Multiple Family Group Therapy

at Oakleigh Treatment Center

Durham, North Carolina

1995 By David May

    He was an older man, well dressed and articulate, who had identified himself as a family member of one of our chemically dependent inpatients.  Not until our closing wrap-up did he further describe himself as a pastor.  His only comment in response to our customary invitation to share briefly 'What you got from the group' was, "I have felt more love in this room tonight than I have experienced in my church during my twelve years there."

    After almost three years of co-facilitating our multiple family therapy group, I'm still surprised (and humbled) by the startling transformation which takes place during the ninety minutes of interaction.  Each Thursday night a remarkably diverse group of folks, mostly strangers to one another at 6:15 P.M., laughs, cries, confesses, and loves its way to "family," community, healing, and hope by 7:45 P.M.

    Because this 90-minute metamorphosis happens so frequently, my wonder, curiosity and careful observation have led me to the following conclusions:

    1.  When people gather out of their common pain, anger, and longing or healing, and are courageous enough to speak openly from the heart, healing takes place in all.

    2.  When family pain is given voice in the group community, the isolation and self-centeredness of addiction is cracked.

    3.  When family members hear other families unloading the spectrum of their feelings associated with addiction there is instant relief and bonding with those "who know us in our pain."  The barriers of secrecy and loneliness are broken through.

    4.  When we speak our truth among those who long for freedom and that truth can be received without judgment, we are all transformed.

    5.  When we (even strangers) speak openly from the heart with others who long for relief and release we discover we are much more alike than different, and therefore are less fearful of one another.

    6.  When we are not afraid, most people are loving, compassionate listeners, and healers.

    7.  When we recognize we are in a safe place, and know we will be heard, each of us has something important to share that would not be missed.

    8.  Family and community are wherever we find patience, concern, compassion, forgiveness, identity, and acceptance (the ingredients of love).

    9.  For those of us of the Christian tradition, some of these components of "transformation" are recognized as descriptions of the early Church, but often forgotten relics in our churches today.

    10.  When we claim our vulnerability, our areas of powerlessness, and our need for help in community, we begin to uncover the true resources of the power and freedom of the real self.

David May is a Clinical social Worker at Oakleigh an inpatient/outpatient chemical dependency treatment center at Durham Regional Hospital.  the multi-family group is for inpatients, intensive outpatients, former patients, and family members or other supporters.  This article was published in the Summer of 1995 issue of "The North Carolina Multiple Family Group Therapy Networking Newsletter," Natalie Boorman, Editor.

Multi-Family Group at the

Duke Addictions Program

1996 By Bohdan Hrynewyh, MSW

    Multi-Family Group (MFG) has been an integral part of the Intensive Outpatient Program at the Duke Alcoholism and Addictions Program (DAAP) since its start.  The MFG, which meets after a family lecture, attracts between 15 and 45 people weekly.  Two to four therapists facilitate group.  during the last five years over a hundred trainees have observed the group.  We invite anyone to come to group, including friends, ministers, employers, friends, and AA sponsors.

    This is what we have seen and learned:

    Functions:  In MFG, families learn about addictive disorders, their own roles in the disease process and recovery, how to navigate common dilemmas, how to get support in defining needs and limits, and have opportunities to break family rules of "don't talk, don't feel, and don't trust."  Often, family members discover feelings and talk about hurts and hopes in a new way.

    Process Elements:  Process elements addressed include mood/energy level of the group, body language of members 9as a reaction to others), the norms of the group or families, and commonalities.

    Size and Time:  If there are more than 32 people (the capacity of the group  therapy room), two groups are formed.  We ask group members to self-select the groups.  The preferred length of group is 75 minutes.

    Leadership:  The most important attribute for successful MFG leader is confidence.  The size of the group and silence can be intimidating.  Trusting group process and well timed interventions create an environment where group members take chances and co-create a successful group.

    Opening Rituals:  Group cohesion ("background cohesion") results from group members having frequent, ongoing contact within DAAP.  Nevertheless, each meeting of the MFG is a new group experience as the members change.  To help facilitate cohesion, leaders provide opening structure.  For example, in one opening ritual everyone states who they are with (if alone, who they want to be with in group), and "what happened in your family in the last week that you want to talk about."  This reveals the energy level, themes, and situations which should be addressed.  Another opening involves members speaking to their neighbor on "what has gone well or been difficult this week with your family?"

    Non-Standard Interventions:  It can be helpful  for members to speak to an absent person in an empty chair.  Good candidates have significant emotional content and are outgoing.  The leader manages the event, asking others to take the roles of missing people or to be an "alter ego."  Another technique is a "fishbowl," (circle within a circle).  The inner circle can be family members while the patients observe from the outside or vice versa.  The outer group reflects to the inner group what they saw, or the outer group can change places with the inner group and have their own session in response to the first part.

    Monopolizers and Wallflowers:  If a member dominates group, the leader may assess the reaction of the group.  The leader can say "This group pretends that the member in the spotlight is the only person struggling with these issues," and an inquiry on how the issue presents in their own lives.  A question such as "how do you think the work you're doing in group affects other group members?" helps.  When a member is quiet, boy cues suggest a question such as "What have you been thinking about while all this is going on?"

    Common Themes:  A MFG has reoccurring themes.  Group leaders need an understanding of these themes in order to provide a brief "psycho educational moment" when the group seems counter-therapeutic.

            Three common themes are:

            1) Trust, lack of it, and how to regain it

            2) The difference between enabling and supporting (how to draw a line say "no" or define needs as a family member)

            3) Unexpressed emotion (anger, fear, sadness) being voiced.

We help members deal with these issues in encounters in the group, rather than as abstract issues which take place "out there."

    A thriving weekly multi-family group provides its own "marketing" in the ongoing effort to attract attendees.  Both patients and family members talk to others, and group leaders who are enthusiastic help recruit.  Given sufficient attendance, training, and programmatic support, a multi-family group can be the high point of a program's week for both the members and group leaders.

Bohdan Hrynewych, MSW, is the Program Coordinator at the Duke Alcoholism and Addictions Program in Durham, NC.  This article appeared in the Summer 1996 edition of The N.C. Multiple Family Group Therapy Networking Newsletter, Volume 2, Number 1, Natalie Boorman, Editor.

"Amazing Grace" at Oakleigh

1996 By David May

    Oakleigh's Multi-Family Therapy Group, in continuous operation since late 1992, recently surpassed 5,000 group participants.  We often marvel at the power of honest, community, and love to bring people together, to open hearts and minds, and to heal brokenness. There is, it seems to me, a frightening and wonderful contradiction within the phenomenon of chemical addiction.  It robs us of human dignity and self-respect, it destroys false pride and our and our belief in invincibility, it erodes trust, strains or breaks family ties, wipes out material security, and threatens to darken the light of the soul.  In short, it brings us to our knees to that sacred place of surrender - which is the window to grace (or acceptance).

            "I once was lost, but now I'm found

            Blind, but now I see"

The family, like God, suffers and waits.  The addict suffers, surrenders, returns and is embraced.  We are all family.

David May is clinical social worker at Oakleigh, at Durham, N.C., an inpatient/outpatient CD treatment Center, a component of Durham Regional Hospital.  The multi-family group is for inpatients, intensive outpatients, former patients members or other supporters (819-470-6600).


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