In a powerful look inside family-based therapy, researchers reveal how group sessions helped parents of anxious teens feel less alone, rebuild communication, and rediscover hope at home.
Study: Does multifamily therapy help parents of adolescents with anxiety-based school refusal? A qualitative approach. Image credit: Jacob Lund/Shutterstock.com
Multifamily therapy, a form of psychotherapy, can potentially strengthen family interactions and bonding and improve perceived self-efficacy and self-confidence of parents of adolescents who refuse to go to school due to anxiety issues, as reported by a new study published in PLOS ONE.
Background
School refusal or absenteeism is a genuine public health concern, as it can significantly increase the risk of school dropout among children and adolescents and negatively affect their professional, personal, and social lives in adulthood.
Several factors can potentially increase the risk of school refusal among adolescents, including anxiety, excessive fearfulness, unhappiness, unexplained physical symptoms, depression, and sleep disorders.
Social anxiety, in particular, has been linked to school refusal among adolescents. Several studies indicate that social anxiety in adolescents significantly affects their schooling and relationships with others.
Several strategies have been developed to control anxiety-based school refusal among children and adolescents. In this context, family interventions have shown effective outcomes, as parents of adolescents with such problems often experience exhaustion, frustration, helplessness, guilt, and anxiety.
Multifamily therapy is one such family intervention in which a therapist brings together multiple families sharing similar struggles with the intention of developing a supportive community. This therapy combines the elements of group and family therapies, allowing families to learn from each other’s experiences and work jointly with the therapist to overcome each of their shared or very specific individual problems.
In the current study, researchers aimed to explore the experiences of parents who participated in the MULTI FAST program, which offers multifamily therapy to adolescents with anxiety-based school refusal and their families.
A total of 31 parents from the MULTI FAST program participated in this study. A semi-structured qualitative interview was conducted with each parent six months after the completion of multifamily therapy.
Key findings and significance
The analysis of parents’ interviews highlighted four main domains: changes in parents’ representations of their adolescents, parents looking at themselves in a new light, parents expressing their distress to their adolescents, and new family interactions.
Specifically, the interviews highlighted the importance of group meetings, where parents facing similar problems met with each other and shared their experiences about school refusal. This helped them feel less alone, stigmatized, judged, and guilty, and regain self-confidence and abilities.
It was also observed in the interviews that parents of adolescents with school refusal often feel distress, sadness, and helplessness. The multifamily therapy helped these parents express these emotions to their teenagers and other family members.
Some parents reported realizing their own negative, and often traumatic, experiences at school, which potentially impacted their communications about school with teenagers. Similarly, teenagers discovered their parents’ school-time experiences, which helped them better understand their parents’ reactions to school refusal.
Another important finding from the interviews was the change in parents’ representations of their teenagers. Multifamily therapy helped them realize that their teenagers have important skills, can analyze difficult situations, and can find solutions. The therapy also helped parents better understand their teenagers' needs and how their own reactions can either reduce or, on the contrary, increase their teenagers' anxiety levels.
Overall, the parents reported that participating in multifamily therapy significantly improved family interactions and communications and strengthened family bonding.
The observed benefits of multifamily therapy are primarily associated with mixing families with diverse backgrounds and socioeconomic statuses. The vast diversity of family profiles is considered to be a reassuring factor, helping parents conclude that family functioning cannot be the cause of school-based anxiety, especially when they perceive other families as more competent than themselves. Such reassurance helps parents alleviate their feelings of guilt.
Multifamily therapy sessions help parents from different families share their painful experiences and emotions, allowing them to become each other’s “co-therapists,” as described by the study authors. This further helps parents regain their confidence and ability to empathize with their teenagers and cope.
Similarly, listening and talking to other teenagers during therapy sessions is a key experience for parents, helping them realize their own teenagers' distress. Similarly, when teenagers listen to other parents’ experiences, they become more understanding of their own parents’ emotions and reactions regarding school refusal.
Focusing on family interactions is another key aspect of multifamily therapy. During therapy sessions, families are asked to describe recurring conflicts within their families and subsequently look for strategies to manage these conflicts differently. Such activities require family members to work on family functioning through collaboration, which potentially improves family interactions and communications and strengthens family bonding.
Parents also reported that many adolescents had resumed school or vocational training within six to twelve months after therapy. However, the researchers emphasized that the study’s qualitative design cannot prove a direct therapeutic effect, as the results reflect parents’ perceptions rather than measured clinical outcomes.
The authors noted that the relief experienced by parents might partly reflect access the structured mental-health care itself, and the plan to conduct a future quantitative study to assess the measurable effectiveness of multifamily therapy for adolescents with anxiety-based school refusal.
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