Families helping families: implementing a multifamily therapy group with substance-abusing adolescents.

Abstract

The professional literature identifies a variety of risk factors that indicate whether an adolescent is at risk of substance use (Hawkins, Catalano, & Miller, 1992). Many of these risk factors revolve around family composition and dynamics such as family drug use, family interaction patterns, and boundaries (Smith & Springer, 1998). Therefore, in treating a substance-abusing adolescent, the family is a key target of intervention. Multifamily therapy groups (MFTGs) have been used to involve families in treatment and have been found to be effective with a variety of populations across many settings (Meezan & O'Keefe, 1998; O'Shea & Phelps, 1985). We developed an MFTG model that was used in conjunction with individual and family therapy with substance-abusing adolescents. This article provides a theoretical overview of the MFTG model and describes and illustrates the implementation of the model with substance-abusing adolescents and their families. STRUCTURE OF THE MFTG Our MFTG model was a treatment component of a therapeutic milieu for substance-abusing adolescents. As part of the program, adolescents and their families voluntarily attended weekly individual family therapy sessions and a multifamily therapy The average size of the MFTGs was four to five families, for a total of from 12 to 15 clients. (MFTGs much larger than this are not recommended because they can become overwhelming for all involved.) Each group session lasted 1 1/2 hours. The average age of the adolescent group members was 15 years. Most of the adolescents were polysubstance abusers, using primarily alcohol and marijuana, and had coexisting mental health diagnoses such as depressive and anxiety disorders, oppositional defiant disorder, and attention-deficit hyperactivity disorder. The MFTG was an open Membership changed each week, so each group session began with introductions and a brief review of the group rules, such as What we say in group stays in group. Adolescent members introduced themselves and the rest of their family. Sometimes, the group leaders began the sessions with a brief 10-to 15-minute presentation of psycho educational material. However, some group leaders began sessions simply by inviting families to share how their week had gone and what type of progress they were making on their goals. Very often, this approach led to intense groups marked by member-to-member interaction. OVERVIEW OF THE MFTG MODEL The proposed MFTG model integrates techniques and interventions primarily from four modalities: solution-focused and structural family therapy, and an interactional and mutual aid approach. Solution-Focused Therapy Solution-focused therapy (SFT) (Berg & de Shazer, 1991; de Shazer, 1985; Selekman, 1997) underscores the positive attributes that clients bring with them to treatment. It is a strength-based approach. Using SFT, clients are encouraged to develop future-oriented, positively worded goals. Practitioners are encouraged to work in partnership with clients and to foster collaborative relationships with resources that may benefit the client. We used two techniques from SFT: (1) the scaling question and (2) the miracle question (Berg & de Shazer, 1991; de Shazer, 1994). The scaling question provides a direct and nonthreatening way to monitor client functioning on goals over time. Consider the following illustration. Johnny's primary goal was to get along better with his parents. Using the scaling question, the group leaders asked Johnny to rate, on a scale from 1 to 10, how well he got along with his parents during the preceding week, with 1 indicating that he did not get along with them at all and 10 indicating that he got along with them great. Suppose Johnny gave a rating of 6. The leaders would then ask Johnny what he and his parents could do over the next week to make it from a 6 to a 7. …