Paul K

In conducting and observing Multiple Family Group Therapy sessions for many years, this writer has observed several styles, trends, and foci of group leadership. One frequently hears such expressions as 'the group runs itself' or 'all you have to do is get things rolling'. Often, this seems true enough. On the other hand, groups can often be observed to noticeably: a) focus on one family, b) seem focused on the exclusive aspects of a clinical sub-population (i.e., addicted persons, Patients, etc.), c) take on aspects of peer group therapy, d) cater to the verbal, insightful, psychologically minded persons or sub-groups, e) be laisser-faire on one extreme or didactic on the other. There are no doubt other similar observations in this regard to be made but it is hoped that by now, the point is clear for the moment.

Laqueur, often referred to the ideal Multiple Family Group Therapist to have the attributes of an Orchestra Leader or Conductor. Able to heighten the tempo here, lower it there, encourage here, hold back there, and so forth, the leader is able to bring out the best in the orchestra and as well, produce a musical score of quality and integrity. So, there is a balance of "program" (the written music) and "Style" (of the leader, musicians, interpretive prerogative, etc.). The result of all this is hopefully, to have a well running Multiple Family Therapy Group. More importantly, it is integral to have a well running "multiple family" group, with families interacting within and among each other and the therapy reflecting change at systems interfaces viz a vis; exclusively individual, temporal content or parochial concerns. How is this done?

The point thus far has been to emphasize that the trends in many groups that i have observed (or conducted!) share a common concern. That concern is that many groups, while no doubt helpful, may not be utilizing the tremendous potential of the multiple family CONTEXT, with the myriad of systemic levels of interaction, intervention, and invention, which his context offers. It is impossible here to describe with fairness the extraordinary range of therapeutic techniques/methods, which this unique context offers.

Here, I hasten to interpose an acknowledgement. There are certainly, times when a focus on an individual family, educational segments, clinical features, and so forth, is a necessary and valid component to the overall and ongoing Multiple Family Group Therapy process. What I am trying to stress here is that Multiple Family Group Therapists need to keep the General Systems Theory in the forefront in guiding the therapy with the group. This assumes the systemic and integrative nature of several families simultaneously interacting during the therapy process. General System Theory maintains that change occurs at interfaces between systems and subsystems. This is essential to keep in mind so that the multiple family context itself is not neglected or overly compromised.

If you think about it, could just anyone conduct an orchestra? Isn't it just like taking out a pencil or ruler and moving it to the rhythm and beat of a Beethoven pastoral symphony, or a Strauss waltz? Of course, we all know it is more than just that, though not to say that conducting with our pencil is not pleasant and relaxing at times. Leonard Bernstein had to have a keen understand of music theory, instrumentation, harmony, among other things. Just so, the Multiple Family Group Therapist (as "orchestra leader"), must have an analogous appreciation of General Systems Theory, group/family/individual development, technique, and mechanisms of change, (also, among other things).

Theory building in Multiple Family Group Therapy is still young and underdeveloped. Peter Laqueur articulated several "Mechanisms of Change," which have been observed in Multiple Family Group Therapy. These mechanisms are cited in several articles and chapters with the number ranging anywhere from seen to fifteen. This writes review suggests the following fifteen:

Space does not allow further description of these mechanisms here, they will be treated in depth in the next articles in this series.[1] The reference list at the end will be helpful as an introduction. It is clear that these mechanisms of change need further development descriptively, empirically, and anecdotally. The literature clearly needs to develop more extensive descriptions of each mechanism, cite clinical case examples of these mechanisms in progress, and promote attempts at empirical validity. Additionally, other unrecognized mechanisms need to be sought out, interrelationships between mechanisms studied, and new modifications and syntheses arrived at where indicated.

In light of the above, it should still be noted that these mechanisms of change were not arrived at casually or in any haphazard fashion. On the contrary, their development followed several years of observations by Laqueur, staff and colleagues observing the Multiple Family Group Therapy process. These observations included hundreds of group sessions, with over a thousand families between Laqueur's work in New York and Vermont. These observations included many hours of videotape as well as observer reports and team meetings.

While it is certainly not true in all cases, it is this writers experience that the "mechanisms of change" as developed by Laqueur have been frequently overlooked, especially in terms of their dynamic utility in the everyday conducting of multiple family therapy groups. It is this writers contention that these mechanisms are much more than post hoc reflections or just so much theoretical description. They are the vital and operating mechanisms or dynamics that drive the Multiple Family Group Therapy process. While some of these mechanisms are shared by other forms of therapy, their application to Multiple Family Group Therapy is unique. They provide the framework and the means to best insure that the full potential of the multiple family context is achieved. A point to remember is spelled out by Lewis N. Foster in the last edition of the International Journal for Multiple Family Therapist's by the phrase "It's not Family Therapy, it's not Group Therapy. It's Multiple Family Group Therapy." Multiple Family Group Therapy is "its own animal," and needs to be seen as such first and foremost..

This has been the first and introductory article in what is hoped to be a series of articles, which deal with the development of the mechanisms of change. It is hoped that this series will not only develop more fully these mechanisms, but also invite a dialogue and contributions from others. If this article serves any of these purposes, it will be worthwhile.

Similar to many activities such as dance, music or even martial arts and sports, learning can occur at multiple developmental levels simultaneously. The same basic skill domains can be addressed at beginning to advanced levels within the same class, even with the same teacher. Competition can lead to cooperation (even caring) as individuals specific learning needs gain respectability. This is as true for families as it is for students or individuals. The purpose is for everyone to cross the stream as individuals and as families, having then the motivation and ability to help others.

Many learning analogies can and indeed will be made in describing Multiple Family Group Therapy. This writer had the opportunity to attend a traditional rural New England "One Room School," with the first eight grades all in one room with the same teacher. It was a little community, a Camelot experience that, at least for this writer, was very special. Multiple Family Group Therapy can also be that Camelot experience to families. However, unlike mythical Camelot, it does not have to end, but can endure and thrive.

Laqueur, H.P., (1972). Mechanisms of Change in Multiple Family Therapy. In C.J. Sager & H.S. Kaplan (Eds.), "Progress in Group and Family Therapy." New York: Bruner Mazel.

Laqueur, H.P., (1977). Family Therapy (Multiple) and General Systems. In the "International Encyclopedia of Psychiatry, Psychology, Psychoanalysis and Neurology." New York: Aesculapius Publishers, Inc.

O'Shea, M.D. & Phelps, R. (1985). Multiple Family Therapy: Current Status and Critical Appraisal. "Family Process," (24), 555-582.

Strelnick, A.H. (1977). Multiple Family Group Therapy: A Review of the Literature. "Family Process," (16) 307-325.

At the time of the writing of this article Paul K. Thorington was President of the H. Peter Laqueur Foundation, Director of Psychological Services at Seaborne Hospital, Staff Psychologist at the Center for Life Management, and he maintained a private practice in Dover, NH. Dr. Thorington was a student of H. Peter Laqueur, MD.

[1] Article #23 on the MFGT Website is a good resource. The MFGT Resource Center cannot find additional articles written by Dr. Thorington, but we will continue to look. If you come across them, share them with us.