Multiple Family Group Research Articles

Verhaltenstherapeutische Gruppentherapie für Zwangsstörungen

Behavioural Group Therapy for Obsessive-Compulsive Disorder Introduction: The effectiveness of a behavioural group therapy programme over 10 double sessions for patients with obsessive-compulsive disorder (OCD) is evaluated. This out-patient group treatment programme provides education about OCD, instruction in a cognitive behavioural approach to self-treatment, guided behavioural treatment and additional multiple family groups. The group therapy (GRU) is compared with a pure medical treatment (MED) and a combined treatment (GRU/MED). Patients and Methods: For evaluation 155 patients (GRU: 45; MED: 55; GRU/MED: 5) were investigated pre (t1) and post (t2) treatment. The groups did not differ significantly pre-treatment regarding Y-BOCS scores and the duration of disorder. The groups differed according to age, depressive symptoms (Beck Depression Inventory) and psychosocial disability regarding work. Results: All groups showed a significant improvement of clinical pathology (Y-BOCS t1: 25.8 ± 4.9; t2 19,3 ± 7,8; p < 0.001), especially patients who received the group therapy or the combined treatment improved well (GRU t1: 25 ± 5.4; t2: 16.7 ± 8.9; GRU/MED t1: 25.6 ± 5.3, t2: 16.7 ± 7.09) compared to the purely medically treated group (MED t1: 26.4 ± 4; t2: 23.5 ± 5.9). Discussion: Results show that behavioural group therapy with multiple family groups is an effective therapy option for patients with OCD.

Institutional Transition and Cultural Inheritance

Business groups are a prominent enterprise system in most East Asian and emerging economies. This article addresses an important but understudied issue – ownership and control of these large conglomerates. Studying the ownership structure of the top 100 Taiwanese business groups sheds light on the debate between the culturalists and the institutionalists. Culturalists claim family domination even in institutional changes while institutionalists suggest more dispersed and open shareholding after economic liberalization. The longitudinal analysis of group ownership across three time periods reveals a mixed structure. Although the family still controls most of the old, core groupmembers, new firms and joint ventures that are owned by multiple family groups rose significantly during the institutional transition of 1987–93. The evidence shows that organizational changes neither completely comply with emerging rules, nor do they hold on to existing cultural logics. Neither the culturalists nor the institutionalists have correctly predicted the metamorphosis. Rather, the concept of compromise strategy, which allows organizations to retain their core interests while at the same time respond to institutional constraints and/or incentives, provides a proper explanation.

A multiple family group intervention for first‐time juvenile offenders: Comparisons with probation and dropouts on recidivism

AbstractThis study evaluated a multiple‐family group‐intervention program (MFGI) for first‐time juvenile offenders. The recidivism rate for subjects who completed the MFGI (the Family Solutions Program) was compared to recidivism rates of two other groups of first‐time juvenile offenders. Using logistic regression analysis predicting who will recidivate, juvenile first offenders who were placed on probation (N = 95) were 9.3 times more likely to re‐offend compared to the Family Solutions Program (FSP) graduates (N = 267). Families referred to FSP but who dropped out (most never attended the 10 session program) (N = 93) also were 4.4 times more likely to re‐offend compared to FSP graduates. An intent‐to‐treat model comparing the combined group of FSP graduates and dropouts with the probation group indicated that a youth in the probation group was 8.1 times more likely to re‐offend than a youth referred to the FSP. Results indicating better outcomes on recidivism for FSP graduates were significant for both male and female youths. Implications for policy and practitioners are discussed. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 177–200, 2004.

Family Approaches to Treatment for Obsessive Compulsive Disorder

This article reviews the family constellation of patients with obsessive compulsive disorder (OCD), the presence of OCD symptoms among family members, and familial aspects including parental attachment, expressed emotion (EE), and family accommodation. Some evidence supports a negative effect of hostility, emotional overinvolvement, and criticism perceived by the patient on behavioral treatment outcome. However, actual criticism observed by the relative during an interview was associated with more benefit from therapy. Family accommodation predicted poorer family functioning and more severe OCD symptoms after behavioral treatment. A review of the limited treatment literature indicates no actual tests of the effects of psychoeducational and supportive treatments although several reports suggest they are useful for families and patients. Including relatives in treatment has proved beneficial in some studies, especially with children, but not in others. Multiple family groups that focus on behavioral contracting for exposure and stopping rituals may be a promising intervention. Likewise, efforts to reduce family accommodation in the context of behavioral treatment have proved useful. Additional research on the content, process and effects of family interventions for OCD is much needed.

Community-Based multiple family groups to prevent and reduce violent and aggressive behavior: The GREAT Families Program

This paper describes the targeted intervention component of GREAT Schools and Families. The intervention—GREAT Families—is composed of 15 weekly multiple family group meetings (e.g., 4–6 families per group) and addresses parenting practices (discipline, monitoring), family relationship characteristics (communication, support, cohesion), parental involvement and investment in their child's schooling, parent and school relationship building, and planning for the future. High-risk youth and their families—students identified by teachers as aggressive and socially influential among their peers—were targeted for inclusion in the intervention. The paper describes the theoretical model and development of the intervention. Approaches to recruitment, engagement, staff training, and sociocultural sensitivity in work with families in predominantly poor and challenging settings are described. The data being collected throughout the program will aid in examining the theoretical and program processes that can potentially mediate and moderate effects on families. This work can inform us about necessary approaches and procedures to engage and support families in efforts to reduce individual and school grade-level violence and aggression.

HOUSE RULES?: The practice of social organization in Classic-period Chunchucmil, Yucatan, Mexico

This paper presents results of excavations from three house lots at Chunchucmil, a Classic-period site in northwestern Yucatan, Mexico. Each of the three house lots contains multiple residential structures organized around patios with temples on the east side of the patio. The boundaries of the house lots are clearly marked by low walls that encircle the architecture and non-mounded space. These house lots were occupied by multiple-family groups that held a common identity. Inequality existed within these groups insofar as one residence in each group was larger and better constructed than the others. In discussing the succession of leadership within these groups, we argue that social organization resembled the flexible house society model presented by Claude Lévi-Strauss, as opposed to rule-guided models based solely on descent or kinship. The practical nature of social organization is seen in the type of modifications found on the east structures of these groups.

Use of the Multiple Family Group Therapy in Managing Children's ADHD

Parental responses to the use of multiple family group therapy in managing children’s ADHD have been favorable and invite a closer look at the relevant group and family processes that promote feelings of competency in both parents and children. Multiple family group sessions comprise the second phase of a three–part treatment program reviewed in The ADHD Report in June 2000 (Scapillato, Bregman, & Williams, 2000). The first phase consists of parent education about ADHD and training in behavior management strategies; the third phase involves a children’s treatment group focused on improved symptom management and social skills development. The size and composition of the multiple family group is determined through a process of self–selection in the parent group during the preceding weeks, and averages 6 to 10 families, with at least 1 parent and the identified child from each family. Families are self–referred or referred by child assessment clinics in 2 local hospitals, with the principal admission criterion being that the identified child has a diagnosis of ADHD. The perspective of ADHD endorsed in the program is adopted from Russell Barkley (1997, 2000), who views the disorder as involving a deficit in “performance.” A consistent theme is the enhancement of children’s motivation in key areas of functioning.

Family approaches to treatment for obsessive compulsive disorder.

This article reviews the family constellation of patients with obsessive compulsive disorder (OCD), the presence of OCD symptoms among family members, and familial aspects including parental attachment, expressed emotion (EE), and family accommodation. Some evidence supports a negative effect of hostility, emotional over-involvement, and criticism perceived by the patient on behavioral treatment outcome. However, actual criticism observed by the relative during an interview was associated with more benefit from therapy. Family accommodation predicted poorer family functioning and more severe OCD symptoms after behavioral treatment. A review of the limited treatment literature indicates no actual tests of the effects of psycho-educational and supportive treatments, although several reports suggest they are useful for families and patients. Including relatives in treatment has proved beneficial in some studies, especially with children, but not in others. Multiple family groups that focus on behavioral contracting for exposure and stopping rituals may be a promising intervention. Likewise, efforts to reduce family accommodation in the context of behavioral treatment have proved useful. Additional research on the content, process and effects of family interventions for OCD is much needed.

Burden in schizophrenia caregivers: impact of family psychoeducation and awareness of patient suicidality.

Family caregivers of persons with schizophrenia and other psychotic disorders experience high levels of burden. Although a number of patient and caregiver predictors of burden have been identified, little research has investigated the contributions of patient depression, suicidal ideation, and substance abuse. In addition, family psychoeducation interventions have reduced patient symptoms, as well as inpatient treatment utilization; however, it is not known whether or not these interventions reduce family burden. This study investigated predictors of family burden and tested to what degree multiple family group treatment (MFGT), relative to a standard care condition, was associated with reduced family burden. Participants were 90 outpatients with a diagnosis of schizophrenia or other psychotic disorders, and their caregivers who were enrolled in a 2 year psychoeducation intervention. The best set of predictors of burden, identified by stepwise linear regression, was young patient age, awareness of patient's suicidal ideation, and family resources. These variables accounted for 32% of the total variance in burden. Findings suggest that caregiver's awareness of patient's suicidal ideation, not patient's report of suicidal ideation; and that patient age, not duration of the illness, were significant independent predictors of burden. When compared to a standard-care condition over 2 years, MFGT did not reduce family caregiver burden. Discussions focus on the relationship between burden and its predictors, and possible reasons why MFGT did not decrease burden. Modifications are proposed that may increase the impact of MFGT.

Multiple-family groups for urban children with conduct difficulties and their families.

The authors present the results of two studies designed to improve treatment engagement among urban youths with conduct and oppositional behavioral difficulties. In the first study, information on attitudes about mental health treatment was obtained from 159 adult caregivers of children who were referred to an urban child mental health clinic because of disruptive behavioral difficulties. The caregivers listed insufficient time, lack of transportation, the child's not wanting to attend treatment, and the caregiver's concern that treatment might not help as barriers to service use. The data from study 1 were used to design a multiple-family group intervention to be tested in study 2. The families who participated in these groups attended an average of seven sessions during the 16-week study, compared with four sessions for families who participated in family therapy and three for families who participated in individual psychotherapy.

Attachment and affect regulation: a framework for family treatment of conduct disorder.

Conduct disorder (CD), a pervasive adolescent disorder with clinically significant antisocial behaviors, has been a difficult syndrome to treat successfully. Recently, research on affect regulation and attachment has suggested that attachment and affect regulation strategies may underlie the development of conduct disorder in adolescents, implying that attention to these factors might improve family treatment for CD. In this review of the research literature, I discuss the role of attachment and affect regulation in the development and treatment of CD. In addition, I present information about the framework, intervention protocol, and preliminary evidence of effectiveness of an attachment- and affect regulation-based intervention that has been developed and implemented with multiple-family groups of parents and incarcerated adolescents.

Multiple Family Group Therapy: An Interpersonal/Postmodern Approach

Multiple Family Group Therapy has been identified as a viable treatment model for a variety of client populations. A combination of family systems theories and therapeutic group factors provide the opportunity to explore multiple levels of intrapersonal and interpersonal relationships between families. All group members are afforded the opportunity of both giving and receiving feedback about strengthening their own family ties. This article depicts a Multiple Family Group Therapy model based on interpersonal and postmodern theories of therapy. A theoretical base is provided in conjunction with descriptions of weekly activities.

The Development and Implementation of an Affect Regulation and Attachment Intervention for Incarcerated Adolescents and their Parents

The Conduct Disorder Intervention Group of a Marriage and Family Therapy Program of a large Midwestern university used the research and theory about affect regulation and attachment strategies of families to develop a low-cost multiple-family group intervention for incarcerated adolescents and their parents. In this article, the author reviews the research that underlies the intervention, describes the development of the videotapes used, discusses the intervention curriculum, and delineates the roadblocks and new avenues discovered as this intervention was conducted over the past 3 years.

Interest in a Support Group Among Individuals Tested for a BRCA1 Gene Mutation

This article explores interest in a support group among 218 individuals tested for a mutation in BRCA1, a breast and ovarian cancer susceptibility gene. When queried 4 to 7 months after receiving the BRCA1 test results, approximately one-fourth of the participants expressed interest in a hypothetical support group. A mixed-carrier status and multiple family group was preferred over a carrier-only and single family group. The information about interest in a support group among individuals tested for a BRCA1 mutation represents an important step in identifying those who are most receptive to psychosocial interventions.

Family work for schizophrenia: practical application.

To review the evidence for the efficacy, efficiency and effectiveness of family work for schizophrenia. The review is based on the relevant literature but is not intended to be exhaustive, except in the area of practical application. The effectiveness of family work has been established by a series of randomized controlled trials. Relatives groups are efficient in terms of staff time, and multiple family groups may be more efficacious than sessions with single families. However, a substantial proportion of relatives refuse to attend a group and need sessions in the home. Family work skills can be acquired by clinicians working in ordinary settings, although few studies have addressed this question. Problems have been encountered regularly by trained community workers trying to practise their newly acquired skills. Difficulties in implementation may be remedied by adopting a systemic approach and including the managers of the service in the initial training sessions.

Staff training in cognitive-behavioral family intervention in mental illness using the multiple-family group approach: a pilot study.

This article describes a pilot project in which eight Community Mental Health Centre staff were trained in a cognitive-behavioral intervention for families of 37 mentally ill clients. After involvement in training, the staff demonstrated more regular inclusion of family members in routine clinical practice, and a trend towards an increase in relevant knowledge. After involvement in the program, the families experienced a decrease in burden (Family Burden Interview Schedule) even though the primary clients' functioning (Global Assessment of Functioning) did not change. The results are encouraging, indicating that it is possible to train staff in ordinary clinical settings in effective cognitive-behavioral family interventions. The findings need to be replicated in a controlled study with larger samples.

A Multiple Group Psychotherapy Approach to Adolescents with Psychiatric and Substance Abuse Comorbidity

ABSTRACTMultiple group psychotherapy was employed as the primary treatment modality in a day-treatment program as an innovative multifaceted approach to treating adolescents comorbid for psychiatric and substance abuse diagnoses. The concurrent educational program included a high school on site. The groups included Substance Abuse Group, which promoted the 12-step model; Health Group; Psychotherapy Group; Leisure Time Group; Self-Awareness Group; and Multiple Family Group. The effect of the multiple groups was to provide a variety of experiences focusing on varied aspects of normal and dysfunctional adolescent development. Together the combination of groups served to strengthen the participants' cohesiveness, communicating skills, and hopefulness.

Multiple Family Groups: An Alternative for Reducing Disruptive Behavioral Difficulties of Urban Children

Objective: This article presents an evaluation of a multiple family group intervention (MFG) designed to meet the mental health needs of low-income minority children and families. Method: Children participating in the MFG are compared with children demographically and clinically similar who received individual or family therapy services at an urban mental health center. Results: Of the children referred for MFG, 59% were still in service by the 16th group meeting. Of the children assigned to individual or family therapy, only 39% were in service after 16 weeks. Data from the subsamples that attended 16 weeks of MFG or therapy sessions were analyzed, and significant decreases in total disruptive behavior, conduct problems, learning difficulties, hyperactivity, and impulsivity were associated with MFG participation. Conclusion: Follow-up interviews revealed that 70% of MFG parents noted child improvements, in comparison to 54% of parents whose children received individual family therapy.

Multiple-Family Groups: Practice Implications for the 21st Century

ABSTRACT Multiple-Family Groups have been utilized in a variety of settings for almost fifty years in this country. This unique practice approach has undergone many changes and refinements during this period of development. The primary purpose of this chapter is to provide readers with a delineation of the current practice implications of this treatment modality. The history of Multiple-Family Groups (MFG) will be reviewed to provide a historical framework for an increased understanding of its current usages. In addition, new directions for research and further refinement of this practice model will be outlined for clinical practitioners.

A Cultural Challenge: Multiple Family Groups for Post-Separation and Post-Divorce Families in Hong Kong

ABSTRACT This paper discusses the implementation of two multiple family groups for post-separation families and post-divorce families in Hong Kong. The implementation strategies with a systemic perspective and the cultural issues identified will be illustrated.