Multiple Family Therapy Research Articles

Effectiveness of Integrative Structural Family Therapy and Double ABCX Model on Marital Adjustment and Parenting Stress Among Parents of Children with Autism: Randomized Controlled Trial

Marital adjustment is an important predictor of coping with stress among parents of children with autism spectrum disorder (ASD). A randomized controlled trial conducted on 60 parents of children with ASD showed that integrative SFT and double ABCX therapy, conducted over ten sessions of multiple family therapy in group counseling for five weeks and a one-month follow-up at special needs children’s centers in Jordan, resulted in a 48% increase in marital adjustment and a 34% reduction in parenting stress. These therapies significantly improved the well-being of parents of children with autism, while the control group did not.

The effect of multiple family therapy on mental health problems and family functioning: A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to provide an overview of existing controlled trials focusing on the impact of multiple family therapy (MFT) on mental health problems and family functioning, and to examine the efficacy of MFT. Relevant studies were selected following a screening of 3376 studies identified by a systematic search of seven databases. The following data were extracted: participant characteristics, program characteristics, study characteristics, and information of mental health problems and/or family functioning. A total of 31 peer-reviewed, English, controlled studies evaluating the effect of MFT were included in the systematic review. Sixteen studies presenting 16 trials were included in the meta-analysis. All but one of the studies was at risk of bias, with problems concerning confounding, selection of participants and missing data. The findings confirm that MFT is offered in diverse settings, with studies presenting a variety of therapeutic modalities, focal problems, and populations. Individual studies reported some positive findings, including improvements in mental health, vocational outcomes, and social functioning. The findings of the meta-analysis suggest that MFT is associated with improvements in symptoms of schizophrenia. However, this effect was found not to be significant due to the large amount of heterogeneity. In addition, MFT was associated with small improvements in family functioning. We found little evidence to suggest that MFT successfully alleviates mood and conduct problems. To conclude, more methodologically rigorous research is needed to further examine the potential benefits of MFT, as well as the working mechanisms and core components of MFT.

Treatment efficacy of multiple family therapy in helping Chinese children of depressed parents in Hong Kong, China.

This article reports results of a study that assessed the efficacy of multiple family therapy (MFT) for helping children of depressed parent(s), using a quasi-randomized controlled trial design. In total, 76 children participated in the study, with 51 children were assigned to the experimental group (EG) and 25 to the comparison group (CG). The EG children and their parents completed the three-month MFT program, while the CG children and their parents attended two psychoeducational talks scheduled at the same time as the MFT. A group×Time repeated measure ANCOVA did not discern the intervention types having any effect on children's lives in the post-treatment phase or at the three-month follow-up. However, the MFT brought some promising positive changes in the EG children's perceived social support, both overall and that from the father and other family members at three-month follow-up; compared to the CG children, the EG children also attached more importance to the support from their mothers in the post-treatment phase and that from other family members at the three-month follow-up. The results implied the potential efficacy of the MFT in facilitating an increase in the overall social support of children of depressed parents and their positive interactions with both the healthy and the depressed parent and other family members. Owing to multiple statistical limitations, caution is required while interpreting the results. A larger sample and a more sophisticated research design were suggested for future studies examining the efficacy and therapeutic mechanism of the MFT.

Family‐Based Intervention for Chinese Families of Children with Attention Deficit Hyperactivity Disorder (ADHD) in Hong Kong, China

This paper reviews the clinical utility of family‐based treatment, comprised of multiple family therapy (MFT) and structural family therapy (SFT), in helping Hong Kong Chinese families of children with attention deficit hyperactivity disorder. The author identifies the psychosocial service needs of these families and examines the contributions of the adapted MFT and SFT in responding to the psychosocial service needs of these families. Critical issues for clinical practice and research are discussed.

Treatment efficacy of multiple family therapy in helping Hong Kong Chinese parents recover from depression

AbstractThis paper reports on the results of a clinical study that assessed the treatment efficacy of an adapted model of multiple family therapy (MFT) in helping Hong Kong Chinese parents recovering from depression. A total of sixty‐one depressed parents were assigned to either the control group (CG) or the experimental group (EG) on the basis of their motivation and commitment to the MFT programme. Data were collected using standardised measures in the pre‐treatment phase (T1), in the post‐treatment phase (T2) and at a three‐month follow‐up (T3). No significant difference was found between the EG and the CG in regard to the effect of MFT on the parental and family functioning of the depressed parents. However, after the MFT, the EG depressed parents’ level of psychological distress was significantly reduced, an effect which was sustained at 3‐month follow‐up. Clinical and research implications of the study are discussed. Practitioner points Multiple family therapy (MFT) is useful for Hong Kong Chinese parents with depression in recovery. Depressed parents’ psychological distress was reduced after MFT. Depressed parents with lower levels of education are likely to need support or interventions additional to MFT.

Multi‐problem families in intensive specialised multi‐family therapy: Theoretical description and case study report

AbstractSome families experience chronic, severe and intergenerational problems across multiple domains in their lives. These multi‐problem families do not seem to benefit from standard treatment. For them, Intensive Specialized Multi‐Family Therapy (ISMFT) was developed at the Department of Family Psychiatry (DFP) of a mental health organization in the Netherlands. ISMFT is an integrative treatment based on multiple family therapy with added elements of solution‐focused therapy and a focus on the working alliance between families and therapists. This kind of intensive treatment for multi‐problem families is rare across Europe, and is often seen as a ‘last resort’ before a decision on out‐of‐home placement of the children is made. This paper describes the theoretical principles used in ISMFT and uses a case study of an anonymized family to describe the course of treatment and illustrate treatment principles. Practitioner points Offering multi‐family therapy helps families overcome feelings of isolation, maximises their own resources and provides opportunities for support and constructive criticism. Therapists have an important role in facilitating a safe group atmosphere, as well as challenging parents by voicing different perspectives and reflecting on parental behaviour. By making parents the expert on their own families, good treatment results can be achieved in therapy‐resistant multi‐problem families.

Repairing the Parent–Child Relationship for a Hong Kong Chinese Family of an Adult Daughter with High Functioning Autism (HFA) Through Structural Family Therapy and Multiple Family Therapy

Compared to typically developing people, adults with high functioning autism (HFA) are more likely to have been abused during childhood, which would inescapably affect the present relationship with their parent(s). This paper narrates the healing journey of a Hong Kong Chinese family of an adult daughter with HFA, depression and suicidality through two family-focused interventions, structural family therapy (SFT) and multiple family therapy (MFT). Identifying the history of child maltreatment sheds light on direction for treatment. Treatment principles of SFT and MFT adapted to meeting the needs of this clientele are highlighted. Issues of integrating these two approaches are discussed.

Multiple family therapy for Chinese families of children with attention deficit hyperactivity disorder (ADHD): treatment efficacy from the children’s perspective and their subjective experiences

This paper reports the results of our study that assessed the treatment efficacy of multiple family therapy (MFT) from the perspective of participating Chinese children with attention deficit hyperactivity disorder (ADHD) and identified their subjective experiences. Forty‐three children with ADHD in the experimental group (EG) completed a forty‐two‐hour MFT, whilst forty‐five children with ADHD in the control group (CG) had attended two writing classes scheduled three months apart that were similar to those of the MFT. Data from the outcome study were gathered using standardized questionnaires and data from the qualitative study were drawn from thirteen children with ADHD who had completed the MFT and attended the focus group interviews (n = 5) or individual interviews (n = 8) conducted in the post‐treatment phase. The results of the Paired sample t‐test and MANOVA indicated no significant changes on the scores for the four measures adopted (perception of competence, hopefulness, parent‐child relationship and perceived social support) in the pre‐ and post‐treatment for the EG and the CG. Five themes emerged from the narratives of children with ADHD, which revealed the children’s subjective experiences with the MFT: (a) full of fun; (b) building friendships through common experiences; (c) a happy family time; (d) safe space; and (e) positive parental responses and communications.

Special Issue: Community, Psychology and Family Therapy

Special Issue: Community, Psychology and Family Therapy

Multiple Family Therapy: forever promising? Commentary on Gelin et al. (2018) and Cook‐Darzens et al. (2018), The evidence base for Multiple Family Therapy in psychiatric and non‐psychiatric conditions: a review (parts 1 and 2).

Multiple Family Therapy: forever promising? Commentary on Gelin <i>et al</i>. (2018) and Cook‐Darzens <i>et al</i>. (2018), The evidence base for Multiple Family Therapy in psychiatric and non‐psychiatric conditions: a review (parts 1 and 2).

Evidence base for Multiple Family Therapy (MFT) in non‐psychiatric conditions and problems: a review (part 2)

AbstractThis article provides an updated overview of the empirical literature regarding Multiple Family Therapy's (MFT) applications to non‐psychiatric conditions and problems. Although the evidence is not as strong for these disorders as for psychiatric disorders, the benefits of MFT approaches are apparent in the following areas: family management of several severe chronic medical illnesses; prevention of educational failure and exclusion; and treatment of marital distress. MFT research in non‐psychiatric settings has been faced with unique challenges that have mitigated the quality and quantity of outcome and process research produced over the past decade. Future research efforts should focus on: (1) stronger commitment to the evaluation of ongoing MFT programmes; (2) identification and manualization of major MFT programmes; (3) more Randomized Clinical Trials (RCTs) on the effectiveness of MFT programmes in community settings; and (4) higher priority for research on MFT's change processes and patterns of interaction.Practitioner points The treatment of chronic physical diseases is optimized by involving family members, and MFT is a valuable way of doing so: workshops delivered in brief formats are most feasible MFT should be considered for non‐psychiatric problems with the risk of isolation and stigmatization. The presence of other families sharing the same challenges is very useful MFT practitioners should attempt to operationalize their MFT model and include an evaluation component in their therapeutic implementation as routine practice

The evidence base for Multiple Family Therapy in psychiatric disorders: a review (part 1)

AbstractThis article provides an updated and comprehensive overview of the empirical literature regarding Multiple Family Therapy (MFT)'s applications to major psychiatric disorders. It shows that MFT's strongest evidence base is for schizophrenia and chronic psychoses, making its psychoeducational model one of the best available practices for these disorders. There is also a growing body of evidence regarding the usefulness of MFT for mood disorders (particularly in children), eating disorders and alcohol‐substance abuse, but more controlled research is needed for these conditions. Other disorders such as anxiety disorders, autism and attention deficit hyperactivity disorder have been studied in a more anecdotal fashion and require more rigorous investigations. Future research efforts should focus on: (1) the specific advantage of MFT over other active treatment modalities, (2) the comparative efficacy of various MFT models for a given population, and (3) MFT's change processes.Practitioner points McFarlane's psychoeducational MFT model is considered best practice for schizophrenia and other psychoses (and possibly mood disorders), facilitated by its manual‐based approach The Maudsley model is a valuable treatment for adolescent anorexia nervosa. Family therapists who are less ED‐focused in their interventions can also use more generic MFT models MFT practitioners should attempt to operationalize their MFT model and include an evaluation component in their therapeutic implementation

The Therapy Process of Accompanying Mothers in Multiple Family Therapy Groups: Evidence from a German Child Psychiatric Setting

The Therapy Process of Accompanying Mothers in Multiple Family Therapy Groups: Evidence from a German Child Psychiatric Setting This study provides an empirical contribution to the understanding of parents that accompany their children in psychiatric multiple family therapy settings (MFT). To this end, we conducted qualitative interviews with mothers that had successfully participated, with their diagnosed children (ages 3 to 9), in disorder-independent, age-homogeneous, and open family groups (the "Magdeburg Model") for several months. We performed a theoretical coding approach to the extensive interview material (n = 6 interviews, duration = 70 to 100 minutes each) according to Grounded Theory and extracted seven main and 29 sub-categories. These categories yield a coherent, complete, and specific subjective therapy model for this setting. One of the central findings is a profound understanding of to what extent and by which means the family group as a social arena paves and supports the arrival of the mothers in the group, their engagement into the therapy process, and their motivational and volitional steps during therapy. Another relevant result is a reconstruction of what we termed Arriving Home, which is the epitome of the positive cognitive, affective, and behavioral therapeutic development that mothers perceive. Conclusions for clinical practice as well as for qualitative and mixed methods therapy research are discussed.

Multiple family therapy for anorexia nervosa at the Eating Disorder Service, the Children's Hospital at Westmead

The Eating Disorder Service at The Children's Hospital at Westmead (CHW) is a tertiary service that offers a range of family focused treatment options for young people with an eating disorder. Multiple Family Therapy (MFT) is the newest treatment option provided by the service. MFT is now a key intervention offered by a number of services overseas, most notably at the Maudsley Hospital, London, where the model was developed. Despite it's use for more than a decade overseas, we are the first service in Australia to systemically integrate MFT as an additional treatment option within the standard suite of interventions offered. MFT theoretically builds upon the core constructs of family based treatment for anorexia nervosa, whilst adding the unique experience of solidarity for young people and their families. The content of MFT is experiential, involving activities and specific debriefing techniques to help families develop ways to work together against anorexia, increase attunement to their child's needs and feel more agency around the process of recovery. The MFT program at CHW provides the opportunity for up to eight families to work together for a 4-day workshop. Follow-up care is provided by outpatient family therapy or integration into the Intensive Family and Adolescent Eating Disorders Day Program. MFT targets families not progressing in outpatient care or who present with some other complexity with the view that engagement in treatment may be enhanced through the group experience of MFT and the opportunity to receive treatment input from multiple sources. The presentation will describe MFT constructs, the programs implementation at CHW, show material from the therapeutic activities completed and present preliminary data and family experiences from the first five groups.

The Intensive Family &amp; Adolescent Eating Disorders (IFAED) day program: a collaboration between Sydney Children's Hospital Network Eating Disorder Service and The Butterfly Foundation

The Sydney Children's Hospital Network Eating Disorder Service (EDS) at The Children's Hospital at Westmead (CHW) is a tertiary service that offers a range of family focused treatment options for young people with an eating disorder. The Intensive Family and Adolescent Eating Disorder (IFAED) Day Program is a new program that has been operating since September 2014, which targets young people and their families who have not been responding to standard treatment or who present with additional complexity. The IFAED program is designed as a treatment option that is more intensive than outpatient treatment, but less restrictive than overnight inpatient care. It operates five days per week and offers integrative and multidisciplinary care combining medical review, psychological treatment, meal support, secondary education and family support, including multiple family therapy. Theoretically, the program aims to strengthen and support families by increasing treatment intensity and solidarity to address barriers that are preventing progress. Interventions are provided for both families and young people. Underpinning the program is the belief that families are essential to recovery with weekly family therapy and parent groups enabling the family to be more responsive to the young person's behavioural and emotional needs. Group therapy for the young people targets skills to manage distress, improve flexible thinking, explore adolescent issues and improve communication skills. These interventions aim to improve coping and help the family support to be more effective. This presentation will outline the current IFAED Day Program structure and content, theoretical underpinnings and some preliminary outcome data.

What does “eat more” really mean? - Nutritional changes in food intake during a 6 week ‘Restore’ parent group program.

Refeeding a child back to health from an eating disorder can be difficult for families despite having successfully fed their child prior to the illness. Parents and clinicians push to increase food intake, but the question remains ‘how much is enough for weight gain? This dilemma can result in resistance from the child, conflict, increased stress and lack of confidence for parents. Our ‘Restore’ ” group parent program evolved from the Westmead Children’s Hospital “Nourish” program. It incorporates elements from Multiple Family Therapy developed by Ivan Eisler, Maudsley Family Therapy and is enhanced with nutrition education for parents with concomitant weight and symptom monitoring of the child. The nutrition component is delivered by an Accredited Practising Dietitian and includes: using the RAVES approach, food portions, ‘front loading’ and feeding responsibility. Two cohorts were evaluated using FoodWorks analysis of pre/post food diaries, behaviour change and weight gain. Feedback on analysis provided parents insight into the extent eating behaviours affected their childs nutrient intake and weight. This resulted in parents consistently offering often more than double what the child was eating at beginning of treatment. Parents learnt that they must feed their child ‘like they have never fed them before’.

Two models of multiple family therapy in the treatment of adolescent anorexia nervosa: a systematic review.

Multiple family therapy (MFT) is a therapeutic method that brings together several families affected by the same pathology. Although from an ideological and conceptual point of view, MFT is often linked to family therapy and group therapy, it is difficult to define it with precision, a weakness which may in turn hinder research on therapeutic effectiveness. This is most notable in the field of eating disorders (ED) where, in spite of MFT's great popularity, research evidence remains limited. Within the context of a systematic review of the literature on MFT in the treatment of anorexia nervosa, the purpose of this article is to provide a theoretical and clinical framework for describing two MFT models, in an attempt to explore their common and distinct concepts, principles, techniques, and factors of change. The first program is a day treatment adaptation of the Maudsley family-based MFT approach, developed in Belgium at the Therapeutic Centre for Adolescents suffering from Eating Disorders: it focuses on the management of ED symptoms, using a strong cognitive behavioral orientation. The second is an integrated systemic MFT outpatient and inpatient program carried out on the ED unit of a pediatric hospital in Paris, France: it emphasizes intra- and inter-family relationships within a systemic framework. Our effort to describe and compare these two models constitutes a first step toward determining the relative value of different models of MFT. Indeed, each model presents specific characteristics that may make it best suited for specific ED populations and/or types of families.

Multiple Family Therapy for Adolescents with Anorexia Nervosa: a One-year Follow-up

Multiple Family Therapy (MFT) has gained increasing popularity in the treatment of eating disorders and many programs have been developed over the past decade. In this presentation, we examine the effects of a particular model of MFT on eating disorder symptoms, quality of life (OQ-45) and percentage of expected body weight (%EBW) in adolescents with anorexia nervosa. Eighty-two ED adolescents, aged between 11 and 19 years, were assessed pre-, post- treatment and at one-year follow-up using the EDI-2, the OQ-45 and %EBW. Results showed a significant increase in %EBW between the beginning of treatment and the end of treatment. At one-year follow- up, %EBW continue to improve significantly. Symptoms relative to all EDI dimensions (except for bulimia) significantly decreased during treatment. The three dimensions related to quality of life assessment also improved over the course of MFT. At the end of treatment, 70.7% of the patients had a total OQ-45 score below clinical significance. At one-year follow-up, no significant differences were found for the OQ measures and for the EDI measures, showing quality of life, ED symptoms and related psychological features stabilise after the end of treatment. This study suggests that Multiple Family Therapy may benefit adolescents with anorexia nervosa, with improvement on several outcome measures at the end of treatment, remaining stable at one-year follow-up. The improvement of %EBW at one-year follow-up indicate MFT continue to have effects after treatment is complete. However, the lack of a comparison group entails caution when drawing conclusions.

A Grandparent in the room: multiple family therapy for adolescents

Objective To provide a descriptive clinical perspective on the introduction and development of Multiple Family Therapy Groups for Day Patients and Outpatients at Princess Margaret Hospital, Perth Western Australia. Challenges will be discussed including motivation, integration and application with view to sharing with the audience the pitfalls and possibilities of this dynamic approach combining family and group therapies.

Two birds with one stone - how to reduce the waiting list and provide effective treatment at the same time

Resource limitations can often result in creative solutions. This has been the case with the evolution of our parent education and support group, which has enabled timely access to effective treatment. The Early Intervention team is a multidisciplinary team of 1.5 clinicians, (social work/ dietitian/ clinical psychologist) who offer individual, family therapy and now group parent therapy. Treatment for eating disorders is lengthy. Our team treats up to 38 people a year with two thirds using Maudsley Family Based treatment. Until the introduction of we had up to 13 on the waiting list at any one time. The severity, chronicity and complexity of presentations resulted in a greater demand on our services with 97% of those assessed and then recommended for early intervention treatment in 2013 being placed on the waiting list. Our group parent program has evolved from the Westmead Children's Hospital Nourish program. It incorporates elements from Multiple Family Therapy model developed by Ivan Isler and Maudsley Family Therapy, with unique nutrition education for parents and a weight/symptom monitoring component. The Restore parent group is a 6 week educational/therapy based intervention group for parents of a child with an eating disorder and is trans diagnostic. Each cohort is evaluated using pre and post-test measures and weekly participant feedback. Outcomes to date show that is effective in: improving access to treatment by reducing waiting times; improving progress towards the individual's weight goals; reducing Binge/Purge behaviours; increasing parental confidence to bring about the complete recovery of their child in the home setting. The program is a means to provide education and support to parents, provides timely, effective treatment and enables identification of those who need more intensive ongoing therapy. This abstract was presented in the Service Initiatives: Child and Adolescent Refeeding and FBT stream of the 2014 ANZAED Conference.