Ms Mooly Wong, Part-time Professional Consultant Family and Group Practice Research Centre,

1. An alternative way to help families with parenting difficulties – Experiences of conducting Multiple Family Group in Hong Kong Ms Mooly Wong, Part-time Professional Consultant Family and Group Practice Research Centre, Department of Social Work, The Chinese University of Hong Kong

2. Contents The conceptual framework of Multiple Family Group (MFG) The development of MFG in the West and in the local context Our research project Group Contents (Activities, Intervention strategies) Practice Wisdom Q & A

3. What is Multiple Family Group ? Bringing together a number of families with a common problem and helping them resolve their difficulties with their own resources Connecting families and families to build up their social support network Blend of group therapy and family therapy (Asen, Dawson & McHugh, 2001)

4. Conceptual Framework of Multiple Family Group (1) a model of maintenance of a problem (vs an explanatory model of problem) (Eisler, 2005 ) The central role of the symptom in family life Narrowing of time focus on the here-and-now. Restriction of the available patterns of family interaction processes

5. Conceptual Framework of Multiple Family Group (1) The amplification of aspects of family function Diminishing ability to meet family life-cycle needs The loss of a sense of agency (helplessness)

6. Conceptual Framework of Multiple Family Group (2) To locate the problem in the relational context or to contextualize the problem (Asen, Dawson & McHugh, 2001)

7. Conceptual Framework of Multiple Family Group (3) family resilience perspective (vs the deficit perspective on family) A family resilience perspective which affirms ‘family’s capacity for self- repair’ (Walsh, 1996)

8. Conceptual Framework of Multiple Family Group (4) Concepts related to group therapy Greek chorus (Papp, 1980) An individual or the family tell their story or enact their issues in front of a group of people who are asked to comment In old Greece, through the chorus that the gods spoke to the people Families as consultants to other families

9. Conceptual Framework of Multiple Family Group: Summary Seeing things in multiple perspectives Seeing things from different perspectives through the multiple family group activities Connecting families together to fight against social isolation and stigmatization Generate more resources of the families through the expansion of social support network

10. Application of Multiple Family Group in the West Start in psychiatric hospital such as Laquerur in 60s and McFarlence in 80s Intensive day care program for adolescents with eating disorders (Eisler, 2005; Scholz, Rix, Scholz, Gantchev & Thömke, 2005) Intensive multiple family day programmes for families with multiple problems at Marlborough Centre (Asen et al 2001) Family School (Asen et al 2001)

11. Development of MFG in Hong Kong Mutual help group for families with special needs Mutual help and self-help groups for families with psychotic patients (Ma, 1986) Parent groups for mother with children suffering from autism (Ma, 1987)

12. Single-parent families (Lau, 1998) Families of Chinese Schizophrenic patients (Chien & Chen, 2004) Development of MFG in Hong Kong

13. Indigenization of Multiple Family Group Based on the model of Family Day Center and Family School in Marlborough Centre

14. Group Objectives • To generate new and multiple perspective in relation to the problems of the family; • To synthesis the voices of two generations; • To empower the parents’ confident in parenting and the children’s ability • To enrich the resources of the families; and • To build up the social network of the families.

15. Targets • Received referrals from hospital, community center, Youth Integrated Team, IFSC, school etc. • Families with children or youth problems: ADHD, Dyslexia, Emotionally unstable, school refusal, low study motivation, Asperger, aggressive behavior etc.

16. Group Structure • Close-ended • Duration: 1 night of psycho educational talk plus 3 or 4 whole days (usually conducted in weekends) and 2 sessions of reunion • Number of families served: 3 to 8 families, in average 4 families • Number of therapist per group: 2 therapists, plus 1 to 3 helpers • Length of sessions: 2.5 hours for the talk and 6 hours for the whole day program • Voluntary participation • Composition of groups: index client, parents / grand parent (main carer) and siblings

17. Core Multiple Family Activities Psycho education to contextualize the parenting difficulties (slide)

18. 個人、家庭與社會的互維關係下的處境 個人 - 家庭 + 社會

21. Core Multiple Family Activities Reviving of family story Each family get a large drawing paper Each family use materials provided by group and revive the different life stages of the family. Each family shares their story Purposes: 1. process of producing the poster (family interaction pattern, power hierarchy) 2. different perceptions of family members on family issues 3. present family situation (role of symptoms)

22. Core Multiple Family Activities Wanted Poster The group is divided into parent group and children group. The parent group brainstorms the qualities to be an “ideal child” and prioritize them. The children also prepare a poster advertising for an “ideal parent” Using the fish bowl format, two groups will sit in two circles. One group to present the ideas and the other group can ask questions Purposes: 1. perspective taking 2. avoid direct confrontation between parents and children

23. Core Multiple Family Activities Joint meal The group is divided into two sub-group, with the mixture of parents and children from different families Each group is responsible for preparing lunch for the large group Each group will go out for shopping and buying food for the whole group Sharing of experiences after the lunch Purposes: 1. surrogate parenting

24. Core Multiple Family Activities Circle In Circle Out The group is divided into parent group and children group Option 1: Parents make a large circle and the children stand inside the circle. The children use different strategies to go out of the circle. Parents try to prevent them to go out. Option 2: Children make a large circle and parents stand outside of the circle. Parent use different strategies to go inside the circle. Children try to prevent them to go inside. Purpose: 1. control and power issue in the family 2. negotiation process

25. Core Multiple Family Activities Role play (Usually Role Reversal Play) Theme of parent child issue will be chosen by the group The group members will role play the situation. Other family members take turn to play the role of either parent or children to generate different solutions

26. Role of therapist To evolve the metaphoric meaning of the group activities To capture and control the intensity of family interaction To reinforce and expand information between families

27. Video Clip

28. Practice Wisdom 1. Service Model: Family is the unit of intervention: • It is important to involve two generations in dealing with family issues • It is essential to create a context for the negotiation of the voices of two generations

29. Practice Wisdom 2. Service Model: Co-operation with social services units • It can ensure the recruitment of the families • The utilization of community resources could enrich the content of the group • MFG group should be further developed as mutual help group so as to enhance the network of the families • Some families may need other professional services such as individual and family counseling, psychiatric and developmental assessment and treatment etc.

30. Practice Wisdom 3. For the group structure • Important of co-leadership • Homogeneous of the group such as stage of family life cycle, presenting problem

31. Practice Wisdom 2. For Intervention Strategies: • Using “here-and-now context”: • To contextualize the parenting difficulties • To empower the parenting confident of the family • To increase the involvement of family members in dealing with family issues

32. Q&A session

33. References • Asen, E., Dawson, N., & McHugh, B. (2001). Multiple Family Therapy: The Marlborough Model and Its Wider Application, London: H. Karnac (Books) Ltd. • Asen, E. (2002). Multiple family therapy: an overview, Journal of Family Therapy, 24: 3-16 • Chien, W.T., & Chan, S.W.C. (2004). One-year follow up of a multiple family group intervention for Chinese families of patients with schizophrenia, Psychiatric Services, Vol. 55, No. 11, 1276 – 1284. • Dennison, S.T. (2005). A Multiple Family Group Therapy Program for At Risk Adolescents and their Families. U.S.A.: Charles C thoma Publisher Ltd. • Eisler, I. (2005). The empirical and theoretical base of family therapy and multiple family day therapy for adolescent anorexia nervosa, Journal of Family Therapy, 27:104 – 131. • .

34. References • Ma, J. L. C. (1987). The use of grief work in helping the parents of autistic children, Hong Kong Journal of Social Work, 21(1), 26-32. • Ma, J. L. C. (1986). The use of mutual help group in working with the family members of psychotic patients, Hong Kong Journal of Social Work, 20(1), 40-47 • McFarlane, W. R., Link, B., Dushay, R., Marchal, J., & Crilly, J. (1995). Psychoeducational multiple family groups: four-year relapse outcome in schizophrenia, Family Process, Vol. 34, June, 127 – 144. • Papp, P. (1980). The Greek chorus and other techniques of paradoxical therapy, Family Process, 19: 45-57. • Scholz, M., Rix, M., Scholz, K., Gantchev, K., & Thömke, V. (2005). Multiple family therapy for anorexia nervosa: concepts, experiences and results, A 27: 132-141. • Walsh (2002). A family resilience framework: innovative practice application. Family Relations, Vol. 51, No. 2, 130-137.