Multisystemic therapy

Domain V · Systemic, relational, group & community · Scott Henggeler · 1998 · South Carolina, USA

What it is

MST is an intensive, home- and community-based family treatment developed by Scott Henggeler and colleagues at the Family Services Research Center, Medical University of South Carolina (MUSC), which holds the intellectual property; MST Services (Atlanta) licenses it to organisations, not to…

Format

• MST is not organised into fixed sessions or phases. Its organising structure is a recursive "analytic process" (often called the do-loop) repeated every week for every family, inside an ongoing climate of engagement and alignment with the family and key participants. The stages below are the…
• Stage C – Intervention cycles (bulk of treatment). Goals: achieve prioritised intermediary goals (specific, measurable, time-limited) that target the strongest drivers; caregivers do daily or weekly tasks between contacts. Each week the therapist updates the Weekly Case Summary (overarching goals,…

Who practises it, and how they are trained or regulated

• What you need before delivering it under the MST name. The organisation must hold an MST licence (MST Services or an approved Network Partner); individuals are not licensed. Staff: master's-level therapists preferred (some payers allow limited bachelor's-level staff), master's-level or higher supervisor. Training: 5-day (about 30-hour) MST orientation within about two months of hire; quarterly on-site boosters (1.5…
• Version followed: standard licensed Multisystemic Therapy (MST) for youth aged about 12–17 with serious antisocial behaviour, as set out in Henggeler, Schoenwald, Borduin, Rowland & Cunningham (2009, 2nd ed., Guilford; chapter structure used, text not drawn on), the MST Supervisory Manual (Henggeler & Schoenwald, 1998), Henggeler (2012), and current programme parameters published by MST Services and US payers…
• MST is an intensive, home- and community-based family treatment developed by Scott Henggeler and colleagues at the Family Services Research Center, Medical University of South Carolina (MUSC), which holds the intellectual property; MST Services (Atlanta) licenses it to organisations, not to individual clinicians. It is a licensed programme with a team structure, not a technique a lone therapist can adopt: you…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• sessions turning into blame; stop and return to step 1.
• drifting into caregiver-only therapy with no link to youth targets.
• practice only in calm conditions; rehearse with realistic triggers.
• practice that happens only in session; ask for a specific example from the week.
• individual sessions replacing caregiver work; gains that appear in session only.

Problems the guide addresses

• Poor engagement (missed contacts, hard to schedule, plans not followed)
• Therapist-side barriers
• Interventions not working (stuck cases)
• Non-adherence to between-session tasks
• Caregiver wants the youth placed out of home
• Youth refuses to participate
• Conflict with referring agencies (probation, child welfare, courts)
• Rupture in the therapist–caregiver relationship
• Overwhelm and crisis in the family
• Safety concerns, abuse disclosure, suicidality or psychosis

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.