Tämä artikkeli julkaistaan 4. toukokuuta 2024 Alternativni MOD/DOM lehdessä. Alternativni MOD/DOM on lasten ja nuorten asiantuntijoille tarkoitettu aikakausilehti, jota jaetaan ilmaiseksi 500 paperiversiona Bosnia ja Hertsegovinassa, Kroatiassa ja Serbiassa. Saimme olla mukana kertomassa tunteita ja ajatuksia MDFT-terapeutin työstä yhdessä Pietarsaaren MDFT-terapia tiimin sekä MDFT-terapia pääkouluttajan Sylvia Cool kanssa.

Multidimensional family therapy - powerful changes in the family in just six months

Journalist: Ljiljana Ban

"Before, I was constantly under stress at work and felt exhausted. I constantly thought about cases that worked with. I didn't sleep, I started losing my hair. But now I have no more stress. I am clear about what, how and why I do something. Before every session with the family, I know what will happen there. And the family knows everything clearly. Everyone knows. It is clear water, there is nothing hidden in it."

Do these words of Jenna Sundholm sound like part of some commercial? Too good to be true? Surly large number of you who are working in child welfare recognized yourself in the description of the first sentences and after the second part maybe gave up reading in disbelief, but I invite you to continue reading and get to know the group of multidimensional family therapy therapists, because the enthusiasm, commitment, freshness and power they radiate do not leave room for any doubts about what they are saying.

Multidimensional Family Therapy (MDFT) is a family therapy intended for families with adolescents who have multiple behavioral problems. It is an intensive therapy that includes several meetings per week with the family (group and individual) over a period of 6 months. An MDFT team consisting of therapists (4 to 5) and supervisors (1 to 2) is involved in the work. "What I like about this method is that it is the effect of teamwork, and you can feel the strength of the team. The therapist is never left alone. There is a supervisor available at all times for support," says Jenna Sundholm, supervisor and therapist at The wellbeing services county of Vantaa and Kerava, and Sylvia Cool, a master trainer from the Netherlands, further explains: "We take great care of the therapists who work directly with families. Therefore, we have supervisions with two supervisors every week. At meetings, cases or videos from family sessions can be presented in order to jointly analyze what has been done and think about the further course of action. If it is a situation where the therapist feels stuck, the family is called to the office. The therapist then works with the family in one room, while the team behind the screen observes everything and with direct suggestions tries to help the therapist achieve at least a small change in the family. In addition to supervisions, the team also has intervisions, and once a year we gather all teams from Finland and hold master trainings. Mutual care for each other is an important segment of this therapy, all so that the therapists remain motivated in the difficult work they do."

MDFT began to be applied in Finland in 2012 (the method itself originated in the USA in the 80s of the 20th century). Today, there are seven MDFT teams operating in different regions of Finland in the fields of child welfare, education and healthcare. In the Finnish care system, MDFT is an intervention that is applied when other open care measures fail and to prevent the out-of-home placement. In addition to the above, there are other criteria for the application of MDFT, namely:

• the age of the child. It must be an adolescent between the ages of 13-18 (possibly 18 years and 6 months);

• type of difficulties. The adolescent exhibits multiple behavioral problems (a diagnosis is not necessary), is a perpetrator of serious crimes or/and has problems with drug addiction.

• Willingness to change. At least one important adult from the child's family must be motivated to work hard and change (it doesn't have to be a parent, it can be a grandmother or any person who is very important to the child)

If the parents are drug addicts or there are mental health issues, such matters should be resolved and treated before MDFT intervention.

When the basic criteria are met, the supervisor gathers the team and decides which therapist will take over the case. The therapist then contacts the social worker, a meeting is organized in which the family, the social worker and the therapist participate, and a discussion begins about what will be done in the next six months and how. "From the very beginning the family is aware that now they have a person who is there for them and with them. This in itself brings relief to the parents," explains Jenna and continues: "The therapist makes it clear that he is not there to "fix" the adolescent, but to work with everyone in the family. The therapist is like a kind of spider that helps the family build and repair support networks."

This network is built through 4 domains: work with the young person, with parents, family and community and three levels of work: alliance building, application of the treatment plan and strengthening of change.

"The first phase, the phase of building the alliance, is extremely important. During the first four to six weeks, the therapist sits down with mom, dad, and child and listens to their story. And that is what means a lot to the family. In the evaluation they often state that it was the first time that someone listened and heard them," Sylvia describes, and Jenna continues: "If a child uses drugs or has committed a serious crime, of course the parents feel extremely unsuccessful in parenting. They are full of shame, guilt and a sense of failure. That is why our task is to create a space where they can shine, feel important and understand that they are the key to solutions. We make it clear to them that they are the experts for their family. And then, gradually, a big change occurs in the whole family."

MDFT is characterized by a clear work structure. Camila Lundén from The Wellbeing services county of Ostrobotnia states: "I especially like the structure of this method because it is something that keeps you moving forward. You can't just come to the family and talk about the weather. Before the session, you should take time and think about what you want to happen in that room. You must constantly keep in mind the goals that the family has set for themselves and lead the family to their realization. A clear structure makes you stay focused, and that's where the great results we achieve come from." Monica Hällund-Myntti from the same team adds to this: "Using MDFT, you get the power to take time for yourself, think about the family that you work with, make a plan and define goals for the session in a different way than you do in your other job. In another job, it's more like working in a factory."

The multidisciplinary team of Ostrobothnia works in different areas - education, healthcare, family support, and Johanna Hagström-Hietala lists the most common problems with which clients come to them: "These are cases of self-harm, various psychiatric problems, running away from home, living with older men, alcoholism , abuse, addictions, problems at school."

Considering the great results achieved by the implementation of the MDFT, we were interested what are the challenges in their work. As the biggest challenges the support of management structures and money were pointed out. In the two organizations, colleagues have different experiences with management support, which highlighted the importance of this component even more. Despite the lack of understanding of management, colleagues from Ostrobothnia are ready to work in their free time, which shows how much they believe in the whole process. Camila states: "However, I have to say that it is not difficult for me and my colleagues to work in our free time, because we simply enjoy being able to follow the family process. Family sessions are extremely powerful because when you see parents and child talking together about something with a lot of emotion, you also see them re-approach and connect with each other. This method is intensive, but that's why it creates changes, and this motivates me personally to continue applying this intervention." Monika continues in the same vein: "I see results and effects. I can see the change and it's something that inspires me in my other job as well. And there's something else you get on a personal level that makes me willing to work late at night and in my free time."

And as far as finances are concerned, this is an area that needs to be worked on again and again. In the short term MDFT is an expensive intervention, but in the long term it is very cost-effective. Jenna and Camila emphasize that this method does not try to put out the fire, but to make key changes that contribute to the change in the family in the next 25 years.

"The power of MDFT comes from addressing those universal, underlying problems. We are here to connect people from heart to heart. In fact, it all about the love, and the word love is a word that is almost never heard in this work. But it is the most important factor in healing," Sylvia sums up, to which Jenna adds: "We come into the family as human to human. We approach from a position of equals, and no longer from a height. In solving a family problem, we are all involved together. As a worker, I therefore feel more powerful. Even the small salary I receive is not important to me because I feel good, because I see changes. When you see things change - it's priceless." 

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