With over a decade of experience, longtime MST therapist shares what he has learned
Looking back, I remember my very first day in Multisystemic Therapy (MST). To be exact, it was Feb. 5, 2001. As I sat in the MST 5-Day Orientation, feeling a bit overwhelmed, I found myself wondering "What is this MST all about?" and "What I have gotten myself into?" Spring forward 15-plus years, and I cannot imagine myself doing anything else.
As I think about the families I have worked with, the teammates that I have had the privilege to work alongside, the support I received from my supervisors and experts, I realize there are valuable lessons that I have learned that keep me going every day.
I offer them to those who are just coming onboard as a way of saying welcome. And don’t worry, that feeling of a being a "deer caught in the highlights" will go away. Before long, like me, you will have golden nuggets to share.
Making the flexible schedule work
When I first interviewed for the MST therapist position, I was intrigued by the component of the model that was described as "a flexible schedule" to meet the needs of the families we work with. This meant I could be at a school meeting early in the morning, visiting a family’s home late at night or doing sessions on the weekends.
At that time, my children were very young. This work schedule meant I could stay at home and enjoy breakfast with them, not having to rush off to an office every morning. This really appealed to me. I could meet the needs of the MST families and meet my goal of being a very present dad to my four children.
As my children grew and became active in school activities, I found the flexibility of the MST schedule really worked. I would attend that school concert in the middle of the afternoon and get out to see my MST families at night. I would do paperwork early in the morning before my children woke up and stand by them as they got on the school bus. Yes, it took some juggling, but giving myself permission to work in this new way was really helpful. I am indebted to MHY Family Services, the MST provider, for letting me work at home, so this position was not a nine-to-five job, but rather as an opportunity that comes with flexibility to ensure that I offer the best to my MST families and my own family.
Confidence in the structure
I also found early on the structure of the MST model to be a perfect match. Developing clear and measurable goals at the onset of treatment with families and stakeholders, goals that are evaluated weekly, helped me know I was really making a difference. Seeing those real results of keeping youth at home, in school and out of trouble with the law, brought me deep satisfaction in the midst of some very challenging days. Throughout my tenure in MST, I never lost sight of how those short-term goals impacted young people and their families in the long term. For me holding, onto those successes makes it all worthwhile.
Hold onto the successes
Take one of my early cases, this is going way back. I was off to see a family I was "warned about." The youth was a 12-year-old, and he was seriously acting out. As I entered the home, I encountered not one, but three young people "climbing the walls," swearing, fistfighting, being aggressive toward their parent and generally, just being "large and in charge." It seemed that for this family, not only was our identified young person giving this mom a hard time, so were her younger children. She had her hands full. I knew almost immediately a key intervention for helping the entire family would be to get this youth involved in pro-social activities, to give the mom the support she needed and help the boy pick up some very valuable skills.
I learned quickly that the teen had always wanted to join the ski club at school. It just so happens that I love skiing. I used my connections to find free skis for him and worked with the family, school and MHY Family Services to get a scholarship to help pay for ski club. The club was to be a "growth privilege," therefore, not something denied him when he was acting up. (Growth privileges are not taken away for concerning behaviors. Instead, other effective rewards and consequences address acting out.) Once mom saw the value of this concept, she was onboard in helping him earn privileges for things like attending school, communicating at home without aggression and coming home on time. This left ski club as a time for him to enjoy being with his pro-social peers.
As the case was ending, mom and I looked back at how her effective collaboration with school, her use of rewards and consequences, and how her son’s involvement in pro-social activities profoundly impacted his behavior.
I was fortunate enough to follow how this youth did over the years. He continued to go to school, stopped getting in trouble inside and outside of home, remained active in ski club, joined the baseball team and played soccer. It was rewarding for me to see the trajectory of his life had, indeed, changed.
If you are true to the model, it will be true to you
I know it is going to sound like a cliché, but what has served me best all these years in MST is adhering to the model. When I find myself lost, I re-ground my concentrating on the Do Loop (that’s where we create change by slowing down to first seek understanding and then speeding up by acting and doing) and the MST Nine Principles. Using the model with families and my team helps me find my way forward.
I would tell those who are just starting out in MST that if you take the time to learn the model and see the best in families, this will be a great career path.
To learn more about what makes MST an effective intervention, download this white paper.
