Multi-system family therapy: what it is and how psychologists use it

The irruption of very severe problems, such as crime or drug abuse, has the capacity to seriously condition the way in which a family lives its daily life and/or the emotional health of each of the people that make it up.

Sometimes these circumstances precipitate that the group is completely isolated from the rest of society, which ends up making it even more difficult to implement 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 of happiness are articulated.

This is the fundamental purpose of multisystem family therapy, a complex program through which the effort and hope that it is viable to promote well-being materialize without hindrance where many others gave up trying.

• Related article: "Family therapy: types and forms of application"

Multisystem Family Therapy

Multisystemic family therapy describes a form of intensive treatment, which focuses on the approach of the adolescent and his family when there are serious problems that affect the whole group, particularly criminal behaviors and disorders due to dependency/abuse of drugs. 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 stems 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 bind them to the others, in such a way that any variation that occurs in an element of the system would have its reflection on the rest. Thus, the emphasis of the treatment is centered on the collective, 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 there is ample empirical evidence. 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, together with the way in which the times and spaces in which the action takes place are organized.

Hereinafter we will delve into these and other issues, 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).

• You may be interested in: "The 3 stages of adolescence"

Intervention from this type of psychotherapy

The intervention format proposed with multisystemic family therapy is intensive, in such a way that the professionals who dedicate their efforts to it are available to work with families twenty-four hours a day and seven days a week week. That 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 at the family home, which significantly increases adherence to the program. In these meetings, the aim is to identify and treat any known risk factor, as well as more specific situations that could concur over time, to deploy care that must be built on 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, 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), it only manages to cover a very small number of families. With this, it is plausible to dedicate the necessary time to each of these, since Aim for at least one weekly session. And it is that 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 to be satisfied is improve the ability of each parent to adequately respond to the needs of their child, 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 activities illegal).

It is also intended to replace the network of antisocial friends with a more prosocial one (through activities extracurricular activities that are of interest to them), since influences of this type are fundamental in this period. The promotion of quality social support in the family is also elementary, both in its components instrumental (correction of material needs) and affective (active listening to problems, gestures of honey, etc.).

Treatment should 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 solving them. The next lines will expose the basic principles that should guide the intervention.

• You may be interested in: "The 8 types of families (and their characteristics)"

Principles of multisystem family therapy

Below are the ten "rules" that shape this form of therapy, and that give a good account of the objectives and principles that have to support its correct implementation.

1. find fit

According to the principles of the systems paradigm, the problem of the adolescent 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 in it.

Detecting these circumstances (known as group adjustment) is necessary to establish the changes to be made within of family dynamics, perfectly exemplifying how the situation is linked to the interactive pattern of relationships conflicting.

2. positive approach

From this therapeutic perspective the accent is placed on the positive aspects that all family members could show, since it will be from them that the new scenario of interaction that is foreseen and promoted can be built.

Likewise, the recognition of strengths supposes a social reinforcement that has often not been present in their lives, and a unique opportunity to strengthen the sense of self-efficacy regarding the careful. In addition, it is an effective tool to strengthen the bond that unites the therapist with their patients.

3. Increased responsibility

Irresponsible behaviors are usually located at the base of many of the circumstances of an adverse nature that both the adolescent and the family members endure on a daily basis (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 being achieved.

4. present orientation

The objectives of the program must be adjusted to the immediate needs of the family and the adolescent, in such a way that way that the conflict is operationalized in simple terms and practical solutions are offered for its resolution. resolution. In multisystem family therapy it is vital that tools are provided at times of critical and urgent importance, so pragmatism must establish itself as the most basic philosophy in day-to-day work 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 it is that often the series of causes and consequences that precipitate and maintain them within the family unit, as a kind of dynamics forged by habit by which to predict the imminence of a conflict. This privileged information makes it possible to anticipate and prevent moments of difficulty and motivate environmental and behavioral changes aimed at their avoidance or prompt resolution.

6. evolutionary fitness

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 internal experience is unique and ineffable, or motive of broad interest to others), and the need to be accepted by the peer group, contribute decisively to their emotions and their decision-making. decisions. Knowledge of this type of matter will be essential to understand how to approach the adolescent and the ties that she maintains outside the family.

7. continued effort

Contact between the team and the adolescent's entire family is always very close, as it extends over a long period of time through sessions requested by the members of the family. However, all of them are also expected to strive to practice and develop all of the skills that are introduced little by little, in that they are necessary for the expression of the progress. That is why the team tends to persist and never give up, avoiding the reproduction of rejection dynamics in the therapeutic act, and pretending at least one weekly session with the whole group.

8. Assessment

The evaluation of the family is not carried out at the beginning and at the end of the process, but is carried out throughout it and in a continuous manner. This way of proceeding allows the rapid detection of obstacles and the implementation of effective solutions. For all this, the objectives are constantly redefined based on the circumstances that occur in the family environment. The evaluation of results can include semi-structured interviews and scientifically validated questionnaires.

9. Evidence

The therapeutic procedures to be used they must be supported by empirical evidence and have demonstrated their efficacy in the family context where the adolescent is located. Techniques of a cognitive nature (restructuring, training in decision-making, control of impulsive acts, etc.), behavioral (stimulus control, behavior modification, relaxation, etc.) and communication (assertiveness training, reinforcement of positive parenting practices, etc.).

10. Generalization

The goal of the intervention is that any positive change that occurs be generalized to all contexts in which the family intervenes (school, home, courts or any other) and that it is also maintained over time. That is why the team can move to any of these spaces in the event that there is necessity, and that follow-up sessions are usually scheduled in the months that follow the end of the program.