Different Countries, Same Multisystemic Therapy

Posted by Dr. Gregorio Melendez

Jan 21, 2016 9:30:00 AM

Communities may change, but MST does not

Inevitably, someone where I work will ask me a question along the lines of “So, how do we compare to other places that do Multisystemic Therapy?” A difficult question to answer, but my response is always, “It’s the same . . . but different.” It’s about as true an answer as I can possibly give.Same_but_different.jpg

In fact, it is remarkable just how similar children and families are across the places that I have implemented MST. Teens and their parents have the same struggles in Sacramento, California, as they do in Benton Harbor, Michigan; Trollhattan, Sweden; Baden, Switzerland, or any of the other three dozen communities worldwide in which I have worked. Teenagers who choose to smoke marijuana in the Wirral, U.K., do so for the same reasons as young people in Waterbury, Connecticut. Sometimes they are bored. Sometimes they have friends who smoke. Sometimes their parents are too busy to keep a close eye on them. Sometimes they don’t like school. The list is invariably the same. Chances are, no matter where you are reading this, you would say the same for the teens in your area.

Not only are the problems that families face strikingly familiar, but the solutions also have much in common. We reinforce positive behaviors such as attending school and getting involved in positive activities. We improve family relationships by helping them communicate and spend time together. We build and repair relationships between the family and other systems like schools and neighbors. We teach parents how to know where their kids are and what they are doing throughout the day. Above all, Multisystemic Therapy works just as well in any community that I have witnessed it being implemented.

Different countries, different idiosyncrasies 

At the same time, every community and every team that I have worked with has been distinct from one another. In England, people prefer taking their lunch at 1 p.m. They use Celsius to measure temperature, but miles to measure distances. In Sweden, workers are accustomed to taking a mid-morning break, complete with sandwiches. In Switzerland, it is still common for workers and students to go home to eat lunch, and you won’t find American-style bread and cookies anywhere. Swiss trains almost always run on time, but the Swiss often complain about the unreliability of trains. In the U.K., the trains rarely run on time, and people almost never complain. Denmark has the best sandwiches anywhere. Switzerland is not officially a country, but really it’s a collection of semi-autonomous regions. Despite its reputation of luxury and sophistication, Switzerland is mainly influenced by its farming community, even in social care. Up until recently, there was a tradition of farmers being appointed as guardians or caregivers for troubled or neglected children. Even today, there is still a system where children with difficult behaviors can be sent off to a farm to work for a few days, months or even years, often to great effect.

Sweden has no juvenile-justice system and quite possibly the most effective system of social care I have ever seen. It’s modern and well organized. Social workers there are well respected, well paid, well informed on the most effective practices and extremely good at their job. They don’t suffer from the heavy caseloads and turnover seen in other countries or systems. Malmö, Sweden, is a community of barely 300,000 people, but has one of the most diverse populations anywhere. More than half of its residents can either claim being born in another country or being born to parents who emigrated from elsewhere. When I last worked with the MST team in Malmö, not a single member was born to Swedish parents. I never would have thought that I would get more of an education in diversity in Sweden than in the U.S.

I could certainly go on with the hundreds and even thousands of little things that set these different countries, regions, cities, agencies, teams, therapists and families apart from one another, but I would never be able to list them all. All of us in MST have in common a desire to help families and to implement the model with as much consistency and fidelity as we possibly can, and all of us succeed at this despite, or perhaps because of, all the things that make us unique.

To learn more about what makes MST and effective treatment for at-risk youth, download this white paper.

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Topics: MST implementation

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