Note: A.H. Strelnick, MD says the following about this Mechanism of Change. "Learning by analogy is Laqueur's terminology for the method of insight through observation. The potent impact of these observations often is the concrete alternative to family conflict that successful models provide. Families (who have been there) provide important incentive for others to learn and decrease the stigma and isolation created by any problem necessitating therapy. an extension of this concept is learning by identification, whereby individual members of the group find strong similarities in their mutual situations. although Laqueur implies that this is applicable only to parallel family positions (e.g., fathers identifying with fathers, etc.), <patients> so identify with <patients> independent of family position; adolescents dealing with individuation identify with married woman struggling with the same issues, and so on. When this concept is expanded to include the family as a whole, Laqueur labels it an identification constellation, and when applied to situations rather than people, he calls it tuning in to the discovery of parallels and simile in mutual situations. These similarities and differences--significant and trivial, large and small--provide a rich source of reality-testing." (Multiple Family Group Therapy: A Review of the Literature, Family Process)

2. Learning By Indirect Interpretation. Direct interpretation by the therapist, such as, "You behave this way because you hate your father," will most likely mobilize the patient's inner defenses against this unacceptable idea, although outwardly he may eagerly agree. The same observation couched in more general, indirect terminology, such as, "It is possible that a person's inner growth is hampered by his hidden hate of a parent," allows the patient to draw his own conclusions and learn by self-examination without being forced into the defensive by an open confrontation.

3. Use of Modeling. The therapist may use the healthier aspects of one family as a model and challenge to another family to change its behavior. Or the therapist, co-therapist and some observers may themselves model for the group different ways of solving a given conflict. The members of the group will at first imitate the desirable model, but eventually they will integrate it on a deeper level in their own behavior.

4. Learning Through Identification and Identification Constellations. The MFTG through its diversity provides many opportunities for identification. Identical family configurations produce something that could be called identification constellation. In a group containing four young female patients and their mothers (three of the mothers widowed, one divorced) very soon a strong identification of the four young women and the four mothers was observed.

5. Learning Through Trial and Error. The members of an MFTG have a unique opportunity to try out new behavior and either have it reinforced by the approval of the group or reject it if it does not achieve the desired result.

Note: A.H. Strelnick, MD says, "Learning through trial and error becomes another mechanism of change in MFT, because the group gives the family members a uniquely protected, surrogate rich environment in which to experiment with new modes of behavior. Not only the family but the group is present to reinforce more adaptive or discourage maladaptive changes. This is possible, in part, because of the decreased authoritarianism of the group; neither therapist nor parents have the authority they possess in smaller groups. This is well documented in the comparative psychotherapy work of Harrow, Astrachan, Becker et al."

6. Learning To Understand Intrafamilial Codes. Every family seems to develop its own code for internal verbal and nonverbal communication among its members. Not only must the therapist learn to understand this "internal language" of the family in order to reach them, but often the family members themselves are not aware of using a code and another family may have to point out to them what they are doing. a mother may have a specific signal for shutting off further discussion of a painful subject--like stroking her forehead or touching her hair--to which all members of the family react to instantly but without being aware that they react to this signal until somebody points it out to them.

7. Amplification and Modulation of Signals. A sensitive patient can pick up a signal from the therapist and amplify and modulate it. For example, an overanxious father and his rebellious daughter get into frequent violent quarrels in the MFTG. The therapist says, with a twinkle in his eye and a smile to another patient, "Isn't that the very thing we had between you and your mother a few weeks ago?" Patient "B" says, "Sure," and forthwith attacks father "A", "you don't think that your scolding will endear you to your daughter or make her behave better, do you?" The parents of "B" confirm that scolding and fighting did not get them anywhere with their daughter but that a reasonable, open-minded approach worked. Families "C" and "D" pitch in and now the signal from the therapist to "B" has been amplified and modulated in a way that makes it much more effective than if the therapist had just "preached" to father "A."

Note: A.H. Strelnick, MD says, "He uses this as a model for therapist-patient relations, but it also seems appropriate for explaining how any statement is universalized and translated for all to respond to and to understand. Much of this process is concrete translation of one family's situation to another's. Families may gain confidence from another just by properly understanding how the family has been able to cope with a comparable problem." This is "the method by which patients or families may pick up interpretations by the therapist and sensitize others."

8. Delineation of the Field of Interaction. The manner in which MFT helps a family understand a problem within a system of interactions. The family sees how the environment (not just the family) affects an individual and how he affects the behavior of those around him. The family then learns to share joint responsibility for what happens to the "parent" and their home situation. Thus, MFT helps a family make the transition from viewing the "patient-as-the-problem" to the "family-system-as-the-problem." (Strelnick)

9. Those Events That Have the Least Probability of Occurring Have the Most Significant Information Value. (Strelnick) "Any new, more realistic, or appropriate behavior in the family group setting can become the {focus of excitation} for the group as it attempts to emphasize the significance of and reinforce the observed change. These are often insightful, profound, or perturbing statements or behavior from the quietest or most disturbed members of the group. an example I observed was the questioning of a disturbed patient by the eight-year old son of an older patient. The patient, who was deliberately holding back expression of his true feelings, was disarmed by the innocence and sincerity of the small boy asking a question the staff knew they could not ask without the patient withdrawing still further. The patient expressed his deep, negative feelings and for the first time accepted the support of the group."