Multisystemic Therapy (MST)

Multisystemic Therapy, or MST, is an intensive treatment for adolescents with serious behavioural problems. Rather than treating the teenager alone, it works with the whole world around them.

What MST is

The world around a young person means the family, the school, the friends, and the community, and MST sees their behaviour as shaped by all of these together. In this view, the whole is more than the sum of its parts.¹

MST is a systemic therapy, which means it looks at whole systems rather than single people. It is sometimes called an ecological approach.

MST was first developed in the late 1970s.¹ Its founders began from one clear finding. Youth behaviour problems usually have many causes, not one.

Who MST is for

MST was built for young people with serious antisocial behaviour and delinquency.¹ These are teenagers whose actions put them at real risk, which may include serious rule-breaking, aggression, or offending.

Research has long shown this behaviour is not simple. It is linked to the child, family, peers, school, and neighbourhood together.¹ Older treatments often focused on only a small part of this picture.

Because of that narrow focus, many did not work well.¹ MST was designed to take in the whole picture instead.

MST has also been adapted for other serious difficulties over time.¹ Even so, it remains a treatment for serious behaviour in adolescents.

What happens in MST

MST is intensive and closely involved in daily life. Therapists stay available 24 hours a day, seven days a week during treatment.³ MST is shaped to each family, and it is complex work.

Much of the work is with the family. MST draws on several proven family methods. These include structural and behavioural family approaches and parent training.²

Some steps are simple, like agreeing and keeping to a curfew. Others are harder, and may tackle conflict between parents or a parent's depression.²

The therapist and family look closely at daily life together. They try to find which everyday interactions keep the problem going. MST stays in the present and works on clear, specific problems.²

MST also works with the world outside the family. It helps connect a young person with positive activities. These can be sports teams, faith groups, or other adult-supervised groups.¹

MST is delivered by trained teams with ongoing supervision.³ This support lets therapists from different backgrounds do the work.

The family's role

The bond between a young person and their caregivers matters greatly. Young people who struggle with their caregivers are more likely to show behavioural difficulties.² So MST makes family relationships a central target.

It treats family strengths as the main lever for progress.¹ Parents and caregivers are not blamed here.

Getting each family involved is treated as central to progress.¹ Families are supported to take the lead in the work.

Families come in many forms. It may be two parents, a single parent, grandparents, or a relative.² MST works with the family as it actually is.

Culture sits at the heart of how MST is planned. Teams try to bring in therapists who reflect the families they serve.¹ A family's community and background shape the work.

Family therapy can break unhelpful cycles at home.⁴ In their place, it can build warmer and more workable patterns.

What the evidence says

MST is one of the best known family therapies of its kind. It targets the risk factors for serious antisocial behaviour found in research.¹

MST also helped lead the way in holding providers to account.¹ It does this by tracking client outcomes closely.

By the late 2000s, MST reached about 17,300 young people a year.³ That was across 32 states and nine countries. It has been used with families from many cultural backgrounds.¹

Still, MST is not a general therapy for every teenager but a specialised treatment for serious problems. If you are offered MST, ask the provider what the evidence shows for your situation.

If your family is starting MST

MST usually begins with a careful assessment.² The therapist and family look at each part of a young person's life. Together they agree the exact goals of treatment.¹

From there, the work is active and hands-on. Families are expected to take a real part in it.¹ Parents learn practical skills for everyday situations.²

Support is there at any hour if a crisis arises. The team helps the family stay safe and steady through hard moments.

MST also looks ahead to when treatment ends. It helps the family build its own support around them. The aim is to help gains hold after MST stops.¹

Finding help

MST is a team-based programme rather than a solo private therapy. How you reach it can differ from one country to the next.

If you want support for your family, speak to a professional first. You can start with our guide on how to find the right therapist.

In short

MST is an intensive, systemic treatment for serious teenage behaviour, working with the family, school, peers, and community at once. It relies on family strengths and stays close to daily life.

It cannot promise a set result for any one family. But it offers a clear, well-studied way to work on hard problems.

This article is for general information and is not a substitute for professional assessment or care. If this is affecting your life, consider reaching out to a qualified mental health professional.

References

1. [1] Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic Therapy for Antisocial Behavior in Children and Adolescents (2nd ed.). Guilford Press. — Chapter 1 (pt 1) (pp 14-21).
2. [2] Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic Therapy for Antisocial Behavior in Children and Adolescents (2nd ed.). Guilford Press. — Chapter 3 (pt 1) (pp 64-71).
3. [3] Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic Therapy for Antisocial Behavior in Children and Adolescents (2nd ed.). Guilford Press. — Chapter 10 (pt 3) (pp 311-313).
4. [4] John Sargent, M.D., and Neha Sharma, D.O. Family Therapy. In Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed (2017, vols 1+2) (pp 9635-9637).