Identifying an individual solution for each family
"I don't know what to do with her anymore." Ms. Martinez and I sat knee to knee on her black vinyl couch. "Maybe she would be better off living somewhere else. A place where she has lots of rules."
Ms. Martinez's words may have seemed callous but sending her daughter away appeared to be the only viable option to keep her safe. I placed my clipboard on the seat next to me and looked at her face. "I know how overwhelming this all seems right now. We know Gabriela is using drugs, not going to school, and maybe involved in a gang. Sending her away might make some problems go away temporarily but what will happen when she comes home to the same environment? I think we have a better chance of helping Gabriela by looking at all the pieces of the puzzle."
A low whistle escaped her lips, "Miss. Alessandra, that sounds like a hard puzzle!"
Breaking down barriers into manageable pieces
"Let's take it one piece at a time and see what happens." I picked up my papers and began to ask her questions. As we mapped out Gabriela's problem behaviors, some patterns emerged. When we looked at Gabriela’s truancy, it became apparent that Ms. Martinez's communication with the school was close to nonexistent. I asked her about this.
Her face dropped. "They are so mean to me over the phone and only tell me bad news. I don't call anymore because I don't like to hear how bad my daughter is doing and I don't like getting attitude."
"I can imagine that would be discouraging." Ms. Martinez’s anxiety about communicating with her daughter’s school was palpable. It would have been easy to have labeled Ms. Martinez's fear about visiting the school as apathy. Taking the time to explore the barriers to Gabriela's school attendance helped reinforce the first principle of MST, "Finding the fit." Finding the fit is an integral step to tailoring the most effective interventions on a case-by-case basis. Completing fit circles in Multisystemic Therapy helps us understand how a family’s problems fit together and also helps MST clinicians be scientifically minded and avoid blaming any person or system for the youth’s behavior.
Designing interventions tailored to the needs of family
Ms. Martinez revealed to me that she needed help being more assertive with the many systems connected to Gabriela. As we continued with our fit circles, Ms. Martinez shared that she was reluctant to set limits with her daughter due to a deep-seated fear of losing the close bond they shared. She prided herself on the warmth she provided to Gabriela that she never experienced as a child.
Using our fit circles, we designed interventions to target the most powerful and proximal drivers to Gabriela’s acting out behaviors. Once we determined the poor to non-existent communication between Ms. Martinez and the school was a priority driver on the fit for truancy, we planned for a school meeting where I would accompany Ms. Martinez.
During the school visit, Ms. Martinez was able to articulate her expectations to Gabriela and demonstrate a vested interest in her education. Ms. Martinez focused her teary eyes on her daughter, "Gabriela, I need to know where you go. I am your mother and I don't want you wasting your education and following around people who are going to mess you up." Gabriela's guidance counselor recognized Ms. Martinez's sincere dedication and thanked her for coming to support her daughter. She also volunteered to call Ms. Martinez each morning to let her know what time Gabriela arrived at school in order to increase monitoring.
On our way out Ms. Martinez spontaneously hugged me. "Thank you," she said. "My mom didn't ever tell me anything nice about myself. She told me I'd never been anything good and then she left. Gabriela needed to know someone out there cared about what she did. She needed to hear that from me."
Please note: The names have been changed to protect the identity of the family.
To learn more about what makes MST an effective intervention, download this white paper.
