Caregivers are really powerful models in our children’s lives. Even through adolescence, when we might feel as though our teenagers couldn’t care about us less, parents are still the number one influence on behavior and choice-making. Right now, everyone is under stress which naturally means behaviors and pain points are escalated. Schooling virtually, being disconnected from social networks, cancellations of activities, all of these things mean that especially for adolescents, our emotional management and resources are low.

Today, I’m sharing some of the interventions and perspectives that Multi-Systemic Therapy (MST) leads with. Even when you think there’s nothing that can be done, or a child is too out of control, there is so much hope and potential. However, evidence shows that sometimes, change can happen by shifting the focusing from the angry or disconnected teenager and focusing on empowering the caregiver.

Quickly, I’ll share an overview of MST. MST is an evidence-based community based mental health treatment for adolescents and families. The overriding goal of Multisystemic Therapy (MST) is to keep adolescents who have exhibited serious struggles (e.g., drug use, violence, severe criminal behavior) at home, in school, and out of trouble. Through intense involvement with the family, MST aims to uncover and assess the functional origins of adolescent behavioral problems. We work with families very closely over 3-5 months and support the caregivers, address the root issues, and create a strong foundation for future success.

The saying “it takes a village to raise a child” is one we say often because it’s so true! As a society we rely on our village to help mold our children for today’s world. We use this perspective when it comes to problem solving behavioral challenges in children. We work with people in that village to create change that can be sustained long after the clinician leaves. We ask: what are the caregivers’ support systems? Where can they seek help when they need it? Who can encourage them when things get hard or the teenager pushes back (which will happen!)? Strengthening these systems means that there is a place to land when things are hard, and a place to celebrate when things go well.

Here’s the thing: there are no bad kids. Our brains, specifically the part that is responsible for decision making, does not fully develop until we are in our 20’s and sometimes our late 20’s. This means that our ability to make wise decisions also has not developed. There’s a natural limit and reason why some adolescents and children act irrationally and emotionally. That said, these behaviors are going to understandably frustrate the caregiver! MST clinicians work to empower parents in finding a balance between acknowledging the behaviors and their ability to manage those behaviors as the person who is capable of making well thought out decisions. 

Understanding the developmental process and behaviors is important, but understanding alone won’t be enough to shift the family system to create long-term change. That’s why we have to look at each family closely and identify the specific needs. All children are different and require different types of structure. Take school for example: children have individualized education plans to help with their individual education needs. Adhering to a structure or routine is also a type of learning! Humans are capable of becoming accustomed to doing things differently, it just takes work and practice. The MST clinician is there to give a fresh perspective for each child. When you look at all the different influences on a family and a child’s life, you can put measures in place and make a real difference. Is the trigger school? Does the caregiver know how to put boundaries in place and stay strong behind them in an age-appropriate manner? Are there social influences that need to be addressed? Do caregivers work extra long hours and leave a lot of unstructured alone time? Is there depression/anxiety/substance use? Once we understand the makeup of the struggles, we can create solutions to each and every one.

In order to be successful, caregivers need to acknowledge that they are the most influential people in the child’s life. Despite the challenges they may be facing with the child, directives that come from them are more effective and longer lasting than directives that come from a stranger, even if that stranger is a professional therapist. The goal of MST is to help parents change the structure of the child environment to reduce or eliminate the problem behaviors. However that change needs to come from the parent in order for it to have a long lasting effect.

Despite what teenagers might say, they thrive in well structured environments. Routines in the home and school contribute to success. However structure is not just about the routine itself but also how that routine is enforced. This program helps caregivers to enforce that structure in a way that also promotes a healthy and trusting relationship between the caregiver and child.

Something I always tell clients, regardless of the challenge we are working on, is that you can only control yourself and your reactions, not other peoples. That is why we need to be the change we want to see. It can be difficult to take ownership of your role in a situation but the best way to make a change is to do it yourself. The kids that come through MST tend to be defiant which is also the case when it comes to participating in therapy. Working with the caregivers allows the clinician to work around these barriers and focus on creating structure in the home. Change is difficult for everyone and our role is to be a support during these difficult times.

Systemic change is life-long change. When you learn new ways of interacting, build strong supports, create boundaries and work hard for change, there’s so much possibility. If you have questions about MST, or have a family that might be a good fit, please reach out. We’re here. There is hope.

 

About the author:  Khushbu Shah is the MST coordinator for Montgomery County. She has been with Child Guidance Resource Centers and the MST department for over 4 years. When she’s not at work, you can find her practicing recreating restaurant meals at home or hanging out with her dog.