Multisystemic Therapy case study

Denise had tried every parenting course she could in an endless attempt to get her son to attend school, stop getting in trouble with the police and to try to rebuild a relationship with him.

Josh began missing school at the age of 13, started smoking cannabis and became involved in persistent crime, including criminal damage, common assault and taking a vehicle without consent.

For the following three years Denise struggled to cope. At one point she sent Josh to live with his grandmother for six weeks but when he returned home, he refused to leave his bedroom for three months and Denise’s relationship with her mother broke down, leaving her to cope alone. She sought personal therapy and family therapy, which Josh refused to engage with.

During this time Josh was placed on a 12 month supervision order, which was extended due to breaches. By the time he was almost 16, he hadn't been to school at all for 18 months and Denise had been taken to court on truancy charges.

"I went to every parenting course known to man," said Denise. "I didn't know what to do. I went to Josh's school more than he did. One year I was at the police station or in court 18 times. I spent all my time screaming at him, but he wouldn't even look me in the eye or speak to me."

The Brandon Centre in Camden

Just as Denise had started to give up all hope, the Youth Offending Team mentioned a pilot of Multisystemic Therapy (MST) that was due to start at the nearby Brandon Centre in Camden. For Denise, it felt like her last option and she was delighted when she was chosen to take part.

MST works to understand the multiple causes of a young person's problem behaviours and support their emotional well-being. Denise was given a therapist who was available 24/7 and was required to attend three therapy sessions a week.

Geoffrey Baruch, Director of the Brandon Centre, explains: "MST is an intensive, evidence-based intervention to reduce re-offending and antisocial behaviour, and to prevent a young person being placed in care. It lasts for three to five months and a dedicated therapist works with the parent, the wider family and youth justice officers, social workers and mental health workers. It was quite clear that Denise needed something more intensive that was built around her individual requirements to help her with her son, which is what MST provides."

Looking at the strengths

Denise and her therapist began by identifying the problem behaviours and the causes, looking at the strengths in Josh and her family, and assessing what she was doing that was enabling Josh's behaviour.

Looking at the fit between the problems and the broader context, Denise and her therapist began setting goals to change Josh's behaviour.

Denise said: "By using the cognitive behavioural approach and drawing out maps and charts, I could make sense of the mess and jumble of feelings. We started with small things I could manage to build up my confidence, like taking his mobile phone or TV away if he didn't do something I asked him to. These small steps helped me understand Josh's wider behaviour, because by not following through on these simple punishments previously, I was enabling all of his bad behaviour.

"I learnt to be consistent with Josh and I stopped shouting. We went at my speed and once I managed the small things we built up to the bigger goals of reducing his cannabis use, stopping the crime and getting him to school.

There was a change right away

"There was a change right away. We began in November and by December he'd gone for an assessment at a Pupil Referral Unit. He hadn't been to school for 18 months and in the first week he went for two days.

"Our relationship completely changed and on Christmas Day he sat down and had dinner with us for the first time in ages. Josh completed the remaining time on his Reparation Order for his offences. We even went on holiday as a family."

Josh went on to complete an apprenticeship and had the best attendance in his group. He now works as a bricklayer, getting up at 5.45am every morning for work. He hasn't committed an offence for over three years and has stopped smoking cannabis.

Denise has now retrained as a social worker and is using her experiences and learning to help the parents and young people she works with. On the advice of her MST therapist, she has also worked to improve her relationship with her mother, who is now more involved with family life again.

Denise adds: “MST taught me you can't treat an individual person or problem in isolation, you have to look at the wider picture and understand why everything is happening – it's like peeling an onion, stripping back all the layers. It was incredibly hard work, but family life is so much better. I don't know what our lives would have been like without MST.”

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