Making sense of multisystemic therapy: exploring multisystemic therapists' experiences of early adjustment using constructionist grounded theory

Abstract

BACKGROUND AND AIM: Multisystemic Therapy (MST) is an intensive family and community based intervention used to reduce anti-social behaviour in children and adolescents and associated risk factors, such as negative parenting (Henggeler et al., 1992). MST has recently been adopted in Scotland with the formation of two new teams within the health and social care context. There is evidence to suggest that there is a steep learning curve in developing as a multisystemic therapist. Henggeler et al. (2009) reported that treatment outcomes in the first year of a new MST team were lower than that observed in the second year. This indicates that newly established multisystemic therapists require a period of transition in developing their skills and abilities. Additionally, reports suggest that some therapists experience difficulties in adhering to the original model as intended (Schoenwald et al., 2000).

To date, numerous treatment outcome studies exist, as well as studies that have investigated factors involved in promoting therapist and supervisor adherence to the MST model (Henggeler, et al., 2009). However, it is the researcher's understanding that no studies have solely explored therapists' experiences of adjusting to working within the MST model and service structure. This study aims to explore therapists' experiences of becoming a multisystemic therapist and working within this service structure.

METHOD: Interviews were carried out with seven newly appointed multisystemic therapists and two newly appointed multisystemic supervisors. Interviews were recorded and transcribed verbatim. Participants' accounts were analysed using Constructivist Grounded Theory methodology.

RESULTS AND DISCUSSION: The results suggest that the process of early adjustment to MST occurs within interactions between the therapist, the MST model and relationships. The theoretical model indicated that therapists engaged in an overall process of trying to make sense of MST due to the enormity of change encountered in their new roles, responsibilities and relationships. The core category of 'Making Sense of MST' captures a process of reflection where therapists are actively thinking about their experiences and anticipating how to move forward. The processes involved in 'Making Sense of MST' are accounted for in the main categories of 'Locating Source of Struggles', 'Defining Worth' and 'Advocating Change'. The results are discussed in depth and are used to inform implications for clinical practice and further research.