of family therapy--are here defined as mutually nonexclusive "translations" of the systemic paradigm into clinical practice. This definition does not attempt to blur the distinctions among these models but seeks to show their common denominator and thus expands the conceptual and clinical repertoire of the systems-oriented family therapist.

Traditional psychodynamic terms used in describing, diagnosing, and treating individual patients have proven less than helpful in working with families. In an attempt to alleviate this difficulty, and as an aid to the newcomer in the field of family therapy, this glossary of terms is presented. This glossary is not meant to be all-inclusive. Rather, its purpose is to provide the new family therapist with an introduction to the language of the field, an armamentarium from which to work, and to provide a basis of knowledge that is usually not accumulated by the new family therapist until he or she has worked with a number of families over a period of time.