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Perhaps the most significant departure from classical family therapy is MST's inclusiveness: it'll basically incorporate any therapeutic idea, as long as it's been proven to work in rigorous evaluations. For example, MST therapists will often incorporate Cognitive-Behavioral Therapy (CBT), because so many troubled teenagers suffer some degree of depression along with their antisocial behavior. The therapists instruct the primary caretakers in the principles and practice of CBT, which they can then use as long as needed. Similarly, MST therapists don't hesitate to recommend drugs, especially for the many antisocial kids with attention problems that impair their schooling.
The demand for proven interventions has intensified in recent years, as cash-strapped public health agencies are feeling pressure to show taxpayers hard results. This has been a boon for MST. Although a typical intervention takes months and requires a 24-7 commitment of the therapist's time, even this investment is cost effective when compared to the price of running a kid through the juvenile justice system, providing residential treatment, or imprisonment. The approach has been so effective with juvenile delinquents that some localities are experimenting with it as an intervention for kids with psychiatric disorders alone, which is sometimes paid for by Medicaid.
Interestingly, despite its significant debt to the geniuses of family therapy, few MST practitioners are trained in family therapy. That's the way Henggeler likes it. "Too much familiarity with family therapy can actually get in the way of effective work with kids," he says. "It's harder for family therapists to switch to our multidimensional approach." Just as in any family system, it appears, the offspring--even the offspring of family therapy itself--must eventually break with the parent to fulfill their potential.
Wray Herbert is a Washington, D.C. writer who specializes in psychology and mental health issues.