How Multisystemic Therapy Empowers Families: A Therapist's View

Posted by Sarah Johansson

Jan 5, 2015 9:30:00 AM

MST provides parents with the tools to build strong families

When I think about the kids I meet and the families who invite me into their homes, I think about despair that no one should have to experience. These parents at some point lost the power, not only to their child who is acting up, but to the system. If you have ever held the hand of someone who is fighting back the tears as the judge is preparing to announce the decision he or she has made about the child's future, you know what despair I'm talking about.

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The beauty of offering Multisystemic Therapy as an alternative to placement is that you are helping families take back their power. MST helps to empower parents by offering resources, support and tools to regain control over their child's behavior and their child's life. If you look at the nine principles of MST, they are all constructed to do just that.

  1. Finding the Fit—No cookie-cutter solutions. What is the challenge for this specific child and this specific family? What is contributing to James staying out all night? What is making the family reluctant to give Alex a consequence for her negative behavior?

  2. Focusing on positives and strengths—Often when I meet parents, they will reflect, wondering "where did I go wrong?" and share a sense of having fallen short at raising their child. This principle instills hope because there are always strengths, in any and every family, and by pointing these out to the parents, you see a sense of relief in their eyes and a glimmer of hope. It is these strengths that we use to create change. Capitalizing on strengths gives them strategies they can use and continue to implement in the future.

  3. Increasing responsibility—By tailoring interventions to focus on increasing responsible behavior in family members, you are focusing on creating a self-reliant family that does not need support from the system because they have the tools to address challenges on their own.

  4. Present focused, action oriented and well defined—Contrary to popular beliefs, therapy, especially MST, does not mean fluffy conversations about our feelings. This principle means that based on the measurable treatment goals to address current behaviors, interventions are developed that require action. He locks himself in his room when the parent is trying to implement a consequence? Let's get off the couch and remove the lock from the door right now. She ignores the parent's calls when she didn't make it home on time for curfew? Let's install the app that locks her phone from all activity, but to call the parent back. The school never returns the parent's attempts to reach them? Let's use tomorrow's session to visit the school and see if we can find someone with whom the parent can maintain contact. Empowering the parents, one action-oriented intervention at a time.

  5. Targeting sequences—So, something didn't go according to plan. That's frustrating. Let's troubleshoot. By looking at sequences, the parent learns to evaluate an incident and identify what could have been done differently to create a more desirable outcome for them and the youth. Altering predictable sequences also allows families to change interaction patterns that have sometimes been problematic for years, thus this principle is at the heart of MST’s family therapy approach.

  6. Developmentally appropriate—To set up the family for success, all interventions need to be tailored to the youth's age and maturity level. Sometimes this is trickier than one might think. A parent will say "she's 17, so she should be able to handle this." But if a 17-year-old is behaving like a 10-year-old, we can't treat her like her chronological age. We have to develop interventions that target the 10-year-old behavior. When this is explained to parents, they will often chuckle, nod in agreement and say, “All right, let's do this.” At the same time, we make sure parents understand the changing needs as teens grow and mature. Similarly, all interventions are adjusted to the parents’ skills and take the family’s culture into account.

  7. Continuous effort—The idea behind this is that MST requires family members to work daily or weekly with interventions. And this makes sense for two reasons:
    • MST is time limited, and we want as much bang for our buck as possible.
    • Continuous effort becomes a part of the family's pattern long after they are done with MST. That equals sustainable change.
  8. Evaluation and accountability— MST holds therapists and their teams accountable for outcomes. If something isn’t working, we don’t blame the family. Ever. The family is doing the best they can with what they are given. It is my job as a therapist to provide them with tools that predict and address any barriers to their effectiveness. I am the support, I am the sounding board, I am the troubleshooting partner for the parents. I also assess our progress and effectiveness from multiple perspectives. I don’t assume that Diego is going to school because he walked into the house right after he should have made it from the train; I ask Dad to check Diego’s attendance records with the school and help the parents develop a link to the school to continue checking in after I’m gone.

  9. Generalization— The ultimate principle in giving power back to the family. All the interventions developed in treatment are tailored for the family to be able to maintain when MST is long gone. I am there for a very limited time. So the tools I offer need to be tools that can be used in the long run, without my support. When a family sends me a message six months after we closed to share how they just handled a situation with one of their other kids on their own with what they learned from MST, it gives me evidence of how this treatment has long-term effect for these families.

To me, this is how I view my role—to help build empowered families. By offering a family MST as an alternative to placement, the system is also empowering the family. Give those holding back tears in that courtroom the opportunity to gain control over their family's destiny, and let them spread that knowledge throughout their community.

“The strength of a nation derives from the integrity of the home.”– Confucius

Sarah Johansson is a clinical MST supervisor at Safe Space Sheltering Arms in New York City

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Topics: MST Community