Multifamily psychoanalysis

1. Introduction

Version followed: Jorge E. García Badaracco's Psicoanálisis Multifamiliar (PMF) as set out in Comunidad terapéutica psicoanalítica de estructura multifamiliar (1990) and Psicoanálisis multifamiliar: los otros en nosotros y el descubrimiento del sí mismo (Paidós, 2000), plus his later papers on virtualidad sana (2006–2010). The practical setting details come from the open outpatient multifamily group (GPMF) as Spanish and Italian continuators run it (Rome school around Andrea Narracci; Spanish public-network groups). Where a detail comes from a continuator and not from Badaracco, it is tagged.

Status. PMF is a clinical-theoretical approach, not a manualised therapy. Badaracco gave no session protocol, scripts or formal phases in the sources. The techniques below are the ones he and his direct continuators describe. Anything I derive is marked [synthesis]. [source: García Badaracco 2000, introduction; Mascaró 2005; Narracci & Ceppi 2011]

What it is. Badaracco began large groups with about 40 "chronic" inpatients at the Hospital Borda (Buenos Aires) in the early 1960s, and then brought families in. In 1968 he founded a private clinic (DITEM) that he ran for 25 years as a psychoanalytic therapeutic community. The multifamily group was the axis around which the whole treatment turned. It is a large, open, heterogeneous group of patients, relatives, therapists and auxiliary staff that he calls the setting most like everyday family life. It runs alongside individual, family and small-group psychoanalysis and does not replace them. [source: Mascaró 2005; Jáñez 2021; García Badaracco 2000 via Cryan & Quiroga 2014]

How change happens. Severe mental illness, and psychosis above all, is understood as two or three people trapped across generations in mutually pathogenic interdependences. The patient is "inhabited" by others: internal presences and pathogenic identifications, the objeto enloquecedor, that stop them from being themselves. Symptoms are read as communication and the crisis as a desperate rebellion against not living one's own life. Several things together make change possible:

many families mirroring one another;
multiple transferences spread across the group;
therapists, and later the group itself, acting as a "third";
a context of psychological safety.

Together these let the interdependences show up and be thought about in the here and now. The patient can then desidentify (loosen pathogenic identifications), develop recursos yoicos genuinos (genuine ego resources) and let a latent virtualidad sana (healthy potential) emerge. For that to happen, the clinician first has to see and trust that potential. [source: Narracci & Ceppi 2011; García Badaracco 2010; Russo & Moscati 2022; Marín-Arévalo 2016]

2. Framework

No formal phase model. None of the primary texts defines treatment phases, session counts or criteria for moving from one stage to the next. Mascaró (2005) describes only structural movement, from inpatient community to day hospital to outpatient care. The trajectory below is pieced together from Badaracco's concepts and the clinical accounts of his continuators. [uncertain] [synthesis]

Settings (structural levels)

Psychoanalytic therapeutic community (DITEM model). The inpatient community and a mixed day hospital for patients leaving inpatient care. The multifamily group is the hub, combined with individual, family and group psychoanalysis. The team works as a "substitute family" that receives the patient's and the family's transference. [source: Mascaró 2005; Mascaró 2002; García Badaracco 1989 via Cryan & Quiroga 2014]
Outpatient/public-network GPMF (continuators). An open group with no fixed end and no minimum or maximum number of sessions. Specific services report:
- roughly 15–40 participants;
- weekly or fortnightly meetings of about 90 minutes;
- participants sitting in a circle, or concentric circles in large groups;
- at least 2–3 professionals ("operators");
- attendance voluntary and flexible, with any family member welcome and people free to come alone.
Domínguez (2024) recommends at least four consecutive sessions before a family judges whether the group is useful. Badaracco himself ran a hospital group twice a week. [source: Domínguez 2024; Martínez García de Castro & Perles 2010; Tabasso et al. 2017; Marín-Arévalo 2016; García Badaracco 2010]

Process trajectory (as an orientation, not a protocol) [synthesis from the cited sources]

Entry and a context of safety. Goal: the family attends, patients and relatives can speak without being judged, and a reliable bond forms with the team and the group (Badaracco's "interdependencia de confiabilidad"). Markers: the family returns, members speak "from themselves", and fear of violence goes down. [source: García Badaracco 2010; Domínguez 2024]
Interdependences emerge in the here and now. Goal: pathogenic family patterns, "characters" (personajes) and armour show up in how members act in the group, and other families mirror them. Markers: members recognise their own family in another's story, and the therapist, then other members, act as a third. [source: Cryan & Quiroga 2014; Tabasso et al. 2017; Narracci & Ceppi 2011]
Desidentification. Goal: loosening identifications with the objeto enloquecedor. Mitre (2010) calls this the hardest and most relapse-prone stage, in which the patient seems "better" but feels worse. Markers: the person reports new inner space for reflection, and parents begin to change too. [source: Mitre 2010; García Badaracco 2000 introduction]
Genuine ego resources and autonomy. Goal: the true self comes through, and patients and relatives become co-therapists for newer members. Markers: members help others from their own experience, and new ways of relating carry over into daily life. [source: Mascaró 2005; García Badaracco 2000 via Cryan & Quiroga 2014]

There are no published criteria for moving between stages or for discharge from the open group. Families may stay on after a patient's discharge from the day hospital, and may leave and return. [uncertain] [source: Martínez García de Castro & Perles 2010; Domínguez 2024]

3. Guiding principles

See the virtualidad sana first. The patient can discover their healthy potential only after the carer has seen it, so look for health, not only illness. [source: Russo & Moscati 2022; García Badaracco 2010]
Don't look at the patient only as "the sick one". Badaracco considered that gaze potentially pathogenic. Address the person, not the diagnosis. [source: Marín-Arévalo 2016 citing García Badaracco 2006]
Illness is relational and transgenerational. Treat the family web, not the identified patient alone. Parents' own histories and wounds are material for the work. [source: Narracci & Ceppi 2011; Arroyo 2018]
Symptoms communicate. Ask what a symptom or crisis is trying to say before you try to suppress it in the group. [source: Marín-Arévalo 2016 citing García Badaracco 2007; Narracci & Ceppi 2011]
A context of safety comes before insight. Build trust and reduce fear first, because severe patients often cannot tolerate an orthodox analytic frame. [source: García Badaracco 2010; Russo & Moscati 2022]
Containing limits, not punishment. The multifamily setting offers "límites seguros que contienen su destructividad fantaseada" (safe limits that contain fantasised destructiveness): hold limits so madness can be expressed safely. [source: García Badaracco 2000, introduction]
Respectful silence and a supportive gaze are interventions. An "actitud solidaria de respetuoso silencio" (a supportive attitude of respectful silence) can do more than an interpretation. Use presence deliberately. [source: García Badaracco 2000, introduction]
The therapist facilitates and does not direct. There is no set topic and no common thread to impose. Tolerate uncertainty and trust the group to regulate itself. [source: Lucas Arranz & López Aboal 2017 citing García Badaracco; Tabasso et al. 2017]
Everyone speaks from their own experience, therapists included. No advice and no interpretations handed down from above. [source: Marín-Arévalo 2016; Jáñez 2021]
Be the "third", then hand that role to the group. Step into the dyadic pathogenic web so violence doesn't turn into action. Later, let other members take this role. [source: Cryan & Quiroga 2014 citing García Badaracco 2000; Narracci & Ceppi 2011]
Multiple transferences are a resource. Spreading transference across many people makes split-off parts speakable and protects the therapist from getting trapped. [source: Narracci & Ceppi 2011; Mascaró 2011 via Burghi; García Badaracco 2005]
Everyone is a potential therapeutic agent. Patients and relatives become co-therapists, and peers' feedback often lands better than the professional's. [source: Mascaró 2005; Lucas Arranz & López Aboal 2017]
Diversity guards against a single truth. Avoid single or universal solutions and talk rather than try to be right. [source: Domínguez 2024; Mourelle & Puñales 2013 via Burghi] [uncertain: secondary]
Every change counts. Watch for "no change". In this context Badaracco treats any change as positive and resistance as showing up as non-change. [source: García Badaracco 2010]
The group is a laboratory for teaching and treatment. Staff learn from experience inside the group, and the group keeps the institution from hardening and prevents iatrogenic practice. [source: García Badaracco 2010; Mascaró 2005]
Integration, not substitution. The group complements individual, family and other treatments. [source: García Badaracco 2000 introduction; Cryan & Quiroga 2014]

4. Intervention inventory

This section lists the interventions Badaracco and his continuators actually describe, with the source for each. None is a scripted technique in the original texts; the steps put them into operation [synthesis]. All example wording is mine and illustrative, except short quotes, which are cited.

4.1 Convening and keeping an open multifamily group

Purpose / when: Set up the core device: a large, open, heterogeneous group of patients, relatives and staff. Use it from the start of treatment, alongside other modalities. [source: García Badaracco 2000 introduction; Mascaró 2005; Domínguez 2024]
Steps:
1. Agree with the treating team which families will be invited. Referral comes from that team.
2. Invite the whole family, while making clear that the patient or one relative can come alone. Invite professionals from the family's wider network too.
3. Fix a regular slot: weekly or fortnightly, about 90 minutes, in the same room, with chairs in a circle (concentric circles if numbers are large).
4. Have at least two or three professionals present, plus trainees or other staff as participants.
5. Keep the group open: there is no cap on numbers, new families arrive continually and members may leave and come back.
6. Don't penalise absence or interpret it. Keep re-inviting absent relatives.
7. Suggest that a family attend about four consecutive sessions before deciding whether the group is useful.
Example language (illustrative): "Anyone in the family is welcome, including people who aren't 'the patient'. Some families come together and some send one person. Both are fine."
Watch for: Timing that excludes one group. One service found that afternoon sessions drew mostly families and morning sessions mostly patients. Look for families bringing extra relatives over time, which is a sign of growing trust. [source: Martínez García de Castro & Perles 2010; Domínguez 2024]

4.2 Opening without a topic and letting the material emerge

Purpose / when: At the start of every session. Discussion follows what participants bring, not an agenda, and every contribution carries equal weight. [source: Tabasso et al. 2017; Jáñez 2021]
Steps:
1. Give a brief presentation: who the professionals are, and any newcomers named by first name.
2. Restate the few rules: speak in turn, speak from yourself, and keep the action inside the group (no acting out).
3. Allow silence, then make an open invitation to speak.
4. Let the group choose its theme. Don't steer to a topic chosen in advance.
Example language (illustrative): "There's no set topic here. Whoever wants to can begin with whatever is on their mind today."
Watch for: Talk that stays at the level of general opinion or metaphor. See 4.11 for moving it toward concrete events. [source: Jáñez 2021]

4.3 Asking people to speak "from themselves" (no advice, no interpretation)

Purpose / when: The basic rule of participation. It keeps contributions experiential, stops lecturing between families, and applies to staff as well. [source: Marín-Arévalo 2016, "desde uno mismo"; Jáñez 2021; Lucas Arranz & López Aboal 2017]
Steps:
1. State the rule at the opening, and briefly to newcomers.
2. When someone gives advice ("you should…") or diagnoses another person, gently redirect them to their own experience.
3. Model it yourself: when you speak, describe what you felt or what it stirred in you.
Example language (illustrative): "Rather than telling him what to do, could you say what hearing that stirred up in you, maybe something from your own family?"
Watch for: Working: members link what they heard to their own history. Not working: debates about who is right, or a pile-up of advice. Redirect each time. [source: Marín-Arévalo 2016]

4.4 Respectful silence and the supportive gaze

Purpose / when: Badaracco names an "actitud solidaria de respetuoso silencio" (supportive, respectful silence) and the way the analyst looks at a person (mirada) as therapeutic in themselves. Together they build an "interdependencia de confiabilidad" (interdependence of trust). Use this throughout, and especially when someone is exposed or suffering. [source: García Badaracco 2000 introduction; García Badaracco 2010]
Steps:
1. When painful material comes up, don't rush in to fill the silence or reassure.
2. Look at the speaker with steady, interested attention, showing a wish to understand and contain.
3. If needed, say only a few words that acknowledge the person and give them room to go on.
Example language (illustrative): "Take your time. We're listening."
Watch for: Silence that is felt as abandonment or judgement. In very fragile patients, follow it with a brief verbal acknowledgement. [synthesis]

4.5 Seeing and naming the virtualidad sana

Purpose / when: The patient can find their healthy potential only after the carer has seen it. Use this especially when a patient is labelled "chronic" or seen only through symptoms. [source: Russo & Moscati 2022; García Badaracco 2010; Mitre 2010]
Steps:
1. Before the group, check your own view of each patient: does it include health, or only illness? Do this as a team.
2. In the group, notice and name moments of capacity: concern for another person, humour, an accurate perception.
3. Speak to the person, not the diagnosis, and avoid talking about a patient as "the ill one" in front of the family.
4. Tolerate the pain that comes with reaching the healthy part. Russo & Moscati link access to it with being able to bear deep pain.
Example language (illustrative): "A moment ago you were the one who noticed how tired your mother looked. That's a real capacity in you."
Watch for: Fear of normality. Patients, families and staff can all be frightened by it and may undercut improvement. Expect it and name it. [source: Russo & Moscati 2022]

4.6 Acting as the "third" in the pathogenic web

Purpose / when: In a fused parent–child exchange (the pre-oedipal pattern), the therapist steps in as a third person so that contained violence is not acted out and a triadic relation becomes possible. Over time the group takes over this role. Use it when a dyad locks into escalation or mutual capture. [source: Cryan & Quiroga 2014 citing García Badaracco 2000; Narracci & Ceppi 2011]
Steps:
1. Notice the closed loop: two people answering only each other, rising tension, everyone else shut out.
2. Enter calmly by addressing both, or by describing what is happening between them.
3. Open the loop to the group by asking others what they see or feel.
4. As the group matures, wait for members to take up the third position themselves.
Example language (illustrative): "You two seem caught in something that keeps going round. Can we stop for a moment and hear from others what they're noticing?"
Watch for: Siding with one member of the dyad, which turns the third into an ally. Look for other members starting to step in spontaneously. [synthesis]

4.7 Bringing pathological and pathogenic interdependences to light in the here and now

Purpose / when: Point out the repetitive, entrapping patterns ("pathological and pathogenic interdependences") as they play out between family members in the room, so they can turn into thought. Use this when a family repeats its pattern live. [source: Tabasso et al. 2017; Cryan & Quiroga 2014 citing García Badaracco 2000; Scalise & Russo 2008]
Steps:
1. Watch the interaction itself, not just the content: who answers for whom, who silences whom, who becomes ill when another improves.
2. Describe the sequence plainly, without blaming anyone.
3. Ask the family members whether it is familiar, and ask other families whether something similar happens at home.
4. Link it, tentatively, to the family history, including the parents' own histories.
Example language (illustrative): "Each time Marco starts to speak, Mum finishes the sentence for him. I wonder if that happens at home too, and what it's like for each of you."
Watch for: Family members feeling accused, which leads to defensive closure. Pathogenic does not mean blameworthy. Badaracco locates the patterns across generations. [source: Narracci & Ceppi 2011] [synthesis on wording]

4.8 Metaphoric mirroring and linking across families

Purpose / when: Another family's story lets members see their own home from a distance, noticing similarities and differences. Use it whenever one family's material echoes another's. [source: Tabasso et al. 2017; Narracci & Ceppi 2011; Martínez García de Castro & Perles 2010]
Steps:
1. While one family speaks, notice whose faces or bodies react in other families.
2. Invite them in: "does this remind anyone of something?"
3. Point out parallels between families explicitly, and the differences too.
4. Let identification move across roles. A son may speak to another family's father, and a mother may hear her own child in someone else's son.
Example language (illustrative): "Mrs R, you were nodding while Ana was talking about her father. Did it remind you of something in your own family?"
Watch for: Working: people make discoveries about their own family through another's story, as when a mother hears accounts of abuse in the group and connects them to her son's absence. [source: Domínguez 2024]

4.9 Enabling members as co-therapists

Purpose / when: Patients and relatives become therapeutic agents for one another. Peer feedback and peers' questions are often accepted more readily than the professional's. Use this when one member's experience could reach another person who is stuck. [source: Mascaró 2005; Lucas Arranz & López Aboal 2017; Marín-Arévalo 2016]
Steps:
1. Notice who in the room has lived through something similar, especially further along in their process.
2. Invite that person to speak to the one who is struggling, from their own experience.
3. Afterwards, check how it landed with the recipient.
Example language (illustrative): "Luis, you've talked before about the year you wouldn't leave your room. Is there something from that time you'd want to say to Pablo?"
Watch for: A helper who uses the role to avoid their own material, or who slips into advice. Gently bring them back to their own experience. [synthesis]

4.10 Working from "universal hypotheses" instead of interpretation (Italian continuation)

Purpose / when: Mitre (2017) contrasts working from universal hypotheses with interpretation. Interpretation can feel like the analyst's idea imposed on the patient and can close down lived experience. Universal hypotheses stir experience that leads members to discover things for themselves. The underlying theme is that the presence of others in us is universal. Use them with very disturbed patients who reject interpretation. [source: Mitre 2017, abstract only] [uncertain: full method]
Steps [synthesis, from the abstract]:
1. Instead of saying something about this patient, offer a general statement about human experience that includes everyone, the therapist too.
2. Leave it open, and let members say whether and how it applies to them.
Example language (illustrative): "I think all of us carry our parents' voices inside us, some that help and some that stop us being ourselves."
Watch for: Working: members begin speaking from their own experience rather than from a "character". [source: Mitre 2017]

4.11 Naming what is happening in the room: clarification, confrontation, from abstract to concrete

Purpose / when: Bring live tension into view without interpreting it. Jáñez (2021) describes the coordinator reading bodily and tonal "forms", naming the tension in the room, and using clarification and confrontation rather than interpretation. Use it when the room is charged but nobody is saying anything, or when talk drifts into abstraction. [source: Jáñez 2021, a sociodramatic reading of the GMF; Martínez García de Castro & Perles 2010] [uncertain: this is a continuator's framing]
Steps:
1. Notice a visible form of tension: clenched hands, someone turned away, a change in voice.
2. Describe it neutrally, and ask the person whether they want to say something about it.
3. When talk becomes general or metaphorical, ask for a concrete recent event.
4. Keep the tension in a workable range, neither too high nor too low, by choosing non-directive questions.
Example language (illustrative): "Darío, I notice you've pushed your chair back while your father was talking. Is something going on for you?" / "Can you tell us about a specific moment this week when that happened?"
Watch for: Naming someone's body can feel like exposure to a paranoid patient. Name the atmosphere of the room before you single out an individual. [synthesis]

4.12 Speaking from the therapist's own experience and countertransference

Purpose / when: Therapists take part from their own experience, with countertransference as their main tool. When the therapist gets caught in the family's pattern, naming it openly can change the scene. [source: Marín-Arévalo 2016; Mitre 2010; Mitre 2017]
Steps:
1. Track your own reactions during the session: irritation, rescue fantasies, a wish to control.
2. If you notice you are re-enacting a family role, say so briefly and own it. Mitre gives an example of telling a patient "No te estoy permitiendo ser. No te dejo ir" (I'm not letting you be. I won't let you go).
3. Share a personal reaction only when it serves the group's work, and keep it short.
4. Process the rest with colleagues after the session (4.19).
Example language (illustrative): "I realise I've been pushing you to agree with me, a bit like what you describe at home. Let me step back."
Watch for: Disclosure that shifts the group's attention onto the therapist. Working: the patient softens, and other members also start speaking about their own part. [source: Mitre 2010; Mitre 2017] [synthesis on limits]

4.13 Reaching the person behind the "character" (personaje) or armour

Purpose / when: Families organise around a "character" built from the identifications of parents and ancestors, which keeps a precarious balance. Patients present behind armour, such as aggression or caricature. Use this when a member is locked in a role, such as the aggressor, the clown or the perfect parent. [source: Arroyo 2018 citing García Badaracco; Mitre 2010; Mitre 2017]
Steps:
1. Don't argue with the role.
2. Name, warmly, the vulnerable person you can glimpse underneath. In Mitre's case, a coordinator named the child beneath a patient's aggression.
3. Let the group respond to that person rather than to the armour.
Example language (illustrative): "Behind all this anger, I hear a little girl who was waiting a long time for someone to come."
Watch for: Working: the dialogue moves from characters talking to each other to people speaking from their true selves (Mitre 2017). If the person hardens further, back off and come back later. [synthesis]

4.14 Containing violence: words instead of acts

Purpose / when: In the large group, hatred and violence can be spoken without being acted out. As fear of violence drops, members speak more freely. Badaracco reads hostile behaviour as possibly a plea for help from a position of helplessness. Use this whenever aggression rises, someone storms out or there is a threat. [source: Cryan & Quiroga 2014 citing García Badaracco 2000; García Badaracco 2000 introduction; Burghi citing Markez 2009] [uncertain: the last point is a tertiary citation]
Steps:
1. Keep the frame clear: everything may be said and nothing may be done.
2. Step in as the third (4.6), slow the pace and invite the person to put the feeling into words.
3. If a patient leaves the room at a sensitive moment or becomes very agitated, one designated co-coordinator follows, contains them and brings them back. The others carry on with the group.
4. Name the helplessness that may lie under the attack.
5. If there is any risk of physical harm, stop the group's work and follow your institution's safety procedures and a standard risk assessment. [synthesis]
Example language (illustrative): "You're very angry, and you can say all of it here. What we won't do is hurt each other. Tell us what's making you this angry."
Watch for: Working: the patient puts anger into words. In one service a patient with paranoid transference came to verbalise his anger with the group's help. [source: Martínez García de Castro & Perles 2010; Marín-Arévalo 2016]

4.15 Helping members put obstacles into words and checking what speech is doing

Purpose / when: Day-hospital continuators describe several moves:
- helping members say out loud what stops them thinking differently (resentment, guilt, envy, hatred);
- naming emotionally hard topics rather than intellectualising them;
- checking whether a statement works through a theme or covers up a truth;
- defusing comments that could be traumatic for the speaker.
Use these when the talk circles without moving forward. [source: Martínez García de Castro & Perles 2010]
Steps:
1. Notice repetition without development, or intellectual explanations of painful events.
2. Ask what makes it hard to see this differently, and name possible feelings tentatively.
3. If a disclosure is coming out too fast for the speaker, slow it down or soften it. [synthesis on how]
Example language (illustrative): "We've heard this explained very clearly several times. I wonder whether there's something harder underneath, like resentment or guilt, that is difficult to say."
Watch for: Competitive suffering ("who suffered more"). That service met it with containment and by turning attention to positive present aspects. [source: Martínez García de Castro & Perles 2010]

4.16 Pacing: letting the group regulate depth

Purpose / when: If anyone, a therapist included, pushes too fast into difficult areas, the group tends to slow things down. When a member isn't ready, others can respond with empathy and the exploration can wait. Use this when someone is flooded or closes up. [source: Domínguez 2024]
Steps:
1. Notice signs of overload: withdrawal, sudden joking, leaving the room, a change of subject by the group.
2. Respect the slowdown rather than overriding it, and say that the theme can come back later.
3. Return to it in a later session when conditions are better.
Example language (illustrative): "This seems like a lot right now. We can leave it here and come back to it when it feels possible."
Watch for: The difference between pacing and avoidance. If a theme is put off week after week, name the pattern (5.1). [synthesis]

4.17 Accompanying desidentification

Purpose / when: Loosening pathogenic identifications, the "others in us", is felt as deep depersonalisation. Badaracco presents it as not destructive and as the way a true self can emerge. Mitre calls it the hardest stage: the patient seems "better" but feels worse, may fill the emptiness with acting out or relapse, and may have suicidal ideas. Use this when a patient who has been improving suddenly gets worse or relapses. [source: García Badaracco 2000 introduction; Mitre 2010]
Steps:
1. Anticipate the stage with the patient, the family and the team.
2. When relapse comes, frame it in the group as possible fear of the new state, not a return to square one, and don't let parents or staff read it as total failure.
3. Increase accompaniment: closer contact, and coordination with individual therapy and the day hospital.
4. Screen for suicidal thinking using a standard structured risk assessment and your service's protocol.
5. Notice and name new inner space when it appears, for example a patient saying she now has room inside to reflect.
Example language (illustrative): "Sometimes when things start to change, the new calm feels stranger and more frightening than the old trouble. That doesn't mean we're back at the start."
Watch for: Parents changing as well, which Mitre sees as a sign the work is taking hold. [source: Mitre 2010]

4.18 Opening space for the parents' own histories

Purpose / when: The group is a place where parents can work through old wounds and come to tolerate having been involved in their child's illness. Use it when a parent's reactions point to their own unresolved history, such as rigid responses to themes of abuse or loss. [source: Arroyo 2018; Mitre 2017; Domínguez 2024]
Steps:
1. Treat the parent as a participant with a history, not only as an informant about the patient.
2. When a parent reacts strongly, invite them to say what the theme touches in their own childhood.
3. Make links across generations tentatively, and let other families respond.
Example language (illustrative): "When we talk about fathers who shout, you go very quiet. Does it connect with something in your own life, not just as a parent?"
Watch for: Working: the parent comes to feel the group as a place to be themselves, not only a mother or father. In Domínguez's case a rigid father, invited back each time he walked out, later set limits with his own father. [source: Domínguez 2024]

4.19 Team co-coordination and staff processing

Purpose / when: Coordination is done as a team, in every session. One coordinator can act as a third and rescue a colleague who is caught in an enactment. The team as a whole works as a substitute family that receives the patients' and families' transference and contains primitive anxiety. [source: Marín-Arévalo 2016; Mascaró 2002; Tabasso et al. 2017]
Steps:
1. Have two to three coordinators, with nursing, occupational therapy and other staff taking part as participant observers.
2. Before the session, agree who will follow anyone who leaves the room. [synthesis]
3. During the session, watch each other. If a colleague is clearly drawn into a family's script, step in by speaking to the group rather than correcting the colleague.
4. After the session, debrief as a team on countertransference, splits and idealisation or devaluation between staff. The sources don't describe a formal post-group meeting, so this format is [synthesis]. Marín-Arévalo suggests external supervision for conflicts within the team.
Example language (illustrative, in session): "I think Ana and Mr P have got into something that echoes what Mr P describes at home. What do others see?"
Watch for: Staff conflicts spilling into the group. Splitting, idealisation and devaluation between staff mirror the families' dynamics. [source: Marín-Arévalo 2016]

4.20 Integrating the group with the other treatment settings

Purpose / when: Badaracco worked psychoanalytically in individual, group, family and multifamily settings at the same time. The multifamily group complements other treatment and does not replace it. Use this as standing practice. [source: García Badaracco 2000 introduction; Mascaró 2005; Cryan & Quiroga 2014]
Steps:
1. Keep information flowing between the group coordinators and each family's individual or family therapists, with consent.
2. Take projections and themes raised in the group into individual or family sessions afterwards.
3. In a therapeutic-community or day-hospital setting, make the multifamily group the hub that other activities refer back to. Those activities include occupational therapy, music therapy and body work.
Example language (illustrative, in an individual session): "In the group on Wednesday you reacted strongly when Mrs L spoke about her son. Shall we look at that here?"
Watch for: Getafe notes that what comes up in the group can be worked on later in individual or family sessions. Contradictory messages from different settings feed splitting, which the team has to work through. [source: Lucas Arranz & López Aboal 2017; Mascaró 2002] [synthesis]

5. Handling problems

5.1 Stuck group or stuck family ("no change"). Badaracco describes resistance in families and institutions as a negative therapeutic reaction: in this context it shows up as no change, and as indifference to the group once the patient improves. Responses:

Name the repetition descriptively (4.7).
Bring in mirroring from other families (4.8).
Ask what the family might fear about the patient getting better.
Check whether the team's own view has become pessimistic or chronic (4.5).

[source: García Badaracco 2010; Russo & Moscati 2022] [synthesis: the specific moves]

5.2 Resistance to joining, and low family attendance. Barriers include stigma, guilt, fear of being judged and individualistic attitudes. A medical model that keeps families passive also lowers attendance, and so does a time slot that suits only one group. Responses:

Don't penalise or interpret absence.
Keep re-inviting.
Let one family member come alone.
Encourage members to bring other people from their network.
Review the schedule.

[source: Domínguez 2024; Martínez García de Castro & Perles 2010]

5.3 Patient walks out, or rigid withdrawal. Responses:

A designated co-coordinator follows and contains the patient and brings them back (4.14).
With rigid members who repeatedly leave over certain themes, keep the invitation open. Domínguez's case shows that repeated return can lead to real change over months.

[source: Marín-Arévalo 2016; Domínguez 2024]

5.4 Aggression, paranoid transference, competitive suffering. Use 4.6, 4.14 and 4.15. Treat excessive reactions to minor disagreements as possible projections of a family's underlying resentment, and say so tentatively. [source: Martínez García de Castro & Perles 2010]

5.5 Overwhelm or flooding. Slow down and allow the group to postpone exploration (4.16). Defuse disclosures that are coming out too fast (4.15). Follow up individually after the session. [source: Domínguez 2024; Martínez García de Castro & Perles 2010] [synthesis: follow-up]

5.6 Relapse during improvement, and suicide risk. Expect it in desidentification (4.17). Respond by:

framing it as fear of the new state;
increasing accompaniment;
carrying out a standard suicide risk assessment and following your service's crisis protocol;
informing the individual therapist.

[source: Mitre 2010] [synthesis: protocol steps]

5.7 Therapist trapped in the family's pattern. In bipersonal work Badaracco himself often felt trapped by the family dynamic, and that is why he moved to the multifamily setting. In the group, other members and colleagues can see the trap and say it aloud. Responses:

Use co-coordinators as the third (4.19).
Name your own enactment (4.12).
Bring it to team debriefing or supervision.

[source: García Badaracco 2005 review; Marín-Arévalo 2016]

5.8 Splits and conflict in the team. Splitting, idealisation and devaluation between staff can spill into the group. Responses:

Hold regular team discussion.
Bring in external supervision.
Present conflicting views in the group as plurality rather than contradiction.

[source: Marín-Arévalo 2016; Mascaró 2002] [synthesis: last point]

5.9 Ruptures with a family (feeling judged, envied, betrayed). Domínguez lists envy, rejection and feeling betrayed as risks that can lead to harm, retraumatisation or dropout. Responses:

Acknowledge the hurt openly in the group.
Repair outside the group if needed.
Keep the door open for the family to come back.

[source: Domínguez 2024] [synthesis: responses]

5.10 Family violence, gender violence, or rival groups. One adaptation (Getafe) left out youths from rival gangs to avoid confrontations. In cases of gender violence or highly conflictual separations, it invited each parent separately. Responses:

Screen beforehand for safety, and run protection and child-safeguarding procedures in parallel. Don't rely on the group alone.

[source: Lucas Arranz & López Aboal 2017] [synthesis: safeguarding]

Problems the sources do not address (all [synthesis]):

Monopolising member. Thank them, link their theme to others ("who else knows this?") and widen the circle. If it persists, describe the pattern as something the group can look at.
Prolonged group silence. Name the atmosphere rather than any individual (4.11). Wait. Then invite the people who have spoken least recently, with no pressure.
Newcomers. Introduce them by first name and briefly restate the rules. Don't press them to speak. Let established members describe in their own words what the group is.
Confidentiality in a large open group. State a group norm about not repeating outside what others said, recognising that it can't be guaranteed. Check consent for students and observers.
Acute psychosis or intoxication in session. A co-coordinator takes the person aside, assesses safety and medical needs, and liaises with the treating team. Keep pharmacological decisions outside the group.
Coordinator fatigue. The Axarquía team describes the group as hard and tiring work. Rotate roles, debrief and arrange supervision. [source for the fatigue: Martínez García de Castro & Perles 2010]

Sources

Sources

Further reading (not drawn on in full)

García Badaracco, J. E. (1990). Comunidad terapéutica psicoanalítica de estructura multifamiliar. Buenos Aires. Italian ed.: FrancoAngeli, 1997. [uncertain: the Argentine publisher wasn't verified, and Nicolò dates the Argentine edition 1989]
García Badaracco, J. E. (2000). Psicoanálisis multifamiliar: los otros en nosotros y el descubrimiento del sí mismo. Buenos Aires: Paidós. Italian ed.: Bollati Boringhieri (dated 2000 by Nicolò and 2004 by Narracci & Ceppi). [uncertain]
García Badaracco, J. E. (2005). Demonios de la mente: biografía de una esquizofrenia. Buenos Aires: Eudeba (revised from Biografía de una esquizofrenia, 1982).
García Badaracco, J. E. (2007). La virtualità sana nella psicosi. Interazioni, 28(2), 16–24.

Limits of this guide. Only the introduction of the 2000 book is drawn on, and none of the 1990 book. Setting details, phases and most operational steps therefore rest on continuators' accounts and are tagged as such. A clinician adopting PMF should read the two books in full. [uncertain]

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