How the MST Model Engages and Motivates Clients in Family-Based Therapy

The outcome of any form of counseling depends on how well the therapist is able to engage the client and their caregivers in sessions.  The same can be said for family therapy interventions. If the therapist isn’t able to engage family members, it can impact how well interventions will be implemented that positively affect the entire family.  

When it comes to family-based counseling, therapists measure client engagement in the following ways: 

• Attending the sessions regularly

• Sharing openly during the sessions

• Being willing to discuss difficult topics 

• Participating in exercises and activities during the session 

• Completing therapy homework between sessions 

• Attempting to integrate insights into their day-to-day life 

When a therapist is able to engage clients, they are likely to achieve better outcomes more quickly, not only for the client but the entire family.  

Multisystemic Therapy (MST) works to address known barriers to client and caregiver engagement and utilize the strategies below, though this is not an exhaustive list.  

MST Borrows From Evidence-Based Research for Strategies To Ensure Family Engagement

Murray Bowen’s family systems theory holds that individuals are inseparable from their networks of relationships. Engaging the whole family in the therapeutic process can improve outcomes with at-risk youths.  

• Engagement in family-based counseling may improve: 
• Stability in the home 
• Relationships between family members 
• The child’s self-esteem and self-worth 
• Stressful situations that may be affecting the child 
• Conflict management in the family 
• Behavior that is modeled to the child/ren 

Because home stability and familial relationships can significantly decrease mental health symptoms, family engagement can result in better outcomes for the child and their entire family. 

Barriers Therapists Encounter When Engaging the Family System  

MST assumes that clients and caregivers are doing the very best they can based on their own unique strengths, struggles, and circumstances. Some factors may make it difficult for them to attend and fully participate in counseling sessions. It is the therapist’s responsibility to develop interventions to overcome any identified challenges to engagement. 

MST therapists address the below barriers by meeting when it would work best for the caregiver, coming to the home for a session, and tailoring interventions to address unique family factors that pose barriers to treatment success.  

Barriers families may encounter: 

• Work schedules that interfere with appointments 
• Difficulties with transportation  
• Mental health problems that affect functioning (including depression, agoraphobia, or substance use problems) 
• Physical health issues 
• When cognitions and misunderstandings are a barrier to family-based counseling, the MST therapist will address the following challenges: 
  • Fears and anxieties around self-expression 
  • Distrust of the counselor and/or family members 
  • Mental health stigma 
  • Negative or unrealistic expectations of counseling 

MST therapists consistently take the one down to seek to understand in a sensitive, empathetic way what is causing the lack of engagement. Therapists ask open-ended questions that allow the client and caregiver input every step of the way during treatment.   

Strategies To Increase Family Engagement

Motivational interviewing  when a client or caregiver has substance use behaviors

In MST,  Motivational interviewing is used to engage clients to address substance use behaviors. Motivational interviewing is a strategy often used to help motivate ambivalent clients to change their behavior and adhere to their plan to change. It’s proven to be effective in helping clients with substance use problems and a range of other situations. 

Motivational interviewing often involves: 

• Exploring the possible pros and cons of making a change 
• Discussing your client’s motivations to change 
• Creating optimism by discussing other instances where they demonstrated resilience 
• Discussing what change looks like to them 
• Honoring their autonomy by emphasizing that change is up to them
  

Focusing on the client’s values 

It is critical to ask the client what they want from family counseling and check in throughout treatment. It may be that they feel hopeless, apathetic, or distant from the challenges being discussed in family therapy. 

You could ask questions like: 

• What is motivating you to be here today? 
• What changes are you hoping to achieve? 
• If you could improve any aspect of your life, how would it look?

These questions can be tailored to your client’s situation.

Individual counseling 

When there are individual youth factors presenting a challenge in treatment, individual counseling sessions may improve engagement in family-based counseling.  

Some family members may feel more comfortable discussing their personal difficulties in a private session. On the other hand, a family member in crisis may need a more personalized and private session so that group sessions can be spent engaging all family members, not just the individual in crisis. 

Creating connection 

Counselors work to engage family members by increasing their trust and demonstrating respect for their clients. Counselors work to ensure that sessions are a safe space for sharing. Connecting with the client can help them feel more invested in counseling. 

A connection can be established through a number of ways, including: 

• Setting clear expectations for counseling and therapy sessions 
• Showing empathy and compassion 
• Practicing active listening  
• Using relatable metaphors and analogies  
• Using humor or levity where appropriate

Establishing a connection may take longer with some clients than with others. Time and patience, along with consistent effort and tailoring the approach to the family, may help.

Stress management strategies 

Therapists should tune into times when clients and caregivers are feeling overwhelmed and stressed, which can cause clients to participate little in counseling sessions — or to miss them altogether. Helping them employ stress management strategies could help them be more present during sessions. 

Stress management strategies might include:  

• Identifying key stressors 
• Discussing priorities 
• Considering whether stress-inducing, low-priority commitments could be avoided 
• Exploring healthy stress-relief techniques 
• Identifying habits that can reduce stress (such as sleep patterns and time management techniques) 

Stress management strategies are useful skills that can serve your client beyond helping them engage more in counseling sessions. It can improve their quality of life and that of their family.

Social support strategies 

When a client lacks social support, and it contributes to a lack of engagement, it is helpful to take a systemic approach.  

Consider helping the client brainstorm resources and strategies that might make it easier for them to attend. In some cases, counselors may suggest other support services.  

If a client struggles to attend because of substance use, the therapist would look at the contributions to the substance use and intervene to address the concerns while simultaneously addressing other concerns. In this case, a multi-systemic approach, such as Multisystemic Therapy (MST), provides the mental health and substance abuse help needed for client progress. 

MST uses evidence-based practices to help at-risk families gain work and life skills to make healthy choices and lead successful, fulfilling lives.  

MST is an evidence-based alternative to incarceration or severe system consequences due to serious externalizing, anti-social, and/or criminal behaviors. MST effectively treats youth and their families by utilizing a built-in suite of interventions within the home, school, and community settings. Treatment is tailored to the family and their individual strengths and needs, which could include but is not limited to the following types of therapies: Family Therapy, Cognitive Behavioral Therapy, Drug and Alcohol Treatment, Mental Health Services, Peer Ecology Assessment and Intervention, Trauma-informed treatment, and Educational/ Vocational Support. 

If you or someone you know is interested in learning more about Multisystemic Therapy,  contact us here.