A Theoretical Framework for
Multiple Family Group Therapy
With Chemically Dependent and
Other At-Risk Families
©1991 by Lewis N. Foster
"Teach the families to help themselves."
(H. Peter Laqueur's motto for MFGT)
The addiction process in a family dictates social adaptation that intoxicates the system's thinking, feeling and behavior. Recovery is enhanced when therapy takes place in a social setting like Multiple Family Group Therapy (MFGT). The therapists' approach to the chemically dependent families will have to disturb well-established mental processes and use revolutionary strategy. Experiencing the chemically dependent families as a system calls for a unique frame-of-reference for the therapist.
There are no experts in the systems approach, but the systems approach is an honorable artistic concept. Therapists need to keep in the foreground of their thinking the curious human characteristics of our MFGT members. The environment, interaction patterns, and family structure all assist in sustaining (or changing) behavior. Families improve awareness by attending to immediate experience in the MFGT session. Changing response patterns modifies behavior. The systems approach begins when we see the MFGT world through the eyes of the individuals and families.
Therapists discover as they use the systems approach that every person’s world view is wonderfully restricted, including the therapists', and it's not what we don't know that causes problems, it's what we know that is not true. This sets us up for doubt. Many therapists know, for example, that a family or families have completed needed emotional, structural or communication work when it has been done in the presence of the therapist.
Distrust always occurs in the environment of ignorance, and there is craftiness in the family and therapist's approach to a system. When you applied for the job you have, for example, did you tell the potential employer all the negative characteristics about yourself? Did the employer tell you everything you would be doing and all the negative aspects of the organization? We choose to involve ourselves in systems that emulate our frame-of-reference. The aims of MFGT are to help families be more spontaneous, stretch themselves to their creative limits and achieve genuineness (congruence), empathic understanding, and positive regard among each other and to build community.
So, the dominant purpose of the systems approach, when working with chemically dependent (or at-risk) families in MFGT, probably lies in the creation of a theory of deception by the therapist and in an understanding of the ways in which the human being can be deceived about his world and in an interaction between these different viewpoints. One-way to look at the systems approach is to see it as a tool to understand how systems stay just the way they are.
If we want to see what the system is really up to, we must carefully watch what it actually does, not what it says it does.
The nature of the systems approach is a continuum with chaos at one end and enlightenment at the other end. The two are inseparable aspects of humans living in families, and communities, and the system creates some of its own potential. This aptitude is transmitted from generation to generation and must be investigated.
Know that in every behavior, no matter how destructive it appears there are positive intents. The person attempting suicide, for example, is behaviorally saying, "I'm tired of this dead existence." The individual using mood-altering drugs does so to feel good. The at-risk family is a force of expression (energy system) whose goal is aliveness (existence).
When studying at-risk family systems in MFGT it may not be possible for the therapist(s) to totally separate from the created family group system. This is why therapists must have their own counselor and support system. Those who think not are in denial.
Systems are made up of sets of components that work together for the overall objective of the whole. The systems approach is a way of thinking about total systems and their components. Every system is embedded in a larger system. The emphasis is on the process of exchanging energy and information. The therapist's function is the steersman of the therapeutic process. The families provide the content.
MFGT assists in cutting through the denial and shame found in at-risk families. H. Peter Laqueur, MD, said, "families in the MFGT session observe similar conflict situations and learn from them."
Each family in the MFGT session is influenced by the interrelation among all of the families. Individual families in the multiple family therapy groups determine the temperament of the group. (Sobriety calls for families in MFGT to be more in touch with their feelings and less conforming to rigid rules and roles.) The MFGT system has an affect on the behavior of the individual families. When one system joins another system, both systems change. When systems are formed (or new families enter the group) the new system will influence the old. One significant change in the system will bring about other changes in the system.
Change in MFGT takes place when boundaries open. Boundaries define who and what ideas and things are included in a family and the level of intimacy. The solution of one at-risk family has a great deal to do with the solution of another family’s anxiety. All at-risk families have certain basic structural features in common.
Most families have unfinished business, usually unexpressed emotion. The completion of this business brings about change. Emphasis is on awareness, expression, and acceptance of feelings and early decisions. Encourage here-and-now experiences but do not discount past experiences. Experiencing in the moment and acting out those moments fish-bowled in MFGT create an alive and vibrant experience for families. Allow honest confrontation, even though the feedback may seem skeptical and potentially irritating to the receiver, it is valuable. Pay attention to nonverbal ques by the body. They furnish extremely important clues about relationships in the family and multiple family therapy groups.
Backtrack present feelings to their earliest presentation in the family's (or individuals) memory. Recreate the setting and check for early decisions that may be adversely affecting life today. Consider a more appropriate decision for today’s situation. As a family becomes enlightened so must its rules and roles. When practiced in a safe and accepting MFGT environment new behaviors become skills. At-risk families can be helped to extend past their imagined limits. Spontaneous involvement and emotional release take place when families learn they are not the only ones experiencing this chaos.
Growth takes place in MFGT through the development of relationships with others that are satisfying, enhancing and validating. Families learn in MFGT: to empathize with other families feelings without losing themselves; to detach with love and allow others to experience the natural and logical consequences of their decisions and actions; to take responsibility for their own decisions and actions; to accept each individual as unique and valuable; to allow others to be in charge of themselves; and to experience separateness as wholeness.
Keep in mind when pondering systems that it's wise to question and take a close look at the most obvious and simple assumptions or hypothesis. There is more to the system.
Like an artist the therapist can only give birth to, and become a master of, their own therapy style (see the article, "Developing Your Multiple Family Group Therapy Style").
MULTIPLE FAMILY GROUP THERAPY
A son in treatment confirmed that his mother was the easiest to manipulate and get money from. With discussion and coaching mother agreed to let her husband be responsible for giving the son money. She supported her sons’ appraisal of the situation and thought that this change may be healthy for she, and the relationship between her husband and son. I walked over to the son and whispered in his ear, "at some point in the MFT session today ask your mother for five dollars." He agreed to, and we went on with the session. Being creative, the son asked his mother for five dollars during a break. She gave it to him. When everyone returned to the group he let me know that he had gotten the money. I asked the son if he had five dollars and he responded, "Yes". I asked where did you get it? He shared openly and everyone in the MFT group laughed. Mother looked shocked. We processed this and without being prompted the mother demanded that the son return the money. He did and everyone had fun. She had the chance to practice and will never forget the experience.
Role Playing (Gestalt exercises)
Any Gestalt exercise can be adapted for Multiple Family Group Therapy. One family with a stepfather who attends a MFTG had never talked about the death of the natural father and husband. Stepfather was the first to say that everyone needed to deal with the unresolved grief and to begin talking about thoughts and feelings surrounding the death with each other. Fish bowled in the family group the family was encouraged to checkout each others thoughts and feelings. They discovered that the reason no one talked about the dead father/husband was to protect each other from the pain. Each came to understand that all were harboring unresolved grief.
A plan was agreed on by the family to continue talking about the death and to bring a favorite picture of the dead father and husband to group next week.
During the next MFGT session the picture of the father/husband was place in a chair and the family (including the stepfather) sat facing the pictures. Each in turn began to share what they have missed and what it has been like for them to live without the father/husband since his death. The intensity grew and everyone (including group members) began to experience the emotion of the situation. The family set the pace and was allowed all the time that they needed.
When a transition was in order the therapist asked each family member to share what they thought the deceased father/husband would say to them in response to their statements. They reconfirmed his love for them and desire for them to have happy lives.
"What do you need to do to say goodbye to your father/husband and let him go in peace to heaven?” asked the therapist. "What do you think he needs to say to you?"
The family carefully said goodbye and verbalized what they thought father/husband would say to them. Crying and hugging each other the family let go and cried together.
The group rediscovered that it is in death that we human beings learn to care. While processing the experience, multiple family group participants experienced and discovered a little more of themselves.
Chair work in MFGT is powerful.
Focusing On Self
Linda shared with the multiple family therapy groups that she and her husband live in the same house, sleep in the same bed and occasionally have meals together. This has been going on for over ten years. The children are gone and she is lonely. The last conversation they had about each other was just after their marriage thirty-five years ago. Linda now thinks her husband was an alcoholic when she married him. In the past he smoked marijuana and would use cocaine when his friends offered it to him. Drugs left her life when she became pregnant and decided not to return to them. The therapist directs her to focus on herself and not talk about her husband who is getting help for his addiction. She talks about herself and smoothly moves to talking about her husband again. The therapist playfully redirects her to herself by asking, "whom are you talking about?”
A mother, her daughter and three sons came to a multiple family therapy group one Monday night. One of the twin sons was very angry trailing behind everyone with a mad look on his face. He found a chair and pulled it up next to his unhappy looking mother and sat down. As I watched throughout the session I noticed that, of all the places the son could have found a seat, he chose to sit next to his mother. I pointed this out at an appropriate time during the session and both (mother and son) began to smile. Mother looked at me and winked.
Discussion and Evaluation
Asking the group what everyone thinks about a comment or discussion between a married couple, family, other group members, etc., and what came to mind about their own situation allows the therapist to become less central. Families can hear from each other what they cannot or may not be able to hear from a therapist. When a family has been fish bowled discussing a chosen topic (or sharing their concerns, etc.) for about twenty minutes, the group can be asked by the family what they thought or felt about their own situation while the family was fish bowled and talking to each other. When the group member’s share from their experience and frame of reference this lets the fish bowled family know (and every one else) that they are not alone in their pain, concerns, etc.
Experience comes in many ways, and when groups of families join together, each family has healthy experiences that can be called on to help others. Invite them to share ideas.
Responding to a parent's questions about what to do with a teenager (adolescent) who "talked back" to her when she asked or told him to do something, I asked if he (the son) did what she wanted him to do? The mother said, "Yes, he does it, but I can't stand his mouthing off and griping and whining." I shared an example in my life.
My twelve-year-old son does that. Just yesterday I asked him if he would get his laundry out of the dryer so I could dry my jeans. He became irritated and it progressed into madness. He stomped in the direction of the dryer, mumbling under his breath, removed his cloths from the dryer and repeated the stomping and mumbling past me, and threw his cloths on his bed. I took my jeans out of the washer and placed them into the dryer. I returned to my computer to complete a story I was writing.
We had fun eating hot-dogs together at a local lunch counter an hour later and continued with our plans to paint the lawn furniture during the afternoon.
The words of a wise old lady therapist (Jackie McLeod-Doubles) played over and over in my mind. Her voice was saying, "be careful what battles you choose to win with your adolescent." I did not want to break his spirit. I just wanted him to take his cloths out of the dryer. When he does what I ask him to do, I'll do my best to overlook the stomping and mumbling under his breath. There are occasions when he has learned that mumbling out of my ear range is best. Sometimes I become inducted and frolic on his battlefield.
Parents shared more examples and adolescents in the group and everyone had fun talking about himself or herself.
A couple living together for many years came to the multiple family therapy groups. One of them made a comment during a session about not being able to trust the other. They were invited to talk about not trusting each other, but found it difficult. They were allowed to struggle and no one rescued them. The silence became loud. Asking if they were willing to try an experiment the therapist placed a blindfold over the eyes of one of them. Another couple, which could trust each other, because they had worked on trusting, was asked to follow the couple with out saying anything, and to return with the couple in ten minutes. The partner out of the room and down the street led the person with the blindfold for five minutes in one direction. The blind folded person was instructed to listen and follow the instructions of the other and to say nothing, excepting to clarify instructions. The leader was directed to protect the safety of the blind folded partner and to tell everything about to happen to the blind folded person. The couple observing was instructed to be prepared to report back to the group what they observed, thought and felt during the experiment.
While the couples were on the "Blind Walk" the group discussed their thoughts about what the experience was like for the couples, what they were thinking, feeling and doing. Upon the return of the couples the two observes were asked to share their observations. Then the blind folded person was asked what the experience was like, and finally the leader talked about being the leader. The group discussed what might have been learned by doing this exercise.
Conflicts usually develop not because the other agrees or disagrees, but because they think we don't understand.
Mary and John came to the group after John had spent thirty days in a psychiatric hospital. John said he had a nervous breakdown. About a year earlier John had been in an inpatient treatment program for the treatment of his addiction to alcohol and medications. During his addiction treatment Mary took part in the family program that included attending multiple family group therapy. During one session John told Mary about his infidelity over the past dozen years. When John was discharged they did not continue with marital therapy as recommended and Mary began to verbally and behaviorally hurt John, because as she said, she wanted John to hurt as much as she was hurting over his running around on her.
She admitted that during the dozen years she thought he was not faithful, but John never validated her thoughts or feelings when she asked. She admitted that it was validating to have John be honest, because on some level she knew. She didn't think he understood how painful this was to her.
John expressed that his nervous breakdown was partly in response to Mary's actions toward him and the awareness of the pain he caused her. It all became overwhelming to John and he couldn't take it anymore. John said that he came to the group to get support for himself and Mary who he thinks needs to forgive him and let go of the past.
When the two were invited to discuss this between each other in the group they had no problem focusing on the other's "can of worms." She would open up his "can of worms" and take one worm at a time out and explain it and throw it at him. There was always a big juicy worm in the can when she put her hand into the can. John did the same thing to Mary.
The intervention decided on by the therapists was to work towards having Mary and John take their own "can of worms" and look at their worms rather than focusing on the other's "can of worms." This was explained to them using the "can of worms" metaphor and they were given the opportunity to practice in the group. Both were encouraged to bring their anger and hurt about the past to the group weekly rather than infecting the other with their "dis-ease" during the week.
As they began focusing on themselves and shared with the other their perceptions of their own "worms in the can" understanding surfaced and their marital relationship improved. John didn't understand that Mary didn't want to be angry and hurt and that she disliked that part of herself. When he gave her permission to be angry and hurt, and not taking it personally, he stopped reinforcing her behavior. Mary stopped reinforcing John's negative behavior as well. They began to go to a local restaurant with other families for ice cream after the multiple family groups meeting weekly.
Kay and Tim came to therapy after being married for about two and one half years. Tim is six feet tall and weighs about 200 pounds and Kay is a petite 110 pounds. Tim was thirty-eight and Kay twenty-two years old. Their baby girl was about one year old. This was Tim's third marriage and Kay's first. They met at the bank where Kay is employed, dated for several months and Kay lived with Tim for about a year before they were married. At the time of their first session Kay had been separated from Tim for several months. She agreed to return to Tim with their baby girl if Tim would come to therapy. Tim agreed and was following through with his commitment. Kay reported that she left Tim because of his emotional and verbal abuse of her and that she was afraid that he might physically abuse her. When Kay left, Tim made no attempts to visit Kay or their baby girl at Kay's parent's home. Kay initiated all contact over the three months. Tim closed himself up emotionally and detached from Kay with anger. His anger was alive and well during the therapy session.
Giving and Receiving of Feedback
A quiet and shy farmer brought his son to the multiple family groups for treatment of alcohol and drug addiction. He said little during the first few multiple family group therapy sessions. Letting others know the secrets in his family was not easy. The farmer's wife identified with the mothers in the group and began sharing immediately. The son claimed he could handle the problem himself and didn't know why his father forced him to come. They had spent thousands of personal and insurance dollars on inpatient treatment and nothing was working.
A salesman in the group took a risk and asked the farmer if he hated his son's addiction. With surprise in his eyes the farmer responded with a strong "yes."
The salesman leaned forward resting his elbows on his knees and spoke in a caring way, "I had to learn to love my daughter's addiction. It became clear when I realized that the addiction and my daughter are one and the same. If I hate her addiction I hate her, and me. I was building a love -- hate relationship. I didn't want to look at me. When I began to just love her I set her free to make her own choices. I also learned to love her enough to allow her to experience the consequences of her choices.
You know human nature hasn't changed in thousands of years. Technology changes, for example, the technology of psychology, but human nature remains consistent. It was uncontaminated love that set my family free. You, your family, and your daughter are who you are and that is okay. Before you can go where you want to go, you have to arrive where you are. You can't, not be where you are."
Eyes of the participants turned towards the farmer. There were tears rolling down his cheeks. Then there were tears rolling down everyone else’s cheeks. The farmer looked at the salesman and nodded his head in agreement and said, "thank you."
The next year, ninety minutes a week, brought about big changes and the farmer and the salesman helped many families, including their own. The Multiple Family Group Therapy cost twenty-five dollars a session. They spent just over one thousand dollars.
It's the families that do the therapy, not the therapist.
Hot Seat (Love seat)
Mary and Richard were together in the inpatient multiple family therapy groups for the first time. The therapist invited them to bring their chairs to the center of the group to talk to each other. As Richard stood he said, "So this is the hot seat everyone talks about." The therapist said, "No, this is the love seat."
Richard was asked if he was willing to find out from Mary what it has been like for her to live with him while he was under the influence of alcohol. He asked and she shared in a non-blaming & non-judgmental way what she had see, how she had felt, what she thought, and what she did in response to his drinking.
Richard listened with tears in his eyes. When Mary finished Mary was asked if she was willing to find out from Richard what it has been like for him to live with her codependency while he was under the influence. She asked and Richard shared in a non-blaming & non-judgmental way what he had seen, how he had felt, what he thought, and what he did in response to her codependency.
Mary listened with tears in her eyes. The "Hot Seat" changed into the "Love Seat" and intimacy began to surface. Both sides of the conflict were discussed (understanding).
It was a powerful experience for the group. The group shared what came to mind about their own experience (audience participation) when Mary and Richard moved their chairs from the middle of the circle.
Participants of the multiple family therapy group can and will become more involved if the therapist(s) find ways to invite participation. An exercise I consistently use is to get the couple or family coming out of a fishbowl experience to ask for feedback from the group. I prompt the group at the beginning of the fishbowl exercise.
After the people are seated in the middle of the circle I call the groups attention to the working family by saying to the fish bowled family, "while you are talking to each other, I'm going to ask everyone in the outer circle to remain quiet, and to pay attention to what they feel and what comes to mind about their own experience. After you finish we'll take the time for you to ask the group for their reaction (feedback)."
As long as the feedback is non-punitive, blaming or harmful in some way, I'll avoid involving myself. This helps me remain true to my theoretical guide by becoming progressively less central in the multiple family group therapy sessions. In fact, if the group is talking to each other (not trying to change the world for example) many things can be learned (by the therapist(s)) about the individual families' social interaction patterns and structural makeup by simply observing (participant observer).
Changing of "it" statements to "I" statements
Larry explained to the group that when his wife drank and used the medications prescribed by her doctor it made him feel alone because Carol was unavailable emotionally and physically. The therapist asked Larry if he was willing to say, "I choose to feel alone" rather than "it made me feel alone." This places the responsibility for how Larry feels on Larry rather than on someone outside of Larry. It also returns the power to Larry rather than Larry surrendering his power to Carol.
Lead By Following
Ronda and her fourteen-year-old daughter arrived forty-five minutes late for the multiple family therapy groups. She agreed to bring pictures of her parents several sessions ago after explaining how painful Christmas was without her parents. They have been deceased for seven years. The therapist made plans with her to do some grief work. Since this agreement of several weeks ago, Rhonda has consistently arrived late for the group. The therapist explained to Ronda that this type of work required that they begin early in the session, and that she needed to come to group on time. Five weeks after the agreement, Ronda arrived late again with the pictures in hand. As usual, the focus of the group had taken a direction early in the session and families were working. Rhonda was irritated and fumbled with the pictures, not paying attention to what other families were doing. She whispered to her daughter that they had just as well leave. The daughter interrupted the group and told the therapist that her mother brought the pictures tonight.
The therapist responded to the daughter by explaining that he and her mother needs to talk about that before the end of the group and refocused on the topic being discussed prior to the interruption. This did not sit well with Ronda.
Fifteen minutes before the end of the group the therapist thanked Ronda for coming and bringing the pictures of her parents. It was explained to her again the need for her to arrive on time to the MFT group. She began to blame the therapist for her not working on the grief for weeks. According to Ronda another family had left the group because the therapist did not take charge and she was thinking about not coming back.
The therapist asked Ronda if she was saying goodbye to the group tonight, and she began to cry. She explained how frustrating it has been to sit while another group member dominated the conversation and told the therapist that he was suppose to be in charge. The therapist explained that he was only a guide and the group is responsible for the group. He also, stroked Rhode’s courage for bringing her thoughts and feelings out into the open.
Other group members responded to Ronda positively. One outspoken male explained to Ronda that he would be upset if she came late and the group stopped what they were doing to accommodate her. He suggested that she make a contract with the therapist to have special time next week at the beginning of the session and that she arrive on time. Everyone in the group verbally supported the idea and Ronda asked the therapist if this was acceptable. The contract was made and Ronda agreed to be on time to the multiple family therapy groups.
The therapist led by following Ronda’s behavior rather than listening to her voice. If you want to know what the system is really up to, pay attention to what it does not what it says it does.
"Strings" (Virginia Satir)
One therapist I know used string to tie a family together during a multiple family group therapy session. The family was instructed to continue discussing the issues. As each family member moved, the attached string demonstrated how each person in the system affects the other when they change positions physically. This can be related to attitudes, feelings and behavior.
Group Sculpt (LNF)
After the group has been together for several months, have someone in the group sculpt the group. It is a powerful experience for all. Have the sculptor explain to each person why they were placed as they were and afterwards get each group member to share what they think and feel about where they were placed (while remaining in the sculpt).
Another option is to have staff members in your agency sculpt the staff during a staff meeting or staff support group or staff processing session. Do two or three staff sculpts with different staff members to demonstrate how each person comes from their own frame of reference. Process the experience as a group afterwards.
"Yes-No" Exercises (HPL)
Invite a husband and wife to stand opposite each other, at arms length, hands on the shoulders of the other with elbows locked. Have one of them say "yes" and the other say "no," making sure they understand to speak loud and clear. After each exchange they are to speak louder and, without taking their hands off each other's shoulders, push each other without jerking. Peter Laqueur used to say let's see who wins. The therapist watches them closely to make sure everything is safe. You will see that people who claim to have little communication will after this exercise have a clearer perception of how far this is true. It may be that they have not really looked at each other in a long time, but in this exercise, confronting each other and touching, they bay again become more aware. The degree of their anger will determine how cooperative they are to do the exercise. There may be an extreme case where one or both may refuse. This exercise was created and used by H. Peter Laqueur, MD.
The use of silence is a multiple family group therapy session is powerful and increases the intensity and anxiety level of participants. As one participant put it, "silence is loud." When a group, or family fish-bowled, becomes silent, allow the silence to exist. Someone will break the silence when his or her anxiety level has peaked. Therapists must learn, through experience or training that silence in a session is okay. The need to maintain verbal conversation during a multiple family group therapy session probably has more to do with the therapists need than the participants. It is the family (families) that does the therapy.
"Back-To-Back" Exercise (HPL)
To demonstrate communication or the lack of communication, two people are invited to stand back-to-back, and without speaking, find a way to change the situation they are presently in. The amount of time they remain back-to-back is dependent on the amount of conflict or lack of communication that exists in the relationship. Usually one will make a movement that is followed by one or both turning around. There may be a time when the conflict is so severe that both or one may simply walk away for the situation. I've never had anyone leave the room, but I guess that is possible. So, if you want to see what this relationship is really about, watch what it does, not what it says it does.
"Join Hands" Exercise (HPL)
When the patient and their spouse are in the multiple family therapy group together, the "Join Hands" exercise created by H. Peter Laqueur, MD, can provide valuable information about the relationship of these two people. Have them stand as far away from each other as they can within the center of the circle of families. One stands still and the other, with arms reaching out, walks to the spouse and takes their hands. Ask them to pay attention to the way they feel as they go through the stages of this exercise. Next, the other walks to their spouse and takes their hands. The final stage finds the two walking towards each other with arms stretched out until they meet in the middle. They are then invited to tell the group their emotional response to the different ways of joining hands. Which did they like lease and which did they like the most?
Staging A Crisis
Once the family has settled into the MFTG the therapist’s job becomes more focused on the patterns of behavior that surface from week to week with the families. Some time during the session each week can be focused on identifying and discovering these patterns by having the families bring into the session any concerns that surfaced over the past week. A family can be fish bowled and asked to act out the crisis that took place at home last week. In this way, the therapist and group of families can provide support and interventions can be created to interrupt the pattern of behavior.
Drawings have been a technique used in family therapy for decades. Crayons and paper provide children with an activity if they become restless and their drawings can be used to improve their self-esteem and self-image. At the end of the session children can be invited to show their art and to tell the group about it. Taking the art home carries meaning as well. They can be asked to draw their family or draw what makes them happy/sad. Families can be given paper and crayons and asked to draw their family. When everyone is finished each family can introduce his or her picture and tell the story. Any drawing activity can be adapted to MFGT. Be creative and experiment. They are great ways to help families join together.
United Front (SS & NC)
The "Yes-No" exercise on page 12 can be adapted to include both parents of an adolescent IP. When the adolescent is rebelling and in control, have the parents stand facing their child with their hands on his shoulders and chest. Ask the adolescent to put one hand on a shoulder of each parent. Continue with the exercise as described on page 12 and process afterwards.
The idea for this adapted "Yes-No" exercise came from Susan Smith and Nora Chambers (Youth Homes, Inc.) at the First Annual North Carolina Conference on MFGT at Greensboro Colle
"Cutting the Apron String" (JWT)
She stood fish-bowled in the Multiple Family Therapy Group (MFTG), crying and holding one end of a blue ribbon while her son held the other end.
Her homework assignment last week was to purchase blue ribbon and bring it to the MFTG session today.
The son stood with tears surfacing as he listened and watched his mother ready herself for "cutting-the-apron-string." He will not be returning to his mother's home after treatment.
Both agree that he needs to move to a Halfway House where he can build a more independent life for himself. Since his father's death eighteen years ago, he and mother have been inseparable.
Today he is twenty-nine, a college graduate, unemployed, and dependent on his mother and being discharged from his third inpatient addiction treatment program.
Mother recognizes her dependency on the son and is in treatment for herself. Fears have prevented her from allowing her son to emotionally and physically detach and leave home. Both are dancing a very rigid and common dance.
The ordeal of "cutting-the-apron-string" is an official good-bye. Both say what they want to do this, but before, mother cuts the apron string, she shares her dreams, fears and limits with her son.
He can come to visit, but not to live. He will need to find a job and learn to budget his money. Mother will not be the bank or bail him out of trouble. Beginning today, he will be allowed to experience the consequences of his decisions and actions.
A tear gently rolls down the son's cheek. He accepts the conditions and shares his dreams, fears and limits with his mother.
"I won't be home every weekend and I won't call every day. I love you and want you to have a happy life. I am going to take care of myself. I miss you already, but I must get on with my life. Good-bye mother, let's do lunch sometime."
Scissors touch the blue ribbon and mother quickly looks into her son's eyes. Big tears roll across her face. She closes the scissors and says good-bye.
At the moment of liberation they reach and hold each other to cry. There are very few dry eyes in the multiple family therapy groups.
Everyone receives a gift from this exercise and resulting group discussion. The idea for "cutting-the-apron-string" comes from a story told to me by Jack W. Tobin, MS, MA, LPC, of Florence, SC
The evening before their sons (Mike & Mark) left home for college, Jack and Nancy Tobin prepared their son's favorite meal.
Nancy purchased an apron prior to the celebration.
At the end of the ritual, Jack and Nancy stood holding one end of the apron and the son held the other. Everyone said good-bye in his or her own way and the apron was cut.
This writer was so moved by the power of the story, and rite-of-passage, that I've used it in Multiple Family Therapy Groups (with leaving home issues) since about 1986.
There are occasions when props will serve a practical purpose (like a magic wand for example) during a multiple family group therapy or psychoeducation session. Bud Edge, of Myrtle Beach, South Carolina, has a very real looking rubber snake that he throws into the center of the group to demonstrate how people instinctively know to fight or flight. After things have settled, Bud will collect the snake and replace it with a simulated bottle of BOOZ. The resulting discussion is centered on the disease of addiction and how knowing the danger makes little difference when it comes to addiction.
Teaching Tales (MHE)
Milton H. Erickson, MD, has had a mysterious effect on this writer, administrator and multiple family group therapist. My Voice Will Go With You, The Teaching Tales of Milton H. Erickson, by Sidney Rosen, was the first of dozens of books that I read which focused on the works of the Father of Modern Hypnotherapy. Rather than say something directly to a family in the multiple family therapy groups, which may call out their resistance, use a story that can say the same thing in a more gentle or funny way. Speak to the back of their mind rather than the front of their mind. Ministers use this approach every Sunday morning.
A man and his son were walking along a county road early one morning leading a consented donkey named "Hinny" who was nibbling grass along the way. A field worker noticed them and yelled, "How stupid! One of you could be riding that donkey instead of walking. Save your strength." The father took the advice of the worker and rode the donkey into the next town. They felt they had received good advice. As they were leaving the town, a saintly woman cried, "Oh my, you should be ashamed of yourself making your son walk. Let your son ride." They exchanged places and continued their journey to the market. Then a traveler passed by and yelled, "Old man that is a strong donkey, both of you can ride." So the father jumped on the donkey and they continued their journey. As they turned the corner to cross an old swinging bridge a man viewing them remarked, "You're going to kill that donkey. Two riders on one donkey are too much. You should be carrying the donkey." Quickly, the father and son dismounted and lifted the donkey onto their shoulders and started across the bridge. The planks on the bridge were wet from the morning dew. The father slipped and the donkey fell to its death into the rocky valley below. The moral of the story is "if you try to please everyone you might loose your Hinny."
Someone in South Carolina had the identified patient, who was in treatment for addiction, lay face-up on the floor with arms and legs up like a dead cockroach, and asked his family members to take hold of hands, legs and head. They were instructed to lift the limp body of the identified patient off the floor, which they did. The therapist withdrew from the situation and took a seat in the circle of families while remaining silent. The family struggled to hold the patient up until someone in the family decided she wasn't going to hold him up any longer. As the weight increased for each person left, they decided to let go of the patient. Observing this, members of the group began to relate the exercise to how families hold-up, take care of, and rescue family members who are not making a contribution to the family, but taking advantage of or living off the family.
Colt-45 Therapy (LNF)
One widowed sixty-six year old mother of a thirty-eight year old son struggled to identify what she intended to do when her long-time addicted son left his seventh inpatient treatment program. She consistently turned to her son for an answer to what she should do. The therapist moved in the direction of the mother explaining that a make-believe Colt-45 gun is pointed at her son. The therapist pretended to pull the trigger, then looked at the mother and said, "your son is dead and on his way to heaven. What are you going to do now?" The son was directed to move to the corner behind his mother so she could not see him. Things were silent for a long minute, and then the mother began to cry. Several intense minutes of crying passed and the mother said, "I've got to make up my own mind and not be dependent on my son to give me the answers." The son returned to his seat and the mother began setting limits and taking care of herself.
Drama Triangle Exercise (JMcD)
Families can get stuck in a rut moving from persecutor, rescuer and victim. Explaining this usually makes no change in the family’s behavior. By having the family stand fish bowled in the MFTG and continuing with their conversation(s) the therapist can demonstrate how they change positions on the Karpman Drama Triangle. Take three separate pieces of paper and write on one the word PERSECUTOR. On the second piece of paper write the word RESCUER. On the third piece of paper write the word VICTIM. When the family is caught in this cyclic rut place the appropriate piece of paper by the PERSECUTOR, VICTIM and RESCUER. As they change roles move the piece of paper or move the person to the appropriate position. Explain that their job is to keep talking and your job is to place them on the right piece of paper or to place the right piece of paper behind them. When they ask what it is that you are doing take the time to explain and then have them return to their conversation(s). When they begin to focus on self and take responsibility rather than focus on someone else, remove the pieces of paper. This will demonstrate that they are getting off the drama triangle, and helps them begin to recognize the difference. When they return to persecuting, rescuing or being the victim place the appropriate piece of paper behind them. Members of the group will quickly recognize the process and gain valuable insight into their own situations. Having the family ask for feedback from the group after the exercise will generate much dialogue. I observed Jackie McLeod-Doubles and Ronald S. Johnson demonstrate this exercise and have used it in MFGT since.
Create a Story (JMcD & LNF)
There are times in family therapy that the family comes to therapy with nothing to talk about. This is a chance for the family and the therapist(s) to have fun creating a story. Someone begins the story with one sentence and the next person adds a line, then the next, until someone ends the story. Another story can be started and the process continued. Sometimes the stories run together or one story is continued in another. This is an exercise that told itself during a multiple family therapy group led by Jackie Doubles and Lewis Foster in Florence, SC during 1993. Themes and/or processes will surface that can generate something meaningful.
Andy and his parents (Ruth and John) came to the Multiple Family Group with the ability to talk to each other only about the weather. And sometimes that was a struggle.
"This has been going on since Andy was about fourteen," according to Ruth. John looked angry and determined to be in control. Seventeen-year-old Andy seems embittered claiming that everything will be okay when he leaves home for college in a few months.
John reports that he and his son haven't communicated for years and has accepted that they probably never will. His job as vice-president of sales for an international company keeps him on the road and, in some ways, out of touch with his family.
When John is at home he runs things his way and he remains in the control tower. "Kids today just don't appreciate how easy they have it,” complains John. "Sometimes I don't want to come home. My wife sides with Andy most of the time and I think she is too soft on him."
They attended the group for several months and the parents began to work together and John became a more active parent, which improved his relationship with Ruth. Andy and John participated in some father-son sports activities and they claimed to be closer.
John was asked to write a letter to Andy telling him everything he always wanted to say, but never found the time or a way to say them. The letter was to be written before Andy left for college and given to him the night before his leaving home.
Weeks of work went into the letter. The night before Andy left for college John and Ruth had a special family dinner and they all said good-byes. The letter was given to Andy who read it to himself while at the dinner table. With tears in his eyes he looked at his dad and said thanks. The two hugged and Andy was taken to college the next morning. He took the letter with him.
Andy will always have the letter and can read what his dad wanted to say to him, but never could, for the rest of his life.
John Bailey, retired Army Major, Vietnam Veteran and Substance Abuse Counselor, of Kentucky wrote a letter to his son similar to the one above. He told this story during an exercise at the 1993 Annual Kentucky Conference on Multiple Family Group Therapy. Alben Barkley, Vietnam Veteran, Substance Abuse Counselor and grandson of a former vice-president of the United States, came up with the name, Separation Papers.
There have been times when adolescents would not talk about what life around home is like. I've asked one female adolescent to share with another female adolescent about the same age, what it would be like for the other adolescent to come to her house and live for a week. The other adolescent will then share in the same way.
The index patient (IP) was a fourteen-year-old female diagnosed with an eating addiction. Father was a physician who always gave special attention to emergencies. Mother was in control. Around in circles the family went focusing on the daughters' eating addiction. All three agreed that they did not know what to do.
Three hangers from the coat rack were taken and one was given to each family member as they stood in the middle of the MFTG. All three hangers were hooked together and the family was asked to continue talking with each other. The therapist asked them to walk slowly in a circle while holding on to the long end of their hangers. When asked to reverse directions they did so.
Group members observing began to comment that their conversation matched their walking in circles. Group members were asked to define the hangers and hooks that each family member was holding. Mothers' hook was control and fear. Fathers' hook was giving special attention to emergencies and being controlled. Daughters' hook was getting special attention with her eating addiction.
The therapist asked the daughter if she could be guaranteed to get fathers attention when her eating addiction became an emergency. The daughters' answer was a surprised, "yes." All were asked to share what they wanted. Dad wanted more control of his time. Mother wanted to care less about what other's thought about her and to be less afraid. Daughter wanted more attention from dad and more control over her life.
They talked with each other about how the family could help each get what they wanted. Dad agreed to let others take more emergency calls and to spend more time with the family. Mother agreed to work on being less in control. Daughter agreed to talk more with her parents and to spend more time with her mother and father. All agreed to continue to attend the MFTG.
This exercise told itself during a workshop in March of 1995 at Medicorp Recovery Network, Inc., Winston-Salem, NC.
Families are born, families live and families die. Sometimes families die prematurely.
Addiction in a family dictates social adaptation that intoxicates the system's thinking, feeling and behavior. Recovery is enhanced when therapy takes place in a social setting.
Learning about addiction, codependency and related issues influences a family's thinking and behavior.
Sobriety calls for the family to be more in touch with their feelings and less conforming to rigid rules and roles.
The environment, interaction patterns, and family structure all assist in sustaining (or changing) behavior.
Behavior is learned in response to the family's internal and external environment, and modified by changing response patterns.
Multiple Family Group Therapy assists in cutting through the denial and shame found in addicted families.
Spontaneous involvement and emotional release are goals for participant-observers of the MFGT group.
Families improve awareness by attending to immediate experience in the MFGT session.
Families in the MFGT observe similar conflict situations and learn from them. (H. Peter Laqueur, <HPL>)
Growth takes place through the development of relationships with others that are satisfying, enhancing and validating.
In every behavior, no matter how destructive it appears, there are positive intents.
The family is a force of expression (energy system) whose goal is existence (aliveness).
New behaviors become skills when practiced in a safe and accepting Multiple Family Therapy group environment.
Families should be helped to stretch to their creative limits.
KEY CONCEPTS FOR CHANGE
Knowledge gained in a classroom (less threatening) begins the intervention and prompts behavior change.
One of the most important functions of learning is to be more spontaneous. (Insight follows behavior change.)
The aim is to achieve genuineness (congruence), empathic understanding, and positive regard among families.
Emphasis is on awareness, expression, and acceptance of feelings.
Encourage here-and-now experiences but do not discount past experiences.
Most families have unfinished business, usually unexpressed emotion. The completion of this business brings about change.
Experiencing in the moment and acting out those moments create an alive and vibrant experience for families.
Honest confrontation is valuable, even though the feedback may seem skeptical and potentially irritating to the receiver.
The accepting environment of the Multiple Family Therapy group cultivates conflict settling and problem solving.
A trusting and connected MFT group climate enhances successful therapy.
Nonverbal cues by the body furnish extremely important clues about relationships in the family.
The following qualities are needed to have a good sense of self and family; intimacy, honesty, courage, commitment, responsibility, authority, expression, congruency, validation, and spontaneity.
To enjoy meaningful relationships, families need to experience differences as growth-producing; separateness as wholeness, not isolation; and assertion as vital to growth; they must have the ability to allow others to be in charge of themselves, to empathize with another’s feelings without losing self, and to accept the consequences of other individual’s actions without question and to take full responsibility for their own actions.
Bowen, M. Principles and Techniques of Multiple Family Therapy. in Bradt, J.D. and Moynihan, C.J. (Eds.), Systems therapy.
elected papers: theory, technique, and research. Washington, D.C., 1976.
Carter, E., McGoldrick, M. The Family Life Cycle. New York: Gardner Press, 1980.
Edwards, J.T. Multiple Family Groups for Adolescent Problems. in Working With Families: Guidelines and Techniques, the
"Blue Book" 1993 edition. Unpublished. order from the MFGT Resource Center for $8.00 bound, 79 pages.
Foster, L.N. It's Not Family Therapy, It's Not Group Therapy, It's Multiple Family Group Therapy. Florence, SC:
Foster, L.N. MFGT Efficient and Effective Option for Managed Care Providers. Florence, SC: MFGTRC, 1994.
Foster, L.N. A Theoretical Framework for Multiple Family Group Therapy With Chemically Dependent and Other At-Risk
Families. Florence, SC: MFGTRC, 1993.
Foster, L.N. The H. Peter Laqueur, MD, Model of Multiple Family Group Therapy. Florence, SC: MFGTRC, 1993.
Foster, L.N. The Coliseum Model of Multiple Family Group Therapy. Florence, SC: MFGTRC, 1994.
Foster, L.N. A Family Psychoeducation Model of Multiple FamilyGroup Therapy and the Management of Schizophrenia.
Florence, SC: MFGTRC, 1994.
Foster, L.N. Ideas for the Stages of Multiple Family Group Therapy Sessions. Florence, SC: MFGTRC, 1994.
Foster, L.N. The Makings of a Multiple Family Group Therapy Program. Florence, SC: MFGTRC, 1994.
Foster, L.N. Multiple Family Group Therapy Evaluation and Session Guide. Florence, SC: MFGTRC, 1990.
Foster, L.N. Principles of Supervising Multiple Family Group Therapists. Florence, SC: MFGTRC, 1994.
Foster, L.N. Resource Center for Multiple Family Group Therapy Opens In Florence, S.C. Florence, SC: MFGTRC, News
Foster, L., Kahn, C., Kahn, D. Determining Responsibilities (A device for deciding individual responsibility with
adolescents). Florence, SC: MFGTRC, 1990.
Frager, S. Multiple Family Therapy: A Literature Review. Family Therapy, Vol V(2), 1978.
Frager, S. Community-Universality Exercises in Multi-Family Therapy. Family Therapy, Vol 12(3), 245-251, 1985.
Gonzalez, S., Steinglass, P., Reiss, D. Putting the Illness In Its Place: Discussion Groups For Families With Chronic
Medical Illnesses. Family Process, 28(1), 69-88, 1989.
Haley, J. Leaving Home: The Therapy of Disturbed Young People. New York: McGrawhill, 1980.
Havens, R.A. The Wisdom of Milton H. Erickson. New York, NY: Irving Publishers, Inc., 1985.
Hyde, A.P., Goldman, C.R. Use of A Multi-Modal MFG in the Comprehensive Treatment and Rehabilitation of
Schizophrenia. Columbia, SC: 1988. Order from MFGTRC.
Hyde, A.P., Goldman, C.R. Family Issues That May Interfere With the Treatment and Rehabilitation of Schizophrenia.
Columbia, SC: 1989. Order from MFGTRC.
Holder, J.A. Using Perceptual Adjustment Therapy (PAT) in Multiple Family Therapy Groups. A videotaped interview.
Florence, SC: MFGTRC, 1994. (app 100 minutes).
Hoopes, Fisher, Barlow Structured Family Facilitation Programs: Enrichment, Education and Treatment. Rockville, MD: Aspen
Howe, J. Multiple-Family Therapy: A Model for Social Workers at Children's Homes. Lake Waccamaw, NC: 1994, (MFGTRC).
Howe, J., Morrison, B., Ray, B., Smith, S., Tutor, J., and Foster, L. Multiple Family Group Therapy for Social Workers
Children's Homes (A videotaped interview). Florence, SC: MFGTRC, 1994. (app 100 minutes).
Karpel, M.A., Strauss, E.S. Family Evaluation. New York: Gardner Press, 1983.
Kaufman, E., Kaufman, P. Multiple Family Therapy: A New Direction in the Treatment of Drug Abusers. American
Journal of Drug and Alcohol Abuse, 4(4), 467-478, 1977.
Kosten, T., Hogan, I, Jalali, B., Steidl, J. The Effect of Multiple Family Therapy on Addicted Family Functioning:
A Pilot Study. Advances in Alcohol and Substance Abuse, 5(3), 51-62, 1986.
Lansky, M., Bley, C., McVey, G., Brothman, B. Multiple Family Groups as Aftercare. International Journal of Group
Psychotherapy, 28, 211-224, 1978.
Laqueur, H.P. Multiple Family Therapy: Questions & Answers. In Techniques of Family Psychotherapy: A Primer, Donald A.
Bloch (ed), New York: Grune & Stratton, 1973.
Laqueur, H.P. Mechanisms of Change In Multiple Family Therapy. In Progress in Group and Family Therapy, Clifford J. Sager and
Helen Singer Kaplan (eds.), New York: Brunner/Mazel, 1972.
Laqueur, H.P. Multiple Family Therapy. In P. Guerin, (Ed.), Family Therapy, Theory and Practice (pp 405-414).
New York: Gardner Press, 1976.
Minuchin, S., Fishman, H.C. Family Therapy Techniques. Cambridge: Harvard University Press, 1974.
McFarlane, W.R. Multiple-Family Psychoeducational Group Treatment Manuel. Unpublished. February, 1991. Order from MFGTRC.
McKamy, L. Multiple Family Therapy on an Alcohol Treatment Unit. Family Therapy, 3(3), 197-209, 1976.
Nichols, M.P. Family Therapy Concepts and Methods. New York: Gardner Press, 1984.
Nuckols, C., Saunders, T., Weigand, M. Healthy Families. NAADAC Journal, Spring, 1992.
Orvin, G.H. The George H. Orvin, MD, Model of Adolescent Psychiatry and Adolescent Multiple Family Group Therapy
A videotaped interview. Florence, SC: MFGTRC, 1994. (app 100 minutes).
O'Shea, M.O., Phelps, R. Multiple Family Therapy: Current Status and Critical Appraisal. Family Process, Vol 24, pp 555-582,
Raasoch, J., Laqueur, H.P. Learning Multiple Family Therapy Through Simulated Workshops. Family Process, Vol 18,
Raasoch, J.W. Multiple Family Therapy. In the Handbook of Innovative Psychotherapies, New York: John Wiley and Sons,
Rosen, S. My Voice Will Go With You: The Teaching Tales of Milton H. Erickson. New York, NY: W.W. Northon and
Saunders, T.M. Some Thoughts on Community. Winter Park, FL: Family Systems Consultants. Order from MFGTRC.
Saunders, T.M. Go Ahead - Kill Yourself! - Save Your Family the Trouble. Plantation, FL: Distinctive Publishing Corp,
Saunders, T.M. The Family Terrorist: Negotiating Extortion in a Multiple Families Group. Unpublished paper. Winter
Park, FL: 1992. (order from MFGTRC)
Sherman, R., Fredman, N. Handbook of Structured Techniques In Marriage and Family Therapy. New York: Brunner/Mazel,
Slagerman, M., Yager, J. Multiple Family Group Treatment for Eating Disorders. Psychiatric Medicine, 7(4), pp 269-
Staton, M.C., Todd, T.D. The Family Therapy of Drug Abuse and Addiction. New York: Gilford Press, 1982.
Steinglass, P., Gonzalez, S., Desovitz, I., Reiss, D. Discussion Groups for Chronic Hemodialysis Patients and
Their Families. General Hospital Psychiatry, 4, pp 7-14, 1982.
Strelnick, A.H. Multiple Family Group Therapy: A Review of the Literature. Family Process, 19(3), 308-325, 1977.
Thorington, P.K. The H. Peter Laqueur, MD, Model of Multiple Family Group Therapy, a workshop presented in Florence, SC
1991 and Oklahoma City 1994.
Wolf, F.A. Taking The Quantim Leap. New York: Harper and Roe, 1981.
Wolberg, L.R., Aronson, M.L. Group and Family Therapy 1980. New York: Brunner/Mazel, 1980. pp 24-31 a tribute to
H. Peter Laqueur, MD.
Yalom, I. The Theory and Practice of Group Psychotherapy. New York: Basic Books, 1975.
Zeig, J.K. The Evolution of Psychotherapy. New York: Brunner/Mazel, 1987.
Zeig, J.K. The Evolution of Psychotherapy: The Second Conference. New York: Brunner/Mazel, 1992.
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