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Title: Long-term outcomes in multisystemic therapy : a qualitative investigation in to caregiver perspective
Author: Gomez, Bhupinderjit Kaur
ISNI:       0000 0004 2748 1799
Awarding Body: University of London
Current Institution: Royal Holloway, University of London
Date of Award: 2012
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Background: Multisystemic Therapy (MST) is a time limited evidence-based intervention for young people with antisocial behaviour and other emotional and behavioural difficulties. Despite it's robust evidence base with over 19 Randomised Control Trials (RCT), long-term follow-up of outcomes and quantitative process-outcome studies little is known about how these positive outcomes are achieved, how they might be sustained and what the effects of the intervention are beyond improvements in offending rates for families after MST finishes. The aims of this study were to explore this. Method: A qualitative approach was adopted and ten semi-structured interviews were carried out with twelve caregivers. A Grounded Theory analysis was used. Results: Nine theoretical codes emerged to form a model of the process of sustained change from caregiver perspectives: Shifting the relationship to help; Care-giver-therapist alliance as a helpful model; Supporting a family alliance; Privileging a positive story of son/daughter; Shifting perspectives: from individual to interpersonal; Sharing responsibility for change; . Increased positive communication in relationships; Increased personal resilience to new challenges; Increased family resilience. Conclusions: The study revised the current model of change in MST based on caregiver perspectives. 1) It draws attention to the therapeutic alliance as a process of change and . sustained change. 2) Reciprocal processes are highlighted between MST's more linear conceptualisation of how outcomes are achieved. 3) Caregivers highlighted more detail on improved family functioning as an outcome and it's importance in sustaining change. These factors are reconceptualised using systemic theory and referred to as 'second order changes.' 4) These second order changes, facilitated in part by the therapist alliance, fed in to the concept of Resilience for both the family and the caregiver, which contributed to sustained change. Clinical implications and future research directions and study limitations are also discussed.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available