Multisystem family therapy: what it is and how it is used by psychologists

The occurrence of very serious problems, such as crime or drug addiction, has the ability to severely condition the way a family lives their daily life and / or the emotional health of each of the people who make it up.

Sometimes these circumstances cause the group to isolate themselves completely from the rest of society, which ends up making it even more difficult to put in place mechanisms to overcome these moments of difficulty.

It is for this reason that, on many occasions, the social ostracism to which they are subjected acts as the further catalyst of many of their misfortunes; and it becomes essential that treatments are articulated to break this inertia and find the way to happiness.

This is the fundamental objective of multisystem family therapy, A complex program through which unconditionally materializes the effort and hope that are viable to promote well-being where many others have given up trying.

    Multisystem family therapy

    Multisystem family therapy describes a form of intensive treatment, which focuses on the management of the adolescent and his family when there are serious problems affecting the whole, in particular criminal behavior and substance abuse disorders. / abuse. These are groups that may have experienced several failures in previous attempts to reverse their situation.To the point that society has often decided to abandon efforts to integrate its members into common spaces.

    The philosophy behind this model stems from systemic traditions, which understand human beings as social individuals and inextricably linked to the group to which they belong (usually the family).

    Thus, the understanding of their reality would refer directly to the relationships that unite them to others, so that any variation that would occur in one element of the system would reflect on the rest. For that, the treatment focuses on the collective and not on its members separately.

    The therapeutic approach uses various techniques from different schools, in particular cognitive and behavioral, for which there is a lot of empirical evidence. The decision-making process, from which one or the other is selected, takes place on the basis of consensus. a small group of professionals who form a coordinated work team. This cohesion of the therapists is the differentiating element of the perspective, next to the way in which the times and spaces in which the action takes place are organized.

    From now on, we will delve into these and other questions, from which it will be possible to understand the specific characteristics of this very interesting proposition (and for which there is more and more evidence of effectiveness).

      Intervention of this type of psychotherapy

      The intervention format offered with multisystem family therapy is intensive, so the professionals who dedicate their efforts are available to work with families twenty hours a day, seven days a week. This is why a coordinated group is necessary. that there is always the possibility that at least one of its members can intervene in the event of a crisis, Even during the most untimely hours of the night.

      The intervention is carried out in the family home, which obviously increases adherence to the program. The purpose of these meetings is to identify and address known risk factors, as well as more specific situations that may arise over time, in order to draw attention to the need to build a relationship of trust between all the parts. The therapist engaged in this form of treatment must have the ability to deal with unforeseen events and be able to tolerate stress / uncertainty.

      The team of professionals, by the way they offer their proposal (at the request of the patients themselves and at any time of the day or night), only manages to cover a very small number of families. With this, it is plausible to devote the necessary time to each of them, because the goal is set at at least one weekly session. And perhaps another essential descriptive element of this therapy is that it is never “left” to the family, and any eventual failure is taken on as the responsibility of the team.

      One of the fundamental objectives to be achieved is improve the ability of each parent to adequately meet the needs of their child, This also results in a strengthening of relations with the school and with the judicial authorities (in cases where the adolescent has participated in illegal activities).

      He also aims to replace the network of antisocial friends with a more prosocial network (through extracurricular activities that interest him), as such influences are fundamental at this time. The promotion of quality social support in the family is also elementary, both in its instrumental (modification of material needs) and emotional components (active listening to problems, gestures of affection, etc.).

      Treatment should be sensitive to any mental health problems that may arise in any member of the family, and articulate factual techniques in order to provide them with a solution. The following lines will outline the basic principles that should guide the intervention.

        Principles of multisystem family therapy

        Here are the ten “rules” which shape this form of therapy and which reflect the objectives and principles that must underpin its successful implementation.

        1. Find the fit

        According to the principles of the systemic paradigm, the adolescent’s problem will adapt to the characteristics of his family environment, So that in this will be able to detect elements that maintain the situation along the time through its functional relationship.

        Detection of these circumstances (called group adjustment) is necessary to establish the changes that will need to be made within family dynamics, perfectly illustrating how the situation relates to the interactive model of conflicting relationships.

        2. Positive approach

        In this therapeutic perspective the focus is on the positive aspects that everyone in the family could show, Since it is from them that the new anticipated and promoted interaction scenario can be constructed.

        Likewise, recognition of strengths is a social reinforcement often absent from their lives and a unique opportunity to reinforce the sense of self-efficacy in care. In addition, it is an effective tool for strengthening the bond between the therapist and his patients.

        3. Increased responsibility

        Irresponsible behavior is often the root of many adverse circumstances that the adolescent and their family members endure in their daily lives (inability to delay rewards, insufficient self-care, intolerance of frustration, etc.). Therefore, care must be taken to promote a subjective sense of responsibility, by reorganizing roles at home and abroad. Achievement and goal orientation are essential, In addition to reinforcing all the advances made.

        4. Orientation to the present

        The objectives of the program should be tailored to the immediate needs of the family and the adolescent, so that the conflict is operationalized in simple terms and practical solutions are offered for its resolution. In multisystem family therapy it is vital that tools are provided at times of critical and urgent importance, Pragmatism must therefore be erected as the most basic philosophy on a daily basis with the group.

        5. Sequence identification

        Over time and observation of the family unit, the therapist discovers how events tend to happen. And it is often that the series of causes and consequences can be localized that precipitates them and keeps them within the familiar unity, like a sort of habit-forged dynamic to predict impending conflict. This privileged information makes it possible to anticipate and prevent moments of difficulty and to motivate environmental and behavioral changes geared towards their avoidance or rapid resolution.

        6. Evolutionary adequacy

        Adolescence has peculiarities in the ways of feeling and thinking, which must be taken into account. Phenomena such as personal fable or imaginary audience (through which the young person perceives that his inner experience is unique and ineffable, or a reason of great interest to others), and the need to be accepted by the group of peers, contribute decisively to their emotions and decision-making. Knowing these types of issues will be essential in understanding how to approach the adolescent and the connections he has outside the home.

        7. Continuous effort

        The contact between the team and the whole family of the teenager is always very close, because it extends over a long period through sessions requested by the members of the latter. However, all should also strive to practice and develop all the skills that are introduced little by little, in the fact that they are necessary for progress to be expressed. This is why the team tends to persist and never give up, prevent the reproduction of the dynamic of rejection in the therapeutic act, And claiming at least one weekly session with the whole group.

        8. Evaluation

        Family assessment is not carried out at the beginning and end of the process, but develops throughout it and on an ongoing basis. This way of proceeding allows the rapid detection of obstacles and the implementation of effective solutions. For all this, goals are constantly redefined according to the circumstances of the family environment. Assessment of results may include semi-structured interviews and scientifically validated questionnaires.

        9. Proof

        Therapeutic procedures to be used they must be supported by empirical evidence and demonstrated to be effective in the family context in which the teenager is. Cognitive (restructuring, decision training, control of impulsive acts, etc.), behavioral (control of stimuli, behavior modification, relaxation, etc.) and communication (assertiveness training) techniques are often used. used., Reinforcement of positive parenting practices, etc.).

        10. Generalization

        The aim of the intervention is that any positive change that occurs is generalized to all contexts in which the family operates (School, home, courts or any other) and that it is also maintained over time. This is why the team can move to any of these spaces when needed, and follow-up sessions are usually scheduled in the months following the end of the program.

        Bibliographical references:

        • Eeren, HV, Goosens, LM, Scholte, RH, Busschbach, JJ and van der Rijken, RE (2018). Multisystem therapy and functional family therapy in relation to its effectiveness using the propensity score method. Journal of Anomalous Child Psychology, 46 (5), 1037-1050.
        • Henggeler, SW (2012). Multisystem therapy: clinical fundamentals and research results. Psychosocial intervention, 21 (2), 1-8.

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