Finding the Right FIT for Mum and Son With Multisystemic Therapy
MST clinicians often get asked how we effect change in families who are mandated to services or families who have not had success in other services. The answer is pretty straightforward, in MST, we maintain a constant focus on engagement and alignment, we meet people where they are and leverage their strengths for change.
This case began deceptively well. The family had bought into meeting with the therapist and changing the son’s behavior. Then a barrier was hit. The mother wasn’t buying MST’s focus on working with and treating the entire family.
During the first week, trying to understand the dynamics, we discussed all the things that were getting in the way of successful collaboration and completed an MST FIT circle to collate the information we gathered. We called it “Mum and MST not working well together.” The most powerful thing that we identified was mum struggling with the idea that we would not be working with her son one to one. The therapist explained the process of MST and the importance of sustainable changes. Mum felt that if we did not work with the youth, then she was responsible. She felt that our focus on her was communicating that we saw her as the problem. This was not how we wanted her to see it. But she felt blamed, so we tried to understand everything that was driving her perception.
In the second week, we completed another MST FIT on “Mum feeling responsible/blamed for her son's behavior.” Out of this understanding, we started to include the youth’s dad in making plans and did some basic cognitive behavioral therapy work with mum. At this point, she was not giving us permission to go into much depth, but she was working with us.
In hindsight, mum was telling us through the process that we hadn’t agreed on the best way forward. Still, she was meeting with the therapist, doing homework and engaging in sessions, so our low engagement and alignment with her wasn’t obvious. We could see the advances and assumed that she could, too, and would start to believe progress was being made. Mum was willing to come up with plans, put them in place and see what worked. Ultimately, there was no agreement on why this youth showed these problem behaviors. This became apparent in week 11 when we identified that his conduct was escalating in an extinction burst, one last push back against the changes. However, mum found this really difficult because it looked to her like the plans weren’t working.
We went back to that FIT we started early on of “Mum and MST not working well together” and tried to get a deeper understanding of this. We found mum’s driver. She felt her son was in charge. Delving further, we found a mismatch between how we were viewing parental authority and how she viewed it. We were encouraging mum to keep her control by not getting drawn into arguments and confrontation. Mum felt MST was letting the boy win by encouraging her to disengage from conflict.
Now that we could see that mum wanted more authority in the home, we could define the way forward with more accurately designed interventions that better suited what she wanted to achieve. At this point, we paused and spent some time explaining to the mother how MST wanted to work with her and asking how she wanted to work with us. We started scaling sessions on how helpful they had been to get a good picture of whether we were still working together and in a way that felt beneficial to mum. This allowed us to move from therapist “knowing and telling” mum and her wanting to see change, to a more collaborative approach. We focused on the strengths of what she was doing right and on building on these rather than the areas where we did not agree. This gave her more say and ownership, which fitted with her sense of responsibility. The struggle of feeling responsible shifted and now became the strength of being responsible.
By listening and understanding these barriers, we were able to address them in a way that made the mum feel in charge of the MST process. This, in turn, led to her feeling empowered to manage her son’s challenging behavior. She could them generalize this feeling of empowerment when dealing with other professionals.
Emma Lowe is an MST Therapist from the UK Barnsley Team