What do MST Therapists do?
MST Therapists do the work in the family home rather than in a clinic and are on call 24 hours a day. Appointments are made to suit the family so they may take place in the evening or at weekends. The Therapists tailor their working week and time-off accordingly and in co-ordination with the Supervisor and the other therapists. The MST Team will cover each other so that during time off, families can be supported and be in contact with the team. Remuneration takes account of the flexibility expected of the therapist. The average caseload isfour to six families. In the beginning, the worker may be in the home every day. As needed, they will spend time at school and meet with the young person’s peer group and extended family. A key part of the process begins with engaging the family, a significant challenge in some cases. MST Therapists are closely supervised and monitored for adherence to the MST principles and receive weekly guidance and feedback about their interventions with the families on their caseloads.
The MST process begins with the identification of the problem behaviours, a process that involves the whole family. In other words, parents are key in identifying treatment targets. Examples of these behaviours include non-compliance with family rules, failure to attend school, failure to complete school work, substance use, disrespect to authority figures, and assaultive behaviour. While the focus is on elimination of problem behaviours, this is accomplished in great measure by building on strengths. The assessment process also involves identifying the strengths in the young person and his/her family, which can include a hobby, athletic ability, a trusting relationship with an extended family member or teacher, warmth and love among family members. The next step is an assessment of the factors in the young person’s ecology that support the continuation of the problem behaviours and the factors that operate as obstacles to their elimination. These factors may be found in any sphere of the young person’s ecology: family, peers, school, neighbourhood or the linkages among them. Therefore, therapists are called upon to find information from all of these sources, by going to the school, spending time with the peer group, or speaking with extended family members. Examples of these factors might include poor discipline skills on the part of the parents or teachers, marital discord, parental substance use, poor supervision, peer reinforcement of problem behaviours, neighbourhood culture, that condones violence or encourages antisocial values, low commitment to education, chaotic school environment, poor parent-to-school communication, or financial stresses experienced by the family.
By identifying the “fit” between the problems and the broader systemic context, MST Therapists are defining both the targets of intervention and the indicators of whether the measures undertaken have been effective. A therapeutic strategy should produce observable results in the problem behaviour or else the strategy is revised. In other words, positive changes in the behaviour (eg, school attendance) is used as indication that the intervention (eg, parent contacting the school daily) is on the right track. Failure to achieve positive changes requires a reassessment of the “fit” and plainly indicates the need to try a new approach. The MST service providers are ultimately accountable for overcoming barriers to change. Blaming language such as “sabotage,” “resistance,” and “intractable problems” are not permitted. In fact, diagnostic labels of any type are discouraged in favour of a perspective that focuses on challenges and strengths.
MST is designed to be an intense but short-term involvement that can result in the generalisation of treatment gains over the long-term. Ideally, the frequency and duration of contacts will decrease over time, being intense in the beginning but lessening as improvements are observed. No social service intervention can last forever, so the ultimate goal is to empower the family or other caregiver to continue with the strategies and interventions that were successful. The clearly articulated definition of success permits objective definition of when the case can be closed.