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Introduction to Multifamily Groups . Alex Kopelowicz, MD Raising the Bar Project-Valley Nonprofit Resources Human Interaction Research Institute. PORT Treatment Recommendations.

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introduction to multifamily groups

Introduction to Multifamily Groups

Alex Kopelowicz, MD

Raising the Bar Project-Valley Nonprofit ResourcesHuman Interaction Research Institute

port treatment recommendations
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
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
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
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)

slide6

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 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
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
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
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
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
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
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
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
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
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
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
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