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The professional literature identifies a variety of risk factors that indicate whether an adolescent is at risk of substance use (Hawkins, Catalano, & Miller, 1992). Many of these risk factors revolve around family composition and dynamics such as family drug use, family interaction patterns, and boundaries (Smith & Springer, 1998).
Therefore, in treating a substance-abusing adolescent, the family is a key target of intervention. Multifamily therapy groups (MFTGs) have been used to involve families in treatment and have been found to be effective with a variety of populations across many settings (Meezan & O'Keefe, 1998; O'Shea & Phelps, 1985).
We developed an MFTG model that was used in conjunction with individual and family therapy with substance-abusing adolescents. This article provides a theoretical overview of the MFTG model and describes and illustrates the implementation of the model with substance-abusing adolescents and their families.
Structure of MFTG
Overview of MFTG Model
We used two techniques from SFT: ( 1) the scaling question and ( 2) the miracle question (Berg & de Shazer, 1991; de Shazer, 1994). The scaling question provides a direct and nonthreatening way to monitor client functioning on goals over time. Consider the following illustration.
Johnny's primary goal was to get along better with his parents. Using the scaling question, the group leaders asked Johnny to rate, on a scale from 1 to 10, how well he got along with his parents during the preceding week, with 1 indicating that he did not get along with them at all and 10 indicating that he got along with them great. Suppose Johnny gave a rating of 6. The leaders would then ask Johnny what he and his parents could do over the next week to make it from a 6 to a 7. Johnny's parents also would be invited to provide their own rating. The purpose of asking clients to think in terms of one-point increments when using the scaling question is to set them up for success by having them gradually implement new behaviors or coping skills.
The miracle question also provides a means to set goals with group members. It helps clients envision how things could be. Consider the following example: The leaders may have asked Johnny, "Pretend that you went home tonight and went to bed, and while you were sleeping a miracle happened so that when you woke up in the morning you and your parents got along great. When you woke up tomorrow, how would you know that this miracle happened? What would be the first thing that you would notice?"
Scaling and miracle questions were used to assist with individualized goal setting and to monitor client functioning over time. Both questions consistently generated detailed descriptions from clients, including identification of specific behaviors, thoughts, and feelings.
Structural Family Therapy
One technique used from structural family therapy was joining, which involves building a relationship with each family member in a strategic way. With one Hispanic family that maintained a patriarchal hierarchy, the group leaders typically addressed the father first in an attempt to respect their family system and its structure and to acknowledge the importance of their culture. A structural family therapist might label this process as maintenance, which involves acknowledging a family's current rules, roles, and structure.
Once a family is engaged in the therapeutic process, it is then safe to gently unbalance the family system and restructure some of its rules or boundaries. Another technique used from structural family therapy was mimesis, which involves mirroring a family's mood, communication patterns, and so forth. Enactment, which entails allowing a family to "act out" its problems in front of the group, was used frequently. Such enactments gave group members material to work with, as members could provide direct feedback to the family based on what they had just observed. This approach is generally much more powerful than providing feedback solely on the basis of a family's description of the problem.
Interpersonal and Mutual Aid Approaches
For example, the parents of one family argued with their 15-year-old daughter, Jessica, about basic household rules. With little apparent progress being made, one group leader gently interrupted this interaction and asked if any of the other families in the group were able to relate to what Jessica's family was experiencing. Several families provided feedback directly to Jessica's family about what they observed and offered suggestions for how to approach the problem differently on the basis of their own experience. Had the group leaders attempted to provide this feedback, it most likely would have had less of an effect. The leaders were able to use the here-and-now interaction of the group to create a mutual aid system between families.
Moreover, parents from various families provided feedback to Jessica about her behavior (objective parenting), and adolescents from various families provided feedback to Jessica's parents about their parenting style (objective childrening). The following interactions illustrate objective childrening. One adolescent shared with Jessica's parents that he thought they were being too strict about curfew and stated that he, too, would have a difficult time with this rule. However, another adolescent in the group supported Jessica's parents, stating that they were right to be strict with Jessica because she frequently broke rules at home. This kind of interaction across generations allows family members the opportunity to hear confirming or challenging perspectives from group members that can serve as a reality check. Notice that most of the real work was done by the group members, and not by the group leaders. This approach is a key aspect of the MFTG model.
Integrating the Models
Finally, the rationale for choosing these approaches was based on existing literature that supports the use of these modalities with children, adolescents, and families (Corder, Whiteside, & Haizlip, 1981; Fishman, Stanton, & Rosman, 1982; Nadelman, 1994).
Reflection Exercise #11
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