MST's analytic process gives hope to families with troubled adolescents.

Families with adolescents who have committed crimes are often at the end of their tether and have lost all hope. The first question to their MST therapist often is “what could you possibly do that we haven’t tried?” Then they say, “And believe me, we’ve tried everything, and nothing works.” What they quickly come to learn is that MST's approach to working with families is different from anything they've tried in the past.

That's because MST is rooted in understanding the family's unique circumstances and their strengths. The therapist uses the MST Analytic Process, what we call the Do Loop to create change by slowing down to first seek understanding and then speeding up by acting and doing.

First, the therapist works with the youth, family, and other key stakeholders to establish engagement and alignment. One critical step is to identify everyone involved and ask them for their desired outcomes. The therapist might ask “What do we want to accomplish together in the next three to five months?” Desired outcomes can sound very different from family to family. For instance, families might say, “I just want her to listen to me" or “To get my family back”. We often hear the hopelessness in their voices when we start, and we quickly look for opportunities to help them turn things around. 

Therapists also endeavor to get a clear picture of the youth’s primary (referral) behaviors, asking about the intensity, frequency, and duration of these conducts. This helps the therapist, supervisor, and expert know what behaviors are of most concern at the start and during each week as treatment progresses.

Using the analytic process effectively is crucial for success.

This collaborative thinking and teaching families that by focusing on their strengths, building their skills, and their natural supports and resources, they have the power to create change. Families become less reliant on outside systems and more able to manage current and ongoing problems. If a therapist is working with a 15-year-old female with a history of aggression, running away, and not going to school, we need to have an understanding of what is behind this behavior, including the biggest reason or what we call, the prioritized driver.

For example, the parents identified that their daughter's friends were greatly influencing her behavior. She was hanging late at night with them and then cutting school the next day. A potential strategy would be for the mom to retrieve the girl from her friend’s house every night at nine. The therapist helps mom create the plan and role-plays to ensure mom is ready to run with it. If the plan works and the youth is returned home safely, she may earn a positive reward for her compliance. If the plan fails, the therapist and mom look at what did work (advances)—and what didn’t work (barriers). If we tweak or change one thing, will the plan be more successful? This disciplined thinking is the crucial step of slowing down to understand what did and didn’t work before trying something new or different. This process occurs until the family sees the behavior change they’ve wanted. The therapist encourages the family to not give up and to believe there is light at the end of this tunnel.

At the end of MST treatment.

The therapist circles back to the top of the Do Loop with the family to assess whether the ultimate goal of MST was achieved—is the youth at home, attending school, or enrolled in a vocational training program? Is she out of trouble with the law, meaning no new arrests? This then allows us to gather evidence of how well the family is equipped to generalize what they have learned in treatment and will they be able to use the techniques they've learned long after the therapist is gone.  

Jessica Crowe, LCSW is an MST Clinical Supervisor at Tides Family Services, Lori Moore is an MST Coach for MST Services

To learn more about MST,  download this white paper.