Multiple Family Group Therapy (MFGT)
By Alicia M. Homrich and Arthur M. Horne
Alicia M. Homrich, PhD
Overview
Multiple Family Group Therapy (MFGT) involves the simultaneous treatment of several families together in one group led by one or more therapists. As a modality, MFGT encompasses diverse settings, organizational structures, clientele and approaches. Ranging from two to thirty or more families, weekend marathons to open, on-going weekly meetings, this therapeutic form is designed to help families help themselves and each other change and grow. MFGT combines family therapy with group therapy in both theory and practice. "The essential element is the presence of other families in the group. The multiple family therapy system seems to be more powerful than a single family system and more potent than a peer group system" (Benningfield, 1978, p. 32).
H. Peter Laqueur is the first author known to have published on this mode of treatment beginning with work he initiated in the mid 1960's. He is considered the originator or "father" therapeutic form which began at an in-patient, psychiatric hospital setting for families of schizophrenics. Since its inception, MFGT has been successfully operationalized in out-patient mental health settings, post discharge follow-up for inpatients, correctional institutions, school settings, and as supplementary treatment for family members with mental illness, addictions and other issues such as physical and sexual abuse.
O'Shea and Phelps (1985), in their comprehensive article examining this model of therapy, proposed a working definition of MFGT as: a deliberate, planful, psychosocial intervention with two or more families present in the same room with a trained therapist for all or most of the sessions. Each participating family should have two or more members that represent at least two generations in the family and are present for all or most of the sessions. Sessions should have an explicit focus on problems or concerns shared by all families in attendance, (p. 573). In addition, the authors emphasize the significance of cross-generational family interchange and the emphasis on presenting interactional patterns within the family.
Description of MFGT
Treatment Phases of MFGT
According to Laqueur (1980) there are three phases of treatment in MFGT. Phase one is evidenced by the families' sense of relief, or initial anxiety release, that something is finally being done to help with the problem, thus generating a spark of hope. Phase two begins when resistance to treatment appears as families experience fear of exposure and begin to realize that "a serious change in attitude and behavior is required not only of one member of the family but of all of them" (p.22). The third phase, which is reached slowly, occurs when the family realizes that simultaneous change is needed from all family members and the real work begins in which families commence to help themselves and each other with openness and increased self-confidence.
Role of the Therapist
The therapist in MFGT is more active than in peer group therapy or individual family therapy and can be compared to the conductor of an orchestra or a theatrical director. Regardless of the analogy, leadership of a multiple family therapy group requires an active role i a fast-paced setting. The skills needed to maintain the appropriate atmosphere for group dynamics in MFGT are similar to those of a typical group leader. However, some of the requirements of the multiple family group therapist are more challenging in that the situations presented may be very original in nature and will require a more acute sense of timing, a greater range of technique, and substantial knowledge of family dynamics and intervention methods (Frager, 1978).
The MFG therapist provides descriptive information, attempts to elicit feelings, locates and displays alliances and counter alliances, does not take sides, is sensitive and perceptive to the needs of all group members, and helps the group focus on basic messages inherent in the group (Benningfield, 1978). The therapist(s) will, at the same time, be less powerful and less central "because the group is the primary mechanism for changing the family system. The group becomes the mirror in which the family sees itself. The group encourages, challenges, supports, and reflects so that the family members can become who they want to be in relationship to each other" (p.32).
Group Work and Multiple Family Therapy
Both group work and family therapy are based in systems theory which is a structural metatheory emphasizing interaction or the process of exchanging energy and information (Durkin, 1980). Systems theory provides the common ground which combines family therapy and group therapy into MFGT.
MFGT is similar to group therapy in that it brings together a variety of people. It is different from group therapy in that its members are all related, have a common history and go home together with their belief systems and behavior patterns still in active operation. The dynamics of the MFGT group will be more heavily influenced by the history as well as the current dynamics of the families participating in the group than might be the case with individuals in a group setting, primarily because there are so many people enacting the family dynamics.
Frager (1978) identified curative factors of MFGT as universality, cross-interaction, identification, analogy, models, peer support, milieu, reality testing, role change, sharing of different attitudes, and catharsis (p. 109). These factors can be conceptualized as combining the advantages of group therapy with total family units. Frager also believes that whole families interacting with other whole families creates a learning environment in which the "group experience can provide a clearer picture of family dynamics to the family since feedback is usually offered in concrete behavior examples as opposed to abstract theoretical concepts, helping the family to reach conclusions based on explicit evidence rather than distorted communications" (p. 112).
O'Shea and Phelps (1985) identify that the most distinctive feature of MFGT is that it "attempts implicitly or explicitly to establish a social network that can provide cohesion and mutual support" (p. 573), and Benningfield (1978) cities the utilization of other families as co-therapists as a primary mechanism for change as significant in MFGT.
Future Implications for MFGT
While this form of therapy has not achieved the popularity originally predicted by its founding clinicians, MFGT may simply be suffering from delayed development. Future potential may have some promised based on changes in the current therapeutic environment. Several emerging trends in psychotherapy may influence the resurgence of MFGT.
With the advent of managed care and accompanying economic restrictions on therapeutic interventions, MFGT is a cost effective way to help families. A greater professional to client/family ration makes it an attractive alternative to time and cost intensive individual or single-family therapy. More families can be served with less professional staff time as well as reduced overhead in the form of duplicated office space and clerical support which results in administrative and economic benefits to the managing organization.
MFGT also has transcultural implications in the treatment of family functioning. O'Shea and Phelps (1985) believe that: the multiple family group is a microcosm of the larger social and cultural context by virtue of the fact that several ages, family roles, phases of psychosocial development, and stages of the martial-family life cycle are embodied simultaneously by the participants. As such, it more accurately reflects the social/cultural context and provides more qualitatively varied opportunities for learning, adaptation and growth that group therapy does, (p. 569).
Additionally, the MFGT format may actually offer specific cultural groups a more familiar environment in which community-based helping and problem solving is valued, thus creating safer context in which to make familial changes.
Other advantages or characteristics of MFGT include a situation in which the presence of two or more "identified patients" or symptomatic family members diffuses the stigma associated with being the problem bearer allowing for a shift in emphasis toward understanding individual differences of family members between and within groups, resulting in a more positive perspective. The MFG is also less hierarchical than the traditional therapist-client dyad, and "families do not have to cope with the 'authority' of the therapist in isolation but can observe obliquely from their peers" (Benningfield, 1978, p 29). Further, troubled families often live in isolation, which often compounds some of their problems. The very action of being involved with other families, especially in a therapeutic setting, can help families establish relationships and expand beyond their own unit to find help and support in others. The individual-in-relation-to-self perspective is replaced with a broader individual-in-relation-to-others approach with a contextual focus on the individual as part of a system or community.
Conclusion
Multiple Family Group Therapy may have been ahead of its time initially, however, the resurgence of this integrated form of group and family therapy appears to be slowly regaining recognition and consideration within currently changing therapeutic perspectives. New and innovative applications of MFGT are likely to develop in the future.
References
Benningfield, A. B. (1978). Multiple family therapy systems. Journal of Marriage and Family counseling, 4(2), 25-34.
Durkin, H. E. (1980). A systems approach to multiple family therapy--the connecting link between group and family systems psychotherapy. In L. R. Wolberg & M. L. Aronson (Eds.), Group and family therapy, 1980 (pp. 24-32). New York: Brunner/Mazel.
Frager, S. (1978). Multiple family therapy: A literature review. Family Therapy, 592, 105-120.
Laqueur, H. P. (1980). The theory and practice of multiple family. In L. R. Wolberg & M L. Aronson (Eds.), Group and family therapy, 1980 (pp. 15-23). New York: Brunner/Mazel.
O'Shea, M. D., & Phelps, R. (1985). Multiple family therapy: Current status and critical appraisal. Family Process, 24(4), 555-582.
Slipp, S. (1993). Family therapy and multiple-family therapy. In H. I. Kaplan, & B. J. Sadock (Eds.), Comprehensive Group Psychotherapy (3rd ed., pp. 270-283). Baltimore Williams & Wilkins.
At the time of the publication of this article, Alicia M. Homrich, M.A. was a second-year doctoral student in the Counseling Psychology program at the University of Georgia. Today Dr. Homrich is a Licensed Psychologist, LMFT, NCC, has been a Professor of Counseling at Rollins College for 20 years, specializing in family and relationship therapy, solution focused therapy, creating standards for professional conduct in counselor education, and gatekeeping as a professional standard. She has researched, published, and presented on the obligation as gatekeepers and the ethical expectations for supervisors, educators, and clinical trainers. Dr Homrich has served multiple professional associations to advance mental health counseling. She is a past president and fellow of the Association for Specialists in Group Work (ASGW) and recognized by local and national professional groups for her service contributions. Dr. Homrich is co-editor of a book (2018) with Dr. Kathryn Henderson on best practices in gatekeeping for the clinical professions.
Arthur M. Horne, Ph.D. is a Professor and the Program Coordinator of the Counseling Psychology program at the University of Georgia. Another article by Dr. Horne is, "Effectiveness of a MFG Intervention for Juvenile First Offenders in Reducing Parent Stress. (https://www.families4change.org/wp-content/uploads/2014/10/FSPinJCFS2007.pdf)