The outbreak 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 who make up the family.

Sometimes, these circumstances precipitate the group to become completely isolated from the rest of society, which ends up making it even more difficult to put in place mechanisms to transcend such difficult moments.

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 be articulated aimed at breaking this inertia and recovering the path to happiness.

This is the fundamental purpose of multi-systemic family therapy , a complex program through which the effort and hope that it is feasible to promote well-being where many others have given up trying, are materialized without restriction.

Multisystemic Family Therapy

Multi-systemic family therapy describes a form of intensive treatment, which focuses on addressing the adolescent and his or her family when there are serious problems affecting the whole, particularly criminal behaviour and drug dependence/abuse disorders. These are groups that may have experienced multiple failures in previous attempts to reverse their situation , to the extent that society has often decided to abandon efforts to integrate its members into common spaces.

The philosophy behind this model arises from the systemic traditions, which understand human beings as social individuals and indissolubly linked to the collective to which they belong (generally the family).

Thus, the understanding of their reality would refer in a direct way to the relations that unite them to the others, in such a way that any variation that happened in an element of the system would have its reflection on the rest. Therefore, the emphasis of the treatment is centred 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 behavioural, for which there is ample empirical evidence. The decision-making process, from which one or another is selected, is carried out on the basis of 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 organised.

In the following, we will delve into these and other issues, from which it will be possible to understand the concrete 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 multi-systemic family therapy is intensive, so that the professionals who devote 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 inopportune hours of the night.

The intervention is carried out in the family home, which ostensibly increases adherence to the program. These meetings are intended to identify and address any known risk factors, as well as more specific situations that may arise over time, in order to build 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 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. This makes it plausible to dedicate the necessary time to each of these, since sets itself the objective of at least one session per week . Perhaps another of the essential descriptive elements of this therapy is that the family is never “abandoned”, and that any possible failure is assumed to be the responsibility of the team.

One of the basic objectives to be satisfied is to improve the ability of each parent to give an adequate response to the needs of their child , which also translates into a strengthening of the relationship with the educational centre 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 to them), as influences of this type are fundamental in this period. The promotion of quality social support in the family is also elementary, both in its instrumental components (remedying material needs) and affective ones (active listening to problems, gestures of affection, etc.).

Treatment should be sensitive to all mental health issues that may arise in any family member, and articulate evidence-based techniques to address them . The following lines will set out the basic principles that should guide the intervention.

Principles of Multisystemic Family Therapy

The following are the ten “rules” that shape this form of therapy, and which give a good account of the objectives and principles that must underlie its correct implementation.

1. Find the setting

According to the principles of the systemic paradigm, the problem of the adolescent will be adapted to the characteristics of his/her family environment , so that in this environment it will be possible to detect elements that maintain the situation over time through their functional relationship.

Detecting these circumstances (known as group adjustment) is necessary to establish the changes to be made within the family dynamics, perfectly illustrating 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 scenario of interaction that is foreseen and promoted can be built.

In addition, the recognition of strengths provides social reinforcement that has often not been present in their lives, and a unique opportunity to strengthen the sense of self-efficacy with regard to care. In addition, it is an effective tool for strengthening the bond between the therapist and his patients.

3. Increased responsibility

Irresponsible behaviors are often at the root of many of the adverse circumstances that both the adolescent and family members endure in their daily lives (inability to delay rewards, poor self-care, intolerance of frustration, etc.). This is why care must be taken to promote a subjective sense of responsibility by reorganizing roles in the home and outside it. Achievement and goal orientation are fundamental , as well as reinforcing all the advances that are made.

4. Orientation towards the present

The objectives of the programme must be adjusted to the immediate needs of the family and the adolescent, in such a way that the conflict is made operational in simple terms and practical solutions are offered for its resolution. In multi-systemic family therapy it is vital that tools are provided in moments of critical and urgent importance , so pragmatism must be established as the most elementary philosophy in the day-to-day work with the group.

5. Sequence identification

With the passage of time, and observation of the family unit, the therapist discovers the way in which events tend to happen . The fact is that the series of causes and consequences that precipitate and maintain them within the family unit can often be located, as a kind of dynamic 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 to motivate environmental and behavioral changes aimed at their avoidance or early resolution.

6. Evolutionary adaptation

Adolescence harbours 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 a reason of broad interest to others), and the need to be accepted by the group of peers, contribute decisively to his emotions and his decision making. Knowledge about such issues will be essential to understanding how to approach the adolescent and the bonds he or she maintains outside the family.

7. Continued effort

The contact between the team and all the adolescent$0027s family is always very close, since it extends over a long period of time through sessions demanded by the members of the team. However, all of them are also expected to make an effort to practice and develop all of the skills that are gradually introduced, in terms of what is necessary for them to express their progress. That is why the team tends to persist and never give up, avoiding the reproduction of rejection dynamics in the therapeutic act , and aiming at least for a weekly session with the whole group.

8. Evaluation

The evaluation of the family is not carried out at the beginning and end of the process, but rather it is developed throughout the process and in a continuous way. This procedure allows the rapid detection of obstacles and the implementation of effective solutions. Therefore, the objectives are constantly redefined according to 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 be used must be supported by empirical evidence and have demonstrated their efficacy in the family context in which the adolescent is located. The techniques used are usually of a cognitive nature (restructuring, training in decision making, control of impulsive acts, etc.), behavioural (control of stimuli, behavioural modification, relaxation, etc.) and communicative (training in assertiveness, reinforcement of positive parenting practices, etc.).

10. Generalization

The aim of the intervention is that any positive change that occurs becomes generalised to all the contexts in which the family intervenes (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 if the need arises, and follow-up sessions are usually scheduled in the months following the end of the programme.

Bibliographic references:

  • Eeren, H.V., Goosens, L.M., Scholte, R.H., Busschbach, J.J. and van der Rijken, R.E. (2018). Multisystemic Therapy and Functional Family Therapy Compared on their Effectiveness Using the Propensity Score Method. Journal of Abnormal Child Psychology, 46(5), 1037-1050.
  • Henggeler, S.W. (2012). Multisystemic Therapy: Clinical Foundations and Research Outcomes. Psychosocial Intervention, 21(2), 1-8.