Multiple Family Therapy: The Marlborough Model and Its Wider Applications

Views: 539
Ratings: (0)

If a troubled family contains the resources to solve its own problems, then why not bring such families together, to share their experiences and support each other?This is the approach of the Marlborough Family Service, the institution at the forefront of development for child-protection cases, school-based interventions and family therapy for ethnic-minority communities for over twenty years. In this book three long-standing staff members describe for the first time their innovative work with a range of family problems, from marital violence and child abuse to educational problems and eating disorders.

List price: $22.99

Your Price: $18.39

You Save: 20%

 

6 Slices

Format Buy Remix

CHAPTER ONE: Developing a contextual approach

ePub

The work described in this book has been developed over the past twenty-five years at the Marlborough Family Service. This is a publicly funded institution, part of Britain’s National Health Service, serving a defined catchment area and located in the middle of London. The Marlborough offers a range of therapeutic and consultative work for children, teenagers, adults, couples, and families. It is a child and family consultation service, integrated with the adult psychotherapy service and with a strong link to the local community health team which caters for seriously mentally ill adults. The Marlborough is an all-age service, with the youngest client 2 days of age and the oldest 96 years old. It therefore can take referrals without having to be limited by the traditionally rigid age boundaries between child and adolescent and adult and old-age mental heath services. The Marlborough is staffed by a multidisciplinary team of child, adult, and family therapists, social workers, teachers, nurses, clinical psychologist, and psychiatrists. All staff, however diverse their trainings and interests, share the basic values of the family systems approach. This means adopting an interactional framework that counteracts the potential for overemphasizing individual blame. Conceptualizing behaviour in the context of relationships is liberating as it offers the potential for a far-wider range of choices about how things might change if they have got stuck. The approach developed—the Marlborough model—above all emphasizes context: individuals live in contexts, usually families. Families live in contexts: their neighbourhoods. Within their living context, families and their individual members relate to friendship networks, to work spheres, to schools or nurseries, to religious or cultural institutions, to professional networks which enter their lives. A contextual approach attempts to address all these contexts, all the different systems and sub-systems of which the child, the adult, and the family are part.

 

CHAPTER TWO: Multiple family therapy-history and concepts

ePub

The idea of treating a number of families together was first pioneered in the early 1960s by Laqueur and his co-workers (Laqueur, La Burt, & Morong, 1964). This group saw the multi-family setting as a useful context for trying out different behaviours and new role relationships. Here, the resources of all family members could be used more successfully, with several families being treated together in one group. The major aims was to improve inter- and intra-family communication, in the hope that this might help relatives to understand some of the troubled behaviours of the index patient. This led to running groups for schizophrenics and their relatives (Laqueur, 1972). Laqueur worked initially with schizophrenic patients and their families on a hospital ward—alongside insulin-shock treatment. He saw this as a pragmatic response to the need for improving ward management,

At the outset, multiple family therapy was a rather peculiar blend of group therapy and family therapy, introduced at a time of dwindling inpatient resources. Laqueur and his team worked from the premise that difficulties in relationships derive from dysfunctional feedback loops across subsystem boundaries. However, he also made use of other theoretical models, such as psychody-namic ideas and attachment theory. He hypothesized that in normal development secondary objects of attachment gradually replace primary ones and that therefore the presence of other families allowed a person to struggle towards increasing independence and self-differentiation by identifying with members of other families and learning by analogy (Laqueur, 1973).

 

CHAPTER THREE: Developing a day unit for families

ePub

From individual group therapy
to family group therapy

This chapter describes the history and past and present work of the Marlborough Family Day Unit—probably the first of its kind in the world. In a paper entitled “An Institution for Change: Developing a Family Day Unit”, Alan Cooklin, the founder of the Marlborough Family Day Unit, provocatively juxtaposes the concepts of “change” and “institution” (Cooklin et al., 1983). The notion of institutionalized change seems full of contradictions, and it was the encounter with many seemingly “impossible” families that generated the idea of creating an institution specializing in promoting change for these families.

The idea of bringing together so-called multi-problem families for joint therapy was inspired by the therapeutic community movement, believing—as it did at the time—in ideas such as “democracy “, “openness”, and “shared responsibility”. Maxwell Jones (1968) had experimented with the creation of a “social” therapy, involving adults who had been invariably diagnosed as suffering from personality disorder or psychopathy. He believed that, by putting them together in a “real living situation” in a therapeutic milieu, they might dilute the traditional mental hospital setting and de-medicalize their own treatment. This ethos reflected a move away from traditional authoritarian hospital hierarchies to a setting where patients—nowadays called “users”—would not only participate in their own treatment, but also be involved in helping fellow sufferers. The idea of having the potential to be helpful, rather than being simply at the receiving end of some help, seemed a first step to decrease the dependence of chronic patients on institutions and to mobilize self-help resources. Jones’s model seemed to make sense for groups of individuals, and if it worked— might it not work for groups of families?

 

CHAPTER FOUR: The Family School

ePub

Twenty years ago, Brenda McHugh and Neil Dawson were employed in the Family School to teach the children of the families who attended the Family Day Unit. However, after these therapists had been immersed in systemic practice for a period of time and trained in family therapy both at the Marlborough and at the Institute of Family Therapy, London, it became clear that there was a chance to develop the therapeutic potential of the Family School in its own right. There was a unique opportunity to use children’s learning as a face-saving route to provide therapeutic help for families who might otherwise have shied away from the implied stigma or fears associated with therapy in its more usual format.

Originally, children attended the Family School on their own and rejoined their parents in the day unit after the teaching programme was finished. The first significant systemic initiative was an experiment in which a parent spent a session with his or her child in the Family School. This proved to be successful in promoting change, and so a process developed over the years of increasing the number of parents who would attend with their child at any one time. Today, the Family School is always full, with nine families taking part in the multi-family classroom every day (Dawson & McHugh, 1986a, 1986b, 1987, 1988,1994).

 

CHAPTER FIVE: Applications of the Marlborough Model

ePub

Over the years, many colleagues from different countries and work settings have visited the Marlborough’s Family Day Unit and Family School. The day and residential units set up in the 1980s and early 1990s and in part inspired by our work, mostly located in Scandinavia, seemed to differ in two major aspects: the degree of inter-family work and the staffing levels. In these units, families largely tend to receive their therapeutic inputs separately, with only very occasional meetings involving other families. The therapeutic potential of families consulting to each other is not exploited, with all therapy provided only by staff. In some instances, the staff in residential family-units by far outnumber clients, with staff-client ratios of 3:1. How do families and their individual members construct the apparent need for such large staff numbers? Perhaps some might think that their problems are so serious that only multiple staff can have a hope of addressing these. Others will have their own sense of helplessness reinforced by the presence of too many helpers. Families and their individual members will tend to look to therapists to provide solutions for their problems and issues, to be addressed in formal therapeutic sessions. Conversely, in such settings therapists have to think of themselves as providing their special expertise, and these efforts can inadvertently lead to the “institutionalization” of their clients. It is at times quite difficult to understand what staff employed in large numbers do all day. One experience that the Marlborough team has had over and over again is how “unemployed” therapists can frequently feel in day or residential settings—even when it is only three of them dealing with up to ten families. If therapists see themselves predominantly as catalysts, enabling inter-actions between family members and families to take place, then this different frame can result in therapists being less central.

 

CHAPTER SIX: Skills and techniques in multiple family therapy

ePub

This chapter lists a variety of techniques and interventions that can be used in multiple family therapy. The context within which this work takes place as well the specific issues will dictate how the techniques are adapted or modified. Clearly, one of the key features of family group work is that it focuses on the whole group and the interactions between families rather than simply on one individual family. The therapists’stances are multi-positional: they join and disengage within short time-frames, and they are at different times central or peripheral to the group, always aiming to facilitate interactions between families.

Setting up multi-family groups

There are many different sizes of multi-family groups, ranging from three to sixteen or more families. Too few families, and the work is more difficult, with too few inter-family interactions and too much reliance on the therapist generating ideas. Families also tend to feel quite exposed in a small group. At the other end of the spectrum, too many families being seen at the same time carries the danger of therapists relying on the families to treat each other, losing sight of individual families and their members. Our favoured number of families is between six and eight. This does not require a similar number of therapists: each therapist should be able to be the key worker for up to three families at the same time. It is worth noting that units that have tried a much higher staff-patient ratio have found that their personnel often felt unemployed, not knowing what to do or else becoming too involved.

 

Details

Print Book
E-Books
Slices

Format name
ePub (DRM)
Encrypted
true
Sku
9781780497235
Isbn
9781780497235
File size
0 Bytes
Printing
Disabled
Copying
Disabled
Read aloud
No
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata