Introduction to
Multifamily Groups
Alex Kopelowicz, MD
Raising the Bar Project-Valley Nonprofit Resources
Human Interaction Research Institute
PORT Treatment
Recommendations

Patients who have on-going contact
with their families should be offered a
family psychosocial intervention which
spans at least nine months and which
provides a combination of education
about the illness, family support, crisis
intervention, and problem solving skills
training. Such interventions should also
be offered to non-family caregivers.
Standard Approaches to Family
Work in Serious Mental Illness

Psychoeducation

Communication skills training

Problem solving techniques

Social network development (MFG)
Better outcomes in family
psychoeducation

Over 20 controlled clinical trials, comparing to standard
outpatient treatment, have shown:
– Much lower relapse rates and rehospitalization

Up to 75% reductions of rates; minimally 50%
– Increased employment

At least twice the number of consumers employed, and up to
four times greater--over 50% employed after two years--when
combined with supported employment
– Improved family relationships and well-being
– Reduced friction and family burden
– Reduced medical illness in family members

Doctor visits for family members decreased by over 50% in one
year
Dixon et al 2003
MFG TRAINING PROGRAM
DAY 1
9:00- 9:30am
Welcome/Overview of MFG Training
What is MFG and why should we do it?
9:30 -12:00 pm
The Psychoeducational Workshop
12:00-1:00 pm
Lunch
1:00 – 4:00 pm
McFarlane Videoconference
Science of Mental Disorders
Family Psychoeducation Outcomes
Overview of Treatment Model
DAY 2
9:00 – 12:00 noon
Joining Sessions (Demonstration and Role Play)
12:00 – 1:00 pm
Lunch
1:00 – 4:00 pm
MFG Sessions (Demonstration and Role Play)
Stages of a Psychoeducational
Multifamily Group
Joining
Family and
patient
separately
3-6 weeks
Educational
workshop
Families only
1 day
Ongoing
MFG
Families &
patients
bi-weekly
for 1 year
JOINING with FAMILIES & CLIENTS
JOINING
means to CONNECT, BUILD
RAPPORT, CONVEY EMPATHY, ESTABLISH AN
ALLIANCE, ENGAGE
It is the First Stage of Treatment
Designed to create a bond between
Client/Family Members and Family Clinicians
CLINICIAN as ADVOCATE
JOINING PROCEDURES



THREE Joining Meetings
 SEPARATELY with Relatives and Clients
 WEEKLY – 1 HOUR with Relatives, ½ HOUR
with Clients
Start sessions A.S.A.P. after crisis or
hospitalization
Gain an understanding of family’s stresses,
problems, reactions to illness, etc.
JOINING – I





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15 Minutes of SOCIAL TALK
Review any recent CRISIS: Who and What
Helped or Didn’t
IDENTIFY WARNING SIGNS – PRODROMAL
SIGNS – PRECIPITANTS
Distribute to Families & Keep for Future
Reference
Describe the Plan for On-going MFG sessions
5 Minutes SOCIALIZING
JOINING – II




15 Minutes of SOCIAL TALK
FAMILY’S EXPERIENCE DURING EPISODES
 The Sharing of Painful Events: A Crucial
Aspect of “Joining”
 The Client/Family’s Understanding of
Etiology
Family’s Social Network & Resources
(Material & Emotional)
5 Minutes SOCIALIZING
JOINING – III




15 Minutes of SOCIAL TALK
FAMILY’S SOCIAL NETWORK &
RESOURCES
SHORT & LONG-TERM GOALS (e.g.,
Prevent Relapse)
Preparation for Workshop & MFGs
MULTIFAMILY GROUPS
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Five to Eight Families
Two Clinicians
1 ½-Hour Sessions – Biweekly – 1 Year
Minimum
Refreshments/Snacks are provided
Initial Sessions avoid emphasis on clinical
issues
Initial Sessions emphasize establishing a
working alliance by building group identity
and developing a sense of mutual interest
and concern. Drop outs are Failures
FIRST MFG SESSION
“GETTING TO KNOW EACH OTHER”
 Go Around the Room





Background
Hobbies
Occupation
Interests
Clinician Goes First (Discloses/Shares with the Group
SETTING BASIC RULES
 Regular ATTENDANCE (for Relatives)
 CONFIDENTIALITY (No Pressure to Disclose)
 INTERACTION AMONG MEMBERS
 PHYSICAL/EMOTIONAL CONTROL
SECOND MFG SESSION

“HOW MENTAL ILLNESS HAS CHANGED OUR LIVES”






Building a SENSE OF TRUST & COMMITMENT
Sense of COMMON EXPERIENCE (Listen to each other)
Strengthening GROUP IDENTITY & SENSE OF RELIEF
The PATIENT’S INNER EXPERIENCES
Clinicians emphasize the vital role of SHARING GRIEF,
CONFUSION, GUILT, FEAR with those “on the same boat”.
AND HOPE
Remind participants about Problem Solving (next session)
GENERAL POINTS



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New Members
Late-Arriving Members
Reminders about Attending
Crises & Emergencies
COMMUNICATION & INTERACTIONS
 Clinicians DON’T speak for clients or relatives
 Interaction among member is essential
 Clients are ENCOURAGED (not pressured) to
participate
 Respect other’s turn and avoid criticism
PROBLEM SOLVING IN MFGs


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The CORE of MFG Sessions
Designed to compensate Information-Processing
Deficits in Mental Disorders
FORMAT:
Checking in
15 Minutes
Go-round
20 Minutes
Selecting a Problem to Solve
5 Minutes
Solving the Problem
45 Minutes
Wrap-up Socializing
5 Minutes
Clinicians should GET READY and HAVE A PLAN –
IN ADVANCE
SELECTING A PROBLEM
TO SOLVE


TOPICS:
Safety in The Home
Medication Compliance
Drugs and Alcohol
Life Events
Outside Agency Events
Disagreements among Family Members
Conflict with a Family Guideline
“REJECTED” PROBLEMS:
Make a Direct Suggestion and Review Outcome
Meet Outside the Group (E.G., Crises)
Refer to Past Solutions that Apply
Refer to Solution/Family with Successful Outcome
THE PROBLEM-SOLVING
METHOD
1.
2.
3.
4.
5.
6.
Define the Problem or Goal
List Possible Solutions
Evaluate Advantages and
Disadvantages of each Solution
Choose “the best” Solution
Implement Plan to Carry Out Solution
Review Implementation and Outcome