Cover Story

Before he joined the Multisystemic Therapy (MST) program, psychologist Phillippe Cunningham, PhD, says that he was frustrated because the juvenile detention centers he worked in released teenagers into problem communities, and they would "come right back."

A 16-year-old youth who recently underwent an MST intervention supervised by Cunningham fared a lot better. The young man, who started out in the program abusing drugs and intimidating his mother, ended up curbing his behaviors and developing a stronger bond with his mom. His mom got better too.

Because MST is pragmatic and focused on juvenile justice outcomes, the six-member MST team, including one therapist who worked on-site, first spotlighted the youth's law-related problem--drug use--and worked the case around that, Cunningham says.

Once they named the surface problem, team members delved into causal factors. They soon discovered that the young man's mother, a single parent, was seriously depressed. The young man, who could intimidate the mother with size alone--he weighed about 200 pounds--ran the household, albeit chaotically.

The team's first priority was therefore to treat the mother's depression and rekindle her parental role. The on-site therapist did this in several ways: She provided cognitive-behavioral therapy to combat the mother's depression, helped her build social supports and taught her effective parenting skills. If the mother had trouble enforcing rules with her son, the therapist was there to help her figure out why and to do something about it, visiting as often as four times a week if needed.

Meanwhile, the team made a plan to tackle the young man's substance abuse. It included rewards and punishments that took advantage of the mother's newly expanding parenting skills, and it provided support when the mother needed it.

"When the mom started to gain more energy, she began to show up at the corner where the kid went to hang out," says Cunningham with a chuckle. The mother also nipped in the bud a strategy her son used when she'd ground him: running away to a house down the street. The mother called the head of the other household, telling her not to let her son in when he was under curfew.

The team also taught the mother how to be a more affectionate parent, says Cunningham. She learned to ask the young man about his day and to otherwise show interest in him--including with hugs.

"The kid was like, 'Don't hug me,' like most teenagers do," Cunningham says. "But it was more like he was saying, 'Gimme more, gimme more, gimme more.'"

A key ingredient to the treatment's success was removing barriers to the family's healthy functioning, Cunningham says.

"Our assumption is that families want to save their kids and therapists want good outcomes," he says, "and if that's not happening, something must be getting in the way. My job is to figure out what's getting in the way."