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.

Introduction: School refusal is an important public health concern in adolescent psychiatry increasing over the past several years (5% of child and adolescent psychiatry consultations in France). Multifamily therapy has developed over 30 years. Its efficacy is validated in adult, child and adolescent psychiatry, including for children at risk of school exclusion. In this study, we aimed to explore the adolescents and their parent's experience of a multifamily therapy treatment of school refusal with a qualitative method.Materials and Methods: This qualitative study is based on an Interpretative Phenomenological Analysis approach. We conducted 15 semi-structured interviews, participants were adolescents (n = 6) and their parents (n = 9) who experienced multifamily therapy in an adolescent department in Paris. Data analysis was performed independently by two researchers.Results: For the six families, school was a source of suffering, system paralysis and social exclusion. Families reported painful emotions and separation anxiety. For teenagers, multifamily therapy increased self-confidence and allowed group experience. For parents, it gave support and relieved from feelings of stigmatization and guilt. Parents became more aware of their adolescent's suffering and their insight. They all considered that multifamily therapy improved intra-family communication and expression of emotion. Participants highlighted the benefits of intergenerational interactions, activities, group and guidance from therapists.Discussion: Multifamily therapy uses therapeutic tools from both family therapy (joining, resonance, family competence, and metacommunication) and group therapy (use of media, identity device, and mirror reactions). Parents expect school solutions from multifamily therapy and question how psychiatric treatment can deal with school, school refusal being therefore understood as a social functioning disorder.

Multifamily therapy (MFT) is a unique treatment approach that is growing in popularity for adolescents with anorexia nervosa (AN) and their families. MFT aims to create change through experiential and activity-based content and purposeful use of group processes. Despite growing evidence supporting MFT's efficacy, there is limited understanding of possible mechanisms of change. This study explored interactive group processes associated with MFT for adolescent AN and how these processes may influence change in MFT. A short-term ethnographic field approach was taken with observational data collected across two MFT groups. Qualitative interviews and focus groups were also conducted with young people, parents, and facilitators following each group. The data were analyzed using reflexive thematic analysis. Five themes and seven subthemes were generated, and a hypothesized model based on these themes was developed. Relational processes (Theme 1) and learning processes (Theme 2) occurred within individual families and between families in the group. These processes were understood to contribute to whole group dynamics (Theme 3) where emotional safety and momentum built across the week. Facilitator responsiveness (Theme 4) was crucial in navigating uncertainty and supporting these processes. These themes were understood to be interconnected and contributed to a way forward toward recovery (Theme 5) for individual families and for the group as a whole. These findings suggest that several unique group processes play an important role in promoting change within MFT. Consequently, MFT may offer a valuable alternative for families for whom traditional single-family therapy has not been effective.

Multi-family therapy (MFT), a blend of systemic family therapy and group therapy, has been widely applied in Western countries since the 1950s. Although indigenous models of MFT have recently been developed in Chinese contexts such as Hong Kong and Singapore, the treatment modality remains new to helping professionals in China. This article describes a short-term training in MFT which comprises theoretical and experiential components, and reports the results of our evaluation in regard to the training effectiveness. Between April 2023 and September 2024, 232 helping professionals participated in training workshops conducted in four cities in China: Hong Kong, Hangzhou, Shenzhen, and Kunming. The training model was deemed helpful in promoting the perceived conceptual, perceptual, and executive competencies concerning MFT, and trainees with less work experience benefited from the training more than experienced trainees. This article discusses the value of short-term training and experiential exercises for enhancing perceived competencies in MFT.

Background Multifamily groups (MFG) have shown to reduce the risk of relapse of psychotic symptoms in first episodes of psychosis (FEPs) but are not frequently implemented in treatment programs. This paper describes the implementation of the interfamily therapy-model in a FEP early intervention program within a Mental Health Centre in Spain . The aims were to examine (a) relapses (measured as re-hospitalization), (b) duration of re-hospitalizations and (c) voluntary versus involuntary re-hospitalizations during participation in MFG compared with the previous year. Methods Twenty-one subjects participated in a MFG over 12 months, 11 participants with a diagnosis of psychosis and 10 family members. Results Patients and their relatives participated in around 50% of treatment sessions and manifested satisfactory experience during treatment. Among the patients who participated in MFG, a lower relapse rate was observed: a lower number of psychiatric admissions (7 versus 3) and of shorter duration [23.57 (SD 18.5) days pretreatment versus 19.33 (SD 10.2) days during treatment] although it was not statistically significant (p > 0.05), probably due to small sample size. Discussion Multifamily therapy has been well accepted by both patients and their families, with a high degree of participation. Our impression is that the simultaneous participation in different therapeutic activities (individual, group and multifamily) improves the experience of the therapeutic process.

Multifamily therapy (MFT) for adolescent eating disorders (ED) is anchored in systemic theory and family therapy, but two conceptual and practical paths have emerged from this common framework. The first one, called ED-focused MFT, is centered on behavioral change and weight gain in the early stages of treatment, while the second, known as relationship-focused MFT, is less directly focused on symptom improvement and more on family changes. Compared to ED-focused MFT, validation of more relationship-focused MFT models has been lagging behind although they are frequently implemented and practiced in Europe. The purpose of this article is to give more visibility to existing relationship-focused MFT models by presenting an integrative, yet predominantly family-oriented MFT program developed for adolescent anorexia nervosa (AN) (12 to 18 years) on the ED unit of a large pediatric hospital in France. After presenting the history and development of this relationship-focused MFT program, including the challenges it encountered and its evaluation, we describe its rationale and objectives, then outline its course and content, giving illustrations of techniques and activities for each of the five phases of the program. Finally, we review the current status of this model, its advantages and limitations, and provide a critical appraisal of existing evidence and recommended future research directions.

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.

multifamily group therapy

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.

The therapeutic alliance is central to couples and family therapy. Although the formal concept of therapeutic alliance has not been used widely within the family therapy field, virtually every prominent clinical theorist has addressed the importance of establishing and maintaining a positive therapeutic relationship with the family. The alliance in couples and family treatment differs from the alliance in individual psychotherapy in that the couples and family therapist must establish and maintain multiple alliances. They also must adopt a conceptual framework that accounts for the interactions within triangles or three-person systems, recognize the influence of the system operating on him or her, and appreciate how different models of family therapy define the position of the therapist in relation to the couple or family. An integrative review of the therapeutic alliance in couples and family therapy is followed by a discussion of problems in the therapeutic relationship. Two general clinical strategies for managing difficulties in the alliance then are illustrated through case vignettes. © 1995 John Wiley & Sons, Inc. J Clin Psychol/In Session 56: 211–224, 2000.

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 Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders

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

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 therapeutic alliance concept has been confined primarily to the literature on individual psychotherapy. This paper formally introduces the concept into the family and marital therapy domain and presents various clinical hypotheses about the nature of the alliance and its role in familyand marital therapy. A systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework. The implications of this integrative‐alliance concept for family, couple and individual therapy research are examined. Three new system‐ically oriented scales to measure the alliance in individual, couple and family therapy are presented along with some preliminary data on their methodological characteristics.