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A group approach to family therapy

March 2, 2010
by Sharon Cowan, LCSW, MAC
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Seeing multiple families at once could yield clinical and cost benefits

In today’s environment of limited time resources for treatment of chemically dependent adults and the need for more economically advantageous treatment that is empirically proven effective, treatment providers should consider using multifamily therapy groups as opposed to individual family therapy sessions. Using multifamily therapy groups is one concept that has not been applied much to the treatment of chemically dependent adults.1,2 However, it has been used for some time with chemically dependent adolescents.3 It also has been used in the treatment of other adult populations for addictive behaviors such as eating disorders.4,5

Multifamily therapy groups are more cost-effective than individual family therapy sessions, which are often limited or not offered in many facilities because of cost or lack of time. Individual family therapy sessions also can represent a cost that insurance plans might not pay. Multifamily therapy groups can include a number of families and require less time resources than those for individual family therapy sessions. Because this is not an additional service since the chemically dependent person would be in group during that time anyway, insurance companies are more likely to pay for it.

For the purpose of clarity, some explanation of terms follows. In modern American society the term “family” has taken on a much broader definition. The American family is no longer seen as only an adult male, an adult female and their biological children. Today’s American family as seen in chemically dependent adults could include spouses, common-law spouses, stepparents, biological parents, homosexual or cohabitating adults and/or their parents. For the purpose of this article the term “family” to participate in multifamily groups would mean any adults living with the chemically dependent client or who provide social or financial support to that person.

The term “chemically dependent” refers to any chemical substance to which a person might become addicted. “Multifamily therapy group” refers to two or more families who meet for the purpose of being led in a group therapy session by a trained therapist.

Limited services
Because of limited time resources, treatment for chemically dependent adults often has been reduced to 90 hours followed by 90 minutes of aftercare or continuing care once a week for a minimum of six months. This treatment also includes only the individual who is chemically dependent. This occurs even though research has shown that the involvement of the spouse, significant other and/or parents in the treatment process increases the chances of sustained recovery.

Many treatment providers lack the time even to include individual family therapy sessions for their clients except in the most resistant or difficult cases where sustained recovery is impossible without family support. As an example, the following is the chemical dependency treatment program at a small private-practice clinic, with services paid for by insurance. The clinic has two programs: a daytime partial hospitalization program (PHP) for six hours a day for 15 days, and a nighttime intensive outpatient program (IOP) for three hours a day for 30 days. Each program employs one master’s-level therapist. The daytime therapist receives a salary for 42.5 hours a week and the evening therapist receives a salary for 40 hours a week. This is the breakout of each therapist’s time, if each therapist has 10 clients:

  PHP Therapist IOP Therapist
Group Time 25 hours 23 hours
Individual Therapy 10 hours 10 hours
Paperwork 7.5 hours 7 hours

*This therapist does one hour a day of group for the PHP therapist and the three-hour multifamily group for both programs.
**Paperwork includes daily progress notes, admission paperwork, treatment plans and weekly staffing summaries for each client.

Also included in these programs is a one-hour individual session each week for each client. It is clear that there is not sufficient time for any attempt to include one family session a week for each client. Utilizing multifamily therapy groups takes only three hours a week as opposed to 20 hours for individual family therapy sessions. The one three-hour multifamily therapy group is presented for all clients. Facilities with larger caseloads and more therapists could adjust their programs accordingly.

Family education
These groups also are used to provide family education sessions. One of the factors involved in the treatment of chemical dependency from a family systems standpoint is that the family is often as unaware of chemical dependency and its effect on the family system as the chemically dependent individual is. Family members also are often unaware that behaviors on their part have resulted in reinforcing the use of addictive substances by the chemically dependent individual. Therefore, education on various aspects of chemical dependency’s effect on the family system, and actions they can take to help them and the chemically dependent individual, could be presented to all families through this process.