Multiple impact therapy

1. Introduction

Version followed: the original Galveston format of the Youth Development Project, University of Texas Medical Branch (MacGregor 1962; MacGregor, Ritchie, Serrano & Schuster, directed by McDanald & Goolishian, 1964), as MacGregor summarised it in his entry "Multiple Impact Therapy" in The Psychotherapy Guidebook (Herink, ed.). Later adaptations (nursing teams, day-treatment intake, crisis programmes) are noted where they differ. [source: MacGregor, Psychotherapy Guidebook entry (excerpt); Wikipedia, Multiple impact therapy]

Source caveat. The abstract of MacGregor's 1962 Family Process paper (systemagazin's Family Process index) and library catalogue records for the 1964 book confirm the setting (an outpatient adolescent clinic), the format (one family given a team's full resources for about half a week), the components (opening team-family conference, then different combinations: multiple-therapist sessions, individual interviews, group therapy, brief staff conferences) and routine follow-up at 6 and 18 months. The 1964 book, the full 1962 paper, Ritchie (1960), MacGregor's full Guidebook entry and Abikoff's (1980) thesis PDF are not drawn on here [uncertain]. How overlapping visits, staff conferences and the closing conference were run, and the timing of each segment, therefore remain [synthesis] or [uncertain]. [source: research log]

Multiple impact therapy (MIT) is a brief, intensive, team-based family method. It was developed from 1957 at the Youth Development Project, an outpatient adolescent psychiatric clinic of the University of Texas Medical Branch in Galveston, for adolescents and their families in crisis. Many families lived 50 to 450 miles away and could not attend weekly sessions for months. So the team gave one family its full resources for about half a week (roughly two to two and a half days), followed by a few follow-up visits. MacGregor describes it as a team-family method for diagnosis, treatment planning and "freeing natural growth processes" in the family. [source: MacGregor 1962 abstract; MacGregor, Guidebook excerpt; Rambo & Boyd 2017 abstract, citing Ritchie 1960]

Core idea of change. MacGregor's 1962 study tested the premise that "self-rehabilitating family processes can be mobilized" by brief intervention. The adolescent's problem is understood through the family's structure, roles and communication patterns. A team meets the family in a series of different combinations over a short, concentrated period. This lets the team see those patterns from several angles and name them back to the family. The aim is to restart the family's own development, not to provide long-term therapy. [source: MacGregor 1962 abstract; MacGregor, Guidebook excerpt; Wikipedia] [synthesis: how seeing patterns from several angles produces change]

Status today: MIT is mainly a historical model. Harold Goolishian played a central role in developing it in the 1950s, and it was one of the earliest federally funded family therapy projects. [source: Swarthmore Works record, abstract of Goolishian obituary, American Psychologist 1993] No current certification, licence or fidelity programme was found. Its lineage runs through the Galveston Family Institute (1978), now the Houston Galveston Institute, which today teaches collaborative-dialogic practice rather than MIT itself. A clinician adapting MIT now is building an intensive team-based family assessment and intervention on its template, not delivering a licensed programme. [source: Wikipedia, Houston Galveston Institute] [uncertain: absence of current training is inferred from not finding any]

2. Framework

Format. One family (the identified adolescent, parents and often siblings) receives the full resources of a team for about half a week, i.e. roughly two to two and a half consecutive days. The work is scheduled in half-day segments. MacGregor's 1962 report gives routine follow-up at 6 and 18 months, with home visits for half the cases. [source: MacGregor 1962 abstract (half a week; follow-up); MacGregor, Guidebook excerpt (half-day segments)] [uncertain: the length of individual sessions and breaks was not found]

Team. MacGregor's 1962 abstract calls it an "orthopsychiatric team" working full time from April 1958, without giving its size. [source: MacGregor 1962 abstract] In the usage of the time that implies psychiatry, psychology and social work, which matches the authors' professions (MacGregor, psychologist; Ritchie, social worker; Serrano, Schuster and McDanald, psychiatrists). [uncertain: roster inferred] Wikipedia, attributing it to the 1962 paper, lists a psychologist, an associate therapist, a social worker, a nurse and a member of the family's community agency or inpatient clinic, and says other users ran sessions with up to nine therapists. [source: Wikipedia] [uncertain: this roster could not be checked against the paper]

Sequence of components (MacGregor's list). The Guidebook entry lists the five steps below. The 1962 abstract adds that after the opening team-family conference the work runs through "a series of different combinations" of the people involved. It names the building blocks as multiple-therapist sessions, individual interviews, group therapy and brief staff conferences (see 4.6, 4.6a, 4.7). [source: MacGregor, Guidebook excerpt; MacGregor 1962 abstract]

1. Brief team conference: the team briefs itself and plans.
2. Team-family conference: the whole team meets the whole family.
3. Separate conferences held at the same time: subsets of the team meet segments of the family, for example by generation (parents in one room, adolescent in another).
4. Overlapping sessions: team members move between the separate interviews and join them.
5. Reconvened team-family conference: everyone meets again.

Phase table (as reconstructed from the summaries).

Indications reported. Developed for adolescents and their families in crisis at an outpatient adolescent clinic: 12 families in the 1957–58 development phase and 55 families with problem adolescents after April 1958. [source: MacGregor 1962 abstract] Later reported uses: conventional outpatient therapy has failed; as an alternative to hospitalisation or a final step before it; families in group therapy making little progress; screening whether a young person needs admission. [source: Wikipedia]

3. Guiding principles

• The family, not the adolescent, is the unit of diagnosis and treatment. Practically: invite and expect the whole household. Read the symptom as information about family structure and roles. [source: Wikipedia; MacGregor, Guidebook excerpt]
• Diagnosis, planning and treatment happen together. Practically: there is no separate assessment phase. Every interview is both data-gathering and intervention. [source: MacGregor, Guidebook excerpt ("team-family method for diagnosis, treatment planning")]
• Free the family's natural growth processes rather than install change. Practically: aim to remove blocks such as rigid roles and closed communication, then hand development back to the family. The premise is that the family's own "self-rehabilitating" processes can be mobilised in a brief intervention. Do not set up long-term dependency. [source: MacGregor, Guidebook excerpt; MacGregor 1962 abstract]
• Intensity and concentration create momentum. Practically: give one family the whole team's time for about half a week, in consecutive half-day segments, with the family staying locally. Momentum from the intensive is meant to reduce the total number of sessions. [source: MacGregor 1962 abstract; Guidebook excerpt; Wikipedia (momentum)]
• Multiple perspectives through an interdisciplinary team. Practically: each discipline views parent, adolescent and family; differences in view are working material, not noise. [source: Wikipedia]
• Respect generational boundaries when splitting the family. Practically: interview by generation (parents together, adolescent separately) so each can speak freely, including about personal resentments. [source: MacGregor, Guidebook excerpt; Wikipedia]
• Flexible combinations. Practically: after the opening conference the team chooses which members and which therapists meet next, according to what needs linking. [source: MacGregor 1962 abstract ("a series of different combinations"); Wikipedia]
• Identify and modify structure, roles and communication. Practically: name specific patterns (who speaks for whom, who is excluded, which role the adolescent carries) and test change in session. [source: Wikipedia]
• Bring the community in. Practically: include a referring-agency or inpatient staff member on the team. This builds trust with parents and continuity after the intensive. [source: Wikipedia, attributed to the 1962 paper] [uncertain: not mentioned in the 1962 abstract]
• Make the team's own process visible. Practically: team members report to one another in front of the family what they have learned elsewhere. They can model open, respectful disagreement. [uncertain: widely attributed to MIT in textbooks, not confirmed in a primary source]
• Practical outcome orientation. Practically: the intensive ends with concrete decisions about placement, school and further treatment. [source: Wikipedia]

4. Intervention inventory

The procedures are listed in the order they occur. MacGregor's Guidebook list covers 4.2 to 4.6 and 4.8. His 1962 abstract confirms multiple-therapist sessions in different combinations (4.6), individual interviews and group therapy (4.6a), brief staff conferences (4.7) and follow-up (4.11). Items 4.1, 4.9 and 4.10 come from secondary summaries. No source describes session mechanics, so the step-by-step detail in every item is the author's [synthesis] unless tagged otherwise. All example wording is the author's own and is labelled (illustrative); no verbatim MIT session language was available.

4.1 Referral, selection and preparation

• Purpose / when: Choose families for whom a half-week team intensive fits: an adolescent and family in crisis, prior treatment failure, possible hospitalisation, or a family living too far away for weekly work (Galveston families travelled 50 to 450 miles). [source: MacGregor 1962 abstract; Wikipedia; Rambo & Boyd 2017 abstract, citing Ritchie 1960]
• Steps: (1) Take the referral from the agency, school, court or inpatient unit and invite that worker to join the team. (2) Confirm that both parents (or all caregivers) and the adolescent will attend both days; siblings are usually included. (3) Arrange two consecutive days, with the family staying locally if they travel. (4) Book all team members for the full block. (5) Collect referral information for the team briefing. (6) Screen for acute risk such as suicidality, violence or abuse; such risk needs immediate safety management alongside or before the intensive. [synthesis for 2, 4 and 6]
• Example language (illustrative): "We work a bit differently. Your whole family meets with a team of us for two or three full days, in different groupings. Most of the work gets done in those days, then we see you again some months later."
• Watch for: A parent refusing to come; agreement "only for the child's sake"; an unresolved safety issue. It is working when all members commit to the full block. [synthesis]

4.2 Brief team conference (pre-briefing)

• Purpose / when: At the start of Day 1, before meeting the family, give everyone a shared picture of the referral and agree a plan. [source: MacGregor, Guidebook excerpt; Wikipedia ("planning and briefing session")]
• Steps: (1) The referring worker or intake clinician summarises the problem, history and family composition. (2) Assign a team member to each family segment for the separate conferences. (3) Agree initial hypotheses about structure and roles, held loosely. (4) Agree when and how the team will regroup and how overlapping visits will be signalled. [steps 2-4: synthesis]
• Example language (illustrative, team to team): "Let's keep two hypotheses open: father and son locked in a power struggle, or mother protecting the son from father. I'll take the parents, you take the boy, and we cross over after about an hour."
• Watch for: The team arriving with a fixed diagnosis of the adolescent rather than a family view. It is working when roles are clear and the hypotheses are explicitly provisional.

4.3 Opening team-family conference

• Purpose / when: Immediately after the briefing. The whole team meets the whole family to introduce the method, hear each member's account and see the family's interaction live. [source: MacGregor, Guidebook excerpt]
• Steps: (1) Introduce each team member and their role, including the community worker. (2) Explain the two-day structure and that the team will split up and recombine. (3) Ask each family member in turn why they think they are here and what they hope will change, starting with the parents. (4) Note seating, who answers for whom, interruptions, alliances and who stays silent. (5) Close by announcing the split into separate conferences. [steps 1-5: synthesis consistent with the component description]
• Example language (illustrative): "Each of you probably sees the problem a bit differently. We want to hear all those views. Mrs. A., what brought you here? ... And what's your version, Tom?"
• Watch for: One member monopolising; the adolescent being discussed in the third person. It is working when every member has spoken and the team has seen at least one live pattern.

4.4 Concurrent separate conferences (by generation)

• Purpose / when: Straight after the opening conference. Subsets of the team meet family segments at the same time, typically parents with one or two therapists and the adolescent with another, with siblings seen as needed. Members can voice personal resentments and their own view without the others present. [source: MacGregor, Guidebook excerpt; Wikipedia]
• Steps: (1) Parents: explore their view of the problem's source, the marriage, parenting agreements and disagreements, and their own family backgrounds. (2) Adolescent: explore their view of the family, school and peers, and how family patterns connect with the behaviour (the original summaries mention delinquency). (3) Each therapist listens for roles, alliances and communication rules that link the two accounts. (4) Agree with each segment what may be shared with the others, and decline to keep secrets that bear on safety. [steps 1-2: Wikipedia; 3-4: synthesis]
• Example language (illustrative, to adolescent): "In here you can say it straight. What happens at home just before things blow up? ... When your dad shouts, where's your mum?"
• Example language (illustrative, to parents): "If Tom weren't in trouble, what would the two of you be arguing about?"
• Watch for: Parents uniting against the adolescent; the adolescent going silent; disclosures of abuse, which are a mandatory-reporting matter [synthesis]. It is working when each segment says something it would not say in the joint meeting.

4.5 Overlapping sessions

• Purpose / when: During the separate conferences. A team member from one interview joins another, so information and perspectives move across the family segments and the team. [source: MacGregor, Guidebook excerpt (component named)] [uncertain: the detailed mechanics below are not confirmed in a primary text]
• Steps: (1) At an agreed point, therapist A (for example, with the adolescent) joins therapist B's interview with the parents. (2) The visitor briefly reports, with any permission agreed, the gist of what the adolescent's view was. (3) The two therapists discuss it with the parents present and invite their response. (4) Therapists may then swap or return to their own segment. [synthesis]
• Example language (illustrative, visiting therapist to colleague, in front of parents): "What struck me with Tom was how much he wants his dad's approval. He just doesn't think he can get it except by being tough."
• Watch for: Breaches of what a member asked to keep private; parents feeling ambushed. It is working when parents engage with the other person's view instead of rebutting it.

4.6 Multiple-therapist sessions in chosen combinations

• Purpose / when: After the opening conference and through Day 2. The work proceeds through a series of different combinations of family members and therapists, including multiple-therapist sessions, as the emerging picture requires: for example father and son with two therapists, mother and daughter, or the marital pair. [source: MacGregor 1962 abstract; Wikipedia] [examples: synthesis]
• Steps: (1) In a short team huddle, decide which relationship most needs work (e.g. a cut-off father-son dyad). (2) Convene that subset with the therapists who know each side. (3) Help them speak directly to each other about the issue raised in the separate interviews; block speaking for the other or detouring through a third person. (4) Name the pattern as it happens and have them try a different exchange. [steps 1, 3-4: synthesis]
• Example language (illustrative): "Rather than tell me, could you tell your son what you just told us about being afraid he'll end up like your brother?"
• Watch for: Escalation beyond what the session can contain; a scapegoat being re-targeted. It is working when there is a direct exchange that differs from the usual pattern.

4.6a Individual interviews and group therapy sessions

• Purpose / when: MacGregor's 1962 abstract lists individual interviews and group therapy among the components used within the intensive, alongside multiple-therapist sessions. Wikipedia reports that individual plus group sessions gave the best results in the development series. Use an individual interview when one member needs to be heard alone. [source: MacGregor 1962 abstract; Wikipedia] [uncertain: who made up the groups (adolescents, parents or several families) and how long they ran were not found]
• Steps: (1) In a staff conference, decide who needs an individual interview (often the adolescent, or a parent whose own history is surfacing). (2) Keep it to one segment and agree beforehand what may be fed back to the team and family. (3) If the clinic runs a suitable group (for example an adolescents' or parents' group), the member may join one session during the intensive; brief the group leader. (4) Bring what emerges into the next combination or the reconvened conference. [synthesis]
• Example language (illustrative): "I'd like some time with you on your own this afternoon. Afterwards we'll agree together what you want the rest of the team to know."
• Watch for: The individual interview turning into a secret-keeping alliance; a member using the group to avoid the family sessions. It is working when the material is carried back into the family work. [synthesis]

4.7 Team conferences between segments (staffing)

• Purpose / when: "Brief staff conferences" are one of the components named in MacGregor's 1962 abstract. Hold them between half-day segments, for example at lunch or the end of Day 1, to pool observations, revise hypotheses and choose the next combinations. [source: MacGregor 1962 abstract (component named); Guidebook excerpt (half-day segments)] [timing and content: synthesis]
• Steps: (1) Each member reports in a few minutes what they saw. (2) Look for convergences and disagreements between disciplines; disagreements point to where the family splits the team. (3) Pick one or two target patterns for the next segment. (4) Agree who will name what at the reconvened conference. [synthesis]
• Example language (illustrative, team to team): "Notice that I'm siding with the mother and you with the father. That might be exactly what happens to Tom."
• Watch for: Team rivalry (a documented drawback of MIT); unresolved splits being acted out in front of the family. It is working when the team leaves with a shared, specific focus. [source for team conflict: Wikipedia]

4.8 Reconvened team-family conference (end of Day 1)

• Purpose / when: At the close of Day 1. The whole family and team meet again; members share what they gained and the team feeds back the patterns it observed. [source: MacGregor, Guidebook excerpt; Wikipedia]
• Steps: (1) Ask each member what, if anything, looks different after the day. (2) Team members summarise what they learned, in non-blaming family-pattern terms, linking each person's distress to the shared pattern. (3) Highlight any new behaviour seen during the day. (4) Set the task for the evening and Day 2 (e.g. notice when the old pattern starts). [steps 2-4: synthesis]
• Example language (illustrative): "Today we saw a family where everyone is working very hard to keep things calm, and Tom has ended up as the one who carries the anger for all of you. Tomorrow we'd like to see what happens when that load is shared."
• Watch for: Feedback heard as blame; one member not endorsing any change. It is working when members voice changed attitudes toward one another (the Day 1 goal reported in the summaries). [source: Wikipedia]

4.9 Day 2: consolidation and practical planning

• Purpose / when: The second day. It keeps the improved attitudes and applies them to the real situation, and settles concrete decisions such as whether the adolescent stays in hospital, returns to school, or needs another treatment. [source: Wikipedia]
• Steps: (1) Brief team huddle on the evening's reports. (2) Joint or subgroup sessions, chosen as in 4.6, focused on concrete issues (curfews, school return, the parents' joint stance). (3) Have the family negotiate decisions with the team present, the therapists coaching rather than deciding. (4) A closing team-family conference states the recommendations, the referral or placement decisions and the follow-up date. (5) Hand over a written or verbal plan to the community worker. [steps 1, 3, 5: synthesis]
• Example language (illustrative): "You've agreed Tom goes back to school on Monday. What will each of you do if the first week goes badly?"
• Watch for: Relapse into old patterns overnight. Use it as live material, not as failure. It is working when the family reaches decisions jointly and the parents act as a unit. [synthesis]

4.10 Involving the community or inpatient worker

• Purpose / when: Throughout. A staff member from the referring community agency or inpatient unit sits on the team. This builds trust and respect with parents and carries the plan forward. [source: Wikipedia, attributed to the 1962 paper] [uncertain: not mentioned in the 1962 abstract]
• Steps: (1) Invite the worker at referral. (2) Give them a defined role, for example co-interviewing a segment or reporting the context. (3) Have them present at the closing conference. (4) Agree that they will hold the plan between the intensive and follow-up. [steps 2-4: synthesis]
• Example language (illustrative): "Ms. B. from your county office will be with us both days, so she knows exactly what we agreed and can help between now and the next meeting."
• Watch for: The family seeing the worker as an enforcer (court, child protection). Clarify the worker's role openly. [synthesis]

4.11 Follow-up team-family conferences

• Purpose / when: MacGregor's 1962 report gives routine follow-up at 6 and 18 months, with home visits for half the cases. Review what held, reinforce the family's own problem-solving and adjust the plan. [source: MacGregor 1962 abstract] [uncertain: Wikipedia gives 2 and 6 months; the abstract's timing is followed here]
• Steps: (1) Reconvene the family with as much of the original team as possible, at the clinic or by a home visit (the original team visited half the families at home). (2) Ask each member what has changed and what has slipped. (3) Credit the changes to the family's efforts. (4) If the old pattern has returned, use a short version of 4.4 to 4.8. (5) Decide whether to close, do another follow-up or refer for ongoing therapy. [home visits: MacGregor 1962 abstract; steps 2-5: synthesis]
• Example language (illustrative): "What have you managed to keep from those two days, and what has crept back?"
• Watch for: Families attributing change to the team instead of to themselves; deterioration requiring a higher level of care.

4.12 Published adaptations (context only)

• Day-treatment intake: Tovey & Morton (1985) adapted MIT as an intake procedure for a day-treatment programme. [source: cited in Wikipedia] [uncertain]
• Nursing teams: Shaw et al. (1977) described MIT with nurses on the team. [source: cited in Wikipedia] [uncertain]
• Crisis family treatment: Washington County (Oregon) Children's Services Division's Immediate Conflict-Resolution Family Treatment Program was built on MIT together with family crisis theory. [source: Abikoff 1980 thesis abstract, via CORE]
• Piaget & Serber (1970): a further published report of MIT. [source: cited in Wikipedia] [uncertain]

5. Handling problems

The only difficulties the sources name are team conflict and the method's resource cost. Everything else here is [synthesis].

• Conflict within the interdisciplinary team [source: Wikipedia names this as a drawback]: Schedule staffing slots (4.7) and treat splits as possible mirrors of the family's splits. Agree a team lead for each day, and settle disagreements about recommendations before the closing conference, not in front of the family. Open disagreement in front of the family should be deliberate and respectful, never a turf contest. [synthesis]
• Resource intensity / "efficiency" [source: Wikipedia names relative efficiency as contested]: Use a reduced team (two or three clinicians plus the community worker). Run the intensive over two half-days a week apart if the family cannot stay locally. Say that this is an adaptation. [synthesis]
• A key member will not attend: Do not start the intensive with the parental pair incomplete. Phone the absent parent, framing their view as essential to the young person, or offer a separate first appointment. If they still refuse, run a modified intensive and name their absence as part of the pattern. [synthesis]
• Stuck family (no shift by the end of Day 1): In staffing, look for the pattern the team itself is caught in (for example, everyone talking to the mother). Change the combinations, e.g. convene the dyad that has been avoided, or see siblings who may describe the family more freely. On Day 2, reduce the goal to one concrete decision. [synthesis]
• Resistance / blaming the adolescent: Acknowledge the parents' exhaustion. In the separate parent interview, ask about their own relationship and families of origin. Feed the adolescent's view back through an overlapping visit (4.5), so it is not delivered as a confrontation. [synthesis]
• Overwhelm (a member breaks down or the session escalates): Split the group at once. One therapist stays with the distressed member and another with the rest. Reconvene only when de-escalated. With a long, intense day, build in breaks and food. [synthesis]
• Rupture with a team member ("you're on his side"): A different team member acknowledges the perception in the next joint meeting. The accused therapist may step back for one segment. Name the alliance as information about the family. [synthesis]
• Non-adherence after the intensive (plan not followed): Have the community worker contact the family within one to two weeks. At follow-up, ask what got in the way before restating the plan. If decisions collapse, consider ongoing family therapy rather than repeating the intensive. [synthesis]
• Confidentiality across overlapping sessions: Agree at the opening conference that the team shares what it learns, and ask each segment what must not be passed on. Safety information is never held as a secret. [synthesis]
• Safeguarding disclosures and acute risk: Disclosures of abuse or violence during separate interviews override the two-day plan. Follow local mandatory-reporting and safety-planning procedures. For suicidal or self-harming adolescents, complete a standard risk assessment, safety planning and lethal-means counselling (safe storage or removal) before and during the intensive. Consider whether admission is needed; MIT was explicitly used as a screen for that decision. [source for admission screening: Wikipedia; remainder synthesis]
• Family travelling a long distance (the original rationale; Galveston families came 50 to 450 miles): Arrange accommodation. Hold follow-ups locally through the community worker, by home visit (used for half the original cases) or by video. [source for distance and home visits: Rambo & Boyd 2017 abstract citing Ritchie 1960; MacGregor 1962 abstract; remainder synthesis]
• Modern context: No fidelity standard exists. Document the components delivered (4.2 to 4.11) so that the adaptation is transparent to supervisors and referrers. [synthesis]

Sources

Sources

• Multiple Impact Therapy, Robert MacGregor (Free Psychotherapy Books / IPI, excerpt of his Psychotherapy Guidebook entry), primary, excerpt only
• Multiple impact therapy (Wikipedia), secondary, summarising MacGregor 1962, Ritchie 1960 and Shaw et al. 1977
• Rambo & Boyd, "Multiple Impact Family Therapy" (NSUWorks record and abstract)
• Abikoff 1980, Multiple Impact Therapy: Evaluation and Design for Future Study (PDXScholar record) and CORE abstract
• Houston Galveston Institute (Wikipedia)
• Prosser 1967, review of Multiple Impact Therapy with Families, Social Work (OUP, metadata only)
• Family Process 1962: contents and abstracts (systemagazin), abstract of MacGregor 1962, primary abstract
• Harold A. Goolishian (1924–1991): Obituary (Swarthmore Works record), abstract only
• Multiple impact therapy with families (Texas A&M library catalogue) and IISG catalogue record, bibliographic data only
• Multiple Impact Family Therapy (Nova Southeastern scholars record), Rambo & Boyd abstract

Further reading (not drawn on) [uncertain where relied on]

• MacGregor, R. (1962). Multiple impact psychotherapy with families. Family Process, 1(1), 15–29. (Abstract via systemagazin; full text not drawn on.)
• MacGregor, R., Ritchie, A. M., Serrano, A. C., & Schuster, F. P., under the direction of McDanald, E. C. & Goolishian, H. A. (1964). Multiple Impact Therapy with Families. New York: McGraw-Hill (Blakiston), 320 pp. (Catalogue records; the IISG record dates it 1963; text not drawn on.)
• MacGregor, R. Multiple impact therapy. In R. Herink (Ed.), The Psychotherapy Guidebook (1980). New York: New American Library.
• Ritchie, A. (1960). Multiple impact therapy: An experiment. Social Work, 5(3), 16–21.
• Shaw, D., Fore, K., Ritchie, A., McAnulty, M., & Nixon, G. (1977). Multiple impact therapy. American Journal of Nursing, 77(2), 246–248.
• Piaget, G. W., & Serber, M. (1970). Multiple impact therapy. Psychiatric Quarterly, 44, 114–124.
• Tovey, R., & Morton, J. (1985). Adapting multiple impact therapy for day treatment intake. Child Welfare, 64(4), 421–426.
• Rambo, A. H., & Boyd, T. V. (2017). Multiple impact family therapy. In J. Lebow, A. Chambers & D. Breunlin (Eds.), Encyclopedia of Couple and Family Therapy. Springer. (Full entry refused, HTTP 429.)