Multi-family groups

1. Introduction

Version followed: (A) McFarlane's psychoeducational multifamily group (PMFG) as set out in McFarlane (2002) and operationalised in the EASA (Oregon) fidelity and training materials, which draw on the Family Psychoeducation Network timeline (rev. 2009), the Draft 2002 Family Psychoeducation Fidelity Scale and McFarlane's 2010 PIER training slides. (B) Systemic multi-family therapy (MFT) as in Asen, Morris & Pommepuy, Systemic Multi-Family Therapy: Concepts and Interventions (Routledge 2025; German edition Carl-Auer 2026), building on the Marlborough model (Asen, Dawson & McHugh 2001) and Asen & Scholz (2010). (C) Maudsley multi-family therapy for adolescent anorexia nervosa (MFT-AN) as delivered in the Eisler et al. (2016) multi-centre trial. Where these differ, each is labelled (A), (B) or (C).

"Multi-family groups" is a format and a family of models, not one therapy. All versions bring several families affected by the same problem into one room so that families help, observe and learn from each other, with clinicians increasingly stepping back. [source: Asen et al. 2026 Leseprobe ch.1; Eisler et al. 2016]

(A) PMFG is a long-term (typically two-year), highly structured psychoeducational group for people with psychosis or other severe mental illness and their families. Change is thought to come from replacing the shrinking, stressed social network around the illness with a "healing" social network of other families, combined with illness education, the Family Guidelines and a fixed problem-solving method; this lowers family stress and helps prevent relapse. [source: McFarlane 2002 contents (Part I ch.3 "The Therapeutic Social Network: A Healing Community"); EASA timeline]
(B) Systemic MFT (Marlborough/Asen) is a flexible group-of-families approach used for child mental health, school exclusion, child protection, violence, eating disorders and psychosis. Change comes from group therapeutic factors (not being alone, mutual support, hope, peer feedback that is accepted more readily than professional feedback), from families seeing their own patterns mirrored in others, and from rapid shifts between contexts (whole group, parents' group, children's group, single family) that create a "Treibhauseffekt" (greenhouse effect) accelerating change. [source: Asen et al. 2026 ch.1.1, 1.7]
(C) MFT-AN extends single-family therapy for anorexia nervosa (FT-AN) into a group of 5–7 families: parents temporarily take charge of eating as an expression of care, the illness is externalised, and the group reduces isolation and stigma, offers new perspectives and allows families to practise new behaviour safely. [source: Eisler et al. 2016]

Related: García Badaracco's psychoanalytic multifamily approach (Argentina) is covered in Domain I guide 047.

2. Framework

(A) McFarlane PMFG [source: EASA MFG intervention timeline; EASA competency checklist]

Phase	Format and length	Goal	Move on when
1. Outreach and engagement	5–30 min contacts with the client; letter, phone, flyer or the client's own invitation to family	Obtain the client's consent; invite the family to partner with client and clinician	Client consents and at least one family member agrees to meet
2. Joining sessions 1–3	Three 60-min single-family meetings (plus optional 30-min meetings with the client alone)	Build an alliance, gather history, early warning signs, strengths, network and goals; prepare for workshop and group	All three joining sessions done (before the workshop or at least before the first group)
3. Family education workshop	One day (4–6 hours), classroom style, run quarterly for all new families; clients and families attend; at least three family speakers	Biosocial illness education, Family Guidelines, problem-solving method	Attended; group assignment made
4. First two group meetings	90 min each	Meeting 1: socialising, no illness talk. Meeting 2: each family's story of how the illness changed their lives	Both held; families know each other as people
5. Ongoing problem-solving groups	90 min every two weeks for about two years	Structured go-around and formal problem-solving on one member's problem per session	Programme ends at about two years [uncertain: criteria for ending or continuing beyond two years]

Group size is not specified in the sources [uncertain]. Two co-facilitators are implied throughout ("co-facilitators model behavior"). [source: EASA timeline]

Applications in McFarlane (2002) beyond schizophrenia: family-aided assertive community treatment, supportive housing, bipolar disorder, major depression, borderline personality disorder, OCD (multifamily behavioural treatment) and chronic medical illness. [source: McFarlane 2002 contents]

Fidelity and training: the EASA competency checklist rates each joining session and the workshop item by item (included / optionally omitted / not applicable), and the timeline cites a Family Psychoeducation Fidelity Scale (draft 2002). No formal licence to deliver under the name is given in the sources [uncertain]; delivery in services such as EASA/PIER is preceded by training and fidelity review. [source: EASA competency checklist; EASA timeline]

(B) Systemic MFT (Asen) [source: Asen et al. 2026 Leseprobe ch.1]

Formats: short format of 2-hour meetings once or twice a month (clinics, outpatient, schools, community services); intensive format in day clinics with 6–8 families for at least six hours per day, daily or another rhythm, over weeks or months. No fixed standard: frequency and length follow needs and resources.
Open or closed groups: closed groups start and end together; in open groups families join at different points, and experienced families often act as mentors.
Staffing: at least two therapists, one active and one observing.
Phases: (1) individual preparation meeting with each family, written project outline, time to decide, second meeting; optional trial session ("Schnuppertreffen") and meeting "graduate" families; network meeting where many professionals are involved. (2) First joint meeting kept informal (refreshments, brief introductions). (3) Early work: therapist talks with individual families in front of others, highlighting commonalities. (4) Middle work: family-to-family interaction, cross-family activities, subgroups. (5) Therapist progressively withdraws to the periphery ("hands-on" to "hands-off"). Criteria for moving between phases are clinical judgement, not fixed [uncertain: not specified in the excerpt].
Settings described in the book: ADHD, autism, anorexia, bulimia, suicidality/self-harm, psychosis, waiting-list MFT; social care projects (Early Days, Kidstime, adoption, family day units, high-conflict families); schools (Family Classroom, Family School). [source: table of contents]
Training: no licence is given; a DGSF-accredited MFT institute exists in Dresden [uncertain].

(C) MFT-AN [source: Eisler et al. 2016; MCCAED training flyer 2020]

Pre-group: families seen individually until 5–7 families are recruited; a new group starts about every six weeks.
Intensive phase: four consecutive full days of multi-family work.
Follow-up phase: six one-day group meetings 4–8 weeks apart over about nine months (10 group days in total); single-family meetings in between as needed.
Whole treatment about 12 months; two therapists per group.
Day content mixes multi-family sessions, separate parents' and adolescents' groups, single-family work, psychoeducation, creative techniques and multifamily meals. A day-by-day timetable is not given [uncertain: it is in the MFT-AN manual (Simic et al.), which is not drawn on].
Training: a four-day intensive training by the Maudsley Centre for Child and Adolescent Eating Disorders, where the manual is given to participants; supervision on request. NICE (2017) recommends MFT as a more intensive form of family intervention for restrictive eating disorders.

3. Guiding principles

Shared across versions

Family as resource, not cause. State early and repeatedly that the family is not to blame. [source: EASA checklist session 1; Eisler et al. 2016]
The group is the therapeutic agent. Route questions and advice between families rather than answering them yourself. [source: Asen et al. 2026 ch.1.1]
Peer feedback lands better than expert feedback. Ask another parent, "What would you say to them?" before giving your own view. [source: Asen et al. 2026 ch.1.1]
Reduce isolation and stigma, raise hope. Make commonalities visible in early sessions. [source: Asen et al. 2026 ch.1.2; Eisler et al. 2016]
Two therapists. Plan roles before each session and debrief after. [source: all three]

(A) PMFG-specific [source: EASA checklist and timeline]

Clinician as colleague and advocate. Share relevant personal information (hobbies, family, background) in joining; drop the detached expert stance.
Socialising is a technique. Always open with 15 minutes and close with 5 minutes of ordinary social talk, in joining and in groups.
Biosocial frame. Explain the illness as a brain disorder sensitive to stress; family behaviour shapes course, not cause.
Structure lowers stimulation. Keep the fixed session format, so meetings stay predictable and low-arousal.
One problem per session, solved formally. Do not drift into open discussion; use the five steps.
Hosts. Act as hosts during workshop breaks and lunch; help families feel welcome.
Family Guidelines (as adapted by VA MIRECC VISN 22 from the University of Rochester "Consumer Centered Family Consultation" training; the list matches the guidelines used in McFarlane-model groups but this version does not cite McFarlane [uncertain]). Each tenet in practical terms:
- Go slow: recovery takes time; protect rest.
- Keep it cool: lower the emotional temperature and disagreement.
- Keep it warm: stay caring, but even out highs and lows.
- Give each other space: time alone is fine; saying no and withdrawing are allowed.
- Set limits: a few clear household rules, applied consistently.
- Ignore what you can't change: let small things go, but never ignore violence, threats or psychotic behaviour; agree a plan ahead.
- Keep it simple: clear, calm, positive communication.
- Follow the treatment plan, adjusting it jointly with client and team.
- Carry on business as usual: restore routines quickly.
- Take care of yourself: carers need their own rest.
- Avoid street drugs and alcohol; discuss use openly; limit caffeine that disturbs sleep.
- Pick up on early warning signs: know this person's specific relapse signs.
- Solve problems step by step.
- Lower expectations temporarily: compare progress with recent months, not with before the illness. [source: VA MIRECC Family Guidelines]

(B) Systemic MFT-specific [source: Asen et al. 2026 ch.1.3–1.9]

From "helped" to "helpers". Families become helpers to each other; avoid becoming substitute parent or "Super-Nanny".
Expert in MFT, not in their children. Say so, and invite families to talk directly to each other.
Keep moving, stay brief. Move around the room, avoid sitting in chairs, stay with one family only 30–60 seconds, then withdraw.
Hands-on to hands-off. Start central, move to the periphery as families take over.
Paired therapists, open disagreement. One active, one observing; position yourselves opposite each other, speak audibly to each other and disagree openly where honest ("four eyes see more than two").
Scan, don't hold centre stage. A scanning gaze signals presence without taking over.
Parents stay responsible. In day or inpatient settings parents keep responsibility for their children during sessions; mark the handover with a small ritual.
Context shifting. Switch quickly between large group, parents' group, children's group and single family; use short spontaneous conversations (about 10 minutes).
Pragmatic confidentiality. Families set their own rules (sometimes written); anonymised sharing is allowed; exceptions are legal requirements, child protection, risk to life and court orders.
"Family" is self-defined. Families decide who counts as family.
Reluctance is not exclusion. Mandated and reluctant families can still benefit.

(C) MFT-AN-specific [source: Eisler et al. 2016]

Parental control of eating as care. Present parents' temporary lead over eating as an expression of care, not control.
Externalise the illness. Separate the young person from the eating disorder.
Starvation explains maintenance. Use the effects of starvation on thinking and behaviour to explain why the illness keeps itself going.
Build on strengths and practise in safety. Use the group to try new behaviour, especially around meals.

4. Intervention inventory

Part A covers McFarlane PMFG procedures [source: EASA competency checklist; EASA MFG intervention timeline; VA MIRECC Family Guidelines; McFarlane 2002 chapter structure]. Part B covers systemic MFT (Asen) [source: Asen et al. 2026 Leseprobe]. Part C covers MFT-AN [source: Eisler et al. 2016]. Where only an item's name was available, steps are marked [synthesis] or [uncertain]. All example language is illustrative.

Part A. McFarlane psychoeducational multifamily group

A1. Outreach and engagement

Purpose / when: first step after referral, to involve family as partners.
Steps: (1) Discuss family involvement with the client in 5–30 min contacts and obtain consent. (2) Ask whom the client counts as family or support. (3) Reach the family by letter, phone, flyer or the client's own invitation. (4) Frame the invitation as joining a partnership of client, family and clinician. [source: EASA timeline]
Example language (illustrative): "We work best when the people closest to you are part of the team. Who would you like us to invite?"
Watch for: client reluctance about specific relatives; respect it and start with whoever the client accepts [synthesis].

A2. Joining session 1: history, early warning signs, orientation

Purpose / when: first single-family meeting (60 min).
Steps: (1) Socialise 15 min (non-illness topics). (2) Present yourself as colleague and advocate; share relevant personal information. (3) Review the client's history with the illness. (4) Identify this person's early warning signs and symptoms. (5) Explain the group structure and what to expect. (6) Say clearly that the family is not to blame. (7) Share relevant illness information. (8) Close with 5 min socialising. [source: EASA checklist]
Example language (illustrative): "Before we talk about the illness, tell me a bit about yourselves. What do you do when you're not worrying about all this?" / "Looking back, what were the first small changes you noticed before things got bad last time?"
Watch for: families arriving braced for blame; the opening socialising and the no-blame statement should visibly lower tension. Write the early warning signs down for later use (A10). [synthesis]

A3. Joining session 2: network, strengths, genogram/sociogram

Purpose / when: second meeting (60 min).
Steps: (1) Socialise 15 min. (2) Explore the family's social network and resources. (3) Identify family and client strengths. (4) Draw a genogram or sociogram together. (5) Socialise 5 min. [source: EASA checklist]
Example language (illustrative): "Who has been around since the illness started, and who has drifted away?"
Watch for: a shrunken network is common and is the target the group addresses; note who might be re-engaged [synthesis, consistent with McFarlane 2002 Part I ch.2–3 titles].

A4. Joining session 3: goals, group history, mental health system experience

Purpose / when: third meeting (60 min), before the workshop.
Steps: (1) Socialise 15 min. (2) Discuss short-term and long-term goals for the family and the client. (3) Answer questions about the workshop. (4) Ask about past experience with groups and any worries about groups. (5) Ask about past experience with mental health services. (6) Discuss how client and family are responding to living with the illness. (7) Socialise 5 min. [source: EASA checklist]
Example language (illustrative): "What would you like to be different in six months? And in two years?" / "Have you been in groups before? What would make one hard for you?"
Watch for: bad prior service experiences; name and acknowledge them, as they predict dropout [synthesis].

A5. Optional individual client meetings during joining

Purpose / when: 30-min meetings with the client alone alongside joining. [source: EASA timeline]
Steps: [synthesis] check the client's own goals and what they do not want discussed in group; agree how to raise sensitive topics.
Example language (illustrative): "Is there anything you'd rather I didn't bring up in front of your family?"

A6. Family education workshop

Purpose / when: single day (4–6 hours), quarterly, after joining, before or around the first groups.
Steps: (1) Plan 2–3 months ahead: room, staff, families, group assignments; confirm family speakers. (2) Run classroom style with breaks and lunch, clinicians acting as hosts. (3) Present: nature, causes, course and outcome of the illness; medication and current treatment; managing the illness; common family reactions; the Family Guidelines; the problem-solving method. (4) Include at least three family speakers varied in gender and age. (5) Answer specific questions in a collegial, open manner. (6) Give handouts. [source: EASA checklist; EASA timeline]
Example language (illustrative): "Most families we meet have felt guilty, angry and exhausted, often all in one week. That's a normal reaction to an abnormal situation."
Watch for: families who sit apart at breaks; staff should actively connect them during breaks and lunch. [source: timeline mentions break and lunch outreach]

A7. First group meeting: getting to know you

Purpose / when: first 90-min group; builds the social network before any illness talk.
Steps: (1) Socialise 15 min. (2) Co-facilitators model by sharing personal information first. (3) Each participant shares personal information and positive aspects of life. (4) No talk of illness. (5) Introductions follow participants' cultural norms. [source: EASA timeline]
Example language (illustrative): "Tonight is just about getting to know each other. I'll start: I grew up by the sea and I'm hopeless at gardening."
Watch for: members drifting into illness talk; gently redirect and promise space next time [synthesis].

A8. Second group meeting: how the illness changed our lives

Purpose / when: second 90-min group (titles vary between services, e.g. "Living with a mental illness").
Steps: (1) Socialise 15 min. (2) Each family and client tells the story of the illness's impact. (3) Leaders link common experiences and continue partnership building. [source: EASA timeline]
Example language (illustrative): "As each family speaks, notice what sounds familiar."
Watch for: one family's story going on too long; time-keep evenly and offer to continue later [synthesis].

A9. Go-around

Purpose / when: each ongoing group, after 15 min socialising; 20 min.
Steps: (1) Each member reports the past two weeks' events, relevant biosocial information (symptoms, early warning signs, medication, stress) and which Family Guidelines applied. (2) A leader records each person's input on a board under "Going well" and "Could be better". (3) Leaders triage urgent needs. [source: EASA timeline]
Example language (illustrative): "Quick round: what's gone well, what could be better, and did any of the guidelines come up?"
Watch for: crisis content (relapse signs, risk); deal with it outside the problem-solving slot if needed (see Section 5).

A10. Early warning sign monitoring

Purpose / when: identified in joining session 1; reviewed in the go-around; Family Guideline "pick up on early warning signs".
Steps: (1) List the person's specific signs from past episodes. (2) Review them in each go-around. (3) If signs appear, select them as the problem for problem-solving or arrange extra clinical contact. [source: EASA checklist; VA MIRECC guidelines; step 3 partly synthesis]
Example language (illustrative): "Last time, sleep went first. How has sleep been?"

A11. Problem selection

Purpose / when: 5 min after the go-around.
Steps: (1) Leaders choose a single problem from the go-around board. (2) Explain the choice openly (urgency, solvability). (3) Hand problem-solving over to the group. [source: EASA timeline]
Example language (illustrative): "We'll work on Sam's sleep tonight, because it's an early warning sign for him. Next time we'll come back to Maria's job search."
Watch for: the same family always being chosen; rotate across sessions [synthesis].

A12. Formal problem-solving (five steps)

Purpose / when: 45 min in each ongoing group.
Steps: (1) Define the problem as a clear statement starting "What can [name] do about..." and write it up. (2) Brainstorm about 10 solutions, including unlikely ones, from all families; adjust the number to the time. (3) Weigh pros and cons of each. (4) The person or family whose problem it is chooses the preferred solution or combination. (5) Plan implementation: what, by whom, when and how. [source: EASA timeline and worksheet]
Example language (illustrative): "Let's get as many ideas as possible, even silly ones. No judging yet."
Watch for: members judging ideas during brainstorming; keep steps separate. Working well: ideas come from other families, not leaders [synthesis].

A13. Action plan

Purpose / when: end of problem-solving.
Steps: A leader takes the person through: what will you do, when, will you need help and from whom, and when. The client takes the written plan home. Review it in the next go-around. [source: EASA timeline; review step synthesis]
Example language (illustrative): "So: Tuesday and Thursday you'll switch off screens at ten, and your dad will remind you once. Shall we write that down?"

A14. Closing socialising

Purpose / when: last 5 min of every session.
Steps: return to ordinary social talk so families leave calm. [source: EASA timeline]

A15. Teaching and applying the Family Guidelines

Purpose / when: taught at the workshop, referred to in each go-around and during problem-solving.
Steps: (1) Present the list with examples at the workshop. (2) In the go-around ask which guideline applied. (3) Use a guideline to frame a problem or a solution. [source: EASA checklist and timeline; VA MIRECC Family Guidelines]
Example language (illustrative): "That sounds like 'lower expectations temporarily'. Compared with three months ago, what has improved?"

Part B. Systemic multi-family therapy (Asen, Morris & Pommepuy)

Only chapter 1 of the 2026 German edition is drawn on. Chapter 1 procedures (B1–B8) are sourced. For the basic techniques of chapter 3 (B9–B16) only the names were available, so the steps given are general systemic practice [synthesis], not the authors' wording. The chapter 6 activities (B17) are listed by name only [uncertain].

B1. Preparation meeting with each family

Purpose / when: before the group, to lower fear of exposure and criticism.
Steps: (1) Meet each family alone; explain the model, its evidence and its pros and cons. (2) Give a structured written project outline, ideally co-written with former participants. (3) Offer contact with "graduate" families and allow them to bring supporters. (4) Give time to decide and hold a second meeting. (5) If many professionals are involved (e.g. child protection), hold a network meeting and clarify parallel interventions. [source: Asen et al. 2026 ch.1.3]
Example language (illustrative): "Many families worry about talking in front of strangers. Would it help to speak with a family who has been through the group?"
Watch for: fear of being judged; a trial session (B2) often settles it.

B2. Trial session ("Schnuppertreffen") and informal first meeting

Steps: offer a taster session; keep the first joint meeting informal, with refreshments and brief introductions, no long speeches. [source: ch.1.3]

B3. Co-created group rules and confidentiality agreement

Purpose / when: at the start, revisited as needed.
Steps: (1) Families draft their own rules, sometimes in writing. Typical family obligations are punctuality, notice of absence, respect, non-violence, non-discrimination, no alcohol or drugs in sessions, confidentiality and no social media posting. (2) State the matching obligations of therapists and institution (recordings only for supervision or training, with consent). (3) State the exceptions to confidentiality: legal requirements, child protection, suicide or homicide risk, court orders. (4) Agree that anonymised sharing outside the group is acceptable. [source: ch.1.8]
Example language (illustrative): "What rules do we need so everyone feels safe to speak here?"

B4. Inclusion and exclusion assessment

Steps: (1) Include on the basis of a shared theme (illness, school exclusion, domestic violence, a child in care). (2) Exclude permanently anyone convicted of, or currently suspected of or at risk of, child sexual abuse; also those with a history of violence against strangers. (3) Assess domestic violence in detail; it is not an automatic exclusion. (4) Exclude temporarily during acute psychosis or intoxication; the rest of the family may still attend. (5) Do not exclude for reluctance or a court mandate. (6) Let the family define who counts as family. [source: ch.1.9]

B5. Therapist positioning: moving, brief contacts, withdrawing

Purpose / when: throughout; the core method for getting families to help each other.
Steps: (1) Move around the room rather than sitting. (2) Join a family for 30–60 seconds, prompt, then withdraw. (3) Redirect questions to other families. (4) Over sessions shift from hands-on to hands-off, ending on the periphery. [source: ch.1.4–1.5]
Example language (illustrative): "I'm an expert in running these groups, not in your son. Ask the Ahmeds, they had the same battle last month."
Working: families talk to each other more than to you.

B6. Co-therapist pairing and open conversation between therapists

Steps: (1) One therapist active, one observing. (2) Stand or sit opposite each other. (3) Talk audibly to each other about what you notice, including honest disagreement, as a model and as input for families. [source: ch.1.5]
Example language (illustrative): "I'm seeing the parents get quieter as the kids get louder. Do you see it differently?"

B7. Responsibility handover ritual

Purpose / when: day or inpatient settings, at session start, to make clear that parents, not staff, are in charge of their children.
Steps: the child hands a parent a coloured marble or bracelet; symbols are collected at the end. [source: ch.1.6]

B8. Context shifting and brief spontaneous conversations

Purpose / when: throughout an MFT day, to intensify and speed change.
Steps: (1) Move quickly between whole group, parents' group, children's group and single-family work. (2) Use brief unplanned conversations (about 10 minutes) when something happens, rather than waiting for a formal session. [source: ch.1.7]
Watch for: group pressure is part of the effect; check that it supports rather than shames [synthesis].

B9. Forming subgroups ("Bildung von Untergruppen")

Steps [synthesis]: split by role (parents, children, siblings), by theme or by mixed families; give each a concrete task; reconvene and have each subgroup report.

B10. Five-step intervention model and the "systemic quartet"

Named in ch.3 and linked to the mentalising spiral in ch.4. Content is [uncertain]; do not improvise a version under these names.

B11. Interview techniques and the "Lieutenant Columbo" technique

Steps [synthesis]: use circular and curious questions; the Columbo stance means asking naive, puzzled questions that invite families to explain and reconsider (inferred from the name; the authors' version not drawn on [uncertain]).
Example language (illustrative): "I'm confused, help me out: when Dad steps in, what happens next?"

B12. Structured reflection time and reflecting teams

Steps [synthesis]: after an activity, pause and ask families to reflect on what they noticed in themselves and others; or ask one family or the therapists to talk about another family's interaction while that family listens, then let the observed family respond.
Watch for: reflections must be tentative and kind; stop criticism.

B13. Externalising interventions

Steps [synthesis]: give the problem a name and treat it as outside the person; ask how it tricks the family and when they beat it. Related activities in ch.6 include "letter to the problem", "tricks of the problem" and "problem portrait" (names only).

B14. Role reversal ("Rollentausch")

Steps [synthesis]: parents play the children and children play the parents in a short re-enactment of a typical conflict; then de-role and ask each person what it felt like and what they learned about the other's state of mind. Asen & Fonagy (2017) list role-plays with inverted roles among their mentalising techniques [source: abstract only].
Watch for: mocking; set the frame and stop if it humiliates.

B15. Video feedback

Steps [synthesis]: with consent, record a brief interaction; replay a short clip to the family (with others if agreed); pause and ask what each person was thinking and feeling at that moment.

B16. Foster-care procedure and collaborative psychoeducation

Foster-care procedure: name only [uncertain]; from the name possibly a family temporarily looking after another family's child in an activity, but not confirmed. Collaborative psychoeducation [synthesis]: families pool their own knowledge first, then clinicians add information, instead of lecturing.

B17. MFT activity catalogue (chapter 6, names only)

No procedures are given for these [uncertain]. Do not run them under these names without the book. German titles from the 2026 edition with literal glosses; English titles in the Routledge edition may differ.

Group activities: farewell rituals; affect snapshots (Affektschnappschüsse; cf. "mental state snapshots" in Asen & Fonagy 2017); amoeba game; anonymous letters; blind trust; frozen problems; duck duck goose; family outings; family meals; family remote control; catch the ball; holding on and letting go; fish feelings; photo stories; lost property; birthday surprise party; geography sculpture; burst balloons; stranded on an island; stepping into the other's shoes; kingdom; body feelings; circle game; live sculpture; lie detector; fairy-tale world; masked ball (cf. theatrical masks, Asen & Fonagy 2017); multi-family orchestra; mum protection; closeness and distance; smoke signals; risk-meter; writing with the wrong hand; finding one's place; self-description; spaghetti and marshmallows; speed dating; talent show; tug of war; animal families in the magic forest; tower of Babel; responsibility and irresponsibility; wellness centre; who has ever...?; how it all began; how others see me; wink murder.
Family activities: family pictures and collages; family vehicle; family network map; family rucksack; family tree; family constitution; family coat of arms or website; objects of memory; brain scan (cf. body–mind maps and scans, Asen & Fonagy 2017); wanted!; conflict maps; river of life; new script for family arguments; care labels; reference letters; job advertisement; mood barometer; route planner; clay sculptures; dream house; timelines; goal tree.
Problem-oriented activities: adoption meal; letter to the problem; energy-saving dancing; escalation clock; food collage; traps and treasures; case study; feelings weather forecast; climbing ropes; body poster; bully / victim / bystander; press conference; problem portrait; smack or tap?; Super Nanny; animal guide; tricks of the problem; survival handbook; survival suitcase; swapped roles; volcano eruption; "Zappelmon" (fidget-monster); letter from the future.

Part C. MFT-AN (Maudsley)

C1. Pre-group single-family sessions

Steps: see families individually (FT-AN) until 5–7 families are recruited; begin psychoeducation and parental management of eating. [source: Eisler et al. 2016]

C2. Four-day intensive multi-family block

Purpose: rapidly build solidarity, reduce isolation, start cross-family learning.
Steps: alternate whole-group sessions with separate parents' and adolescents' groups and single-family work; include psychoeducation (effects of starvation), creative techniques and multifamily meals. [source: Eisler et al. 2016] The daily timetable is in the manual [uncertain].

C3. Multifamily meals and mealtime discussion

Purpose: practical help with the fear of eating and weight gain.
Steps: families eat together in the group; afterwards discuss what helped each family support their child. [source: Eisler et al. 2016] [synthesis]: agree beforehand what each parent will do at the table; one therapist observes; in the debrief ask other parents what they noticed that worked; avoid public comment on portion sizes or bodies; no numeric targets in group.
Example language (illustrative): "What did you see the Jones parents do that kept things calm?"
Watch for: distress spikes; plan a calming space and follow medical monitoring rules in place outside the group.

C4. Separate parents' and adolescents' groups

Steps [synthesis]: parents compare strategies and share load; adolescents talk about the illness's effect on their lives without parents present; reconvene and share agreed points.

C5. Externalisation of the eating disorder

Steps: separate the young person from the illness, using narrative techniques. [source: Eisler et al. 2016 (FT-AN, shared by MFT-AN)] [synthesis]: in a group, adolescents can describe the illness's "voice" and parents can describe how it changes their child; cross-family pairs compare.

C6. Cross-family exercises and feedback

Steps: families observe each other, give mutual feedback and try exercises with another family. [source: Eisler et al. 2016] [synthesis]: e.g. a parent from one family advises an adolescent from another, which often lowers defensiveness.

C7. One-day follow-up meetings and between-group family sessions

Steps: six one-day meetings 4–8 weeks apart over about nine months, reviewing progress and shifting from eating to adolescent development and family life; single-family sessions as needed. [source: Eisler et al. 2016; later-phase focus from FT-AN description]

5. Handling problems

Asen et al. (2026) devote chapter 11 ("Problem corner: what to do if... and when?") to conflict between adults, verbal aggression, child protection concerns, dominant or silent members, latecomers, phones in sessions, refusal to participate, running out of time and suicidal thoughts, but only the headings are drawn on [uncertain]. Responses below are tagged by source; untagged bullets inside a [synthesis] item are the guide's own.

Family won't engage or attend (A). Engage through the client's consent and invitation; use joining socialising and the colleague/advocate stance; ask about bad past service experiences in joining session 3. [source: EASA checklist and timeline] Offer a phone joining session or meet at home if travel is the barrier [synthesis].
Fear of exposure in a group (B, C). Individual preparation, contact with graduate families, a trial session, time to decide. [source: Asen et al. 2026 ch.1.3]
Reluctant or court-mandated families (B). Not a reason to exclude; mandated contexts can work. [source: ch.1.9] [synthesis]: name the mandate openly, separate what is non-negotiable from what the family can shape, and pair them with a family that started out equally reluctant.
Acute crisis raised in the go-around (A). Leaders triage urgent needs. [source: EASA timeline] [synthesis]: if risk is immediate, one co-leader steps out with the person and family for risk assessment while the other continues the group; if early warning signs are rising but not urgent, make them tonight's problem.
Suicidal thoughts disclosed in group (all) [synthesis]. Acknowledge without detailed exploration in front of the group; one therapist completes a standard risk assessment and safety plan privately with the person and family, including lethal-means counselling (safe storage or removal); confidentiality exceptions apply (B3). Return to the group with a brief, agreed message.
Acute psychosis or intoxication (B). Temporary exclusion of that person; other family members may attend. [source: ch.1.9]
Child protection concern (B). Confidentiality exceptions apply; follow local safeguarding procedure. Abuse risk is a permanent exclusion criterion. [source: ch.1.8–1.9]
Conflict or verbal aggression between adults (B) [synthesis]. Stop the exchange, refer to the group's own rules (B3), split into subgroups to lower arousal, and have the co-therapist take one party aside briefly. In PMFG groups, apply "keep it cool".
Dominant or silent members [synthesis]. Use structured rounds and the go-around board (A9) so everyone has a slot; in B, give quiet members observer or reporter roles in subgroup tasks; speak privately to dominating members, framing their energy as a resource.
Group drifting into open discussion instead of problem-solving (A) [synthesis]. Return to the step you are on; write the problem statement visibly; time-keep the 45 minutes.
Families looking to therapists for answers (B). Redirect to other families; say you are expert in MFT, not their child; keep moving and withdraw. [source: ch.1.4–1.5]
Therapist sliding into substitute-parent role / children turning to staff (B). Return responsibility to parents, e.g. the handover ritual. [source: ch.1.4, 1.6]
Confidentiality breach or social media posting (B). Revisit and, if needed, rewrite the group rules with the families. [source: ch.1.8; response partly synthesis]
Non-adherence to action plans (A) [synthesis]. Review the plan in the next go-around without blame; ask what got in the way; if it failed because it was too big, apply "go slow" and shrink the next step.
Rupture with a family (all) [synthesis]. Name it, take your share, ask what you missed; in B, use the co-therapist conversation (B6) to voice the possibility that the team got it wrong.
Overwhelm during intensive days (B, C) [synthesis]. Build in breaks and an agreed quiet space; let a family step out of an activity and rejoin; keep to the timetable.
Mealtime distress or refusal (C) [synthesis]. Agree each family's mealtime plan beforehand; parents lead with the therapist coaching briefly; debrief afterwards with the group about what helped. Medical monitoring decisions stay with the treating team.
Stigma and comparison between families (C) [synthesis]. Stop comparisons of weight, intake or bodies; focus on strategies and family life.
Dropout after the workshop or at long-term plateau (A) [synthesis]. Contact the family personally between groups; revisit their joining-session goals; use the second-meeting stories to remind the group of progress since then.
Mixed diagnoses or a family not sharing the group's theme (B). The shared theme is the inclusion criterion; check it before inclusion. [source: ch.1.9]

Sources

Sources

Further reading (full text not drawn on)

McFarlane, W. R. (2002). Multifamily Groups in the Treatment of Severe Psychiatric Disorders. New York: Guilford.
Asen, E., Dawson, N., & McHugh, B. (2001). Multiple Family Therapy: The Marlborough Model and Its Wider Applications. London: Karnac (reissued Routledge).
Asen, E., & Scholz, M. (2010). Multi-Family Therapy: Concepts and Techniques. London: Routledge (German original Praxis der Multifamilientherapie, Carl-Auer 2009).
Asen, E., Morris, E., & Pommepuy, N. (2025). Systemic Multi-Family Therapy: Concepts and Interventions. Routledge; German edition Carl-Auer 2026.
Simic, M., et al. Multi-Family Therapy for Anorexia Nervosa: A Treatment Manual. Routledge [uncertain: year and author list from bookseller listings].

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