Addiction And
Multiple Family Group Therapy

©1991 By Lewis N. Foster

A famous comedian once said, "It ain't what we don't know that causes problems, it's what we know that ain't true." This statement defines codependency. Codependency and addiction cause more pain, unhappiness, health problems and death than all the wars fought on the planet earth. It has been said that there are as many people living today as have lived on earth since the beginning.

Father Joseph Martin Giving A Lecture

I think that addiction and codependency equate to social dis-ease and must take place in a social setting. Multiple Family Group Therapy provides a safe social setting for families as they learn, grow and support each other.  Keep in mind that relapse is part of recovery.  Get families ready so they will not be so shocked and can respond in healthy ways.

As you will see, MFGT is fun, exciting, challenging, emotional, paradoxical, intimate, and nurturing. It is less expensive than individual family therapy and less staff can work with more families.

 The Foster Model of MFGT : The Beginning

In 1980 I joined an organization in Charlotte, NC know as Open House Counseling Service, Inc. It is called the McLeod Center today.  Shortly after arriving I was given the opportunity to train in Family Therapy at the Randolph Clinic which is an outpatient alcoholism treatment center. While in this training I learned about H. Peter Laqueur, MD who began MFGT in 1950. He was in charge of a 100-bed ward of mostly young schizophrenic patients at the New York State Hospital.

H. Peter Laqueur, MD "Father of MFGT"

John T. Edwards, PhD and Lewis N. Foster

Prior to the first session I discussed my idea with the patients on my caseload. I let them know that I would be contacting their families by telephone to let them know about the MFTG and to answer any questions they have. All the families agreed to be involved in the group when they came to visit on Sunday afternoon and they understood that they would be able to spend special time with their family member in treatment. The first session did not include the patient, (IP), but the following sessions did include them.

At three o'clock on the first Sunday afternoon all the families gathered in the prearranged room and the first MFT session at Open House began. John and I introduced ourselves and explained that we work as a family therapy team. (This is the time to explain any special conditions that exist such as: videotaping, observation room and mirror, confidentiality, signing a confidentiality statement, getting permission to videotape, and no smoking, etc.)

After completing the social stage of the session (having everyone introduce himself or herself and share something socially) attention was given to each family and family member individually. Family members were asked to share their concerns about the family and what they would like to see change. This was called the problem definition stage. Questions were asked to clarify and gather needed information and the problem statement was repeated to the family (possibly using a reframe) to make sure everyone understood.

An example of a reframe might be parents who complain about their nineteen year old not following the rules or doing what they want her/him to do, and the therapist reframing the situation by saying that she/he is making a declaration of independence. A positive way to reframe the situation so that the negative is left out.

As individuals and families shared their concerns, commonalities among the individuals and families were pointed out. Subgroups began to emerge that were used in the interaction stage during this session or a later session.

The interaction stage began quite smoothly due to several parents who had to be held back from talking during the problem definition stage. They were encouraged to share and as they talked others in the group began to voice their opinions. Attempts were made to get the individuals to focus on themselves rather than the IP. To accomplish this, the mothers were asked to pull their chairs into the center of the circle (fish bowl) and share with each other what it has been like for them to have a child who is harmfully involved with drugs. The mothers were asked to share: What did you see? What did you think about it? What did you feel? What did you do?

When the mothers had shared for about twenty minutes they were asked to rejoin the circle and observers were invited (by the mothers) to share their experience while the mothers were talking. Everyone was touched by the interactions and some of the group shared how they had come to tears listening to and watching the mothers cry. (The box of tissue was passed around the room while the mothers were fish bowled.) Surprise was voiced about how similar the situations were between families and the commonality of the pain.

One father wanted to talk about how the country has done so little to get those drug dealers who sold his daughter the drugs. He was quickly refocused on the topic and encouraged to talk about what he had experienced while the mothers shared. He had difficulty focusing on himself and continued to talk about situations outside of the room. He was asked to listen to some of the others in the group, and he did.

People who had talked very little began to share and it seemed that everyone grew closer. All recognized that they were not alone and that their family situation was similar to other family's. No longer did they try to cover up their situation. It seemed as though they had become liberated.

I looked at my watch and the ninety minutes were up. They didn't want to stop. The closing stage was at hand and the group was energized. The time was announced and everyone was asked to return next Sunday. It was explained that their family members would be with them next week. Everyone agreed to return and one family asked if they could bring other family members. They were told yes. As the MFT session ended everyone stood around talking to each other and some hugged. John and I had survived our first Multiple Family Therapy Group.

We used Jay Haley's idea of stages and it works beautifully in MFGT sessions. The therapist focuses on the process and the families provide the content.  See the MFGT Evaluation and Session guide.

Jay Haley

Becoming A MFGT Leader

There were many difficult times as the weeks passed and nightly after the MFGT sessions I replayed in my mind events of the group. Of course, the night before the session my stomach churned with anticipation, fear and worry. Every Multiple Family Therapist that I have talked with experienced similar situations until their experience provided some confidence. I think experience is the key to becoming a MFGT Leader and developing your own style.

As my confidence grew and the number of families increased it became clear that more than one group was needed. I didn't have therapists knocking the door down to help, so I began to sell the idea of learning to lead a MFTG to the people available in the organization. One unsuspecting and equipped for the job counselor was Dan Credle who agreed to help, (Dan is retired now, but used to be the director of YMCA Camp Silver Beach at Chesapeake Bay, VA). He began joining me in the MFGT sessions and John T. Edwards, Ph.D., joined us once a month, (John is a Consultant and Trainer in Durham, NC). We met before the session to plan, and processed the group afterwards. Dan began to catch on and in a few weeks took the lead.

Dan Credle (Retired)

Note cards were used to provide guidance and remind us what to do should we become lost. The stages of the session were on one side and options for the interaction stage on the other. This proved helpful, but remembering all the names of the people in the group became overwhelming. A decision was made to provide everyone with nametags. We learned that the first name was sufficient.

Equipped with note cards and nametags our job became less stressful until we had to do something, as Dan might have put it. Joining a group of three to five families and learning to dance with each family as well as the group as a whole and join with each individual is like entering a directory on a computer program. Each directory takes you off into a different direction and there are many subdirectories in each directory.

Every individual has their frame of reference and each family has a different frame of reference. As a group they may be pulled together due to a common symptom, and generally speaking this is where the therapist enters the family systems. Assessing the families in the MFTG will provide the therapist with direction. Too much information before the MFT session can be a hindrance. Use the MFT session to gather information, formulate hunches and set goals. Everyone in the group learns from this and the process helps free the family from shame.

As families experience others making themselves vulnerable they tend to take more risks, which leads to emotional expression and the building of intimacy. Addicted individuals and their families need to learn or relearn intimacy.

This idea of intimacy can be scary to the therapist. I think it important that the therapist be willing to take risks with the group and to join with the group in an intimate way. Accepting each family member unconditionally and loving them as human beings is good modeling and good staging for the MFGT forum. Objectivity is very important and the therapist must be personal but not take things personally. The opportunity to step into someone's resistance, angers, control issues, etc., will always be present. Their allowing this to surface in the session can be seen as an opportunity to earn their trust. After all, they are making themselves vulnerable by exhibiting this behavior in a MFT session.

When this happens ask yourself, "What are they really trying to saying?" They don't know you or the other group members well enough to be that angry. What is it that they really want? Make a mental note and use this information later or in another session. Look them in the eye with empathy.

I wouldn't want you to get the idea that I never find myself caught up in the system of the families in the MFT sessions. It happens to all of us and if you haven't been there it will happen to you if you chose to work with people. The key is to learn from experiences and when you recognize that you are caught in the family's system (inducted) do what you need to do to become objective. And don't beat yourself up; you're a human being. With experience you will get better at avoiding induction.

Having a co-therapist in the MFT session helps with this and if a one-way-mirror is available the observer can provide helpful assistance when they recognize you need rescuing. Other ways to get help are to: videotape or audiotape the session and review it with another professional; verbally process the session with another professional; or have a consultant join you in the group occasionally.

Selling others on getting involved in MFT can begin by asking them to provide feedback or observe the session to provide assistance. I had success getting new employees involved by sharing with them experiences in MFT and inviting them to join in the fun. I was in the inpatient component of Open House and the new employees were outpatient counselors. They fell in love with the idea and today harbor fond memories of their experiences.

Multiple Family Group Therapy attracts attention from the organization. As we grew and became more skilled the Outpatient component of Open House joined in and Multiple Family Group Therapy became one of the successes of the organization. Lynn Vacarella, the Outpatient Director, supported her counselors, and families from the inpatient side of the house were included in the outpatient MFGT sessions, (Lynn is a Therapist in Concord, NC.). The groups became a hub for getting individuals into inpatient treatment and providing continuing care after the inpatient stay. Family members traveled from around the state to take part.

An administrative reminder is when you want to start Multiple Family Group Therapy in your organization, get support from the top and work down. Trying to go from the bottom up will not work. The effort will be sabotaged.

Outpatient families and inpatient families were incorporated into the MFT groups and it proved to be beneficial to all. Other professionals questioned the confidentiality issue between families, but rarely did we have questions from the MFT groups. Everyone was asked to respect the confidentiality of each family and they did. In five years I dealt with the issue once and it was resolved in the MFTG.

Fritz Pearls, Thomas Harris, Jay Haley, Salvador Minuchin, Carl Whitaker, and Milton Erickson occupied my evenings frequently for about five years. Milton Erickson proved to be the most fun. Nights were spent rolling from one side of my bed to the other laughing at Milton Erickson's hypnotic teaching tales. I think that I was doing therapy on myself.

It seems that being single provided the time for me to occupy evenings with reading, and it protected me from possibly making myself vulnerable again. To some people I was known as the "monk." The knowledge I gained catapulted me into a Multiple Family Group Therapy career. Education is not cheap!

Some people say that knowledge is power. Power and control are fantasies. They are like the dog that chases the automobile until it leaves his territory. The therapist that leads a MFT group does so by following. Attempts to be in control or use power may leave the therapist barking in an empty room. The therapist takes charge and manages the process. Group members provide the content.

A good MFG Therapist promotes others, continues to grow personally and professionally, leads a balanced life, maintains a "can-do" attitude, shares knowledge and experience with other professionals, and recognizes that ignorance comes in all degrees.

MFG Therapists with whom I have talked report that they were drawn to the art of MFGT. There seems to be an inner attraction that involves emotion and reason. If you have experienced it, you know what I'm talking about. If not, take the time to observe several MFGT sessions.

END

Suggested Reading: Multiple Family Therapy and Relapse

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