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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