Introduction to Multifamily Groups

Introduction to Multifamily Groups Alex Kopelowicz, MD Raising the Bar Project-Valley Nonprofit ResourcesHuman Interaction Research Institute

PORT Treatment Recommendations • Patients who have on-going contact with their families should be offered a family psychosocial intervention which spans at least nine months and which provides a combination of education about the illness, family support, crisis intervention, and problem solving skills training. Such interventions should also be offered to non-family caregivers.

Standard Approaches to Family Work in Serious Mental Illness • Psychoeducation • Communication skills training • Problem solving techniques • Social network development (MFG)

Better outcomes in family psychoeducation • Over 20 controlled clinical trials, comparing to standard outpatient treatment, have shown: • Much lower relapse rates and rehospitalization • Up to 75% reductions of rates; minimally 50% • Increased employment • At least twice the number of consumers employed, and up to four times greater--over 50% employed after two years--when combined with supported employment • Improved family relationships and well-being • Reduced friction and family burden • Reduced medical illness in family members • Doctor visits for family members decreased by over 50% in one year Dixon et al 2003

MFG TRAINING PROGRAM DAY 1 9:00- 9:30am Welcome/Overview of MFG Training What is MFG and why should we do it? 9:30 -12:00 pm The Psychoeducational Workshop 12:00-1:00 pm Lunch 1:00 – 4:00 pm McFarlane Videoconference Science of Mental Disorders Family Psychoeducation Outcomes Overview of Treatment Model DAY 2 9:00 – 12:00 noon Joining Sessions (Demonstration and Role Play) 12:00 – 1:00 pm Lunch 1:00 – 4:00 pm MFG Sessions (Demonstration and Role Play)

Stages of a Psychoeducational Multifamily Group Educa- tional workshop Ongoing MFG Families & patients bi-weekly for 1 year Joining Family and patient separately 3-6 weeks Families only 1 day

JOINING with FAMILIES & CLIENTS JOINING means to CONNECT, BUILD RAPPORT, CONVEY EMPATHY, ESTABLISH AN ALLIANCE, ENGAGE It is the First Stage of Treatment Designed to create a bond between Client/Family Members and Family Clinicians CLINICIAN as ADVOCATE

JOINING PROCEDURES • THREE Joining Meetings  SEPARATELY with Relatives and Clients  WEEKLY – 1 HOUR with Relatives, ½ HOUR with Clients • Start sessions A.S.A.P. after crisis or hospitalization • Gain an understanding of family’s stresses, problems, reactions to illness, etc.

JOINING – I • 15 Minutes of SOCIAL TALK • Review any recent CRISIS: Who and What Helped or Didn’t • IDENTIFY WARNING SIGNS – PRODROMAL SIGNS – PRECIPITANTS • Distribute to Families & Keep for Future Reference • Describe the Plan for On-going MFG sessions • 5 Minutes SOCIALIZING

JOINING – II • 15 Minutes of SOCIAL TALK • FAMILY’S EXPERIENCE DURING EPISODES  The Sharing of Painful Events: A Crucial Aspect of “Joining”  The Client/Family’s Understanding of Etiology • Family’s Social Network & Resources (Material & Emotional) • 5 Minutes SOCIALIZING

JOINING – III • 15 Minutes of SOCIAL TALK • FAMILY’S SOCIAL NETWORK & RESOURCES • SHORT & LONG-TERM GOALS (e.g., Prevent Relapse) • Preparation for Workshop & MFGs

MULTIFAMILY GROUPS • Five to Eight Families • Two Clinicians • 1 ½-Hour Sessions – Biweekly – 1 Year Minimum • Refreshments/Snacks are provided • Initial Sessions avoid emphasis on clinical issues • Initial Sessions emphasize establishing a working alliance by building group identity and developing a sense of mutual interest and concern. Drop outs are Failures

FIRST MFG SESSION “GETTING TO KNOW EACH OTHER” Go Around the Room  Background  Hobbies  Occupation  Interests  Clinician Goes First (Discloses/Shares with the Group SETTING BASIC RULES  Regular ATTENDANCE (for Relatives)  CONFIDENTIALITY (No Pressure to Disclose)  INTERACTION AMONG MEMBERS  PHYSICAL/EMOTIONAL CONTROL

SECOND MFG SESSION • “HOW MENTAL ILLNESS HAS CHANGED OUR LIVES”  Building a SENSE OF TRUST & COMMITMENT  Sense of COMMON EXPERIENCE (Listen to each other)  Strengthening GROUP IDENTITY & SENSE OF RELIEF  The PATIENT’S INNER EXPERIENCES  Clinicians emphasize the vital role of SHARING GRIEF, CONFUSION, GUILT, FEAR with those “on the same boat”. AND HOPE • Remind participants about Problem Solving (next session)

GENERAL POINTS • New Members • Late-Arriving Members • Reminders about Attending • Crises & Emergencies • COMMUNICATION & INTERACTIONS  Clinicians DON’T speak for clients or relatives  Interaction among member is essential  Clients are ENCOURAGED (not pressured) to participate  Respect other’s turn and avoid criticism

PROBLEM SOLVING IN MFGs • The CORE of MFG Sessions • Designed to compensate Information-Processing Deficits in Mental Disorders • FORMAT: Checking in 15 Minutes Go-round 20 Minutes Selecting a Problem to Solve 5 Minutes Solving the Problem 45 Minutes Wrap-up Socializing 5 Minutes • Clinicians should GET READY and HAVE A PLAN – IN ADVANCE

SELECTING A PROBLEM TO SOLVE • TOPICS: Safety in The Home Medication Compliance Drugs and Alcohol Life Events Outside Agency Events Disagreements among Family Members Conflict with a Family Guideline • “REJECTED” PROBLEMS: Make a Direct Suggestion and Review Outcome Meet Outside the Group (E.G., Crises) Refer to Past Solutions that Apply Refer to Solution/Family with Successful Outcome

THE PROBLEM-SOLVING METHOD • Define the Problem or Goal • List Possible Solutions • Evaluate Advantages and Disadvantages of each Solution • Choose “the best” Solution • Implement Plan to Carry Out Solution • Review Implementation and Outcome

Introduction to Multifamily Groups