Giving a mother hope using MST principle four
Ms. Mitchell always answered the door in pajamas with a cup of half drunk tea in her hand. She would usher me into her living room and approximately 10 minutes into every session would chide herself for forgetting to offer me a cup. We sat in our respective chairs—me facing the window and she keeping a diligent eye on the clock above my head to remind her of the day’s approaching work shift. These were the things that never changed throughout treatment. We cherished our routines, greetings and small familiarities to counter the challenge of raising a young person with persistent challenging behaviors that led to his involvement in the child-welfare system.
“Do you remember the first time I met you?” I asked. We were nearing the end of Multisystemic Therapy (MST) treatment. Endings naturally inspire the mind to wander back to the beginning.
A knowing smile spontaneously broke out onto her face. It was obvious she remembered quite well.
I smiled, too. “Yes,” I said. “You sat where you are now and demanded I tell you exactly what to do and how to do it.” Ms. Mitchell had an extensive history of providers coming into her home who made a quick assessment and left her with a to-do list that felt unmanageable. Her son, Anthony, was 16 years old, and she was afraid of him. I recognized and appreciated her urgency, but also knew treatment would not be successful if Ms. Mitchell was working toward goals she was not part of creating. A key to the MST treatment model is to develop objectives with all the key participants, especially family members. Empowering Ms. Mitchell to identify what she wanted to get out of treatment for her and her family was an important first step to successful endings.
“You never told me what to do or how to feel. Sometimes I didn’t like all the questions you asked, but every time you left, I would think about what we talked about, and I’d realize how many other ways there were to look at my family’s issues,” she said. Anthony had been hospitalized many times due to his aggression and had seriously injured one of his family members.
Learning to let go of the past to reach a better future
Ms. Mitchell clung tightly to negative past experiences with Anthony and repeatedly told me nothing was going to change. Our work together focused on shifting her persistent thoughts of hopelessness toward a more “present” and action-oriented outlook. This was in keeping with MST’s Principle 4—action-oriented, present-focused and well-defined.
When Ms. Mitchell drifted to instances that occurred long ago, I guided her back to what was happening in the present. “I firmly believe present actions are the best indicators of future outcomes. We’re working together to assess what’s happening now, and that’s a good indicator that things will change,” I told her.
As time went on, Ms. Mitchell took comfort in the specifics of a safety plan and expressed relief that I noticed a subtle shift in the volume of her son’s voice required a quick shift in her response to him. Anthony’s aggression began to decrease mainly because Ms. Mitchell was responding to the child in front of her as opposed to the nagging fear in the back of her head that Anthony was immovable.
Mother stops blaming herself
“I thought I wanted someone else to do this for me,” she said. “I thought that maybe he was acting like this because I wasn’t strong enough or because I hadn’t done everything right when he was little.” Ms. Mitchell quickly took the lead on Anthony’s treatment and became more comfortable telling me what she wanted and how I could help her achieve that.
During our last session, I changed our routine slightly. I presented Ms. Mitchell with a small potted plant and a card explaining the significance of the plant. I reminded her that people, just like plants, require seeds to be planted and can only flourish when tended to by one who trusts the seeds will eventually bloom into something remarkable.
Alessandra Longo is an MST-SA Supervisor at Montefiore Medical Center in New York.
To learn more about what makes MST an effective intervention for at-risk juveniles, download this white paper.
