Some benefits and obstacles of multi-family therapy
Multi-family therapy (MFT) is a newer approach for adolescent patients with bulimia nervosa (BN). It differs from the better-known family-based treatment for BN by offering treatment that can include a number of families, rather than one. The families meet weekly, for 20 weeks, with a team of clinicians.
This approach contrasts with that of multi-family therapy for anorexia nervosa (AN), which is far more intense and often involves meeting for 4 or 5 consecutive full days of intervention, which then may be followed by stand-alone days of intervention over several months. In Great Britain, MFT is now recommended for patients with AN; one earlier study showed that offering MFT-AN with family therapy for AN leads to better outcomes than FT-AN alone (BMC Psychiatry. 2016. 16:422).
Researchers at the Maudsley Hospital in London recently invited participants from two multi-family groups at their hospital to share their experiences in a focus group or individual qualitative interviews (J Eat Disord. 2022.10:91).
The multi-family design is based on the single-family model, with a few differences. First, the families are offered weekly sessions. Once established, the groups are closed to new participants. The 90-minute sessions include systemic family therapy, cognitive behavioral therapy, and dialectical behavior therapy. In this study, participants from two consecutive MFT-BN groups were invited to participate. The eligible sample included 7 mothers, 2 fathers, 1 older sibling, and 9 adolescents with diagnoses of BN. Most (15 of the 19) participated. The adolescents who joined the study were between 13 and 17 years of age; 4 had BN, and 2 had atypical BN.
Those taking part in MFT-BN reported it poses definite benefits, but also some obstacles. On the plus side, patients and caregivers alike describe the value of hearing about new perspectives, sharing their own experiences, and learning new skills. The teens and parents/caregivers liked some benefits of the multi-family approach: a reduced sense of isolation, a chance to learn new techniques from each other, gaining improved function and coping skills, and practical skills as well. A final theme was “what remains unspoken.” The parents/caregivers noted that BN symptoms were difficult for their teens to talk about, both with their families and in a group setting. It was challenging for the teens to actively address emotions such as shame, embarrassment, or guilt.
Adolescents had some reservations
The teens were uneasy with sharing unhelpful eating disorder behaviors, especially when other adolescents in the group were at different stages of BN or in recovery. The teens also expressed some direct reservations about MFT-BN. Several felt that the group structure and process sometimes interfered with their ability to express themselves. A balance between openness, confidentiality, and risk was also hard to navigate for some teens. Their worry that parents or clinicians would “overreact” led them to omit certain details and experiences, especially around the subject of “risk.” Several expressed their desire to have more unstructured time during the sessions, mostly time with a peer group, away from the adults. While they felt the structured approach was good, they wanted to share their experiences in a more unstructured way.
The authors stress that further research is needed to explore the experience of MFT-BN and its outcomes across a more diverse range of families and in different treatment settings.