The role of cultural factors in engagement and change in Multisystemic Therapy (MST)

Abstract

Evidence has shown that Multisystemic Therapy (MST) has been particularly effective in the treatment of youth with antisocial behaviour from ethnically diverse backgrounds. Although the process of change within MST has been explored, there is a dearth of research in looking at this for families from ethnic minority backgrounds. This qualitative study aimed to explore ethnic minority caregiver experiences of MST and understand how this might impact on engagement, the presenting problems and the process of change. Semi-structured interviews were conducted with seven ethnic minority caregivers who had completed treatment. A constructivist version of grounded theory was used to analyse the data. Specific cultural theoretical codes that emerged were around the consideration of cultural difference in terms of the engagement process, the conceptualisation of difficulties and the therapist acting as cultural broker in the process of change. This research integrates culturally specific ideas into the existing MST Analytical Process. Practitioner points• Being culturally understood, cultural sensitivity and respecting difference can help engagement with ethnic minority caregivers • The role of culture may be important to consider in the conceptualisation of difficulties • For change to occur therapists may need to act as cultural brokers

Considerations for minority ethnic young people in multisystemic therapy

“…Similarly, to previous MST research (Fox et al, 2016; Kaur et al 2015; Paradisopoulos et al 2015; Tighe et al, 2012), this research highlighted some of the universal similarities across cultures. Nonetheless, theoretical codes unique to second-generation young people did emerge.…”

“…Similarly to Fox et al's (2016) findings, young people described the MST therapist 'acting as a cultural broker' by facilitating perspective-taking. Bhugra and De Silva (2000) suggest that cultural-based differences might not always be articulated as the presenting problem, therefore it is the MST therapist's role to sensitively probe this topic with dual-cultured families.…”

“…In contrast to caregivers (Fox et al, 2016), some young people felt cultural differences between the therapist and family did impact on engagement. Sue and Sue (2012) outlined ways acculturation level might influence the therapeutic encounter; a client who has fully integrated elements of different cultures might feel comfortable working with a therapist of any ethnic background, whereas a client who has devalued the dominant culture may prefer a therapist from his/her own background.…”

“…This study attempts to understand the experiences of second-generation young people in MST and expand upon the findings of Fox et al (2016). The findings suggest that cultural/acculturation differences are important in understanding referral behaviours and the potential complexity of identity development for second-generation young people.…”

“…Nevertheless, randomised control trials that include a subset of non-white families do not equate to valid analysis of ethnic differences in intervention effects (Hohmann & Parron, 1996). Whilst specific factors influencing the implementation of MST have been researched (Kaur et al, 2015; Paradisopoulos et al, 2015; Tighe et al, 2012), only one study to date has explored the influence of cultural factors (Fox et al, 2016), and found that caregivers consider cultural factors important in the engagement and change process in MST. Research with second-generation young people is crucial, as despite decades of attention to the issue, minority ethnic families continue to be less likely to access mental health services than their mainstream counterparts (Wang et al, 2005) and more likely to delay seeking treatment and to drop out (Hoagwood et al, 2010).…”