Therapist’s Comfort Critical for Success of Multisystemic Therapy

Multisystemic Therapy (MST) is a home-based method of therapy that is designed to meet the needs of disadvantaged clients, in particular, youth from poor socioeconomic backgrounds with drug or alcohol problems, domestic violence issues and HIV, among others. “MST interventions integrate empirically supported clinical techniques (e.g., family therapy, behavior therapy, cognitive-behavior therapy) into a broad-based social ecological framework, that addresses relevant risk and protective factors across individual (e.g., positive attitudes toward delinquency and drug use), family (e.g., poor monitoring, inconsistent or lax discipline), peer (e.g., association with drug-using and/or delinquent peers), school (e.g., behavioral problems at school, truancy, academic difficulties), and community (e.g., availability of weapons and drugs, high instability, and psychosocial stress) systems,” said Tatiana Glebova of the Couple and Family Therapy Program at Alliant International University, and lead author of a new study examining the effectiveness of a tool to measure therapists’ comfort in MST delivery.

Knowing that the therapeutic alliance directly influences the outcome of treatment, Glebova and her colleagues interviewed 51 MST therapists using the Therapist Comfort Scale (TCS) in order to determine how their comfort impacted the therapeutic alliance they had with their clients. She found that the therapists who were most uncomfortable in their environments had the weakest bonds with their clients. “Home factors such as visitors, loud music, and level of hygiene were identified as distractions from therapeutic process,” said Glebova. “Safety issues were described as making therapists cautious and overwhelmed.” She added, “Findings regarding therapeutic alliance suggest that therapists who are worried about their safety and welfare may find it difficult to engage fully in the therapeutic relationship.” Additionally, factors such as history of unsuccessful treatment and uncooperative parents also deteriorated the alliance, making the work of the therapist that much more challenging. Glebova said, “Program administrators of home-based mental health services should perhaps consider screening potential job applicants for their comfort in delivering interventions in home- and community-based settings.” She added, “High levels of therapist discomfort, however, may suggest a need for additional training and support.”

Glebova, T., Foster, S. L., Cunningham, P. B., Brennan, P. A., & Whitmore, E. (2011, December 19). Examining Therapist Comfort in Delivering Family Therapy in Home and Community Settings: Development and Evaluation of the Therapist Comfort Scale. Psychotherapy: Theory, Research, Practice, Training. Advance online publication. doi: 10.1037/a0025910

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  • Geena


    January 9th, 2012 at 4:38 PM

    Would this really involve going into these homes to do therapy sessions? Does not sound at all safe to me. I get that the concept could work but if you have all of these fears about what could happen to you while you are there then that is not doing anyone one bit of good.

  • heather


    January 10th, 2012 at 7:37 AM

    If I’m not comfortable in my work environment or have a million problems at home,of course that’s gonna affect my work.And in the role of a therapist,it would negatively influence my patients as well.

    And knowing the sort of problems therapist deal with, they need specialized training to remain mentally strong and not let factors affect them as much.There could be a lot of pitfalls without such training in place.

  • beth deaver

    beth deaver

    January 10th, 2012 at 3:49 PM

    I can really see the benefits of doing therapy sessions in the home. You can get a better grasp of the kind of environment that the patient may be dealing with day in and day out as well as get a truer sense of the support system within the home and the community.

    I realize that this could feel dangerous to some, but look at the opportunities into the patient’s life that you would get with this method that would otherwise be missed in the more general office setting.

    You could make some profound breakthroughs doing this kind of work that may not otherwise be available to you, and that would have to make anytherapist at least excited at the prospect to try it.

  • Hugh


    January 11th, 2012 at 11:36 PM

    It’s a unique problem this-in troubled individuals and those in prisons-they need treatment,they need a therapist,the therapist would like to help them but is afraid for his or her own safety.And a unique problem needs a unique solution.I don’t think we have one yet.

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