Table 1

Principles of MST4

Finding the fitAn assessment is made to understand the “fit” between identified problems and how they manifest and make sense in the entire context of the family’s environment. Assessing the fit of youth and parent successes also helps guide the treatment process.
Focusing on positives and strengthsMST emphasize the positives they find and use strengths as levers for positive change. Focusing on family strengths has numerous advantages, such as building on strategies the family already use, instilling hope, identifying protective factors, decreasing frustration, and enhancing caregivers’ confidence.
Increasing responsibilityInterventions are designed to promote responsible behavior and decrease irresponsible actions by all family members.
Present-focused, action-oriented, and well-definedInterventions deal with what’s happening now in the family’s life. Therapists look for action that can be taken immediately, targeting specific and well-defined problems. Family members are expected to work actively toward goals by focusing on present-oriented solutions, rather than gaining insight or focusing on the past. When the clear goals are met, the treatment can end.
Targeting sequencesInterventions target sequences of behavior within and between the various interacting systems (family, peers, teachers, home, school, and community) that sustain the identified problems.
Developmentally appropriateInterventions are established appropriate to the youth’s age and developmental needs.
Continuous effortInterventions require daily or weekly effort by family members so that the youth and family have frequent opportunities to demonstrate their commitment and practice skills. Advantages of intensive regular efforts to change include more rapid problem resolution, earlier identification of when interventions need fine-tuning, continuous evaluation of outcomes, more frequent corrective interventions, and more opportunities for family members to experience success.
Evaluation and accountabilityIntervention effectiveness is evaluated continuously from multiple perspectives, with MST team members being held accountable for overcoming barriers to successful outcomes. MST does not label families as “resistant, not ready for change or unmotivated.” This approach avoids blaming the family and places the responsibility for positive treatment outcomes on the MST team.
GeneralizationInterventions are designed to invest the caregivers with the ability to address the family’s needs after the intervention is over. The caregiver is viewed as the key to long-term success. Family members drive the change process in collaboration with the MST therapist.