The multifamily group in the treatment of eating disorders
Promoting spaces where families and individuals receiving care can share experiences and emotions during the treatment of an eating disorder (ED) becomes a practice that benefits both the person receiving care and their family.
One such initiative is the one we have developed at the Integrated Functional Unit for Eating Disorders at Sant Joan de Déu Hospital in Barcelona . We conduct what we call Multifamily Groups, aimed at all families, and in this case, also including the individual receiving treatment. The activity aims to create a group space where participants can express, share, and exchange experiences related to managing emotions and the emotional impact of daily life on the disorder. The group is led from an interfamily perspective, meaning it is non-directive and non-interpretive, and without analyzing, judging, or giving advice. In this sense, the group leaders are purely facilitators of dialogue, excluding experiences based on psychoeducational or informational workshops about the disorder itself ( Sempere & Fuenzalida, 2017 ).
Canine therapy in the treatment of eating disorders
On the other hand, this is a group where participants work on recognizing their own emotions and those of others, with the aim of improving the quality of family relationships. All family members are welcome to participate; no one is excluded because it is believed that everyone can experience difficulties in family relationships. The contributions, experiences, and concerns of each person are essential to the richness and usefulness of the group. However, under no circumstances is anyone forced to participate if they do not feel ready.
The role of the group leaders
The group is open and unlimited in size, depending on the number of families participating in the program, and is led by a social worker and a clinical psychologist. A minimum of two people are required to lead this type of group, although more are possible. The professionals leading the group remain attentive and observant of the evolving dialogue, always recognizing the roles assumed by the group members and facilitating everyone's participation. It is important for the facilitators to keep in mind that their role is limited to facilitating the group process, promoting the active participation of the group members, and for this to happen, Drivers must have not only technical skills but also the ability to respect and empathy towards the other participants, without establishing hierarchies.
Therefore, the principles that leaders should have regarding their positioning within the group are:
- Establish an equal relationship: they must be flexible, with an equal position, conveying to families a message of confidence in their own abilities, promoting that they themselves can solve their problems (avoid the role of a professional who offers guidelines or advice).
- Maintain a non-directive approach: Facilitators should not be directive, but they should have a degree of authority without making value judgments. Avoid giving the group too many explanations and information, and refrain from offering solutions, as this can influence or limit the group process. This approach requires flexibility, adopting a position of active curiosity and interest.
- Adopting a proactive approach: the leadership of those in charge should involve actions that facilitate movement within the group. It's necessary to set boundaries in situations where other group members dominate or prevent others from participating. It's also important to cultivate an attitude of active curiosity (wanting to learn more about what's happening) and to discuss universal hypotheses such as "it's happened to everyone."
- It involves continuous learning: it is a highly creative comfort zone, which also enriches therapists by offering the opportunity for self-knowledge and inner work.
What are our goals?
- Promoting group cohesion: Group cohesion is considered the most decisive factor for successful group therapy, as it promotes a sense of belonging, appreciation, and acceptance of individual experiences.
- Promoting an open and multifaceted dialogue: People joining the group tend to approach professionals seeking specific answers. While professionals can provide these answers, the question and reflection will be shifted to the group to encourage a more active role among participants and establish a dialogue.
- Enhancing the emotional support of the participants: The group leader can encourage sincere emotional expressions within the group, sharing the emotions that the different narratives generate in her.
- Promoting flexibility in group communication: the multifamily group is an open, transparent and lax space in its rules, which allows all participants to express themselves in a context where there are no programmed turns to speak, but rather they are spontaneous.
As for the group rules, these are reiterated verbally at the beginning of each session if necessary, depending on the members' length of attendance and their understanding of how the group dynamics work. These are explicit yet informal rules that encompass a new approach to therapy and, in a way, a form of communication retraining for the participants.
The basic rules are as follows:
- Talking about oneself and for oneself.
- Respect others.
- Respect the speaking order.
- Do not judge.
- Not talking about the disorder.
- Confidentiality agreement.
We can conclude that this intervention model helps families feel accompanied, supported, and not judged. It offers a space where everyone can have a place and a voice. In many cases, communication between families improves, reducing ambiguity, as there is greater clarity in expressing each person's individual needs.
It also makes it easier for those being served and their families to take greater responsibility for their process, reduces confusion and withholding of information, and promotes greater ease in reaching agreements both with the team and among themselves.
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