Multiple Family Groups in the Treatment of Severe Psychiatric Disorders
| Manual Title |
Multiple Family Groups in the Treatment of Severe Psychiatric Disorders |
| Creator |
William R. McFarlane, MD |
| Reference |
McFarlane, W.R. (2002). Multiple family groups in the treatment of severe psychiatric disorders. New York:
Guilford Press. |
| Price |
$45.00 |
| Contact Information: |
William R. McFarlane, MD
Director of Research, Department of Psychiatry
22 Bramhall Street
Portland, ME 04102
Phone: 207-871-2091
Voicemail: 207-871-4348
Email: mcfarw@mmc.org
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Program Overview:
Treatment Approach
McFarlane has built upon Anderson and Falloon's work in creating the multiple-family groups.
Treatment Goals:
- Gaining knowledge & coping skills
- Regulating patient's stimulus load
- Improving communication
- Preventing relapse
- Gradually integrating the patient to the highest possible degree of community participation (e.g., social & vocational rehabilitation
- Providing social contact and support
Format:
Treatment has 3 phases:
- Joining: (engaging with single family, often at the time of the acute psychotic break)
- Typically involves 3-5 weekly hour-long home- or clinic-based meetings with the family (patient is not included if too unstable to participate)
- Includes 4 major tasks:
- Assessment of present crisis, the family's reactions & broader functioning
- Inviting family to the multiple-family group (MFG)
- Setting realistic goals / contract (length of treatment, who is involved, etc)
- Emphasizing to the family that clinician is available for crises
- Note: McFarlane (2002) chapter 6 includes review of specific tasks in 3 joining sessions
- Educational workshop:
- 6-8 hours of lectures & discussion to 4-7 families using videotape (patient is NOT included unless clinically stable)
- Includes "survival skills" (a la Anderson's work) for managing schizophrenia & "family guidelines" (see chapter 7 of McFarlane, 2002)
- Multifamily group development: (see chapters 8-9 of McFarlane, 2002, for more details)
- Groups are closed ended, 90-minute meetings (patients are included)
- Meet weekly for 4-6 weeks, then biweekly; groups continue for at least 12 months (but better if 2 years; many groups are ongoing monthly meetings and continue for many years)
- Groups focus on formal problem-solving and communication skills training
- Session structure: socialize (15 min); review of events since last session (20 min); select 1 problem (5 min); formal problem-solving with one family as the focus (45 min); socialize (5 min)
Research:
Dyck et al (2002):
- Methods: Randomly assigned outpatients with schizophrenia at a community mental health center to either:
- 2 years of MFG based on standardized protocol of McFarlane's model or
- Standard care
- Results: 1 year after treatment:
- 9% re-admission rate in MFG treatment group vs.
- 22% re-admission rate in standard care
No change in outpatient treatment
Dyck et al (2000):
- Methods: Randomly assigned 63 stable outpatients from a community
mental health center to either a MFG or standard care
- Results: Participants in MFG had significantly reduced negative symptoms (in comparison to control group). Negative symptoms are significantly associated with subjective quality of life.
The next two papers resulted from the "New York State Family Psychoeducation in Schizophrenia Project." The projects compared MFG treatment to single-family modality.
McFarlane, Lukens et al (1995):
- Methods: Randomly assigned patients from 6 public hospitals in New York to either
- 6-family MFG or
- Single family treatment
- Results After 2 years::
- 16% relapse rate in MFG group
- 27% relapse rate in single-family group
McFarlane, Link et al (1995):
- Methods: Randomly assigned patients from a public hospital in New Jersey to either
MFG or Single family treatment
Results After 2 years:
- 25% relapse rate in MFG group
- 44% relapse rate in single-family group
After 4 years:
- 50% relapse rate in MFG group
- 78% relapse rate in single-family group
Other relevant research findings:
- MFGs more effective in 1st episode of Schizophrenia disorder (McFarlane et al, 2002)
- MFG family members use fewer medical services & have fewer episodes of medical illness compared to standard care control group (McFarlane et al, 2002)
- MFGs nearly double employment rates when combined with other evidence-based practices, especially supported employment or ACT (McFarlane et al, 2000)
Note: Above description reviewed and approved by Dr. McFarlane, 1-21-03
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