Using a family’s strengths is critical to MST success
Some kids have a hard time fitting into the world around them. They have trouble in school. The police know them. They are disconnected from critical family relationships. And their friendships are fleeting, at best. Marissa came into the juvenile-justice system because she was truant from school, pregnant and "running the streets" every night. Her out-of-control behaviors put her at high risk for going into custody.
Kelly, an MST therapist from my team was assigned to work with Marissa and her mom, Bev. Kelly knew her first task was engaging Bev, as caregivers are essential in making interventions work.
Initially, Bev was not so keen to work with Kelly. She was skeptical of this thing called "Multisystemic Therapy" and wasn’t eager to let someone else into her home. She was a strong woman and disdained supports. Early on in treatment, Bev would often respond to Kelly’s suggestions with "no, that won’t work," with a little hint of sarcasm in her voice. For Kelly, this was a bit of a surprise as she was used to most families responding quickly to her high warmth and humor. Bev was different, and Kelly needed to slow down and understand why.
As Kelly listened, she learned a lot about what made Bev who she was. Her life was full of challenges that she had overcome essentially on her own. She worked a job during nightshift hours that she found undesirable, but continued to work as she would do everything she could to provide for her family. She learned early in life to rely on herself instead of others and believed that a strong work ethic was the most important thing. She felt great pride in doing things on her own, without "handouts." These are wonderful traits. However, they were now getting in Bev’s way of accepting help from anyone, including Kelly, and were inadvertently putting her child at risk of going into custody. Bev’s huge strengths made it hard for her to develop that trusting relationship needed to create change with MST.
Recognizing the mother’s love leads to progress
As a team, we racked our brains trying to figure out how to use Bev’s strong points to not only begin to trust Kelly, but also to trust in the process of change and take some action. Finally, we had a breakthrough. In our MST group supervision Kelly shared one of Bev’s key strengths. She said, "When either of her children enters the room, Bev lights up. Her children are her world." We recognized what Bev wanted most was to support her daughter, encourage and guide her on the right path. She wanted to see her children be successful. That was something that we wanted to help her and her family achieve, as well.
In MST sessions, Bev was given a forum to speak her mind, to be empowered to recognize that what she wanted for her children was important. That she was the decision maker. Using Bev’s desire to protect her daughter, Kelly focused on showing Bev that she thought Marissa was a smart, interesting kid, and together they could develop plans that would help the girl achieve all that Bev hoped she would. Kelly spent time engaging Bev in sessions and listening to her perspective. When she saw that Kelly valued her daughter not just in words, but in action, Bev began to view Kelly as a real support system.
Once trust was earned, treatment focused on how mom could set Marissa up for success. Bev expressed to Marissa her concern and desire for her to have a good future. She linked school attendance with Marissa’s work ethic and helped the daughter understand she would have an easier time getting employment if she was able to complete more school. Finally, she engaged in rewarding Marissa for school attendance (as well as ample praise). Together, they focused on curfew violations by having Bev check in and make sure Marissa was home, as a way of showing her that mom cared about her well-being and the health of her unborn child. Marissa responded immediately to mother’s simple check-in system and made an effort to be home so Bev would not worry. Marissa and Bev began to spend time together communicating, doing recreational activities on the weekends. Marissa made an effort to meet curfew and attend school. When the case closed, she was excused medically from school because she was at the end of her pregnancy, but was making an effort to complete schoolwork at home. She was slated to return to school after her child was born.
What made the therapist proud
When I asked Kelly to share with me what she was most proud of about this case, she said, "I did my best to meet the family where they were so that I could match what they needed in a support. Since they were so opposed to supports being in their home—and honestly in their lives in general—and they were expecting a cookie-cutter version of a therapist or formal support, I really tried to show them that a therapist can get just as much work done using a down-to-earth style. They responded very well to my approach, and we were able to accomplish a lot in a very short time as a result."
Kelly’s triumphs with this case are inspiring, but they are not the exceptions to the rule. All the therapists on my team experience success with their cases. The desire to connect and the desire to genuinely care for our families is what helps our team motivate them to change and try the interventions. As a team, we work hard on each case to identify and use individual youth, family, school, peer and community strengths to leverage these strengths in support of the family and young person to make sustainable changes. It is this strength focus–team approach that keeps us all going.
Jill Kleinfelter is an MST Supervisor at Pennsylvania Counseling Services.
To learn more about what makes Multisystemic Therapy such an effective intervention, download this white paper.
