Multifamily Therapy Research Articles

Multi-Family Therapy for Young People With Anorexia Nervosa: Clinicians' and Carers' Perspectives on Systemic Changes

Multi-Family Therapy for Young People With Anorexia Nervosa: Clinicians' and Carers' Perspectives on Systemic Changes

Implementing Multi-Family Therapy Within a Community Eating Disorder Service for Children and Young People

Implementing Multi-Family Therapy Within a Community Eating Disorder Service for Children and Young People

Multifamily Therapy with Anorectic Children and Adolescents in a Day Care Clinic

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.

Familienpsychiatrie – bindungsorientiert, systemisch ausgerichtet, integrativ im akut-tagesklinischen Mehrfamiliensetting: Das FaTZ-Konzept

Family Psychiatry - The Attachment-Focused, Systemic-Oriented, Integrative Concept of the Family Therapy Centre (FaTC), an Acute Multi-Family Day Clinic Up to three quarters of the children of mentally ill parents develop a mental disorder during their lifetime. The transmission occurs essentially through dysfunctional interaction and disturbed attachment. Parent-child interaction is characterized by a vicious circle of escalating symptoms in the child and increasing helplessness in the parents. For this family psychiatric approaches are helpful, which address the interaction in addition to the individual disorders. The Family Therapy Centre (FaTC) Neckargemünd offers family psychiatric, integrated therapy for parents and children in an acute day clinic multi-family setting. The basic therapeutic principles are attachment orientation, mentalisation and systemic perspective with a multi-family therapy approach. Typical family psychiatric case constellations are presented, for which the concept seems particularly helpful: (1) Early childhood regulatory disorders in interaction with mentally ill parents, (2) mother with PTSD and expansive-aggressive preschool child and (3) adolescents with separation anxiety and depressive-anxious mother. The previous experiences are reflected by a moderated focus group of the entire FaTC team. The FaTC concept was evaluated as very helpful. It was positively judged that the family system is visibly present on site (and not only virtually). The focus is on interaction, therefore causal therapy can be offered rather than symptomatic treatment. Limitations of the concept are therapy of severely aggressive adolescents or parents who do not want to participate. The concept of the FaTC is currently being scientifically evaluated.

Multicenter randomized controlled trial on the comparison of multi-family therapy (MFT) and systemic single-family therapy (SFT) in young patients with anorexia nervosa: study protocol of the THERAFAMBEST study

BackgroundAnorexia nervosa (AN) is a serious psychiatric illness that begins most of the time during adolescence. An early and efficacious intervention is crucial to minimize the risk of the illness becoming chronic and to limit the occurrence of comorbidities. There is a global consensus on optimal treatment for adolescents suffering from AN: international guidelines recommend single-family therapy that involves the patient and his/her family. Several family therapy approaches have been developed to date. However, these approaches, which imply a direct questioning of intrafamilial dynamics, are not suitable for all patients and families, and the rates of dropout or poor response to treatment remain quite high. A modality of family therapy has been adapted to AN, known as multi-family therapy (MFT), which consists in bringing together several families whose children suffers from the same illness. Objectives of the present randomized clinical trial are to evaluate whether the implementation of MFT in a multi-disciplinary treatment program for adolescents with AN is at least as efficacious as the use of systemic single-family therapy (SFT), with respect to the evolution of body mass index and other clinical outcomes 12 and 18 months after the start of treatment. A cost-efficiency analysis will also be conducted.MethodsOne hundred fifty patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups. Patients and their families will receive 10 sessions of therapy spread over 12 months. Body weight, eating disorder and other psychopathology-related symptoms, quality of family relationships, and family satisfaction with treatment will be evaluated during the treatment and at an 18 months follow-up. A cost-efficiency analysis will also be carried out.DiscussionWe hypothesize that MFT is at least as efficacious as SFT, but at a lesser cost. The identification of possible preferential indications for each technique could help the improvement of therapeutic indications for adolescents suffering from AN and contribute to the earliness of intervention, which is associated with a better outcome.Trial registrationClinicalTrials.gov, NCT03350594. Registered on 22 November 2017. IDRCB number 2016-A00818-43.

The experience of intolerance of uncertainty for young people with a restrictive eating disorder: a pilot study.

Research is consistently reporting elevated levels of intolerance of uncertainty (IU) in individuals with an eating disorder (ED). Less is known about the phenomenology of uncertainty for this clinical group. The present study aims to advance our understanding of the relationship between IU and restrictive EDs by providing insight into young people's subjective experiences of uncertainty. Thirteen young people with a restrictive ED were recruited from multi-family therapy groups run within the Maudsley Centre for Child and Adolescent Eating Disorders at the South London and Maudsley NHS Foundation Trust. Three focus groups were conducted asking young people to discuss their views, experiences and coping strategies when faced with uncertainty. Data were analysed using interpretative phenomenological analysis which yielded five superordinate themes: (1) young people perceived uncertainty as something negative; (2) high levels of anxiety and stress were identified as primary responses to uncertainty; (3) ED behaviours were given a functional role in reducing uncertainty; (4) need to control various aspects of young peoples' lives was of high importance; (5) young people discussed how they struggled to find ways to cope with uncertainty and often used behaviours associated with the eating disorder psychopathology as coping strategies. Young people's experiences of what uncertainty is like for them revealed a dynamic interplay between ED symptoms and fear of uncertainty. Findings support IU as a relevant concept for young people suffering from a restrictive ED and indicate that further exploration of IU from both theoretical and clinical perspectives could be fruitful. V.

Creating Community – The Introduction of Multi‐Family Therapy for Eating Disorders in Australia

It is well established that connection and support are associated with supporting recovery from eating disorders whereas isolation and feeling misunderstood can be barriers to change. While the consumer and recovery movements have long advocated for treatments that go beyond symptom reduction alone to include factors such as connection with others, there are few treatments that are designed to target these directly for young people with eating disorders and their families. In 2014 the Sydney Children's Hospital Network Eating Disorder Service at The Children's Hospital at Westmead introduced multi‐family therapy (MFT), the first program of its kind in Australia, with a primary aim being to increase solidarity and support for families in addition to helping promote eating disorder recovery more broadly. Rooted in the principles of family therapy for anorexia nervosa, MFT generally brings together six to eight families for a four‐consecutive day workshop followed by six single follow‐up workshops over the course of six months. This paper reviews the current literature available on MFT, describes its introduction at a specialist tertiary eating disorder service in Australia, explores preliminary feedback from families, and discusses the importance of creating solidarity for families affected by eating disorders.

Special Issue: Community, Psychology and Family Therapy

Special Issue: Community, Psychology and Family Therapy

Multi-family therapy for veteran and refugee families: a Delphi study

BackgroundResearch indicates that Posttraumatic stress disorder (PTSD) has an extensive impact on family relationships. Nevertheless, there is a dearth of empirically supported interventions addressing family functioning and PTSD. In the Netherlands, it is considered good clinical practice to offer multi-family therapy (MFT) to veteran and refugee families. MFT for traumatized families aims to address the dysfunctional family patterns that have evolved to address the consequences with trauma.MethodThe aim of this study is to generate a common framework for the practical impact and active ingredients of MFT in families confronted with trauma. The Delphi method was used to study the expert opinion of 11 therapists in Dutch expert trauma institutes.ResultsThe results indicate that MFT is a promising treatment for families dealing with the consequences of trauma. According to experts, positive outcomes include an increased understanding between family members, particularly visible in the de-escalation of conflicts within the family, and improved parenting. One explanation for the effectiveness of MFT with these target groups is its defining feature of therapy with several families.ConclusionsThe findings support the importance of considering family relationships and the family context in interventions for traumatized individuals.

We Used to Live on Our Own Little Islands: A Qualitative Evaluation of Multifamily Therapy with Veterans

ABSTRACTResearch has shown a consistent negative association between increased symptoms of posttraumatic stress disorder (PTSD) in veterans and successful functioning in family relationships. Despite compelling reasons to involve family members in the treatment of veterans, there is still a significant shortage of evidence-based programs. Multifamily therapy (MFT) is a combination of psychodynamic group therapy with systemic therapy and aims to elicit behavioral changes through the restructuring of interactional patterns in families. The purpose of this study is to qualitatively explore the efficacy of MFT in a convenience sample of Dutch veterans (nine) and their family members (23) who participated in an MFT program. Four basic themes were identified in the transcripts of the semi-structured interviews: 1. stronger family bond and reduced conflict, 2. understanding PTSD and its effect on the family, 3. working with other families, and 4. suggestions for improvement of MFT. In this study, participants described angry outbursts, interpersonal withdrawals, and emotional numbing as characteristic of their daily familial experiences. After MFT, the anger outbursts and fights diminished in most cases. MFT results in more fulfilling relationships within veteran families. MFT does not decrease symptomatology but is capable of enhancing the mental health of the veteran and their family members.

Multifamily Therapy for Children With ADHD in Hong Kong: The Different Impacts on Fathers and Mothers

Objective: Medication combined with psychosocial intervention is the recommended treatment for ADHD. What is not clear is which of the parents participate in psychosocial interventions, and whether the impacts are different for fathers and mothers. This is important because of the different roles fathers and mothers have in shaping their child’s development. This article examines the impact of multifamily therapy on a sample of fathers and mothers from Hong Kong whose children suffer from ADHD. Method: Fathers and mothers ratings on ADHD severity, parent–child relationship, parenthood stress, and parental self-esteem were compared between those who attended multifamily therapy and those who attended psychoeducation talks. Results: Fathers and mothers of the multifamily group, but not the psychoeducational group, reported reduction of child ADHD symptom severity. When the reduction was clinically significant, mothers reported an increased sense of competence while fathers reported improved father–child relationship. Conclusion: Fathers and mothers experienced different gains from attending MFT. Fathers’ involvement in their child’s treatment should be encouraged and facilitated.

Multi-Family Pediatric Pain Group Therapy: Capturing Acceptance and Cultivating Change.

Behavioral health interventions for pediatric chronic pain include cognitive-behavioral (CBT), acceptance and commitment (ACT), and family-based therapies, though literature regarding multi-family therapy (MFT) is sparse. This investigation examined the utility and outcomes of the Courage to Act with Pain: Teens Identifying Values, Acceptance, and Treatment Effects (CAPTIVATE) program, which included all three modalities (CBT, ACT, MFT) for youth with chronic pain and their parents. Program utility, engagement, and satisfaction were evaluated via quantitative and qualitative feedback. Pain-specific psychological, behavioral, and interpersonal processes were examined along with outcomes related to disability, quality of life, pain interference, fatigue, anxiety, and depressive symptoms. Participants indicated that CAPTIVATE was constructive, engaging, and helpful for social and family systems. Clinical and statistical improvements with large effect sizes were captured for pain catastrophizing, acceptance, and protective parenting but not family functioning. Similar effects were found for functional disability, pain interference, fatigue, anxiety, and depression. Given the importance of targeting multiple systems in the management of pediatric chronic pain, preliminary findings suggest a potential new group-based treatment option for youth and families. Next steps involve evaluating the differential effect of the program over treatment as usual, as well as specific CBT, ACT, and MFT components and processes that may affect outcomes.

An Aristotelian view of therapists' practice in multifamily therapy for young adults with severe eating disorders.

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.

Family Therapy for Adolescents: A Research‐informed Perspective

Specific research‐informed models of family therapy have been developed for a range of adolescent problems. These include Brief Strategic Family Therapy (BSFT), Functional Family Therapy (FFT), Multisystemic Therapy (MST), Multidimensional Family Therapy (MDFT), and Multidimensional Treatment Foster care (MTFC) for conduct disorder and drug misuse; family‐focused cognitive behaviour therapy for anxiety disorders and depression; Attachment‐based Family Therapy (ABFT) for depression; family‐focused therapy as an adjunct to pharmacological therapy for bipolar disorder; ABFT, youth‐nominated support team, and Dialectical Behaviour Therapy (DBT) combined with Multifamily Therapy for self‐harm; the Maudsley model of family therapy for eating disorders; and psychoeducational family theory for psychosis. All of these approaches aim to reduce individual and familial risk factors which exacerbate adolescent problems, and enhance protective factors which promote resilience and recovery from psychological difficulties.

A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa.

BackgroundConsiderable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa, with a general consensus in the field that eating disorders focussed family therapy (often referred to as Maudsley Family Therapy or Family Based Treatment) currently offers the most promising outcomes. Nevertheless, a significant number do not respond well and additional treatment developments are needed to improve outcomes. Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first randomised controlled trial of multifamily therapy for adolescent anorexia nervosa.MethodsThe study was a pragmatic multicentre randomised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy (MFT-AN) and single family therapy (FT-AN). A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified (restricting type) were randomised to the two treatments using computer generated blocks of random sizes to ensure balanced numbers in the trial arms. Independent assessors, blind to the allocation, completed evaluations at baseline, 3 months, 12 months (end of treatment) and 18 months.ResultsBoth treatment groups showed clinically significant improvements with just under 60% achieving a good or intermediate outcome (on the Morgan-Russell scales) at the end of treatment in the FT-AN group and more than 75% in the MFT-AN group - a statistically significant benefit in favour of the multifamily intervention (OR = 2.55 95%; CI 1.17, 5.52; p = 0.019). At follow-up (18 months post baseline) there was relatively little change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant. Clinically significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology. Approximately half the patients in FT-AN and nearly 60% of those in MFT-AN had started menstruating.ConclusionsThis study confirms previous research findings demonstrating the effectiveness of eating disorder focused family therapy and highlights the additional benefits of bringing together groups of families that maximises the use of family resources and mutual support leading to improved outcomes.Trial RegistrationCurrent Controlled Trials ISRCTN11275465; Registered 29 January 2007 (retrospectively registered)

Multi-Family Therapy with a Reflecting Team: A Preliminary Study on Efficacy among Opiate Addicts in Methadone Maintenance Treatment.

In this study, we evaluate the efficacy of multi-family therapy at reducing the addiction severity and at improving the psychological and family dynamics of opiate addicts receiving methadone treatment at a public treatment center. The study compares multi-family therapy with a reflecting team (MFT-RT) and a standard treatment following a methadone maintenance treatment program. The results show that multi-family therapy with a reflecting team effectively reduces the addiction severity in several of the areas evaluated and noted that this effect is superior to standard treatment. The psychotherapy patients showed improvement in the areas of employment and social support; their drug use diminished and their psychiatric condition improved. At the same time, they needed a lower daily dose of methadone. In addition, the group undergoing standard treatment showed a noteworthy deterioration in their medical condition. Both groups showed a significant increase in their alcohol use. When applied to family treatments, the systemic-constructivist approach by the reflecting team offers combined techniques that can help improve care for the families of patients with addiction problems.

Family Therapy for Child and Adolescent Eating Disorders: A Critical Review.

Eating disorder-focused family therapy has emerged as the strongest evidence-based treatment for adolescent anorexia nervosa, supported by evidence from nine RCTs, and there is increasing evidence of its efficacy in treating adolescent bulimia nervosa (three RCTs). There is also emerging evidence for the efficacy of multifamily therapy formats of this treatment, with a recent RCT demonstrating the benefits of this approach in the treatment of adolescent anorexia nervosa. In this article, we critically review the evidence for eating disorder-focused family therapy through the lens of a moderate common factors paradigm. From this perspective, this treatment is likely to be effective as it provides a supportive and nonblaming context that: one, creates a safe, predictable environment that helps to contain anxiety generated by the eating disorder; two, promotes specific change early on in treatment in eating disorder-related behaviors; and three, provides a vehicle for the mobilization of common factors such as hope and expectancy reinforced by the eating disorder expertise of the multidisciplinary team. In order to improve outcomes for young people, there is a need to develop an improved understanding of the moderators and mediators involved in this treatment approach. Such an understanding could lead to the refining of the therapy, and inform adaptations for those families who do not currently benefit from treatment.

The role of family meals in the treatment of eating disorders: a scoping review of the literature and implications.

Family meal research is a fast growing field that has significant implications for the prevention and treatment of eating disorders (ED). Using a scoping review procedure, this article overviewed major historical and clinical trends that have guided the use of family meals or lunch sessions in adolescent ED family therapy over the past 40years, and synthesized essential findings from current therapeutic family meal research. The relevant body of literature is reported within the framework of three models of family therapy (Maudsley model, family-based treatment, multi-family therapy), with a focus on their specific use of family lunch sessions and related empirical evidence. Although promising, current evidence remains contradictory, tentative and colored by therapists' convictions, resistance and fears. Future research priorities are discussed, including the need for a more direct examination of the impact of the family meal practice on therapeutic change, as well as a better understanding of its active ingredients and of the characteristics of patients/families that may benefit most from it. This review of the literature may help clinicians and family therapists (1) adhere more reliably and confidently to ED-focused treatment protocols that include a strong family meal component, and (2) make more informed decisions regarding the inclusion or exclusion of family meals in their practice. When feasibility or acceptability issues preclude their use, alternatives to family meals are also discussed, including family meal role-plays and drawings, coaching of home-based family meals and manual/DVD-based guidance.

Commentary: Awareness of Risk Factors for Digital Game Addiction: Interviewing Players and Counselors.

Commentary: Awareness of Risk Factors for Digital Game Addiction: Interviewing Players and Counselors.

Partnering with patients and families to develop an innovative multifamily therapy group treatment for adults with anorexia nervosa

While clinical practice recognises and research findings reveal an association between social functioning and relationships with close others and recovery for adults with Anorexia Nervosa (AN), few treatment modalities comprehensively address the social conditions that contribute to and sustain AN. This post-treatment qualitative retrospective study engaged Multifamily Therapy Group (MFTG) alumni as co-investigators in the development and evaluation of a new and innovative Relational/Motivational model of MFTG (MFTG-RM) [Tantillo, M., Sanftner, J., & Hauenstein, E. (2013). Restoring connection in the face of disconnection: An integrative approach to understanding and treating anorexia nervosa. Advances in Eating Disorders: Theory, Research and Practice, 1(1), 21–38.] for adults with AN. Ten families (N = 17) comprising 5 adult patients (ages 20–34, M = 23.4, SD = 5.98), 9 mothers, and 3 fathers participated in one of 2 two-hour study focus groups. Qualitative content analysis was used to code text data an...