Does multifamily therapy help parents of adolescents with anxiety-based school refusal? A qualitative approach

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.

BackgroundThis paper addresses patients` and families` experience of multifamily therapy (MFT) for young adults (18–22) with an eating disorder (ED). EDs are serious illnesses leading to lowered quality of life for the patient and their family. The Regional Centre for Eating Disorders (RESSP) at Nordland Hospital in Bodø, Norway has developed an adjunct psychotherapeutic approach for the treatment of young adult patients with severe EDs. The patient’s family members take part in the multifamily therapy (MFT) group programme.MethodsThe aim of the study was to explore patients` and families` experience of MFT for young adult women with severe EDs. A Grounded Theory (GT) approach was used. Data were collected by field observations in two MFT groups, qualitative group interviews and qualitative individual interviews with patients and their family members. Data were analysed using the constant comparative method. The data analysis consisted of open and selective coding and memo writing.ResultsTwo main categories were identified: ‘Connectedness and recognition’ and ‘Opening up and sharing`. MFT was described as a space for recognition within which it was possible to speak of things happening in the family with others with similar difficulties. It felt good and freeing, but also painful, to meet others with similar experiences. The participants had in common a considerable loneliness because it is difficult for outsiders to grasp what it is like in a home dominated by an ED. The meeting with other families created an underlying safety. The participants received help to distinguish between realistic and unrealistic concerns and learned about openness and communication in relation to their daughter. Some women with EDs said that MFT was most important for the parents but also had been good for them as things had become better at home.ConclusionThe participants reported that their family had become better at talking to each other after having been in MFT. As a result, they were able to speak more openly about difficult things and share feelings. This gave rise to increased understanding. The study shows that MFT was found to be valuable and important. Never before had these families had such an opportunity, something so directly tailored to them. MFT for adults can be developed further and used in other groups, such as those concerning other chronic illnesses.

Background: Family therapy is considered as the gold standard in treatment of adolescents with anorexia nervosa (AN). Among the different types of family therapy, multi-family therapy (MFT) is increasingly used for treating AN, and shows promising results. In this article, our focus relied on the patients’ and their parents’ perceptions of the effectiveness and the underlying mechanisms of the MFT. Methods: The present pilot exploratory qualitative study included two focus groups conducted using a semi-structured approach: one with the adolescents (n = 3), and another with one or two of their parents (n = 4 mothers; n = 2 fathers). The subjects discussed were the changes observed in both AN symptoms and family interactions following therapy, and the mechanisms underlying these changes. We crossed the perspectives of the adolescents and of the parents on these two points. Results: Qualitative analysis revealed that while both adolescents and parents had difficulties relating the changes they observed in the last year to MFT, they were able to say that the group cohesion had several positive effects and that their family dynamics had improved. In the light of analysis the adolescents perceived more improvements related eating disorders symptoms than their parents did, while parents were concerned about a negative effect of MFT on their children. Discussion: While both patients and parents perceived improvements in both AN symptoms and family interactions in the past year, it was not clear if they considered MFT to have led to these improvements. FG also explored the MFT mechanisms underlying changes. Both adolescents and their parents stressed the beneficial effects of identification to others members of the group and shared experience to overcome social isolation. Parents also mentioned the sympathy they felt for each other. The idea that they give a central place to families in the therapy was also described by the families.

IntroductionPrevention of relapse in schizophrenia is a major public health issue. A recent network meta-analysis investigating interventions for relapse prevention in schizophrenia found that the efficacity of family psychoeducation and systemic integrated interventions were superior to treatment as usual at 12 months (Bighelli I, Leucht S et al. Lancet Psychiatry 2021). Other studies also found that multi-family therapies (MFT) were superior to treatment as usual and family psychoeducation in preventing relapses at 2 and 4 years (McFarlane WR, Lukens EP et al. Archives of General Psychiatry.1995). Considering this, we developped in our community center an MFT program based on systemic approach and psychoeducation.ObjectivesInvestigate the subjective experience of participants of an MFT group focusing on schizophrenia.MethodsA qualitative study was designed to explore personal experience of participants using the Interpretative Phenomenological Analysis (IPA) method in order to analyse participant’s feedback during semi-directive interviews. By using IPA, participants are experts of their experience. Eight participants took part in this study: 4 patients and 4 parents.ResultsWithin all participant’s feedback around 10 different themes emerged. We identified three major themes which we have described as: “Affiliation to the group”, “Framework of Discovery”, “Benefits of MFT”.According to “Affiliation to the group”, all participants report movements of adhesion or rejection towards the group. This theme has been subdivided into two sub-themes: “Temporality”, and “Identification/differentiation”. These sub-themes revealed inter-individuals’ differences.According to “Framework of discovery”, the MFT group has been identified as a secure place allowing self and other’s discovery place. This theme has been divided into two sub-themes: “discovering skills” and “improving oneself and relatives’ understanding”. Participants experience taking a step back and decentering oneself from usual personnal position. According to “Benefits of MFT”, participants report the feeling of belonging to a group, the impact on self-esteem, on mentalization skills, and on the reflexion on family members’ experience of the disease.Conclusions This study is, to our knowledge, the first qualitative study examining the subjective experience of members who participated in a psychoeducational and systemic MFT group focusing on schizophrenia. It provides insight into the families’ experience, both from the patient’s and from each family member’s perspective. Results highlight that participants seized the MFT group as a learning space at several levels: personal, intra-family and inter-family.These data could enlighten professionals working with families on the potential apprehensions of participants, their representations of the group and what process MFT could initiate.Disclosure of InterestNone Declared

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.

Aim: This qualitative study examined the experiences of families with Multi-Family Therapy (MFT) provided by the Early Psychosis Intervention Programme (EPIP) in Singapore. The MFT was piloted over a period of 2 years and findings from this study were used to further refine the MFT to better meet the needs of Singaporean families in the service.Methods: Families who completed the MFT were invited to participate in the study. Nine clients and ten carers who consented to participate in the study were allocated to two client and two carer Focus Group Discussions (FGDs) respectively. A semi-structured interview schedule was used to facilitate the discussions. The FGDs were audio recorded, transcribed, and anonymised. The data was analysed using thematic analysis.Results: Four main themes emerged from the analysis: (1) therapeutic processes of MFT, (2) positive changes in family relationships, (3) improvements in coping with psychosis, and (4) suggestions for improvement in MFT. The families suggested some structural changes to the MFT, and more carers than clients would prefer therapists to offer more expert advice.Conclusions: Findings suggest that a Western-based MFT can be adapted to work with Singaporean families. This study sheds light on the therapeutic processes that may be related to the changes in family relationships and coping with psychosis. In addition, it suggests that therapists taking an expert and authoritative approach may not fit with the needs of younger generations in Singapore. It advocates for therapists to take a flexible and fluid stance to work with Singaporean families.

ABSTRACTThis qualitative study from northern Sweden investigated experiences of multi-family therapy (MFT) in 12 parents of children with anorexia nervosa (AN). The main reported benefit was the opportunity to talk to others in a similar situation, thereby sharing experiences and struggles. MFT resulted in new perspectives and insights that improved family dynamics and enabled new constructive behaviors. In conclusion, MFT seems to be a useful therapeutic modality in the treatment of AN in a northern European setting.

Multifamily Therapy with Anorectic Children and Adolescents in a Day Care Clinic The treatment of children and adolescents suffering from anorexia nervosa represents an enormous challenge for therapists and families as well. After release form inpatient hospital treatment, there frequently is a period of renewed weight loss and a return to anorectic comportment and thought patterns. In view of what may be understood as a relapse, feelings of guilt and shame on the part of both the patients and their parents can be triggered. This often supports dysfunctional relationship dynamics within the affected families. Maintaining anorexia nervosa may be facilitated by being a suitable strategy to solve problems of the family system. Multifamily therapy aims at breaking this cycle and ensuring a stable transition from inpatient to outpatient settings of therapy. It requires an intensive and continuous involvement of the patients' parents in the therapy. Six families participating in a closed group are accompanied over one year by two multifamily therapists during the post inpatient phase. During this period, the parents remain responsible for their children. In the course of a day hospital intervention taking fifteen single days over a year, the parents develop a sense of competence in dealing with the disease. Thereby, the patients get the opportunity to overcome the anorectic isolation and pseudo-autonomy through experiencing their parents as able to understand them and their illness. In this contribution we present first results of a pilot study that suggest effectiveness of this therapy method.

Previous studies have suggested the negative impacts of attention deficit hyperactivity disorder (ADHD) on parent-adolescent interactions. Yet engaging parents, particularly the fathers, to participate in family-based interventions has been challenging in Chinese contexts given the traditional concerns about keeping the family's "face" and the influence of affiliate stigma. Empirical evidence supports multifamily therapy as an effective modality for parental engagement. This study explores the role of mutual support in promoting parental engagement and family communication quality of Chinese families of adolescents with ADHD. Inclusion criteria of the study were (a) Chinese family of at least one adolescent child having an ADHD diagnosis, (b) the adolescent child was aged between 11 and 15 years, and (c) the family participated in a multifamily therapy program. Families who had not completed a multifamily therapy program were excluded. Fourteen Chinese families of adolescents with ADHD who participated in a pilot multifamily therapy program from June 2017 to September 2018 were recruited for this qualitative study. Photo-elicited parent focus groups and photo-elicited individual interviews with adolescents were conducted. The thematic analysis revealed that a low level of hierarchy in the therapist-client relationship contributed to the building of mutual support among the families in the therapy process. The mutual support was found to play a key role in promoting acceptance, father involvement, and open communication within families of adolescents with ADHD. Discussion was conducted on the importance of the nonexpert stance of the therapist for promoting mutual support among Chinese families in a multifamily therapy process.

Background:Eating disorders are serious conditions which also impact the families of adult patients. There are few qualitative studies of multifamily therapy with adults with severe eating disorders and none concerning the practice of therapists in multifamily therapy.Objectives:The aim of the study is to explore therapists’ practice in multifamily therapy.Research design and participants:A grounded theory approach was chosen. Data were collected through participant observation in two multifamily therapy groups and qualitative interviews with the therapists in those groups.Ethical considerations:The study conforms to the principles outlined in the Declaration of Helsinki. All participants in the multifamily therapy groups received information about the research project and signed consent forms. The data are treated confidentially and anonymised.Findings:The core category was identified as ‘having many strings to one’s bow’, consisting of three subcategories: ‘planning and readjusting’, ‘developing as therapist and team’ and ‘regulating the temperature of the group’. This article discusses the empirical findings in the frame of Aristotelian virtue ethics.

Interfamily therapy (IFT) is a specific model for multifamily therapy (MFT) of recent expansion in Latin American and European countries. In IFT a multifamily group becomes a community of learning where professionals and family members establish collaborative relationships and participate in dialogues. This study used a qualitative phenomenological approach to explore the participants' perspective of 14 members and ex-members of two IFT groups conducted in Infant-Juvenile Mental Health Centers in Havana (Cuba). In this study IFT was well accepted and effective, and it was perceived as beneficial due to its positive influence for participants, with benefits on a personal, family and social level. In addition, participants articulated a series of therapeutic elements of IFT that were essential to promote these benefits. In conclusion, IFT seems to be a useful therapeutic model in the treatment of children, adolescents and their families in a Cuban psychiatric setting.

This study tested associations between general parenting dimensions, antismoking socialization practices, and parental smoking status on the one hand and adolescent smoking on the other. These associations were examined within asthmatic adolescents, a group particularly vulnerable to the effects of smoking. Participants were 9,008 young adolescents (aged 11-16 years) from the Netherlands. Associations between factors were tested separately as well as in a combined model using multiple logistic regression analyses. Adolescents with current asthma were more at risk of being current regular smokers. Higher scores on parental involvement and strictness, antismoking socialization, and parental smoking abstinence were associated with lower odds of adolescent smoking. Parents of asthmatic adolescents were more likely to use involvement and strictness. Despite the increased health risks of smoking for people with asthma, parents of asthmatic children were generally not more engaged in antismoking socialization; they just talked more about not smoking. Furthermore, parents of adolescents with asthma were more likely to smoke than were parents of adolescents without asthma. In general, multiple logistic regression analyses showed similar effects for nonasthmatic and asthmatic adolescents. Diagnosis of asthma should be followed by suggestions for parents on how to use antismoking socialization (e.g., setting rules). In addition, the importance of having nonsmoking parents in smoking prevention should be emphasized.

As a research methodology, qualitative research method infuses an added advantage to the exploratory capability that researchers need to explore and investigate their research studies. Qualitative methodology allows researchers to advance and apply their interpersonal and subjectivity skills to their research exploratory processes. However, in a study with an interpretative phenomenological analysis (IPA) approach, the advantageous elements of the study quadruple because of the bonding relationship that the approach allows for the researchers to develop with their research participants. Furthermore, as a qualitative research approach, IPA gives researchers the best opportunity to understand the innermost deliberation of the ‘lived experiences’ of research participants. As an approach that is ‘participant-oriented’, interpretative phenomenological analysis approach allows the interviewees (research participants) to express themselves and their ‘lived experience’ stories the way they see fit without any distortion and/or prosecution. Therefore, utilizing the IPA approach in a qualitative research study reiterates the fact that its main objective and essence are to explore the ‘lived experiences’ of the research participants and allow them to narrate the research findings through their ‘lived experiences’. As such, this paper discusses the historical background of phenomenology as both a theory and a qualitative research approach, an approach that has transitioned into an interpretative analytical tradition. Furthermore, as a resource tool to novice qualitative researchers, this paper provides a step-by-step comprehensive guide to help prepare and equip researchers with ways to utilize and apply the IPA approach in their qualitative research studies. More importantly, this paper also provides an advanced in-depth analysis and usability application for the IPA approach in a qualitatively conducted research study. As such, this paper completely contrasted itself from many books and articles that are written with the premise of providing useful and in-depth information on the subject-matter (phenomenology, as a qualitative approach).

An Adolescent Weight-Loss Program Integrating Family Variables Reduces Energy Intake

The Elementary School Journal Volume 86, Number S O 1986 by The University of Chicago. All rights reserved. 0013-5984/86/8603-0002$01.00 Teachers have strong opinions about parent involvement. Some believe that they can be effective only if they obtain parental assistance on learning activities at home. Others believe that their professional status is in jeopardy if parents are involved in activities that are typically the teachers' responsibilities. The different philosophies and beliefs of teachers reflect the two main, opposing theories of school and family relations. One perspective emphasizes the inherent incompatibility, competition, and conflict between families and schools and supports the separation of the two institutions (Parsons, 1959; Waller, 1932; Weber, 1947). It assumes that school bureaucracies and family organizations are directed, respectively, by educators and parents, who can best fulfill their different goals, roles, and responsibilities independently. Thus, these distinct goals are achieved most efficiently and effectively when teachers maintain their professional, general standards and judgments about the children in their classrooms and when parents maintain their personal, particularistic standards and judgments about their children at home.