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Two models of multiple family therapy in the treatment of adolescent anorexia nervosa: a systematic review

  • Zoé GelinEmail author
  • Solange Cook-Darzens
  • Yves Simon
  • Stéphan Hendrick
Review

Abstract

Multiple family therapy (MFT) is a therapeutic method that brings together several families affected by the same pathology. Although from an ideological and conceptual point of view, MFT is often linked to family therapy and group therapy, it is difficult to define it with precision, a weakness which may in turn hinder research on therapeutic effectiveness. This is most notable in the field of eating disorders (ED) where, in spite of MFT’s great popularity, research evidence remains limited. Within the context of a systematic review of the literature on MFT in the treatment of anorexia nervosa, the purpose of this article is to provide a theoretical and clinical framework for describing two MFT models, in an attempt to explore their common and distinct concepts, principles, techniques, and factors of change. The first program is a day treatment adaptation of the Maudsley family-based MFT approach, developed in Belgium at the Therapeutic Centre for Adolescents suffering from Eating Disorders: it focuses on the management of ED symptoms, using a strong cognitive behavioral orientation. The second is an integrated systemic MFT outpatient and inpatient program carried out on the ED unit of a pediatric hospital in Paris, France: it emphasizes intra- and inter-family relationships within a systemic framework. Our effort to describe and compare these two models constitutes a first step toward determining the relative value of different models of MFT. Indeed, each model presents specific characteristics that may make it best suited for specific ED populations and/or types of families.

Keywords

Multiple family therapy Eating disorders Maudsley method Family-based treatment Integrated systemic therapy Therapeutic process Literature review 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

This is a review article and it does not contain any studies with human participants.

References

  1. 1.
    Dixon L, McFarlane WR, Lefley H, Lucksted A, Cohen M, Falloon I et al (2001) Evidence- based practices for services to families of people with psychiatric disabilities. Psychiatr Serv 52:903–910. doi: 10.1176/appi.ps.52.7.903 CrossRefPubMedGoogle Scholar
  2. 2.
    Dyck D, Hendryx M, Short R, Voss W, McFarlane W (2002) Service use among patients with schizophrenia in psychoeducational multiple-family group treatment. Psychiatr Serv 53:749–754. doi: 10.1176/appi.ps.53.6.749 CrossRefPubMedGoogle Scholar
  3. 3.
    Dyck D, Short R, Hendryx M, Norell D, Myers M, Patterson T et al (2000) Management of negative symptoms among patients with schizophrenia attending multiple-family groups. Psychiatr Serv 51:513–519. doi: 10.1176/appi.ps.51.4.513 CrossRefPubMedGoogle Scholar
  4. 4.
    McFarlane WR (2002) Multifamily groups in the treatment of severe psychiatric disorders. Guilford, New York and LondonGoogle Scholar
  5. 5.
    Fristad MA, Goldberg-Arnold JS, Gavazzi SM (2003) Multi-family psychoeducation groups in the treatment of children with mood disorders. J Marital Fam Therapy 29:491–504. doi: 10.1111/j.1752-0606.2003.tb01691.x CrossRefGoogle Scholar
  6. 6.
    Lemmens G, Eisler I, Buysse A, Heene E, Demyttenaere K (2009) The effects on mood of adjunctive single-family and multi-family group therapy in the treatment of hospitalized patients with major depression. A 15-month follow-up study. Psychother Psychosom 78:98–105. doi: 10.1159/000201935 CrossRefPubMedGoogle Scholar
  7. 7.
    McDonell MG, Dyck DG (2004) Multiple-family group treatment as an effective intervention for children with psychological disorders. Clin Psychol Rev 24:685–706. doi: 10.1016/j.cpr.2004.02.004 CrossRefPubMedGoogle Scholar
  8. 8.
    Barrett P, Farrell L, Dadds M, Boulter N (2005) Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: Long-term follow-up and predictors of outcome. J Am Acad Child Adolesc Psychiatry 44:1005–1014. doi: 10.1097/01.chi.0000172555.26349.94 CrossRefPubMedGoogle Scholar
  9. 9.
    Weine S, Kulauzovic Y, Klebic A, Besic S, Mujagic A, Muzurovic J et al (2008) Evaluating a multiple-family group access intervention for refugees with PTSD. J Marital Fam Therapy 34:149–164. doi: 10.1111/j.1752-0606.2008.00061.x CrossRefGoogle Scholar
  10. 10.
    Marshall JP, Kimball T, Shumway S, Miller M, Jefferies V, Arredondo R (2005) Outcomes of a structured family group in an outpatient alcohol/other drug treatment setting. Alcohol Treat Q 22:39–53. doi: 10.1300/J020v23n04_03 CrossRefGoogle Scholar
  11. 11.
    Fraenkel P (2014) Fresh Start for Families: A collaboratively-built community-based program for families that are homeless. In: Nelson T, Winawer H (eds) Critical topics in family therapy. AFTA Springerbriefs in family therapy, New York, pp 35–43. doi:  10.1007/978-3-319-03248-1_4
  12. 12.
    Steinglass P (1998) Multiple family discussion groups for patients with chronic medical illness. Fam Syst Health 16:55–70. doi: 10.1037/h0089842 CrossRefGoogle Scholar
  13. 13.
    Asen E, Schuff H (2006) Psychosis and multiple family group therapy. J Fam Therapy 28:58–72. doi: 10.1111/j.1467-6427.2006.00337.x CrossRefGoogle Scholar
  14. 14.
    Edwards S (2001) The essential elements of multi-family group therapy: a Delphi study. Doctoral dissertation, Faculty of the Virginia Polytechnic Institute and State UniversityGoogle Scholar
  15. 15.
    Marner T, Westerberg C (1987) Concomitant group therapy with anorectics and their parents as a supplement to family therapy. J Fam Therapy 9:255–263. doi: 10.1046/j.1987.00280.x CrossRefGoogle Scholar
  16. 16.
    Slagerman M, Yager J (1989) Multiple family group treatment for eating disorders: a short term program. Psychiatr Med 7:269–283PubMedGoogle Scholar
  17. 17.
    Wooley SC, Lewis K (1987) Multi-family therapy within an intensive treatment program for bulimia. In: Harkaway J (ed) Eating disorders: The family therapy collections, 20. Aspen Publishers, Rockville, pp 12–24Google Scholar
  18. 18.
    Asen E, Scholz M (2010) Multi-family therapy: concepts and techniques. Routledge, London and New YorkGoogle Scholar
  19. 19.
    Dare C, Eisler I (2000) A multi-family group day treatment programme for adolescent eating disorder. Eur Eat Disord Rev 8:4–18. doi: 10.1002/(SICI)1099-0968(200002)8 CrossRefGoogle Scholar
  20. 20.
    Colahan M, Robinson P (2002) Multi-family groups in the treatment of young adults with eating disorders. J Fam Therapy 24:17–30. doi: 10.1111/1467-6427.00198 CrossRefGoogle Scholar
  21. 21.
    Lock J, Le Grange D (2012) Treatment manual for anorexia nervosa: a family-based approach, 2nd edn. The Guilford Press, New YorkGoogle Scholar
  22. 22.
    Lock J, Le Grange D, Agras S, Dare C (2001) Treatment manual for anorexia nervosa: a family-based approach. The Guilford Press, New-YorkGoogle Scholar
  23. 23.
    Stiles-Shields C, Hoste RR, Doyle PM, Le Grange D (2012) A review of family-based treatment for adolescents with eating disorders. Rev Recent Clin Trials 7:133–140. doi: 10.2174/157488712800100242 CrossRefPubMedGoogle Scholar
  24. 24.
    Fairbairn P, Eisler I (2007) Intensive multiple family day treatment: Clinical and training perspectives. In: Cook-Darzens S (ed) Thérapies multifamiliales. Des groupes comme agents thérapeutiques, Érès, Toulouse, pp 179–203Google Scholar
  25. 25.
    Hollesen A, Clausen L, Rokkedal K (2013) Multiple family therapy for adolescents with anorexia nervosa: a pilot study of eating disorder symptoms and interpersonal functioning. J Fam Therapy 35:53–67. doi: 10.1111/1467-6427.12000 CrossRefGoogle Scholar
  26. 26.
    Knatz S, Kaye W, Marzola E, Boutelle K (2015) A brief, intensive application of family-based treatment for eating disorders. In: Loeb K, Le Grange D, Lock J (eds) Family therapy for adolescent eating and weight disorder: New applications. Routledge, Florence KYGoogle Scholar
  27. 27.
    Scholz M, Rix M, Hegewald K, Gantchev K (2003) Treatment manual for multi-family therapy with anorexia nervosa (translated, revised and adapted by E. Asen). Unpublished manuscript. Dresden 2002, London 2003Google Scholar
  28. 28.
    Scholz M, Rix M, Scholz K, Gantchev K, Thömke V (2005) Multiple family therapy for anorexia nervosa: Concepts, experiences and results. J Fam Therapy 27:132–141. doi: 10.1111/j.1467-6427.2005.00304.x CrossRefGoogle Scholar
  29. 29.
    Simic M, Eisler I (2015) Multi-family therapy. In: Loeb KL, Le Grange D, Lock D (eds) Family therapy for adolescent and weight disorders: New applications. Routledge, New York, pp 110–138Google Scholar
  30. 30.
    Le Grange D, Lock J, Loeb K, Nicholls D (2010) Academy for eating disorders position paper: The role of the family in eating disorders. Int J Eat Disord 43:1–5. doi: 10.1002/eat.20751 PubMedGoogle Scholar
  31. 31.
    Criquillion-Doublet S, Martins E (2012) Groupes de thérapie multifamiliale auprès de jeunes adultes souffrant de TCA. Personal communicationGoogle Scholar
  32. 32.
    Geist R, Heinmaa M, Stephens D, Davis R, Katzman DK (2000) Comparison of family therapy and family group psychoeducation in adolescents with anorexia nervosa. Can J Psychiatry 45:173–178PubMedGoogle Scholar
  33. 33.
    Tantillo M (2006) A relational approach to eating disorders Multifamily Therapy Group: Moving from difference and disconnection to mutual connection. Fam Syst Health 24:82–102CrossRefGoogle Scholar
  34. 34.
    Tantillo M, Sanftner J, Hauenstein J (2013) Restoring connection in the face of disconnection: an integrative approach to understanding and treating anorexia nervosa. Adv Eat Disord Theory Res Pract 1:21–38. doi: 10.1080/21662630.2013.742980 CrossRefGoogle Scholar
  35. 35.
    McFarlane WR (2002) Multifamily groups in the treatment of severe psychiatric disorders. The Guilford Press, New YorkGoogle Scholar
  36. 36.
    Treasure J, Whitaker W, Todd G, Whitney J (2012) A description of multiple family workshops for carers of people with anorexia nervosa. Eur Eat Disord Rev 20:17–22. doi: 10.1002/erv.1075 CrossRefGoogle Scholar
  37. 37.
    Depestele L, Claes L, Lemmens G (2015) Promotion of an autonomy-supportive parental style in a multi-family group for eating disordered adolescents. J Fam Therapy 37:24–40. doi: 10.1111/1467-6427.12047 CrossRefGoogle Scholar
  38. 38.
    Dimitropoulos G, Farquhar J, Freeman VE, Colton PA, Olmsted MP (2015) Pilot study comparing multi-family therapy for adults with anorexia nervosa in an intensive eating disorder program. Eur Eat Disord Rev. doi: 10.1002/erv.2359 PubMedGoogle Scholar
  39. 39.
    Whitney J, Currin L, Murray J, Treasure J (2012) Family work in anorexia nervosa: A qualitative study of carers’ experiences of two methods of family intervention. Eur Eat Disord Rev 20:132–141. doi: 10.1002/erv.1077 CrossRefPubMedGoogle Scholar
  40. 40.
    Whitney J, Murphy T, Landau Gavan K, Todd G, Whitaker W, Treasure J (2012) A practical comparison of two types of family intervention: an exploratory RCT of family day workshops and individual family work as a supplement to inpatient care for adults with anorexia nervosa. Eur Eat Disord Rev 20:142–150. doi: 10.1002/erv.1076 CrossRefPubMedGoogle Scholar
  41. 41.
    Cook-Darzens S (2014) Approches familiales des troubles du comportement alimentaire de l’enfant et de l’adolescent. Érès, ToulouseGoogle Scholar
  42. 42.
    Girz L, Robinson AL, Foroughe M, Jasper K, Boachie A (2013) Adapting family-based therapy to a day hospital programme for adolescents with eating disorders: Preliminary outcomes and trajectories of change. J Fam Therapy 35:102–120. doi: 10.1111/j.1467-6427.2012.00618.x CrossRefGoogle Scholar
  43. 43.
    Honig P (2005) A multi-family group programme as part of an inpatient service for adolescents with a diagnosis of anorexia nervosa. Clin Child Psychol Psychiatry 10:465–475. doi: 10.1177/1359104505056309 CrossRefGoogle Scholar
  44. 44.
    Wallis A, Alford C, Hanson A, Titterton J, Madden S, Kohn M (2013) Innovations in Maudsley family-based treatment for anorexia nervosa at the Children’s Hospital at Westmead: A family admission programme. J Fam Therapy 35:68–81. doi: 10.1111/j.1467-6427.2012.00604.x CrossRefGoogle Scholar
  45. 45.
    Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B (2010) Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry 67:1025–1032. doi: 10.1001/archgenpsychiatry.2010.128 CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Downs KJ, Blow AJ (2013) A substantive and methodological review of family-based treatment for eating disorders: The last 25 years of research. J Fam Therapy 35:3–28. doi: 10.1111/j.1467-6427.2011.00566.x CrossRefGoogle Scholar
  47. 47.
    Eisler I (2005) The empirical and theoretical base of family therapy and multiple family day therapy for adolescent anorexia nervosa. J Fam Therapy 27:104–131. doi: 10.1111/j.1467-6427.2005.00303.x CrossRefGoogle Scholar
  48. 48.
    Rhodes P, Gosbee M, Madden S, Brown J (2005) ‘Communities of concern’ in the family-based treatment of anorexia nervosa: towards a consensus in the Maudsley model. Eur Eat Disord Rev 13:392–398. doi: 10.1002/erv.658 CrossRefGoogle Scholar
  49. 49.
    Hildebrandt T, Bacow T, Markella M, Loeb K (2012) Anxiety in anorexia nervosa and its management in family-based treatment. Eur Eat Disord Rev 20:e1–e16. doi: 10.1002/erv.1071 CrossRefPubMedGoogle Scholar
  50. 50.
    Gelin Z, Bzurovski J, Simon Y, Hendrick S (2014) Thérapie multifamiliale et rite de passage: Quand l’appartenance à une communauté sociale soigne le lien familial. Thérapie Familiale 35:463–473. doi: 10.3917/tf.144.0463 CrossRefGoogle Scholar
  51. 51.
    Gelin Z, Simon Y, Hendrick S (2015) Comment donnons-nous sens à notre vécu d’événements significatifs de vie? Illustration de la méthode IPA appliquée à l’analyse des processus de changements dans le cadre d’une thérapie multifamiliale. Thérapie Familiale 36:133–147CrossRefGoogle Scholar
  52. 52.
    Rolland JS (1993) Mastering family challenges in serious illness and disability. In: Walsh F (ed) Normal family processes, 2nd edn. The Guilford Press, New York, pp 444–473Google Scholar
  53. 53.
    Treasure J, Macdonald P, Schmidt U (2010) The clinician’s guide to collaborative care in eating disorders. Routledge, LondonGoogle Scholar
  54. 54.
    Treasure J, Smith G, Crane A (2007) Skills-based learning for caring for a loved one with an eating disorder: The New Maudsley Method. Routledge, LondonGoogle Scholar
  55. 55.
    Retzlaff R, von Sydow K, Beher S, Haun M, Schweitzer J (2013) The efficacy of systemic therapy for internalizing and other disorders of childhood and adolescence: a systematic review of 38 randomized trials. Fam Process 52:619–652. doi: 10.1111/famp.12041 CrossRefPubMedGoogle Scholar
  56. 56.
    Cook-Darzens S (2007) Thérapies multifamiliales. Des groupes comme agents thérapeutiques. Erès, ToulouseGoogle Scholar
  57. 57.
    Mehl A, Tomanová J, Kuběna A, Papežová H (2013) Adapting multi-family therapy to families who care for a loved one with an eating disorder in the Czech Republic combined with a follow-up pilot study of efficacy. J Fam Therapy 35:82–101. doi: 10.1111/j.1467-6427.2011.00579.x CrossRefGoogle Scholar
  58. 58.
    Salaminiou E (2005) Families in multiple family therapy for adolescent anorexia nervosa: response to treatment, treatment experience and family and individual change. Unpublished PhD thesis, Kings College, University of LondonGoogle Scholar
  59. 59.
    Scholz M, Asen E (2001) Multiple family therapy with eating disordered adolescents: concepts and preliminary results. Eur Eat Disord Rev 9:33–42. doi: 10.1002/erv.364 CrossRefGoogle Scholar
  60. 60.
    Scholz M, Scholz K, Gantchev K, Thömke V (2005) Multiple family therapy for anorexia nervosa: concepts, experiences and results. J Fam Therapy 27:132–141. doi: 10.1111/j.1467-6427.2005.00304.x CrossRefGoogle Scholar
  61. 61.
    Voriadaki T, Simic M, Espie J, Eisler I (2015) Intensive multi-family therapy for adolescent anorexia nervosa: Adolescents’ and parents’ day to day experiences. J Fam Therapy 37:5–23. doi: 10.1111/1467-6427.12067 CrossRefGoogle Scholar
  62. 62.
    Gelin Z, Fuso S, Hendrick S, Cook-Darzens S, Simon Y (2015) The effects of a multiple family therapy on adolescents with eating disorders: an outcome study. Fam Process 54(1):160–172. doi: 10.1111/famp.12103 CrossRefPubMedGoogle Scholar
  63. 63.
    Stewart C, Voulgari S, Eisler I, Hunt K, Simic M (2015) Multi-family therapy for bulimia nervosa in adolescence. Eat Disord J Treat Prev. doi: 10.1080/10640266.2015.1044348 Google Scholar
  64. 64.
    Gabel K, Pinhas L, Eisler I, Katzman D, Heinmaa M (2014) The effect of multiple family therapy on weight gain in adolescents with anorexia nervosa: Pilot data. J Can Acad Child Adolesc Psychiatry 23:196–199PubMedPubMedCentralGoogle Scholar
  65. 65.
    Marzola E, Knatz S, Murray SB, Rockwell R, Boutelle K, Eisler I, Kaye WH (2015) Short-term intensive family therapy for adolescent eating disorders: 30-month outcome. Eur Eat Disord Rev 23:210–218. doi: 10.1002/erv.2353 CrossRefPubMedGoogle Scholar
  66. 66.
    Tantillo M, Sanftner McGraw J, Hauenstein E, Groth SW (2015) Partnering with patients and families to develop an innovative multifamily therapy group treatment for adults with anorexia nervosa. Adv Eat Disord Theory Res Pract. doi: 10.1080/21662630.2015.1048478 Google Scholar
  67. 67.
    Cook-Darzens S, Doyen C, Brunaux F, Rupert F, Bouquet M-J, Bergametti F, Mouren M-C (2005) Thérapie multifamiliale de l’adolescent anorexique. Thérapie Familiale 26:223–245. doi: 10.3917/tf.053.0223 CrossRefGoogle Scholar
  68. 68.
    Doyen C, Cook-Darzens S, Mouren M-C (2012) Multiple family group therapy for young adolescents with anorexia nervosa: A descriptive study. In: Shapiro C (ed) Eating disorders: causes, diagnosis and treatments. Nova Publishers, Hauppauge NY, pp 127–140Google Scholar
  69. 69.
    Whitney J, Murphy T, Landau S, Gavan K, Todd G, Whitaker W, Treasure J (2012) A practical comparison of two types of family intervention: an exploratory RCT of family day workshops and individual family work as a supplement to inpatient care for adults with anorexia nervosa. Eur Eat Disord Rev 20:142–150. doi: 10.1002/erv.1076 CrossRefPubMedGoogle Scholar
  70. 70.
    Asen E (2002) Multiple family therapy: an overview. J Fam Therapy 24:3–16. doi: 10.1111/1467-6427.00197 CrossRefGoogle Scholar
  71. 71.
    Bishop P, Clilverd A, Cooklin A, Hunt U (2002) Mental health matters: A multi-family framework for mental health intervention. J Fam Therapy 24:31–45. doi: 10.1111/1467-6427.00199 CrossRefGoogle Scholar
  72. 72.
    Laqueur H (1972) Mechanisms of change in multiple family therapy. In: Sager CJ, Kaplan HS (eds) Progress in group and family therapy. Brunner/Mazel, New York, pp 400–415Google Scholar
  73. 73.
    Godart N, Berthoz S, Curt F, Perdereau F, Rein Z, Wallier J et al (2012) A randomized controlled trial of adjunctive family therapy and treatment as usual following inpatient treatment for anorexia nervosa adolescents. PLoS One 7:1–9. doi: 10.1371/journal.pone.0028249 CrossRefGoogle Scholar
  74. 74.
    Onnis L, Barbara E, Bernardini M, Caggese A, Di Giacomo S, Giambartolomei A et al (2012) Family relations and eating disorders. The effectiveness of an integrated approach in the treatment of anorexia and bulimia in teenagers: results of a case-control systemic research. Eat Weight Disord 17:36–48. doi: 10.1007/BF03325326 CrossRefGoogle Scholar
  75. 75.
    Agras W, Lock J, Brandt H et al (2014) Comparison of two family therapies for adolescent anorexia nervosa: a randomized parallel trial. JAMA Psychiatry 71:1279–1286. doi: 10.1001/jamapsychiatry.2014.1025 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Zoé Gelin
    • 1
    Email author
  • Solange Cook-Darzens
    • 2
  • Yves Simon
    • 3
  • Stéphan Hendrick
    • 1
  1. 1.Systemic and Psychodynamic Clinical Psychology DepartmentUniversity of MonsMonsBelgium
  2. 2.Child and Adolescent Psychiatry DepartmentRobert Debré HospitalParisFrance
  3. 3.Centre Thérapeutique du Trouble alimentaire de l’Adolescent (CTTA)Le Domaine Centre HospitalierBraine l’AlleudBelgium

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