“The beginning is the most important part of the work.” —Plato
The treatment had a bumpy start. The dad was verbally abusive toward me, to put it mildly, from the moment I walked in. Practically the first words out of his mouth were “F’ off! You can keep your f-ing treatment,” adding that the “F-ing boy is never coming to my house ever again!”
This anger isn’t uncommon. Juvenile offenders we see in Multisystemic Therapy have pushed their parents, caregivers, and families to the brink. Many of our families are beaten down trying to deal with their beyond-control children and have lost all hope. After trying what seems like everything, they wonder why to bother anymore. Often, they just want the pain and frustration to stop.
The despair may be viewed as simply giving up. However, with Multisystemic Therapy, we try to understand where parents like this father are coming from. With a more in-depth look, we pinpoint how to make the first of many changes. Often, it starts with very small steps, bits of coaching on a continuous, daily basis with small targets that help parents gradually build up the set of skills needed to manage, and then to maintain positive new behaviors.
For this family, let’s go back to the beginning. Their son was placed in the care of the local authority due to serious attacks directed at his parents and younger sister.
He was physically and verbally aggressive, missing from home as many as five times a week (often returned in an ambulance or by the police) and not attending school. He had three criminal convictions and was smoking cannabis daily. He was so unmanageable that some people felt that he didn’t belong at home or in the community.
Understandably, his parents were very reluctant to bring their son home. They were afraid. He carried knives and had threatened his dad with one. He had even assaulted his father and knocked him out
How MST addressed these complex problems
Given the attacks, I worked with the family to put a safety plan in place. This was aimed at stopping the violence and the immediate high-risk conduct of the son. To develop the safety plan, I made several visits to the home, day and night, to see how the family functioned. An underlying assumption in MST is that to best understand why a child is acting out, we must observe the ecology where the behavior is occurring. This meant understanding the minutia of what was happening, gathering sequences of actions to help the family recognize and change their behavioral patterns. The safety plan was tailored toward taking advantage of the family’s strengths. I offered 24/7 support to help and coach them through difficult situations. Over a few weeks, this led to reduced violence and a safer-feeling environment. I was able to establish credibility and put in place the foundation to intervene with unacceptable actions.
MST recognizes that there are outside influences. I made school visits and helped the family work closely with school personnel to address the son’s misconduct there.
We went one step further. Support from police was elicited to manage and supervise the young man when he was outside the home.
The case was closed after four-and-a-half months. The youth was no longer anti-social. He started college with the ambition to join the services. His dad, who when we first met told me to “F off!” now shared with me, “I’ve got my son back.”
Shane Ferris is an MST therapist and Dave Callahan is an MST Supervisor with the Manchester team at Action for Children.
