Multisystemic family therapy: what it is and how psychologists use it.

A summary of this type of psychotherapy applied to families with problems to solve.

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

Sometimes these circumstances cause the group to become completely isolated from the rest of society, which makes 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 to articulate treatments aimed at breaking this inertia and recovering the path to happiness.

This is the fundamental purpose of multisystemic family therapyA complex program through which the effort and the hope that it is feasible to promote well-being where many others have given up trying are materialized without hindrance.

Multisystemic family therapy

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 whole group, particularly delinquent behaviors and drug dependency/abuse disorders. These are groups that may have experienced multiple failures in previous attempts to reverse their situation, to the point that many times they may have been unable to find a solution to their problems.They are groups that may have experienced multiple failures in previous attempts to reverse their situation, to the point that society has often decided to abandon efforts to integrate their members into common spaces.

The philosophy underlying this model arises from 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 relationships that link them to others, in such a way that any variation occurring in one element of the system would have its reflection on the rest. For this reason, the emphasis of the treatment is centered on the collective, and not on its individual members..

The treatment approach makes use of several techniques from different schools, especially cognitive and behavioral, for which there is ample empirical evidence. The decision-making process, on the basis of which one or the other is selected, is based on the consensus of a small group of professionals who make up a small group of professionals. 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 is developed are organized.

In the following we will delve into these and other issues, from which it will be possible to understand the specific characteristics of this 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, in such a way 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 a 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. The aim of these meetings is to identify and treat any known risk factors, as well as more specific situations that may arise over time, in order to provide care that must be based 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. It is therefore plausible to dedicate the necessary time to each one of them, since aims for 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 eventual failure is assumed as the responsibility of the team.

One of the basic objectives to be met is to to improve each parent's ability to respond adequately to the needs of their child, which also translates into the ability of each parent to respond adequately to their child's needs.This also translates into a strengthening of relations with the educational center and with the judicial authorities (in those cases in which the adolescent has been involved 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 the child), 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 instrumental (meeting material needs) and affective (active listening to problems, gestures of affection, etc.) components.

Treatment should be sensitive to all mental health problems that may appear in any member of the family, and should articulate evidence-based techniques with the aim of resolving them.. The following lines will expose 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 what are the objectives and principles that must underpin its correct implementation.

1. Finding the fit

According to the principles of the systemic paradigm, the adolescent's problem will be adapted to the characteristics of his or her family environment, so that elements that maintain the situation over time can be detected through their functional relationship.Thus, elements that maintain the situation over time through their functional relationship can be detected in the family environment.

Detecting these circumstances (known as group adjustment) is necessary to establish the changes to be made within the 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 may show, since it will be from them that the family will be able to develop the positive aspects of the situation.It is from them that the new scenario of interaction that is foreseen and promoted can be built.

Likewise, the recognition of strengths is a social reinforcement that has often not been present in their lives, and a unique opportunity to enhance a sense of self-efficacy in caregiving. It is also an effective tool for strengthening the therapist's bond with their patients.

3. Increased responsibility

Irresponsible behaviors are often at the root of many of the adverse circumstances that both the adolescent and his or her family members endure in their daily lives (inability to delay rewards, poor self-care, intolerance to frustration, etc.). For this reason, care must be taken to promote a subjective sense of responsibility, reorganizing roles at home and outside the home. Achievement and goal orientation are fundamental.and to reinforce all progress that is 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 of critical and urgent importance, so pragmatism is the key.Thus, pragmatism should be the most basic philosophy in the day-to-day work with the group.

5. Identifying sequences

With the passage of time, and the observation of the family unit, the therapist discovers the way in which events tend to happen.. And it is often possible to locate the series of causes and consequences that precipitate and maintain them within the family unit, as a sort of habit-formed dynamics by which to predict the imminence of a conflict. This privileged information makes it possible to anticipate and prevent moments of difficulty and to motivate environmental and behavioral changes aimed at their avoidance or prompt resolution.

6. Evolutionary adaptation

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 youngster perceives that his inner experience is unique and ineffable, or a motive of wide interest to others), and the need to be accepted by the peer group, contribute decisively to his emotions and decision making. Knowledge of these types of issues will be essential to understand how to approach the adolescent and the bonds he maintains at the extrafamilial level.

7. Continuous effort

The 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 family members. However, they are also expected to make an effort to practice and develop all the skills that are gradually introduced, as they are necessary for progress to be expressed. This is why the team tends to persist and never give up, avoiding the reproduction of rejection dynamics in the therapeutic act, and aiming at a minimum of one session per year.and aiming at a minimum of one session per week with the whole group.

8. Evaluation

The evaluation of the family is not carried out at the beginning and at the end of the process, but is developed throughout the process and in a continuous way. This way of proceeding allows the rapid detection of obstacles and the implementation of effective solutions. For all these reasons, the objectives are constantly redefined according to the circumstances that arise 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. in which the adolescent is placed. Cognitive (restructuring, training in decision making, control of impulsive acts, etc.), behavioral (stimulus control, behavior modification, relaxation, etc.) and communicative (assertiveness training, reinforcement of positive parenting practices, etc.) techniques are usually used.

10. Generalization

The goal of the intervention is that any positive changes that occur are generalized to all the 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 case there is a need, and follow-up sessions are usually scheduled in the months following the end of the program.