July 02, 2012
Multifamily Group Therapy for Clients with Severe and Persistent Mental Illness
Although there are many forms of therapy which have proven effective for clients with a variety of mental illness diagnoses, there is inconclusive data in regards to schizophrenia. However, one type of therapy has shown to be quite effective: multifamily group therapy (McFarlane 2002). The goals of multifamily groups are to create social networks for families and clients with schizophrenia and bipolar disorder, to educate families about the illness, to reduce symptoms, and to teach problem solving. Research suggests that clients attending multifamily groups have a relapse rate of 50% less than clients not attending the group. Also, over a two year period, clients in the group reported significantly lower negative symptoms (McDonnell et al 2007).
The structure of a multifamily group is important for the integrity and validity of the group. The group runs bi-weekly for two years and typically involves eight families and two leaders. The group begins with two joining sessions in which the leader meets privately with the family and then the client to discuss precipitants, symptoms, coping, and family reactions. Families then attend an educational workshop with other families during a 6 hour session. Usually this is hosted by a multi-disciplinary team which allows family members to ask questions from practitioners with a variety of backgrounds. Next the group begins. The first two sessions are unique in regard to topic. The first session is a “getting to know you” session and illness is not discussed. The second session discusses how the illness has impacted the family.
All later sessions begin with socialization and the bulk of the session is a problem solving activity in which there is a go-around of something good and a struggle. The leader writes all struggles on the board and then chooses one based on severity. The group then discusses possible solutions and writes them on a board. After there are at least 10 options, the group rates the pros and cons of each option. The client then chooses two options to try over the next two weeks.
Group problem solving has proven to be effective because it raises new ideas and options that families may not have considered, and it allows for socialization. The group also follows specific guidelines set by leaders which promote healthy communication and low emotional expression. The role of the leaders is to collaborate with families and facilitate discussion. The leaders are also educators and coaches. These types of groups can be run in any setting and are often led in community mental health facilities.
Art Group Therapy for Clients with Severe and Persistent Mental Illness
As a social work intern at Community Support and Treatment Services (CSTS), I run an art group for clients with severe and persistent mental illness. The group meets weekly for one hour, and typically five clients attend the group. This type of group is unique in that it is not a discussion-based group. At times, I have struggled with how much emphasis I should place on socializations, because some clients attend for social interaction. The group is currently structured in a manner that promotes indirect social interaction.
The group begins with five minutes of introductions which include names and an interesting fact or getting-to-know-you question posed by the leader. The leader also introduces the group, meeting times, and theme of the week. Examples of themes include healing, stigma, mood, and identity. The leader also has a couple project suggestions for clients who prefer to follow a model. Project ideas include: puzzles, print making, paper mache, painting, origami, mobiles, and picture frames. The group has 45 minutes to work on projects, and the leader engages in conversation with clients if they are interested in socializing. The final 10 minutes is a time for sharing projects with the group, and group members provide feedback to the client.
The group has proven to be effective as measured by feedback from members and high rate of attendance by current members. The group also utilizes Yalom’s approaches to group development. The key factors include: instilling hope through peer-peer interactions, imitating behavior, increasing social network, interpersonal learning, universality (reducing stigma), group cohesion, and altruism. The group is centered around art so there is little pressure to speak with other members, but many members choose to engage in peer-peer interactions. The leader is also able to model appropriate social interaction. Finally, members are able to increase confidence by creating unique projects which build self-esteem and reduce the stigma that they feel.