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How group therapy can hold the key to treating mental illness

JORI BOLTON/The Globe and Mail

This spring, Kelle Sickerson didn't hesitate when child psychiatrists at the Mayo Clinic suggested her 17-year-old daughter, Jayme, attend an intense two-week program with other teens to treat her depression. Nothing else – especially not the multiple medications she was taking – seemed to be helping.

The hitch? Sickerson and her husband had to attend, too, and participate in daily sessions with other parents and participants, something that Sickerson says she was loathe to do.

"We took a leap of faith," she said. "We were at the end of our rope – we didn't want her to kill herself."

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Today, Sickerson reports that it was a move that saved her daughter, her family and her marriage. She bursts into tears describing how they connected with other families.

"Those people are my friends now," says the mother of two from Des Moines, Iowa. "When you have something that huge in common, it doesn't take long."

It's a mouthful of a term, but multi-family group therapy (MFGT), in which patients and their families meet with other patients and families, has been around for decades. Now, it is poised to enjoy the spotlight again. A new study has found promise in using MFGT with U.S. veterans who have suffered traumatic brain injuries. And the Mayo outpatient program that Sickerson and her family attended in Rochester, Minnesota, has just morphed from pilot to permanent status.

MFGT is often used as a last resort after other treatments and therapies fail, but proponents say that, despite its image as being unwieldy, it should be more widely available – especially for young people with mental health problems and their families. Patients and family members benefit as much from their fellow participants as from the credentialed experts who steer the therapy.

At the Mayo program, called the Child and Adolescent Integrated Mood Program (CAIMP), families take part in therapy and education classes both in parent- or kid-only groups and all together for 10 consecutive weekdays from 8 a.m. to 4 p.m. They attend everything from social skills lessons for the teens to sessions using cognitive behavioural therapy tenets to reframe negative thoughts.

One of the more harrowing activities Sickerson's family did with the group was create a crisis management plan if the teens were suicidal: whom to call, where to go. As Sickerson puts it, "It was big stuff."

While program founder and psychiatrist Jarrod Leffler won't have formal results of CAIMP's success rate to publish until later this year, early signs are positive. Of 26 patients (and 41 parents) who have attended since November, all but one – who left to be hospitalized – completed the program.

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"It's so powerful when you get these families together and invested in the treatment," says Leffler. "It does more than help the symptoms – it helps the whole system. If the system improves, obviously the other things will improve as well."

Psychologist Linda Greenberg uses multi-family therapy at Montreal's Jewish General Hospital and says she hopes the new attention rejuvenates the method.

She has been working with five families at a time for most of the last 25 years. In her practice, a family must include siblings – even babies and grandparents – if they live together. It can be chaotic, but only when "the adults don't talk about their issues. When there's tension in a family, that's when the kids act up. When the parents talk about their issues, the kids calm down."

Greenberg says participants make leaps forward by seeing themselves in others. In one session, she organized the group into moms and dads to tease out tensions between couples. One mom had no problem pointing out the destructive, alcoholic ways of another woman's husband.

It was clear to Greenberg that the woman was also talking to her own husband. "Even if she denied it, her husband heard her," she says. Greenberg adds that the same thing can happen with children telling other parents something they can't tell their own.

Session rules are strict: If a family member can't make it, the whole family must sit out. Also: no pee breaks. "People like to leave the room when issues get too hot for them," Greenberg says.

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This absolute commitment may seem severe, but experts say it's crucial. Leffler says that when children see their parents dropping everything to participate in his two-week program, it sends a profound signal: "They feel backed," he says. "There's a sense of pride or recognition of the commitment of the parents."

At the Hospital for Sick Children in Toronto, a weekly multi-family therapy session is a mandatory part of a program that accepts up to eight adolescents with eating disorders. The kids are at the hospital all day and eat their meals there. The group sessions help families to process what's going on, and to plan for their child's eventual return home. The eight families will also arrange a joint meal with the help of therapists and a dietician.

"We find eating disorders to be a very isolating experience for families," says Seena Grewal, associate head of the program. "It helps them see they're not alone, that many of the things they've experienced in their family are part of the eating disorder, not because of their family."

She adds that there's power to hearing this from peers, not just doctors and therapists.

A recent study from Mount Sinai Hospital in New York about the use of MFGT with Iraq veterans suffering from traumatic brain injuries found that patients and caregivers alike reported improvements in symptoms and the ability to cope – so much so that researchers are hoping to launch a broad clinical trial as a follow-up.

While researchers plug away at measuring the clinical merit of MFGT, Kelle Sickerson says she and her family see only upsides to their experience.

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Sickerson begins to cry again when I ask how Jayme is doing.

Before the program, her daughter wasn't really getting out of bed. She is now down to one medication, she's attending school again and dreams of being a nurse. She's made a testimonial video for the Mayo and has forged friendships with other kids from the program.

"She's happy," says Sickerson. "Laughing. Funny. Joyful."

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