Multi-family therapy helps families cope better with psychosis

Bringing together of different families in the context of early psychosis treatment, with the goal of working mutually to overcome each of their specific and very individual problems, is effective in Singaporean families, helping them face up to the challenges of psychotic episodes and rebuild relationships, according to a study.

“Multi-Family Therapy (MFT) is a Western-based model that combines the theory and practice of group and family therapies, and its key therapeutic aim is to foster mutual support and learning between families who face similar difficulties,” according to the study authors.

“Most adaptations of MFT to work with Asian families draw on a psychoeducational model, and it was only recently that a MFT based on therapeutic activities was developed in Singapore,” they added. [J Fam Therapy 2021;doi:10.1111/1467-6427.12329; Psychiatr Serv 2007;58:1003-1006; Soc Work Ment Health 2012;10:384-408]

The current MFT adapted for Singaporean families under the Early Psychosis Intervention Programme (EPIP) was activity-based and consisted of four weekly sessions and a follow-up session. The therapeutic activities included ‘Image of Psychosis’, ‘Multi-Family Group Discussion’, ‘Family Tree’, ‘Sculpting and ‘Letter to Psychosis’, among others.

The said activities, which were intended to engage families to work in a creative way, were designed to have a clearer understanding of psychosis and its impact, serve as a space for families to learn from one another about new ways of managing psychosis, to expand the families’ support network, and help them draw on their resources to manage psychosis.

In the present study, the authors interviewed families (nine patients and 10 caregivers) who completed the MFT. Data analysis revealed four main themes encompassing (1) the therapeutic processes of MFT, (2) positive changes in family relationships, (3) psychosis coping improvements, and (4) ideas for better MFT.

The first theme elucidated the mechanisms of MFT. The participants felt validated and comforted by others who were in similar situation, and they felt that they were not alone. They also reported feeling safe, which encouraged them to share openly with each other.

The second theme indicated increased empathy and understanding within the family unit. Some participants noticed that there was more communication and positive interactions with their family members. This facilitated conversations that would not otherwise have had in the context of home. Other participants also reported increased family cohesion and unity.

Aside from the interpersonal gains, FMT also conferred intrapersonal gains in terms of improving one's capacity in dealing with psychosis, as pointed out in the third theme. The participants said they gained a better understanding of and coming to terms with the illness.

Finally, the participants offered suggestions for improvement in MFT. Caregivers specifically would rather that therapists extended more expert advice.  

“[The] findings suggest that a Western-based MFT can be adapted to work with Singaporean families. This study sheds light on the therapeutic processes that may be related to the changes in family relationships and coping with psychosis,” the authors pointed out.

“Interestingly, it also suggests that taking an expert and authoritative stance may not fit with the younger generations in Singapore, as participants who expressed preference for this approach were caregivers but not young adult patients. Thus, therapists [should] adopt a flexible and fluid stance that attends to different generations when working with Singaporean families,” they added.