Employment Multifamily Group
Project
Alex Kopelowicz, MD
Roberto Zarate, PhD
Human Interaction Research Institute
New Haven, CT – March 15-16, 2012
MFG Staff Training: Day 1
8:00-8:30 am
Breakfast
8:30-9:15 am
Brief Introductions by Agencies
9:15-9:45 am
Welcome/Overview of the MFG Training Program
9:45-10:30- am
What is MFG and Why Should We Do It?
10:30-10:45 am
Break
10:45-12:30 pm
MFG Components (Joining Sessions, Educational
Workshop & Problem Solving Groups)
12:30-1:30 pm
Lunch
1:30 – 4:00 pm
Joining Sessions (Demonstration & Role Plays)
MFG Staff Training: Day 2
8:00-8:30 am
Breakfast
8:30–9:00 am
Review/Overview of Problem Solving in MFGs
9:00-10:30 am
MFG Sessions (Demonstration and Role Plays)
10:30-10:45 am
Break
10:45-12:00 noon
MFG Sessions (Role Plays Continued)
12:00–1:00 pm
Lunch
1:00–3:00 pm
MFG Sessions (Role Plays Continued)
3:00 -3:30 pm
Questions and Wrap-Up
Standard Approaches
to Family Work

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 (Dixon, 2003), have shown:
– 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
1-Year Survival Rates Among Bipolar
Patients in Family-Focused Treatment
Versus Case Management
Cumulative Survival Rate
1
FFT, N=31
0.8
0.6
0.4
CM, N=70
0.2
0
0
5
10
Pretreatment
15
20
25
30
35
Treatment
40
45
50
55
Follow-up
Wilcoxon Test, c2 (1)=3.99, P =.046
Miklowitz DJ, et al. Biol Psychiatry, 2000;48(6):582-592
Stages of a Psychoeducational
Multifamily Group
Joining
Family and
clients
separately
3-6weeks
Educational
workshop
Families only
1 day
Ongoing
MFG
Families &
clients
bi-weekly
6 months
Joining with Families and Clients
JOINING
means to CONNECT, BUILD
RAPPORT, CONVEY EMPATHY, ESTABLISH AN
ALLIANCE, ENGAGE
It is the first stage of intervention
Designed to create a bond between
Client/Family Members and Family Counselors
COUNSELOR as ADVOCATE
Joining Proecedures



THREE Joining Meetings
 SEPARATELY with Relatives and Clients
 WEEKLY – 1 HOUR with Relatives, ½ HOUR
with Clients
Start sessions A.S.A.P. after client/family
enrolls
Gain an understanding of family’s stresses,
problems, reactions to client’s
unemployment/underemployment, etc.
JOINING – I







15 Minutes of SOCIAL TALK
Discuss the experience of looking for, getting
and losing jobs
Review any recent stressful event: Who and
what helped or didn’t
IDENTIFY WARNING SIGNS OF STRESS –
PRECIPITANTS
Distribute to families & keep for future
reference
Describe the plan for ongoing MFG sessions
5 Minutes SOCIALIZING
JOINING – II





15 Minutes of SOCIAL TALK
Review past experiences with co-workers,
supervisors, supervisees, etc.
FAMILY’S EXPERIENCE DURING
STRESSFUL EVENTS
 The sharing of painful events: A crucial
aspect of “Joining”
 The client/family’s understanding of
causes
Family’s social network & resources
(material & emotional)
5 Minutes SOCIALIZING
JOINING – III





15 Minutes of SOCIAL TALK
Family’s social network & resources
Developing and maintaining a support
network
SHORT & LONG-TERM GOALS (e.g.,
Employment)
Preparation for Workshop & MFGs
MULTIFAMILY GROUPS






Five to eight families
Two family counselors/facilitators
1 ½-hour sessions – biweekly over six
months or more
Refreshments/snacks are provided
Initial sessions avoid emphasis on conflict
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
 Counselor 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 UNEMPLOYMENT/UNDEREMPLOYMENT 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 CLIENT’S INNER EXPERIENCES
Counselors 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





New Members
Late-Arriving Members
Reminders about Attending
Crises & Emergencies
COMMUNICATION & INTERACTIONS
 Counselors DON’T speak for clients or relatives
 Interaction among members is essential
 Clients are ENCOURAGED (not pressured) to
participate
 Respect other’s turn and avoid criticism
PROBLEM SOLVING IN MFGs




The CORE of MFG Sessions
Designed to compensate for limited education
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
Counselors should GET READY and HAVE A PLAN –
IN ADVANCE
Selecting an Employment-Related
Problem to Solve


TOPICS: (Identified prior to MFG or during group)
Transportation
Child Care
Drugs and Alcohol
Life Events/Domestic Problems
Housing
Disagreements among Family Members
“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