Multisystemic Family Therapy: What It Is And How Psychologists Use It
The emergence of very severe problems, such as crime or drug abuse, has the capacity to seriously condition the way a family lives its daily life and/or the emotional health of each of the people who make it up.
Sometimes, these circumstances lead to the group being completely isolated from the rest of society, which ends up making it even more difficult to put in place mechanisms that make it possible to transcend such moments of difficulty.
It is for this reason that, on many occasions, the social ostracism to which they are subjected acts as the subsequent catalyst for many of their misfortunes; and it becomes unavoidable that treatments aimed at breaking this inertia and recovering the path to happiness be articulated.
This is the fundamental purpose of multisystemic family therapy a complex program through which the effort and hope that it is viable to promote well-being where many others gave up trying are materialized without restrictions.
Multisystemic family therapy describes a form of intensive treatment, which focuses on addressing the adolescent and his or her family when there are serious problems that affect the entire group, particularly criminal behavior and drug dependence/abuse disorders. These are groups that may have experienced multiple failures in previous attempts to reverse their situation to the point that many times society has decided to abandon efforts to integrate its members into common spaces.
The philosophy underlying this model arises from systemic traditions, which understand human beings as social individuals and inextricably linked with the group to which they belong (generally the family).
Thus, the understanding of their reality would refer directly to the relationships that unite them to the others, in such a way that any variation that occurs in one element of the system would have its reflection on the rest. Thus, The emphasis of the treatment is focused on the group, and not on its members separately
The treatment approach makes use of several techniques that come from different schools, especially cognitive and behavioral, for which ample empirical evidence is available. The decision-making process, from which one or the other is selected, is carried out based on consensus of a small group of professionals who form a coordinated work team. This cohesion of therapists is the differentiating element of the perspective, along with 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 proposal (and for which there is growing evidence of effectiveness).
Intervention from this type of psychotherapy
The intervention format proposed with multisystemic family therapy is intensive, so that the professionals who dedicate their efforts to it are available to work with families twenty-four hours a day, seven days a week. This is why a coordinated group is required, so that there is always the possibility that at least one of its members can intervene in any crisis even during the most ungodly hours of the night.
The intervention is carried out in the family home, which significantly increases adherence to the program. These meetings aim to identify and treat any known risk factors, as well as more specific situations that may arise over time, to deploy attention that must be built on a relationship of trust between all parties. The therapist who engages 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, due to the way in which they offer their proposal (at the request of the patients themselves and at any time of the day or night), only covers a very small number of families. With this, it is plausible to dedicate the necessary time to each of these, since At least one weekly session is set as a goal And perhaps another of the essential descriptive elements of this therapy is that the family is never “abandoned”, and that any eventual failure is assumed as the responsibility of the team.
One of the basic objectives that is intended to be satisfied is improve the ability of each parent to adequately respond to their child’s needs which also translates into a strengthening of relations with the educational center and with the judicial authorities (in those cases in which the adolescent has participated in illegal activities).
It is also intended to replace the network of antisocial friends with a more prosocial one (through extracurricular activities that are of interest), since influences of this type are fundamental in this period. The promotion of quality social support in the family is also essential, both in its instrumental components (remediation of material needs) and affective (active listening to problems, gestures of affection, etc.).
The treatment must be sensitive to all mental health problems that may appear in any member of the family, and articulate evidence-based techniques with the aim of providing solutions The next lines will expose the basic principles that should guide the intervention.
Below are the ten “rules” that shape this form of therapy, and that give a good account of the objectives and principles that must underpin its correct 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 elements that maintain the situation over time through their functional relationship can be detected.
Detecting these circumstances (known as group adjustment) is necessary to establish the changes that will have to be made within family dynamics, perfectly exemplifying how the situation is linked to the interactive pattern of conflictive relationships.
2. Positive approach
From this therapeutic perspective The emphasis is placed on the positive aspects that all the people in the family could show since it will be from them that the new interaction scenario that is anticipated and promoted can be built.
Likewise, the recognition of strengths represents a social reinforcement that has often not been present in their lives, and a unique opportunity to strengthen their sense of self-efficacy regarding care. In addition, it is an effective tool to strengthen the bond between the therapist and their patients.
3. Increased responsibility
Irresponsible behaviors are often at the root of many of the adverse circumstances that both adolescents and their family members endure in their daily lives (inability to delay rewards, poor self-care, intolerance of frustration, etc.). That is why care must be taken to promote a subjective sense of responsibility, reorganizing roles at home and outside of it. Achievement and goal orientation are essential as well as reinforce all the advances that are achieved.
4. Orientation towards the present
The objectives of the program must be adjusted to the immediate needs of the family and the adolescent, in such a way that the conflict is operationalized in simple terms and practical solutions are offered for its resolution. In multisystemic family therapy It is vital that tools are provided at times that are critically and urgently important so pragmatism must be established as the most basic philosophy in day-to-day life with the group.
5. Sequence identification
With the passage of time, and the observation of the family unit, the therapist discovers the way events tend to happen And the series of causes and consequences that precipitate and maintain them within the family unit can often be located, as a kind of dynamics forged by habit through which to predict the imminence of a conflict. This privileged information allows us to anticipate and prevent moments of difficulty and motivate environmental and behavioral changes aimed at their avoidance or prompt resolution.
Adolescence harbors peculiarities in the ways of feeling and thinking, which must be taken into account Phenomena such as the personal fable or the imaginary audience (through which the young person perceives that his or her internal experience is unique and ineffable, or a source of broad interest for others), and the need to be accepted by the peer group, contribute decisively to their emotions and decision-making. Knowledge about this type of issues will be essential to understand how to approach the adolescent and the ties that he maintains at an extra-familial level.
7. Continued effort
The contact between the team and the adolescent’s entire family is always very close, as it extends over a long time through sessions requested by its members. However, all of them are also expected to make an effort to practice and develop all of the skills that are introduced little by little, as they are necessary for progress to be expressed. That is why the team tends to persist and never give up, preventing rejection dynamics from reproducing in the therapeutic act and aiming for at least one weekly session with the entire group.
8. Evaluation
The evaluation of the family is not carried out at the beginning and at the end of the process, but rather it is developed throughout it and on an ongoing basis. This way of proceeding allows for the rapid detection of obstacles and the implementation of effective solutions. For all this, The objectives are constantly redefined depending on the circumstances that occur in the family environment The evaluation of results may include semi-structured interviews and scientifically validated questionnaires.
9. Evidence
The therapeutic procedures to use They must be supported by empirical evidence and have demonstrated their effectiveness in the family context where the adolescent is located. Cognitive techniques are usually used (restructuring, decision-making training, control of impulsive acts, etc.), behavioral (stimulus control, behavioral modification, relaxation, etc.) and communicative (assertiveness training, reinforcement of positive parenting practices, etc.).
10. Generalization
The objective of the intervention is that any positive change that occurs is generalized to all the contexts in which the family intervenes (school, home, courts or any other) and that is also maintained over time. This is why the team can travel to any of these spaces if the need exists, and follow-up sessions are usually scheduled in the months following the end of the program.
