Multifamily Group Treatment for Schizophrenia

Abstract

Multifamily group treatment (MFGT) is an evidence-based intervention for treating persons with severe mental illness, particularly schizophrenia, and their families that integrates psychoeducation and behavioral family therapy in a multiple-family group format. Although multifamily group treatment was first pioneered more than half a century ago by Laqueur (Laqueur et al., 1964), only in the past 15 years has a coherent theoretical model and empirical evidence for its effectiveness been available to clinicians. The work by William McFarlane and his colleagues in the United States has greatly contributed to the model's subsequent refinement and empirical support (McFarlane, 1983, 2002). There are four major stages in his MFGT program: joining (i.e., building rapport/ alliance) among individual patients and families, conducting an educational workshop about schizophrenia for families, relapse prevention through the use of problem-solving format groups attended by both patients and families, and vocational and social skills rehabilitation in the same multifamily group. MFGT is delivered by two clinicians to groups of 5-8 families over a 2-year period. A main theoretical foundation of MFGT is that by increasing social network size and support by enabling families to benefit from each other's experiences in solving problems, better illness course and improved outcome occur. Across a number of clinical trials, MFGT based on the McFarlane model has been shown to decrease relapse and rehospitalization among patients with schizophrenia and to improve family well-being over the 2-year treatment period (see review in McFarlane et al., 2003). Consequently, the American Psychological Association (2004) recommends MFGT as a best practice for serious mental illness. MFGT has indeed come of age, yet several understudied questions remain, two of which we focus on in the present review. First, are treatment gains sustained past the intervention period? In other words, given the chronic nature of schizophrenia, should we expect that the well-documented effects of MFGT in these patients last? Second, is MFGT effective across ethnic groups? Despite the benefits demonstrated in clinical trials, treatment studies have generally focused on European-American populations. The effectiveness of MFGT for other ethnic samples is virtually unknown. The two studies that we review below are among the most recent evaluations of outcome at 1-year post-treatment, with one study also evaluating the effects of MFGT on an Asian sample. McDonnell and colleagues (2006) examined service utilization, both outpatient and inpatient, in 97 outpatients with schizophrenia (n = 64), schizoaffective disorder (n = 32), or other psychotic disorder (n = 1) at a large urban community mental health center during the 2-year MFGT period and at 1-year post-treatment follow-up. Patients were randomized into standard psychiatric care and MFGT (n = 53; female = 12) or standard care alone (n = 44; female = 9). Most patients received atypical antipsychotic medications and had low levels of psychiatric symptoms. Mean age of MFGT and SC patients was 31.9 years (SD = 8.7) and 33.8 years (SD = 10.2), respectively. Approximately 92% of participants (combined MFGT and SC study samples) were European-American. All MFGT sessions (24 sessions in year 1 and 12 sessions in year 2) followed McFarlane's model as defined by a treatment manual NIH Public Access