What is Multi-Family Therapy?

I would have liked to have worked with this family from Chicago.

I’ve been running multi-family therapy groups since 2005, and I think they are an essential part of any meaningful treatment for people that have either a substance misuse problem and/or a mental health concern. I ran the adult Multi-family group at Hunterdon Drug Awareness for 2.5 years and the adolescent one there for 5 years. For the last year, I’ve proudly co-facilitated the Multi-family group at College Recovery on Thursday nights. A strong Multi-family program has three parts:

(1) A group for clients-only that meets to discuss their own issues and their hopes/joys/concerns/fears/anger/resentment regarding their families.

(2) A group for family/friends/spouses only that meets to discuss their hopes/joys/concerns/fears/anger/resentments regarding their loved one who is in treatment. There should also be a strong element of psycho-education in this group, as well as an introduction to Al-Anon, Nar-Anon, Families Anonymous and a suggestion that family members get some individual, outside therapy as well. A lot of the advice that I’ve written for family members has sprung out of these groups.

(3) Groups 1 and 2 should happen at the same time and last 60 to 90 minutes. After a short break, the Multi-family group brings all the clients and all the family members together for 90 minutes.

Ideally, the Multi-family group should consist of 12 to 30 participants (it takes a strong facilitator to handle a group above 20). Each week, the following should happen at the start of group:

a) ground rules are set – members may not fight about what is talked about in group nor use it as a weapon against each other; cell phones off or on silent; one person speaks at a time; no yelling or cursing (well, I curse, but not at people…it’s part of the stand-up flavor of my groups)

b) confidentiality is explained – if members feel that other members have talked about them outside of group, they should talk to one of the counselors. There are five ways in which a counselor can talk about a client, and they include: a court order, record release, medical emergencies, elder/minor abuse, and threatening to harm oneself or others. If a member thinks that a therapist has talked about them outside of the program and it isn’t for one of the above five reasons, they should bring it up with the clinical director. This is important because people need to feel safe in a group. A good program explains confidentiality and group rules to all of its participants each week

c) introductions – everyone should state their name, where they are from, why they are here, how long they’ve been coming to group and then some kind of fun fact (it should be a theme each week – recently I’ve asked people to say their favorite condiment, time they were coldest, favorite charity/cause, and the actor/actress that they would cast to play themselves)

d) psychoeducation – each group should have a 10 to 30 minute educational component, where family roles, communication styles, brain chemistry, diagnoses, codependency, soft & hard skills, finances and/or other topics are covered

At this point, group turns to an activity or series of conversations. It can be daunting for first time attendees, so they are eased in very slowly (like a fish that you just brought home from a pet store – you let it sit in the bag of water for a while). Some people come every other week or once a month, and that can be helpful and therapeutic for their family. Without question though, Multi-family groups benefits clients and family members who show up on a weekly basis. Here are some of rewards:

a) normalization – Members realize that their problem is a common one, even universal. So often, families don’t discuss their problems because of shame. They think, “Our family is so screwed up,” and, “No one else goes through this,” or, “This is really embarrassing.” Watching and listening to other families talk about and work through these problems helps reduce the shame and stress and allows us to starting addressing the behaviors and emotions.

b) learning -This is a follow up to normalization. Families that come on a regular basis get to observe other families that come on a regular basis. Some of those families are ahead of them, and they can look to them to see the progress and hope. Other families come in after them, and they get to role model for them and also see just how far they have come. A 20 year old man may be extremely frustrated and annoyed by his mother, but he might be able to sympathize with someone else’s mother in the group when she talks about the sleepless nights, anxiety and heartache that she has experienced. By identifying with her, he is able to see his mother in a different light.

c) support – A new community (even culture) is created in the Multi-family group. Members watch, listen, share, laugh and cry together for a number of months. Bonding takes place. We root for each other, and celebrate when good things happen. It truly is a community.

d) practice – Multi-family group gives members a safe place to practice new forms of communication. They both watch others and practice themselves how to address someone without yelling, cursing or belittling and how to answer without rationalizing, excusing or blaming. Members are given multiple sessions on how to identify, acknowledge, accept and ultimately share their emotions. When people become more emotionally mature and supplied with better communication skills, they begin to see their relationships improve.

It is important that family group be long enough (I have found that 90 minutes is ideal). The group room needs to be large and comfortable. Staffing is crucial – a single staff member can handle a group up to 15 people, but anything more than that should have two counselors in it (but it is a good idea for any sized Multi-family group to have two therapists). Those counselors should work together well, observe all the group members (and constantly scan for non-verbal cues and inattention). Both should have a strong working knowledge of the clients and their family members and, perhaps most importantly, bring a strong sense of levity and humor to the situation.