Exploring interactive change processes in multifamily therapy for adolescents with anorexia nervosa

Objective: Multifamily therapy (MFT) is a unique treatment approach that is growing in popularity for adolescents with anorexia nervosa (AN) and their families. MFT aims to create change through experiential and activity-based content and purposeful use of group processes. Despite growing evidence supporting MFT's efficacy, there is limited understanding of possible mechanisms of change. This study explored interactive group processes associated with MFT for adolescent AN and how these processes may influence change in MFT. Methods: A short-term ethnographic field approach was taken with observational data collected across two MFT groups. Qualitative interviews and focus groups were also conducted with young people, parents, and facilitators following each group. The data were analyzed using reflexive thematic analysis. Results: Five themes and seven subthemes were generated, and a hypothesized model based on these themes was developed. Relational processes (Theme 1) and learning processes (Theme 2) occurred within individual families and between families in the group. These processes were understood to contribute to whole group dynamics (Theme 3) where emotional safety and momentum built across the week. Facilitator responsiveness (Theme 4) was crucial in navigating uncertainty and supporting these processes. These themes were understood to be interconnected and contributed to a way forward toward recovery (Theme 5) for individual families and for the group as a whole. Discussion: These findings suggest that several unique group processes play an important role in promoting change within MFT. Consequently, MFT may offer a valuable alternative for families for whom traditional single-family therapy has not been effective.