Abstract
Multiple family therapy (MFT) is a therapeutic method that brings together several families affected by the same pathology. Although from an ideological and conceptual point of view, MFT is often linked to family therapy and group therapy, it is difficult to define it with precision, a weakness which may in turn hinder research on therapeutic effectiveness. This is most notable in the field of eating disorders (ED) where, in spite of MFT’s great popularity, research evidence remains limited. Within the context of a systematic review of the literature on MFT in the treatment of anorexia nervosa, the purpose of this article is to provide a theoretical and clinical framework for describing two MFT models, in an attempt to explore their common and distinct concepts, principles, techniques, and factors of change. The first program is a day treatment adaptation of the Maudsley family-based MFT approach, developed in Belgium at the Therapeutic Centre for Adolescents suffering from Eating Disorders: it focuses on the management of ED symptoms, using a strong cognitive behavioral orientation. The second is an integrated systemic MFT outpatient and inpatient program carried out on the ED unit of a pediatric hospital in Paris, France: it emphasizes intra- and inter-family relationships within a systemic framework. Our effort to describe and compare these two models constitutes a first step toward determining the relative value of different models of MFT. Indeed, each model presents specific characteristics that may make it best suited for specific ED populations and/or types of families.
Similar content being viewed by others
Notes
Twice a year, the group may recruit 1–2 new families, while some veteran families may decide to discontinue regular group attendance while remaining available upon request.
This exercise consists of creating a sub-group that sits in the center of the room (inner group), while the rest of the group sits around it and observes the sub-group discuss a topic or work on a task. Members from the outer group then comment on what they have observed. The inner group may consist of patients vs. non-patients, mothers vs. fathers, the younger generation vs. the older one, one specific family.
Both MFT models also share many concepts and principles with Therapeutic Patient Education programs, including those of partnership between the patient and health care providers, self-management, coping processes, skills enhancement, improvement of quality of life, and involvement of the patient’s family in long-term care (Assal J-Ph. 1995. Patient education 2000, New Trends in patient education. International Congress Series 1076. Amsterdam, 1995).
This exercise involves creating and working with a “fictitious” family in which the various family roles are played by members of different families (father from one family, mother from another, etc.).
References
Dixon L, McFarlane WR, Lefley H, Lucksted A, Cohen M, Falloon I et al (2001) Evidence- based practices for services to families of people with psychiatric disabilities. Psychiatr Serv 52:903–910. doi:10.1176/appi.ps.52.7.903
Dyck D, Hendryx M, Short R, Voss W, McFarlane W (2002) Service use among patients with schizophrenia in psychoeducational multiple-family group treatment. Psychiatr Serv 53:749–754. doi:10.1176/appi.ps.53.6.749
Dyck D, Short R, Hendryx M, Norell D, Myers M, Patterson T et al (2000) Management of negative symptoms among patients with schizophrenia attending multiple-family groups. Psychiatr Serv 51:513–519. doi:10.1176/appi.ps.51.4.513
McFarlane WR (2002) Multifamily groups in the treatment of severe psychiatric disorders. Guilford, New York and London
Fristad MA, Goldberg-Arnold JS, Gavazzi SM (2003) Multi-family psychoeducation groups in the treatment of children with mood disorders. J Marital Fam Therapy 29:491–504. doi:10.1111/j.1752-0606.2003.tb01691.x
Lemmens G, Eisler I, Buysse A, Heene E, Demyttenaere K (2009) The effects on mood of adjunctive single-family and multi-family group therapy in the treatment of hospitalized patients with major depression. A 15-month follow-up study. Psychother Psychosom 78:98–105. doi:10.1159/000201935
McDonell MG, Dyck DG (2004) Multiple-family group treatment as an effective intervention for children with psychological disorders. Clin Psychol Rev 24:685–706. doi:10.1016/j.cpr.2004.02.004
Barrett P, Farrell L, Dadds M, Boulter N (2005) Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: Long-term follow-up and predictors of outcome. J Am Acad Child Adolesc Psychiatry 44:1005–1014. doi:10.1097/01.chi.0000172555.26349.94
Weine S, Kulauzovic Y, Klebic A, Besic S, Mujagic A, Muzurovic J et al (2008) Evaluating a multiple-family group access intervention for refugees with PTSD. J Marital Fam Therapy 34:149–164. doi:10.1111/j.1752-0606.2008.00061.x
Marshall JP, Kimball T, Shumway S, Miller M, Jefferies V, Arredondo R (2005) Outcomes of a structured family group in an outpatient alcohol/other drug treatment setting. Alcohol Treat Q 22:39–53. doi:10.1300/J020v23n04_03
Fraenkel P (2014) Fresh Start for Families: A collaboratively-built community-based program for families that are homeless. In: Nelson T, Winawer H (eds) Critical topics in family therapy. AFTA Springerbriefs in family therapy, New York, pp 35–43. doi: 10.1007/978-3-319-03248-1_4
Steinglass P (1998) Multiple family discussion groups for patients with chronic medical illness. Fam Syst Health 16:55–70. doi:10.1037/h0089842
Asen E, Schuff H (2006) Psychosis and multiple family group therapy. J Fam Therapy 28:58–72. doi:10.1111/j.1467-6427.2006.00337.x
Edwards S (2001) The essential elements of multi-family group therapy: a Delphi study. Doctoral dissertation, Faculty of the Virginia Polytechnic Institute and State University
Marner T, Westerberg C (1987) Concomitant group therapy with anorectics and their parents as a supplement to family therapy. J Fam Therapy 9:255–263. doi:10.1046/j.1987.00280.x
Slagerman M, Yager J (1989) Multiple family group treatment for eating disorders: a short term program. Psychiatr Med 7:269–283
Wooley SC, Lewis K (1987) Multi-family therapy within an intensive treatment program for bulimia. In: Harkaway J (ed) Eating disorders: The family therapy collections, 20. Aspen Publishers, Rockville, pp 12–24
Asen E, Scholz M (2010) Multi-family therapy: concepts and techniques. Routledge, London and New York
Dare C, Eisler I (2000) A multi-family group day treatment programme for adolescent eating disorder. Eur Eat Disord Rev 8:4–18. doi:10.1002/(SICI)1099-0968(200002)8
Colahan M, Robinson P (2002) Multi-family groups in the treatment of young adults with eating disorders. J Fam Therapy 24:17–30. doi:10.1111/1467-6427.00198
Lock J, Le Grange D (2012) Treatment manual for anorexia nervosa: a family-based approach, 2nd edn. The Guilford Press, New York
Lock J, Le Grange D, Agras S, Dare C (2001) Treatment manual for anorexia nervosa: a family-based approach. The Guilford Press, New-York
Stiles-Shields C, Hoste RR, Doyle PM, Le Grange D (2012) A review of family-based treatment for adolescents with eating disorders. Rev Recent Clin Trials 7:133–140. doi:10.2174/157488712800100242
Fairbairn P, Eisler I (2007) Intensive multiple family day treatment: Clinical and training perspectives. In: Cook-Darzens S (ed) Thérapies multifamiliales. Des groupes comme agents thérapeutiques, Érès, Toulouse, pp 179–203
Hollesen A, Clausen L, Rokkedal K (2013) Multiple family therapy for adolescents with anorexia nervosa: a pilot study of eating disorder symptoms and interpersonal functioning. J Fam Therapy 35:53–67. doi:10.1111/1467-6427.12000
Knatz S, Kaye W, Marzola E, Boutelle K (2015) A brief, intensive application of family-based treatment for eating disorders. In: Loeb K, Le Grange D, Lock J (eds) Family therapy for adolescent eating and weight disorder: New applications. Routledge, Florence KY
Scholz M, Rix M, Hegewald K, Gantchev K (2003) Treatment manual for multi-family therapy with anorexia nervosa (translated, revised and adapted by E. Asen). Unpublished manuscript. Dresden 2002, London 2003
Scholz M, Rix M, Scholz K, Gantchev K, Thömke V (2005) Multiple family therapy for anorexia nervosa: Concepts, experiences and results. J Fam Therapy 27:132–141. doi:10.1111/j.1467-6427.2005.00304.x
Simic M, Eisler I (2015) Multi-family therapy. In: Loeb KL, Le Grange D, Lock D (eds) Family therapy for adolescent and weight disorders: New applications. Routledge, New York, pp 110–138
Le Grange D, Lock J, Loeb K, Nicholls D (2010) Academy for eating disorders position paper: The role of the family in eating disorders. Int J Eat Disord 43:1–5. doi:10.1002/eat.20751
Criquillion-Doublet S, Martins E (2012) Groupes de thérapie multifamiliale auprès de jeunes adultes souffrant de TCA. Personal communication
Geist R, Heinmaa M, Stephens D, Davis R, Katzman DK (2000) Comparison of family therapy and family group psychoeducation in adolescents with anorexia nervosa. Can J Psychiatry 45:173–178
Tantillo M (2006) A relational approach to eating disorders Multifamily Therapy Group: Moving from difference and disconnection to mutual connection. Fam Syst Health 24:82–102
Tantillo M, Sanftner J, Hauenstein J (2013) Restoring connection in the face of disconnection: an integrative approach to understanding and treating anorexia nervosa. Adv Eat Disord Theory Res Pract 1:21–38. doi:10.1080/21662630.2013.742980
McFarlane WR (2002) Multifamily groups in the treatment of severe psychiatric disorders. The Guilford Press, New York
Treasure J, Whitaker W, Todd G, Whitney J (2012) A description of multiple family workshops for carers of people with anorexia nervosa. Eur Eat Disord Rev 20:17–22. doi:10.1002/erv.1075
Depestele L, Claes L, Lemmens G (2015) Promotion of an autonomy-supportive parental style in a multi-family group for eating disordered adolescents. J Fam Therapy 37:24–40. doi:10.1111/1467-6427.12047
Dimitropoulos G, Farquhar J, Freeman VE, Colton PA, Olmsted MP (2015) Pilot study comparing multi-family therapy for adults with anorexia nervosa in an intensive eating disorder program. Eur Eat Disord Rev. doi:10.1002/erv.2359
Whitney J, Currin L, Murray J, Treasure J (2012) Family work in anorexia nervosa: A qualitative study of carers’ experiences of two methods of family intervention. Eur Eat Disord Rev 20:132–141. doi:10.1002/erv.1077
Whitney J, Murphy T, Landau Gavan K, Todd G, Whitaker W, Treasure J (2012) A practical comparison of two types of family intervention: an exploratory RCT of family day workshops and individual family work as a supplement to inpatient care for adults with anorexia nervosa. Eur Eat Disord Rev 20:142–150. doi:10.1002/erv.1076
Cook-Darzens S (2014) Approches familiales des troubles du comportement alimentaire de l’enfant et de l’adolescent. Érès, Toulouse
Girz L, Robinson AL, Foroughe M, Jasper K, Boachie A (2013) Adapting family-based therapy to a day hospital programme for adolescents with eating disorders: Preliminary outcomes and trajectories of change. J Fam Therapy 35:102–120. doi:10.1111/j.1467-6427.2012.00618.x
Honig P (2005) A multi-family group programme as part of an inpatient service for adolescents with a diagnosis of anorexia nervosa. Clin Child Psychol Psychiatry 10:465–475. doi:10.1177/1359104505056309
Wallis A, Alford C, Hanson A, Titterton J, Madden S, Kohn M (2013) Innovations in Maudsley family-based treatment for anorexia nervosa at the Children’s Hospital at Westmead: A family admission programme. J Fam Therapy 35:68–81. doi:10.1111/j.1467-6427.2012.00604.x
Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B (2010) Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry 67:1025–1032. doi:10.1001/archgenpsychiatry.2010.128
Downs KJ, Blow AJ (2013) A substantive and methodological review of family-based treatment for eating disorders: The last 25 years of research. J Fam Therapy 35:3–28. doi:10.1111/j.1467-6427.2011.00566.x
Eisler I (2005) The empirical and theoretical base of family therapy and multiple family day therapy for adolescent anorexia nervosa. J Fam Therapy 27:104–131. doi:10.1111/j.1467-6427.2005.00303.x
Rhodes P, Gosbee M, Madden S, Brown J (2005) ‘Communities of concern’ in the family-based treatment of anorexia nervosa: towards a consensus in the Maudsley model. Eur Eat Disord Rev 13:392–398. doi:10.1002/erv.658
Hildebrandt T, Bacow T, Markella M, Loeb K (2012) Anxiety in anorexia nervosa and its management in family-based treatment. Eur Eat Disord Rev 20:e1–e16. doi:10.1002/erv.1071
Gelin Z, Bzurovski J, Simon Y, Hendrick S (2014) Thérapie multifamiliale et rite de passage: Quand l’appartenance à une communauté sociale soigne le lien familial. Thérapie Familiale 35:463–473. doi:10.3917/tf.144.0463
Gelin Z, Simon Y, Hendrick S (2015) Comment donnons-nous sens à notre vécu d’événements significatifs de vie? Illustration de la méthode IPA appliquée à l’analyse des processus de changements dans le cadre d’une thérapie multifamiliale. Thérapie Familiale 36:133–147
Rolland JS (1993) Mastering family challenges in serious illness and disability. In: Walsh F (ed) Normal family processes, 2nd edn. The Guilford Press, New York, pp 444–473
Treasure J, Macdonald P, Schmidt U (2010) The clinician’s guide to collaborative care in eating disorders. Routledge, London
Treasure J, Smith G, Crane A (2007) Skills-based learning for caring for a loved one with an eating disorder: The New Maudsley Method. Routledge, London
Retzlaff R, von Sydow K, Beher S, Haun M, Schweitzer J (2013) The efficacy of systemic therapy for internalizing and other disorders of childhood and adolescence: a systematic review of 38 randomized trials. Fam Process 52:619–652. doi:10.1111/famp.12041
Cook-Darzens S (2007) Thérapies multifamiliales. Des groupes comme agents thérapeutiques. Erès, Toulouse
Mehl A, Tomanová J, Kuběna A, Papežová H (2013) Adapting multi-family therapy to families who care for a loved one with an eating disorder in the Czech Republic combined with a follow-up pilot study of efficacy. J Fam Therapy 35:82–101. doi:10.1111/j.1467-6427.2011.00579.x
Salaminiou E (2005) Families in multiple family therapy for adolescent anorexia nervosa: response to treatment, treatment experience and family and individual change. Unpublished PhD thesis, Kings College, University of London
Scholz M, Asen E (2001) Multiple family therapy with eating disordered adolescents: concepts and preliminary results. Eur Eat Disord Rev 9:33–42. doi:10.1002/erv.364
Scholz M, Scholz K, Gantchev K, Thömke V (2005) Multiple family therapy for anorexia nervosa: concepts, experiences and results. J Fam Therapy 27:132–141. doi:10.1111/j.1467-6427.2005.00304.x
Voriadaki T, Simic M, Espie J, Eisler I (2015) Intensive multi-family therapy for adolescent anorexia nervosa: Adolescents’ and parents’ day to day experiences. J Fam Therapy 37:5–23. doi:10.1111/1467-6427.12067
Gelin Z, Fuso S, Hendrick S, Cook-Darzens S, Simon Y (2015) The effects of a multiple family therapy on adolescents with eating disorders: an outcome study. Fam Process 54(1):160–172. doi:10.1111/famp.12103
Stewart C, Voulgari S, Eisler I, Hunt K, Simic M (2015) Multi-family therapy for bulimia nervosa in adolescence. Eat Disord J Treat Prev. doi:10.1080/10640266.2015.1044348
Gabel K, Pinhas L, Eisler I, Katzman D, Heinmaa M (2014) The effect of multiple family therapy on weight gain in adolescents with anorexia nervosa: Pilot data. J Can Acad Child Adolesc Psychiatry 23:196–199
Marzola E, Knatz S, Murray SB, Rockwell R, Boutelle K, Eisler I, Kaye WH (2015) Short-term intensive family therapy for adolescent eating disorders: 30-month outcome. Eur Eat Disord Rev 23:210–218. doi:10.1002/erv.2353
Tantillo M, Sanftner McGraw J, Hauenstein E, Groth SW (2015) Partnering with patients and families to develop an innovative multifamily therapy group treatment for adults with anorexia nervosa. Adv Eat Disord Theory Res Pract. doi:10.1080/21662630.2015.1048478
Cook-Darzens S, Doyen C, Brunaux F, Rupert F, Bouquet M-J, Bergametti F, Mouren M-C (2005) Thérapie multifamiliale de l’adolescent anorexique. Thérapie Familiale 26:223–245. doi:10.3917/tf.053.0223
Doyen C, Cook-Darzens S, Mouren M-C (2012) Multiple family group therapy for young adolescents with anorexia nervosa: A descriptive study. In: Shapiro C (ed) Eating disorders: causes, diagnosis and treatments. Nova Publishers, Hauppauge NY, pp 127–140
Whitney J, Murphy T, Landau S, Gavan K, Todd G, Whitaker W, Treasure J (2012) A practical comparison of two types of family intervention: an exploratory RCT of family day workshops and individual family work as a supplement to inpatient care for adults with anorexia nervosa. Eur Eat Disord Rev 20:142–150. doi:10.1002/erv.1076
Asen E (2002) Multiple family therapy: an overview. J Fam Therapy 24:3–16. doi:10.1111/1467-6427.00197
Bishop P, Clilverd A, Cooklin A, Hunt U (2002) Mental health matters: A multi-family framework for mental health intervention. J Fam Therapy 24:31–45. doi:10.1111/1467-6427.00199
Laqueur H (1972) Mechanisms of change in multiple family therapy. In: Sager CJ, Kaplan HS (eds) Progress in group and family therapy. Brunner/Mazel, New York, pp 400–415
Godart N, Berthoz S, Curt F, Perdereau F, Rein Z, Wallier J et al (2012) A randomized controlled trial of adjunctive family therapy and treatment as usual following inpatient treatment for anorexia nervosa adolescents. PLoS One 7:1–9. doi:10.1371/journal.pone.0028249
Onnis L, Barbara E, Bernardini M, Caggese A, Di Giacomo S, Giambartolomei A et al (2012) Family relations and eating disorders. The effectiveness of an integrated approach in the treatment of anorexia and bulimia in teenagers: results of a case-control systemic research. Eat Weight Disord 17:36–48. doi:10.1007/BF03325326
Agras W, Lock J, Brandt H et al (2014) Comparison of two family therapies for adolescent anorexia nervosa: a randomized parallel trial. JAMA Psychiatry 71:1279–1286. doi:10.1001/jamapsychiatry.2014.1025
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants performed by any of the authors.
Informed consent
This is a review article and it does not contain any studies with human participants.
Rights and permissions
About this article
Cite this article
Gelin, Z., Cook-Darzens, S., Simon, Y. et al. Two models of multiple family therapy in the treatment of adolescent anorexia nervosa: a systematic review. Eat Weight Disord 21, 19–30 (2016). https://doi.org/10.1007/s40519-015-0207-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40519-015-0207-y